The essential publication for BSAVA members

companion
MARCH 2011
Ferrets at Congress
Sessions on mustelid
medicine
P4
Canine chronic
hepatitis
Search for a viral
aetiology P7
Clinical Conundrum
A case of intermittent
collapse
P10
How to approach
the anorexic rabbit
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3 Association News
Association essentials
46 Find out about ferrets
John Bonner reports on mustelid medicine talks at
Congress
79 Canine chronic hepatitis
Nick Bexfield on the search for a viral aetiology for this
condition
1013 Clinical Conundrum
A case of intermittent collapse
1415 Congress
New titles launched on the BSAVA Balcony, and special
stream of cutting-edge science
1617 Quick Quiz
Check your respiratory and endocrinology know-how
1822 How To
Approach the anorexic rabbit
2324 Petsavers
Climbing high for charity
2527 WSAVA News
The World Small Animal Veterinary Association
2829 The companion Interview
Steve Tasker
30 Meet Your Region
Spotlight on South West Region
31 CPD Diary
Whats on in your area
Additional stock photography Dreamstime.com
Chrispethick; Dmitry Kalinovsky; Eric Issele; Sascha Burkard
companion is published monthly by the British Small
Animal Veterinary Association, Woodrow House,
1 Telford Way, Waterwells Business Park, Quedgeley,
Gloucester GL2 2AB. This magazine is a member
only benefit and is not available on subscription. We
welcome all comments and ideas for future articles.
Tel: 01452 726700
Email: companion@bsava.com
Web: www.bsava.com
ISSN: 2041-2487
Editorial Board
Editor Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVS
Senior Vice-President Richard Dixon BVMS PhD CertVR MRCVS FRSE
CPD Editorial Team
Ian Battersby BVSc DSAM DipECVIM-CA MRCVS
Esther Barrett MA VetMB DVDI DipECVDI MRCVS
Simon Tappin MA VetMB CertSAM DipECVIM-CA MRCVS
Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS
Features Editorial Team
Caroline Bower BVM&S MRCVS
Andrew Fullerton BVSc (Hons) MRCVS
Design and Production
BSAVA Headquarters, Woodrow House
No part of this publication may be reproduced in any form without written permission
of the publisher. Views expressed within this publication do not necessarily represent
those of the Editor or the British Small Animal Veterinary Association.
For future issues, unsolicited features, particularly Clinical Conundrums, are
welcomed and guidelines for authors are available on request; while the publishers
will take every care of material received no responsibility can be accepted for any loss
or damage incurred.
BSAVA is committed to reducing the environmental impact of its publications wherever
possible and companion is printed on paper made from sustainable resources and
can be recycled. When you have finished with this edition please recycle it in your
kerbside collection or local recycling point. Members can access the online archive of
companion at www.bsava.com .
A Presidents
perspective
As Grant Petrie
prepares to pass his
presidential baton to
Andrew Ash, he looks
forward to good
things to come for the
Association he has
led in the past year
S
earch Facebook and Twitter for thebsava and join us
online to get regular news and connect with your
colleagues. During Congress there will be regular
updates so you can keep up with whats happening even if
you arent able to be there.
Follow &
Tweet
with us
BSAVA President, Grant Petrie, comments:
BSAVA is looking ahead to 2011 with great optimism.
Membership is at its highest with an increase of 11.5%
compared to a year ago. It seems to me that the Association is
clearly doing something right and we are grateful to members
for their ongoing support. We have a diverse portfolio of
outstanding education opportunities and member benefits.
There is the comprehensive national and regional CPD
programme, which delivers over 120 meetings a year, the
internationally acclaimed Manuals, our top scientific journal in
JSAP, and of course companion.
Congress is just around the corner and I eagerly await
the world-class CPD with speakers from across the globe,
coupled with a commercial exhibition and social programme
second to none.
Perhaps the most exhilarating project for 2011 is the
development of a postgraduate qualification and I am delighted
that the realisation of this ambitious project lies in the expert hands
of Frances Barr, who has joined us as Academic Director.
I really relish the challenges ahead as I continue to work with
BSAVA as Senior Vice President the BSAVA will strive to deliver
more education and more science. With the postgraduate
qualification initiative in particular this should be a huge leap
forward, not only for BSAVA and its members, but for the
entire veterinary profession.
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ASSOCIATION NEWS
The North American Veterinary
Conference, held in Orlando,
Florida every January, enjoys a
strong relationship with the
BSAVA. The conferences of
each organisation have much
in common and work together
Two Congresses combine
B
SAVA members can now access a
range of Health and Safety
downloads and advice at the
BSAVA website. This invaluable resource
will prove to be hugely beneficial for
practices when preparing for a PPS
inspection. The resource gives advice on
many different areas of legislation and
provides downloadable templates which
can be used to ensure the correct
processes are followed when creating a
Health and Safety practice policy. The
areas covered include:
Company policies and organisation
arrangement
Risk assessments
Safety guidelines
Fire procedures
BSAVA CELEBRATES
250th ANNIVERSARY
WITH FIRST VET
SCHOOL
Dr Stephane Martinot from Lyon vet
school is attending BSAVA Congress
this year to receive a special BSAVA
Award to mark the 250th anniversary
of the profession.
The first veterinary school was
established in Lyon in 1761 by
barrister Claude Bourgelat. BSAVA
presents an annual award in his name
each year in recognition of truly
outstanding international contributions
to the field of small animal practice. So
in this anniversary year BSAVA will be
marking the celebrations by inviting Dr
Stephane Martinot as a representative
of cole Nationale Vtrinaire de Lyon
to both receive a celebratory
anniversary award to take back to
Lyon, and present the Bourgelat
Award to the delighted and deserving
recipient Sydney Mose.
up-to-date information and an easy-to-read practical
style. The Manual of Canine and Feline Behavioural
Medicine was the best seller; one of the editors is
US-based Debra Horwitz who was speaking at NAVC.
The BSAVA and NAVC enjoy a lecture exchange
programme with one another, and our talks at NAVC
this year went down really well. The day was titled The
BSAVA Cardiopulmonary Disease Symposium, and
the focus was on the feline patient, with lectures from
Dr Virgina Luis Fuentes from London and Dr Luca
Ferasin from Berkshire. It was a full day of nine
lectures, chaired by BSAVA President Grant Petrie, and
it was well attended by NAVC delegates. Details of the
NAVC talks at BSAVA this year can be found online
and in The Programme.
Of course in 2012 BSAVA will be co-hosting the
WSAVA Congress and it will be the ideal opportunity
for meeting not only North American and European
vets, but also colleagues from every corner of the
planet. Were looking forward to seeing many NAVC
delegates in Birmingham in April 2012.
BSAVA launch online
Health and Safety advice
section for Members
First aid and accident reporting
Equipment testing
Instruction, information and training
The templates and guidance within
the resource will provide a structure that
practices can use to create their own
individual health and safety documents,
processes and policies for their particular
circumstances.
Pam Mosedale, BSAVA Volunteer and
RCVS Practice Standards Inspector, has
been an integral part of the project from
start to finish and believes that the
resource will help our members working
in practice who want easy-to-use tools to
help them with improving and maintaining
standards in practice and making them
safer places to work in.
BVDSG PRE-CONGRESS MEETING
The British Veterinary Dermatology Study Group pre-Congress meeting this year is titled Dilemmas in
Dermatology. Experienced dermatologists will present complex or demanding cases and helping the audience
through the techniques and approach required to come to an accurate diagnosis and optimal treatment plan.
The meeting will be interactive with each delegate issued with an electronic handset. The speakers include Monika Linek, Alexander
Koutinas, Hillary Jackson, Peter Forsythe and Ian Ramsey. Delegates can register at the BVDSG website www.bvdsg.org.uk.
A
t the recent NAVC Conference in January, there
was a strong BSAVA presence, visible in two
main areas: the busy BSAVA stand, and the
BSAVA-sponsored lectures which took place all day on
the Tuesday.
The BSAVA stand saw delegates stopping off to
browse and buy between lectures. The Manuals are as
popular across the Atlantic as they are here with our
US colleagues impressed with the combination of
03 News.indd 3 21/02/2011 14:10
FERRETS
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F
errets chase rabbits around in their traditional role
in country sports but could they also follow
rabbits as their new popularity as a companion
animal grows? Some practitioners think that ferrets
could soon become such regular recipients of
veterinary services that they, like rabbits, will no longer
be classed as an exotic species.
However, at this stage in the development of ferrets
as a species of veterinary interest, there is still a lot to
learn about their husbandry and medical treatment.
Even some of the most basic information, such as an
accurate estimate of the numbers kept in this country,
is missing. The National Ferret Welfare Society
estimates the figure could be over a million, although
that is largely guesswork since many keepers dont
belong to any recognised bodies.
That may seem a surprisingly large number given
the relative infrequency with which ferrets are presented
at most veterinary practices. This is because a high
proportion of these animals are still kept for hunting,
notes Simon Girling, who divides his working time
between Edinburgh Zoo and his practice in Perth. Such
owners will often claim to have little faith in the value of
veterinary care but they may also be unwilling to
spend very much on treatment for animals with which
they have no deep emotional bond, he points out.
Increasingly popular pet
That may be the case in a traditional rural community
but elsewhere there has been a steady growth in the
numbers of pet ferrets. Like Simon, Molly Varga holds
a diploma in zoo and wildlife medicine and she is
working towards specialist status at Cheshire Pet in
Holmes Chapel near Crewe. She notes that even in
those practices that are not actively seeking ferret
owner clients, general practitioners must have a
working knowledge of their husbandry, preventive
medicine and clinical care.
For those practitioners used to seeing an
occasional hunting ferret, the first thing they will notice
about this new group of pet owners will be a difference
in the range of presenting signs. Working animals will
often be brought in to treat traditional veterinary
emergencies such as traumatic injuries resulting
from encounters with other ferrets, dogs or birds of
prey. In contrast pet animals may come in with much
Find out
about
ferrets
Ferrets are among the more unusual visitors to
the practice waiting room, but for the BSAVA
giving its members greater knowledge and
confidence in dealing with less familiar species
has always been one of the key functions of
Congress. So at this years meeting there will
be two separate sessions on mustelid
medicine. John Bonner talks to Congress
speakers Molly Varga and Simon Girling
04-06 Ferrets.indd 4 21/02/2011 14:09
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FERRETS
less than ideal in this species which should properly
be classed as a super carnivore because of its need
for a high-protein diet. Molly says that the specialist
pet food companies have put considerable effort into
developing complete diets that are suitable for ferrets
but many owners are still unaware of their specific
dietary needs. Indeed, she has a theory that the
relatively high incidence of insulinomas in ferrets may
be a result of excess carbohydrates used as filler in
the older products.
Diagnoses, disease and dispensing
Endocrine disease is a particular problem in ferrets, as
Simon will explain to fellow practitioners in
Birmingham. One of the most frequently diagnosed
conditions in this species is adrenal disease which the
Dutch vet Nico Schoemaker has linked to early
neutering in papers published over the past five years.
It is probably too early to tell whether a change in the
approach to controlling ferret reproduction is having
any effect on the incidence of this condition. Simon
points out that ferret keepers of long experience may
be reluctant to changes in their usual methods, while
Molly feels that the growing awareness of the risks of
early neutering may mean that practitioners and
owners will be more vigilant in looking out for any signs
of adrenal disease.
As with all other minor species there is a shortage
of licensed products for use in treating ferrets and so
most treatments will have to be given off-label. The
one product with a specific indication in ferrets is the
jill jab, Intervets Delvosteron. This is a proligestone-
more diverse conditions, including more degenerative
disorders as pets age.
Treating ferrets as pets
Pet ferrets can often live up to 10 years and in
exceptional cases may reach 14 years. Heart diseases
are one of the more common conditions in middle
aged and older animals as will be discussed by Molly
at her talk at this years Congress. Dealing with dietary
indiscretions is another common reason for their
owners seeking veterinary treatment. I have known
ferrets swallow all sorts of things nuts, ladies tights;
you name it they will try and eat it. Ferrets are like a
six-month-old Labrador puppy that is never going to
grow up. That may be a problem but it is also part of
their appeal, she says.
Yet, even those ferrets kept as pets will have to be
handled with care, as they will bite and are famously
reluctant to let go. With 20 years experience of dealing
with wild predators Molly is comfortable dealing with
this species but recognises that colleagues may be
less confident when carrying out a clinical
examination. She recommends getting the owner or a
VN to gently but firmly hold the ferrets neck and keep
the rest of the body stable. Food supplements such as
Ferretone and Nutrical are useful for bribing the animal
to allow an examination, since these products have an
effect not dissimilar to that of cat nip on feline patients,
she says.
However, she will warn ferret owners against letting
their animals have too much of a good thing. Such
treats will have a high carbohydrate content, which is
Ferrets are like a six-month-old
Labrador puppy that is never going
to grow up. That may be a problem
but it is also part of their appeal
FERRETS
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FERRETS
Find out about ferrets
poor husbandry, I think that is because ferrets have not
been under the same spotlight that has been shining
on rabbits in recent years and has produced such
improvements in the standard of care that they receive.
Neither has there been the same attention paid to
insurance for veterinary treatment in ferrets. Once that
picks up, I think there is going to be rapid progress in
our knowledge of their veterinary needs, she says.
based product used to prevent the reproductive tract
infections and bone marrow aplasia caused by
persistently high oestrogen levels in any un-neutered
female ferret that has not been mated.
Another very useful product for use in ferrets is
deslorelin, used to suppress sex hormone production
in males and females and thus a practical alternative
to neutering. As will be discussed at Congress,
treatment with a 9.4 mg implant has been shown to
produce resolution of the clinical signs of adrenal
neoplasia. Like neutering, this treatment is effective in
reducing aggression in male ferrets and can reduce
the intensity of the odour from their anal gland
secretions, an important consideration particularly for
owners of pet ferrets, he notes.
US comparisons
In the US, ferret owners who wish to avoid the worst of
the pungent odour of their pets waste products can
request to have the ferrets anal glands surgically
excised. Such an operation would, of course, be illegal
in the UK but in most respects, the standards of care
provided for ferrets in North America is higher than
that in Europe, says Molly who worked for many years
in an exotic species practice in Canada. She feels
ferrets are much more established as a pet species on
the other side of the Atlantic and the development of
veterinary services in this area is about 10
years ahead of our own.
Improving husbandry
Nevertheless, the quality of basic husbandry
for most ferrets is reasonably good, Simon
says. When serious problems do occur, it is
usually a result of ignorance among first-time
ferret keepers. He has, for example, had to treat
cases of metabolic bone disease in animals
kept by novices who have fed them on raw
rabbit meat with very low levels of dietary
calcium. On other occasions, owners may be
unaware of the need to mate an entire jill with a
vasectomised male to bring her out of oestrus
and avoid the risk of her developing a
potentially fatal bone marrow condition.
Molly is optimistic that such basic mistakes will
become increasingly rare. If there are instances of
BSAVA MANUAL
OF RODENTS
AND FERRETS
Edited by Emma Keeble
and Anna Meredith
what impressed me about this
book is the increased depth as well
as width of information presented. It is right up to
date, too. What do I like about this BSAVA manual?
Pretty much everything... Veterinary Record
Member price: 49
Non-member price: 75

WHERE TO FIND OUT

ABOUT FERRETS
AT CONGRESS
Molly Varga
Ferrets
Hall 9 Saturday 2 April 9.2510.10
Simon Girling
Endocrine disease in the ferret
Hall 1 Saturday 2 April 14.1515.00
04-06 Ferrets.indd 6 21/02/2011 14:10
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PUBLICATIONS
Canine chronic hepatitis is a
common disease in the United
Kingdom, with a recent study
reporting a prevalence of
12% in a first opinion practice.
Nick Bexfield of the University
of Cambridge outlines the
search for a viral aetiology for
this condition
Search for a
novel virus in canine
chronic hepatitis
M
iddle-aged and older dogs tend to be those
affected by chronic hepatitis, and there is a
female over-representation. Several breeds
have been shown to be predisposed to the
development of the disease, including:
American Cocker Spaniels
West Highland White Terriers
Scottish Terriers
English Cocker Spaniels
Labrador Retrievers
Dobermanns.
Recent data suggest additional breed
predispositions, including English Springer Spaniels,
Yorkshire and Cairn Terriers, and Great Danes.
Clinical findings
Clinical signs are generally vague and non-specific,
with inappetence, lethargy, weight loss, vomiting and
diarrhoea most frequently reported. Clinicopathological
findings include elevation of liver enzymes, bilirubin
and bile acids, reduced blood albumin and blood urea.
A liver biopsy is required for a definitive diagnosis the
disease is characterised histologically by the presence
of hepatocellular apoptosis or necrosis, a variable
mononuclear or mixed inflammatory infiltrate,
regeneration and fibrosis (Figure 1).
Causes of chronic hepatitis
Known causes of chronic hepatitis include:
Viruses canine adenovirus and herpesvirus
Bacteria including Leptospira and Helicobacter
Several toxins
Drugs.
Breed-associated defects in copper metabolism
(Figure 2) have been described, with the Bedlington
Terrier being the most well understood. Studies have
Figure 1: Liver tissue from a 4-year-old dog with
chronic hepatitis. There are dense infiltrates of large
numbers of mononuclear cells within the portal
areas, spreading into the adjacent parenchyma.
Note also the bridging fibrosis, apoptosis and
nodular regeneration. (H&E stain; original
magnification x100)
Breed Aetiology
Bedlington
Terrier
Copper storage disease; occasionally
idiopathic
Dalmatian Copper storage disease in some dogs;
idiopathic in others
Dobermann Copper storage disease in some dogs;
idiopathic in others. Some affected
dogs have a specific dog leucocyte
antigen haplotype, suggesting a
possible autoimmune aetiology
Labrador
Retriever
Idiopathic in the majority of dogs in the
UK; occasionally animals have copper
storage disease. Copper storage
disease is common in animals in other
European countries and the USA
Skye Terrier Copper storage disease; occasionally
idiopathic
Figure 2: Chronic
hepatitis has been
associated with
copper metabolism
disorders in
several breeds
07-09 Publications.indd 7 21/02/2011 14:08
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PUBLICATIONS
Search for a novel virus in
canine chronic hepatitis
also demonstrated anti-nuclear or anti-liver membrane
autoantibodies in dogs with chronic hepatitis, although
a primary immune-mediated aetiology has never been
conclusively demonstrated. However, the cause of
most cases of canine chronic hepatitis is idiopathic.
This means that treatment is supportive and
symptomatic, and that the disease progresses over
time in most dogs.
Viral aetiology
In human medicine, the majority of cases of chronic
hepatitis have a defined, often viral, aetiology.
Interestingly, in some canine cases, the histological
features are also highly indicative of a viral aetiology,
suggesting the presence of an unidentified viral
infection. In fact, a transmissible agent capable of
causing acute and chronic hepatitis has been
previously described in dogs in the UK, and was
termed acidophil cell hepatitis virus. No further work to
identify the transmissible hepatitis-causing agent was
performed, and subsequently several groups of
researchers have unsuccessfully attempted to identify
viruses in canine chronic hepatitis. These groups have
all used conventional PCR-based methods in an
attempt to identify specific viruses in liver tissue. Thus,
we, at the University of Cambridge, are employing
modern molecular approaches to identify viruses in
cases of canine chronic hepatitis.
Viral identification
Traditional methods of virus identification include
electron microscopy, cell culture, inoculation studies
and those that demonstrate the presence of
antibodies to specific viruses. Whilst many of the
viruses known today were first identified using these
techniques, they have limitations for viral identification.
Therefore, in recent years there has been a shift
towards the use of modern molecular techniques
(Figure 3), and several of these techniques are being
used to identify new pathogens in animal diseases
such as canine chronic hepatitis.
Microarray
One of the newer techniques uses sequence
information from known pathogens to identify related
but undiscovered agents through cross hybridisation;
an example of this is a microarray or viral chip.
Microarrays consist of high density oligonucleotide
probes, or segments of DNA, immobilised on a solid
surface (Figure 4). These segments of DNA can
represent thousands of different viruses. Any
complementary sequences (labelled with fluorescent
nucleotides) in a test sample can bind (hybridise) to the
probe on the microarray. The results of hybridisation
are determined and quantified by fluorescence.
Polymerase chain reaction
Another approach involves amplification of pathogen
genomes through PCR. PCR-based approaches have
developed from methods that require complete
knowledge of the pathogen to be amplified
(conventional PCR), through methods that rely on
only limited information about the pathogen
(degenerate PCR), to those that require no prior
information about the pathogen (sequence-
independent PCR).
Subtractive hybridisation Microarrays
5'...GACCATGACCNNNNNN...3'
Random PCR
5'.......TCGCA.......3'
5'.......TTGCA.......3'
5'.......TAGCA.......3'
5'.......TCGTA.......3'
Degenerate PCR
Sequence-independent single
primer amplification
RCA
5'... ...3'
...5' 3'...
5'... ...3'
...5' 3'...
5'... ...3'
...5' 3'...
Figure 3: Modern molecular methods of viral
identification
DNA in test sample
Hybridise
target mixture
to microarray
Analyse
data SCAN
Generate microarray Label with
fluorescent
dyes
Combine
equal
amounts
Figure 4: The principle behind microarray technology
that can be used to identify unknown viruses
07-09 Publications.indd 8 21/02/2011 14:08
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PUBLICATIONS
Conventional PCR is frequently used to identify or
exclude the presence of a virus in a sample.
Conventional PCR relies on the annealing of specific
primers complementary to the pathogen genome
sequence of interest, meaning that prior knowledge of
the viral sequence is a prerequisite. For example,
conventional PCR could be used if canine adenovirus
type 1 (CAV-1) was suspected to be present in a
sample (Figure 5).
Assigning causality
Detection of viruses in a disease such as canine
chronic hepatitis may merely reflect the presence of a
virus in a sample, or the ability of a virus to replicate
within the diseased environment, rather than the virus
causing the disease. Many newly identified animal and
human viruses were initially found in association with
clinical signs; most have not been causally associated
with a particular disease. For example, several
infectious agents have been found in patients with
multiple sclerosis, but causality has yet to be
conclusively proven for any of these. Herpes simplex
virus type 2 (HSV-2) was strongly implicated as the
cause of cervical cancer for many years, until human
papilloma virus DNA was identified in cervical cancer
biopsy samples. Assigning causality involves
combining epidemiological, immunological and
sequence-based information.
Conclusion
Work is ongoing to identify a viral cause of canine
chronic hepatitis. Epidemiological studies strongly
suggest that novel infectious agents remain to be
discovered and contribute to the pathogenesis of a
broad range of other animal diseases such as cancers,
autoimmune disorders and degenerative diseases.
There are several new techniques, including
microarrays and PCR-based methods, that have the
ability to identify viruses in clinical samples. Viral
identification is still a maturing subject, but it is likely that
the new technologies will rapidly impact the field over
the coming decade and accelerate the identification of
novel viruses in companion animal diseases.
An alternative method, degenerate PCR, uses
primers designed to anneal to highly conserved
sequence regions shared among related viruses. As
these regions are almost never completely conserved,
primers generally include some degeneracy that
permits binding to all or the most common known
variants of a virus. For example, this PCR method
could be used if there was a suspicion of an
adenovirus being present in sample, but the particular
type of adenovirus was unknown.
Sequence-independent amplification of viral
nucleic acids avoids the potential limitations of the
other PCR methods. Many hundreds of different
random primers are used to amplify any virus in a
sample. Therefore, this method allows the detection of
a virus without any prior knowledge of the viral family,
genera or species, and is able to detect novel viruses
that are highly divergent from those already known.
This technique has been successfully employed to
identify a wealth of new viruses in human and animal
diseases. Examples of the sequence-independent
technique include random PCR, rolling circle
amplification (RCA) and sequence-independent single
primer amplification.
GASTROENTEROLOGY MANUAL
The investigation, diagnosis and management of
chronic liver disease (including canine chronic
hepatitis) is just one of the topics covered in the
BSAVA Manual of Canine and Feline
Gastroenterology, 2nd edition.
Diagnostic imaging and endoscopy
Diseases described by system
Diagnostic algorithms for presenting
complaints
Critical care and therapeutics
Drug formulary
Visit www.bsava.com to order online or call our Membership and
Customer Services Team on 01452 726700 to purchase your copy.
Member price: 49
Non-member price: 75
Figure 5: Agarose gel in which DNA has been
stained with a dye that fluoresces when viewed
under ultraviolet light. The individual bright bands
represent DNA amplified in a PCR reaction from
clinical samples containing an adenovirus. The
multiple bands on the left correspond to different
size DNA molecules and are used to determine the
size of the sample bands
07-09 Publications.indd 9 21/02/2011 14:08
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CLINICAL CONUNDRUM
Clinical
conundrum
Jacqui Gilmour of the Nantwich Veterinary
Group and Nottingham Vet School invites
companion readers to consider a case of
intermittent collapse
Case presentation
An 8-year-old male entire Greyhound was presented with
intermittent collapse during exercise. The owners reported that the
dog became vacant and motionless in lateral recumbency, shortly
followed by rigidity of the neck and forelimbs. There was no
urination, salivation or vocalisation. No change in behaviour was
apparent before or after the event and the dog recovered rapidly (the
episodes lasted less than 1 minute). The owners felt the dog was
otherwise bright and well.
can be very difficult. Furthermore, neurological
disease and cardiac disease are not mutually
exclusive: a cardiovascular disorder may cause
cerebral hypoxia and thus a seizure, and a seizure
may temporarily induce a cardiac rhythm disturbance.
Classically, seizures tend to occur at rest; thus, the
association with exercise in this case raises the
suspicion of a cardiac disorder. However, functional
movement disorders or metabolic causes of collapse,
e.g. hypoxia or hypoglycaemia, cannot be excluded on
this basis. It is commonly thought that rigidity on
collapse tends to be associated with a neurological
cause (and flaccidity with a cardiac cause) but limb
rigidity and opisthotonus can be seen with cardiac
collapse, most often secondary to cerebral hypoxia
caused by an underlying bradyarrhythmia.
Other features associated with seizures were not
noted in this case: there was no behavioural change
before the event (seizures tend to be preceded by a
prodromal phase); the episodes were short and there
was no motor activity (paddling, chomping, etc.);
recovery was rapid (seizures tend to be followed by a
post-ictal phase lasting minutes to hours).
Finally, there are things of note on clinical
examination that suggest cardiac disease may be
more likely, such as the bradycardia and the heart
murmur. Overall, given the association with exercise
and short duration of the episodes the history and
clinical examination suggested that cardiac disease
was more likely to have caused the collapsing
episodes than neurological or metabolic disease.
At this stage cardiac disease was
considered most likely. What are the
differential diagnoses for the cardiac
abnormalities identified and
can they be prioritised based on the
information we have obtained so far?
A Cardiac-induced collapse
Vasovagal syncope
Bradyarrhythmia
Tachyarrhythmia
Inadequate cardiac output, e.g. dilated
cardiomyopathy
Clinical examination
Physical examination found the dog to be bright, alert
and in good body condition. Clinical examination
revealed pale pink cranial and caudal mucous
membranes with normal capillary refill time. The heart
rate and pulse rate were regular and synchronous, with
no pulse deficits, both 44 beats/min. Respiratory rate
was 20 breaths/min, without increased effort. Rectal
temperature was 38.2C. The apex beat was prominent
and there was a soft grade III/VI systolic murmur, with a
point of maximal intensity over the left apex. The femoral
pulse was strong and there was no jugular distension or
evidence of a jugular pulse. Lung auscultation and
abdominal palpation were unremarkable.
Create a problem list for this case
Collapse
Bradycardia
Systolic murmur
Collapse may be associated with many
disease conditions but cardiac or
neurological causes are most common.
Given the presenting history, is a cardiac
or neurological cause more likely here?
Differentiation of cardiac and neurological collapse
10-13 Clinical Conundrum.indd 10 21/02/2011 14:08
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CLINICAL CONUNDRUM
Right-to-left shunt (causing hypoxia), e.g. reverse
patent ductus arteriosus. (NB Exercise increases
oxygen demand and causes vasoconstriction in
the pulmonary vasculature resulting in increased
pulmonary pressures and worsening of a right to
left shunt.)
Vasovagal syncope is triggered by sudden
excitement (e.g. owner returning home) or sudden
exertion (e.g. sprinting after a rabbit), neither of
which was present in this case. This dog collapses
during steady exercise. The dog was bradycardic on
clinical examination, raising the suspicion of a
bradyarrhythmia. However, detection of a slow heart
rate on clinical examination should not discount a
tachyarrhythmia as the cause of collapse, since the
dog was not collapsed at the time of examination.
Some of the findings on clinical examination did
not correlate well with decreased cardiac output
being the cause of the collapse primarily, detection
of a strong femoral pulse and slow heart rate.
However the murmur is concerning, dogs with dilated
cardiomyopathy often have a soft systolic murmur.
A right-to-left shunt was unlikely since cyanosis of
caudal mucous membranes was not detected on
clinical examination, though it should be borne in
mind that it may be necessary to carefully exercise the
dog in order to exacerbate a shunt and produce a
detectable cyanosis.
B Bradycardia
Cardiac
Sinus bradycardia, atrioventricular block, sick
sinus syndrome, atrial standstill
Metabolic
Hypothyroidism, hyperkalaemia, e.g. Addisons
disease, urethral obstruction
Iatrogenic
Sodium channel blockers (e.g. mexiletine),
beta blockers (e.g. atenolol), potassium
channel blockers (e.g. sotalol), calcium
channel blockers (e.g. diltiazem), digoxin
Suspicion of a metabolic cause of the bradycardia
was low; there was no trembling or gastrointestinal
signs as may be seen with Addisons disease, and the
dog was able to urinate normally, thus ruling out
urethral obstruction. Hypothyroid dogs commonly
show skin changes and weight gain and may heat-
seek, none of which was present in this patient, though
their absence do not exclude the diagnosis. Iatrogenic
causes could be ruled out from the history.
C Systolic murmur over the left heart
Congenital heart disease
Aortic stenosis
Pulmonic stenosis
Tetralogy of Fallot
Atrial septal defect
Relative pulmonic stenosis, e.g. secondary to a
ventricular septal defect
Acquired
Myxomatous mitral valve disease
Mitral valve endocarditis
Left ventricular eccentric hypertrophy, e.g.
dilated cardiomyopathy, 3rd degree
atrioventricular block
Myocarditis
Given the age of this dog and the fact that a
murmur had not been detected on previous
examination, a congenital lesion was less likely. The
point of maximal intensity of the murmur was over the
left apex, increasing the suspicion of a leak in the
mitral valve. Chronic valve disease typically affects
small-breed dogs, and dogs showing clinical signs
often have a harsh murmur of grade IV/VI or greater,
which does not fit with this case. Endocarditis is a
rare condition, in which affected dogs tend to be
unwell and pyrexic, which again does not correlate
with this case.
Why is it useful to examine the jugular
veins in cases such as this, where
cardiac disease is suspected?
Assessment of the jugular veins is a simple way to
gather information about right-sided cardiac function.
In this case, given the suspicion of cardiac disease
and the presence of a murmur, signs of left-sided
congestive heart failure (dyspnoea, tachypnoea)
and right-sided congestive heart failure (jugular
distension/pulsation and ascites) should be
checked for.
The jugular veins can be easily examined by lifting
the animals head (with or without clipping). Jugular
distension and pulsations provide an indication of the
haemodynamic changes in the right heart. Distension
of the jugular veins suggest an increase in central
venous pressure, as they drain into the right side of the
heart. Central venous pressure may be increased due
to increased right heart pressure or to an obstruction
to flow such as a mediastinal mass. Abnormal jugular
pulsations may be seen secondary to right heart
failure, or dysynchrony during the cardiac cycle (e.g.
secondary to an arrhythmia). There were no jugular
pulsations in this patient.
Construct a diagnostic plan for this dog.
Why are you performing these tests?
Biochemistry and haematology are indicated to
evaluate for a metabolic cause of the collapse such as
hypoglycaemia. A thyroid panel is indicated to
investigate metabolic causes of the bradycardia.
Results of these tests were within normal limits.
An ECG is indicated to diagnose the underlying
rhythm and to make a preliminary assessment as to its
threat to the patients health (Figures 1 and 2).
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CLINICAL CONUNDRUM
Clinical conundrum
What rhythm is present?
The P waves occur regularly, as do the QRS
complexes; however, they bear no relationship to each
other. The sinoatrial node is firing, and the impulse is
conducted normally through the atria (the atrial rate is
180/min) but the impulse is not conducted through the
ventricles. The QRS complexes are wide and bizarre
suggesting an origin within the ventricular myocardium
(the ventricular rate is 45/min). Normal P waves with a
ventricular escape rhythm is consistent with third
degree atrioventicular block (3AVB). The sinoatrial
node depolarises at a faster rate than the subsidiary
pacemaker resulting in a faster atrial rate compared to
the ventricular rate.
An atropine response test could be performed, to
assess whether the arrhythmia is vagally mediated and
to give an indication as to whether the rhythm would
respond to medical management. However, high-grade
2AVB and 3AVB rarely show any change with atropine.
Given that this dog has 3AVB, what are
the possible underlying causes? And
what tests would be needed to
differentiate them?
Underlying causes are listed in Table 1. A number of
differentials in this list have already been ruled out;
specifically, digitalis toxicity, electrolyte imbalance and
isolated congenital 3AVB. Echocardiography is the
best tool available in general practice to assess the
heart structure and function, and in this case, to
assess for evidence of cardiomyopathy, neoplasia,
endocarditis, myocarditis and septal defects.
Echocardiography (Figures 3, 4 and 5)
demonstrated an increased left ventricular end diastolic
size, normal systolic size (resulting in an increased
ejection fraction and fractional shortening) and mildly
increased left atrial size. The wall thicknesses were
within normal limits. These findings ruled out dilated
and hypertrophic cardiomyopathy. The right ventricle
and right atrium were enlarged. There was mild mitral
and tricuspid regurgitation, however, the atrioventricular
Figure 3: Right parasternal short axis view at the
heart base; measurement of aortic and left atrial
diameter
Figure 4: Right parasternal long axis view;
measurement of left atrial diameter
Figure 2: Lead II ECG
50 mm/s
1
0

m
m
/
m
V
Cardiac neoplasia
Cardiomyopathy
Digitalis toxicity
AV node fibrosis
Endocarditis
Electrolyte imbalance
Lyme disease (myocarditis)
Isolated congenital AV block
Atrial septal defect, ventricular septal defect
Table 1: Underlying causes of 3AVB
Figure 1: Six lead ECG
50 mm/s
5

m
m
/
m
V
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CLINICAL CONUNDRUM
non-perfect seal and mitral regurgitation. Volume
overload can also affect the right side of the heart
resulting in right heart enlargement.
What other clinical signs may be seen in
patients with 3AVB?
Jugular pulses may occur when the atria contract
against a closed tricuspid valve, i.e. when the P wave
falls between the QRS complex and T wave, producing
cannon a waves in the jugular veins. This was not
detected in this case.
Careful auscultation may detect a quiet fourth heart
sound (atrial contraction) bearing no relationship to the
first and second sounds (valve closure). This was not
detected in this case.
What treatment options are available and
are there any other tests that would be
advisable?
Medical treatment of 3AVB is usually ineffective and
artificial pacing is generally indicated. Antiarrhythmic
drugs are contraindicated, as they tend to suppress
the ventricular rhythm and so can cause further
slowing of the heart rate and decompensation.
Thoracic radiography was performed to confirm
that congestive heart failure was not present.
Pulmonary oedema is only occasionally seen in dogs
with 3AVB and is more likely if there is chronic severe
mitral regurgitation, which was not the case in this dog.
The dog was referred to The Veterinary
Cardiorespiratory Centre, where an artificial
pacemaker was implanted (Figure 6). This dog was a
good candidate for pacemaker implantation, as the
arrhythmia was causing clinical signs and there was
no evidence of underlying myocardial or valvular
disease. Following pacemaker implantation the dogs
collapsing episodes ceased.
Figure 5: Right parasternal short axis view at the
level of the chordate tendinae; M mode recording.
Figure 6: Thoracic radiograph showing correct
placement of the pacemaker
valves were normal in appearance, making
endocarditis less likely. There was no evidence of
neoplasia or septal defects and the myocardium was
normal in appearance, suggesting there was no
inflammation of the myocardium.
What other test could be performed to
help rule out myocarditis?
Troponin I was measured and was mildly elevated.
Troponin I is a marker of myocardial damage and
one would expect a very high value if myocardial
damage, such as in myocarditis, was ongoing. Given
this finding, specific testing for Lyme disease was
not performed.
Based on all the given evidence what is
the final diagnosis?
Having ruled out other underlying causes, this dog
was diagnosed with idiopathic 3rd degree
atrioventricular block (3AVB), the aetiology of which
was presumed to be degenerative changes in the
atrioventricular node.
How does the diagnosis of 3AVB explain
the prominent apex beat, strong femoral
pulse and murmur detected on clinical
examination? Does this explain all of the
original problems identified?
A prominent apex beat and strong femoral pulse can
be explained by the prolonged diastolic filling time
(due to the slow ventricular rate) and increased left
ventricular diastolic size.
Cardiac output (CO) would be decreased (due to
the slow heart rate (HR)) unless forward stroke volume
(SV) was increased (CO = SV x HR). This is achieved
via eccentric hypertrophy, which results in an
increased left ventricular volume whilst contractility is
maintained. Enlargement of the ventricle results in
stretching of the mitral valve annulus, resulting in a
Echocardiographic and radiographic images courtesy of Mike Martin MVB DVC MRCVS
of The Veterinary Cardiorespiratory Centre, Kenilworth
10-13 Clinical Conundrum.indd 13 21/02/2011 14:08
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Congress
New for Congress 2011
BSAVA Manual of Canine and Feline Oncology,
3rd edition
Edited by Jane Dobson and Duncan Lascelles
Building on the success of previous editions, the Editors have sought
to marry the best of the old with the new. All chapters have been
updated, or rewritten, to encompass the important advances made
over the last several years. The principles of diagnostics and clinical
staging and of the main therapeutic modalities are outlined. Individual
tumour types in the body systems of dogs and cats are then
described, using a common approach to aid information retrieval on
aetiology and pathogenesis, presentation and clinical signs,
management, and prognosis.
BSAVA Manual of Canine and Feline
Rehabilitation, Supportive and Palliative Care:
Case Studies in Patient Management
Edited by Samantha Lindley and Penny Watson
Companion animals are undergoing previously uncontemplated
treatments and surviving what would once have been rapidly fatal
conditions. This Manual is aimed at the whole veterinary team, drawing
on all their skills to help patients achieve as full a function and quality of
life as possible after surgery, trauma or disease, and to manage
chronic conditions effectively for the benefit of animal, owner and the
practice team. This truly innovative Manual presents a collection of
Case Studies across a range of canine and feline patients from
discospondylitis to glaucoma in dogs and from triaditis to leg
amputation in cats. These are designed to illustrate the considerations
to be made and the options available within a specific clinical setting.
BSAVA Publications is
pleased to announce
that there will be four
new manuals making
their first appearance
at Congress this year
MEMBER VOUCHERS
BSAVA members, remember to use
your vouchers from the Exhibition
Vouchers booklet (available in your
delegate bag) to receive an extra 5 off
the normal Congress rate on these four
new titles only valid at BSAVA
Congress 2011. Visit the Publications
Stand on the NIA Balcony during
Congress 2011 to purchase your
copies and use your vouchers.
Congress price
55.00
Congress price
49.00
T
he talks will be given on Friday and
Saturday with refreshments provided
on site during the breaks to
encourage further questions and
discussions in an informal atmosphere.
The idea of these sessions is to present
the best and most recent developments in
the universities clinical research efforts, so
it is thought that they will be of particular
interest to practitioners with a special
interest in a topic, residents in training
programmes, specialists, academics and
anyone who wants to hear what is
happening in the world of clinical science.
These will not be classical CPD lectures
they will focus on clinical research studies
that have been recently performed or that
are underway.
Diseases, diagnostic tests and
treatments
On Friday morning, Stijn Niessen and Yaiza
Forcada from the Royal Veterinary College
will be talking about their studies on feline
diabetes mellitus. New understanding in
infectious diseases will also be an
Universities unite for Congress
BSAVA Congress has a new stream that will bring
together frontline clinical researchers from the
university vet schools to present their particular
specialties and studies
important component, with presentations
by Sverine Tasker from the University of
Bristol on haemoplasma research and
Pawel Beczkowski from the University of
Glasgow on viral evolution in the
progression of FIV infection. On Friday
Jane Dobson from the University of
Cambridge will talk about her work on
sarcomas in flat-coated retrievers
On Saturday Rory Bell from the
University of Glasgow will describe the
evolution and use of acute phase proteins
as diagnostic tests in small animal practice.
Angie Hibbert from the University of
Bristol will talk about advances in feline
thyroid carcinoma treatment and will report
on recent experiences using high-dose
radioactive iodine and external beam
radiotherapy in the management of cases.
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14-15 Congress.indd 14 21/02/2011 14:07
Congress
BSAVA Manual of Canine and Feline
Reproduction and Neonatology, 2nd edition
Edited by Gary England and Angelika von Heimendahl
Reproduction and neonatology are important aspects of general
veterinary practice, with a large number of consultations being
undertaken by veterinary surgeons both for the prevention of breeding
and for optimizing reproductive performance and neonatal survival.
The Manual provides a practical approach to reproduction and
neonatology, with the chapters divided into five main sections: the
reproductive cycle; infertility; pregnancy and parturition; neonatology;
and clinical approach to common conditions.
BSAVA Manual of Canine and Feline
Ultrasonography
Edited by Frances Barr and Lorrie Gaschen
The BSAVA Manual of Canine and Feline Ultrasonography is the
newest addition to the diagnostic imaging series. The Manual
discusses the equipment required and the general principles of the
ultrasound examination, before moving on to consider body systems
in individual chapters. Each of the system chapters follows a similar
format: indications; comparison of ultrasonography with other imaging
modalities; imaging technique; normal ultrasonographic appearance;
and interpretation of disease. A DVD-ROM featuring video clips
relevant to the individual chapters accompanies this Manual. n
EXOTIC MANUALS
OFFER
Complete your library of exotic pet titles
with a mix and match offer at BSAVA
Congress. All delegates can use their
voucher from the Exhibition Vouchers
booklet (available in your delegate bag)
to save 25 off the total price when
purchasing three Manuals together
choose one title per list (A, B and C) only:
n List A
Exotic Pets, 5th edition
Rodents and Ferrets
Farm Pets
n List B
Raptors, Pigeons and Passerine
Birds
Reptiles, 2nd edition
Ornamental Fish, 2nd edition
n List C
Rabbit Medicine and Surgery,
2nd edition
Psittacine Birds, 2nd edition
Wildlife Casualties
Congress price
45.00
Congress price
45.00
Not coming to Congress?
At BSAVA Congress this year we are offering all delegates a
huge 25 off the total purchase price when you buy the BSAVA
Manuals of Abdominal Imaging, Musculoskeletal Imaging, and
Thoracic Imaging together. Simply present your voucher from
the Exhibition Vouchers booklet (available in your delegate bag)
when buying the Manuals to receive the discount.
IMAGING MANUALS OFFER
Cutting edge research
On Saturday Professor David Argyle from
the University of Edinburgh will talk about
Stem Cells and the Origins of Cancer.
David and his group have recently identified
a subgroup of cancer cells in dog and cat
tumours that have a stem cell phenotype.
Later on Friday, Professor Brendan
Corcoran from the University of Edinburgh
will talk about myxomatous mitral valve
disease (MMVD) and how we can
understand the inevitable. Professor
Corcoran and his colleagues are
particularly interested in understanding the
mechanisms that control cellular
responses and valve matrix remodelling.
His lecture will outline our current
understanding of the range of changes
seen in diseased heart valves.
Following this lecture, Sonja Fonfara
from the University of Liverpool will talk
about how she has been able to
demonstrate that when heart disease in
dogs worsens there is an increase in
inflammatory cytokines and this may have
an effect on the regulation of extracellular
matrix proteins.
Genetic determinants of disease will
also be considered by Karin Allenspach
from the Royal Veterinary College, who will
speak about her studies on inflammatory
bowel disease in German Shepherds, and
Professor Sean Callanan from the
University College, Dublin, who will speak
about Greyhound meningoencephalitis.
Good practice
The veterinary profession relies on the use
of antimicrobials to control and manage
infectious disease in small companion
animals, but also has a responsibility to
use drugs prudently to protect public
health. Thurid Frietag from University
College, Dublin and Nicola J. Williams
from the University of Liverpool will
describe and discuss the issues
surrounding this subject and present
research studies on antimicrobial
resistance in urinary tract infections and
the effect of prescribing practices.
New initiatives
Nottingham University have recently
established a Centre for Evidence Based
Medicine, and Rachel Dean and her
colleagues will outline their latest work and
their plans for the future. Ben Harris from
the University of Cambridge will present on
ongoing prospective case controlled
multi-centre studies that are being
developed to investigate the importance of
chronic persistent hepatic infections in
dogs. He will also present ongoing studies
on the role that canine herpes virus may
play in perinatal death.
Ian Ramsey of BSAVAs Congress
Programme Committee says the idea of
these sessions is to present the best and
most recent developments in the
universities clinical research efforts, so
come along and find out about the future.
We can guarantee you will learn something
new. You can find more details online at
www.bsava.com. n
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If you are not coming to BSAVA Congress this year, but are
attending one of the Affiliated Group meetings on the Wednesday,
you too will also have the opportunity to purchase copies of the new
Manuals. This year we will have two stands open on the Wednesday:
n Austin Court (foyer) open 10am to 6pm
n ICC (top of the escalators by the internet caf) open 124pm
Dont miss out on this chance to add the newest titles to your
practice library.
14-15 Congress.indd 15 21/02/2011 14:07
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CPD
In April BSAVA will run
two CPD courses that
challenge vets in
practice. Brendan
Corcoran will look at
respiratory disease and
Mike Herrtage will shed
light on endocrinology.
Think you know all you
need to on these
subjects? Test your skills
with this quick quiz.
Course delegates who
bring along the quiz
correctly answered will
be in with a chance to
win either the BSAVA
Manual of Canine and
Feline Endocrinology or
the BSAVA Manual of
Canine and Feline
Cardiorespiratory
Medicine
Quick
quiz
1
Brachycephalic airway syndrome
involves a group of anatomical
deformities that result in varying degrees of
upper airway obstruction. Which of the
following deformities are potentially
amenable to surgical correction?
a. Everted laryngeal saccules
b. Extended soft palate
c. Laryngeal collapse
d. Stenotic nares
e. Tracheal hypoplasia
(Tick all that apply)
3
Bronchoalveolar lavage is a useful
diagnostic tool for respiratory
disorders. Which of the following
statements is true?
a. A good BAL sample should be cellular,
with the presence of macrophages
indicating the lavage has reached
alveolar level
b. A normal BAL should contain no cells
c. Even small numbers of eosinophils in a
sample are likely to be clinically
significant
d. Growth on culture is always clinically
relevant
e. The presence of red blood cells in the
airway invariably indicates respiratory
disease
2
Which of the following statements
relating to feline asthma is not true?
a. Assessing for allergen exposure by
intradermal testing is often valuable
b. Asthma is a reversible
bronchoconstriction resulting in
wheezing and dyspnoea
c. Radiography may show a combination
of hyperinflation and collapse of lung
lobes
d. Rapid response to dexamethasone,
bronchodilators and oxygen is
suggestive of asthma in cats
e. Rib fractures and pneumothorax may
occur in severe cases
4
Thoracocentesis yields a sample of
fluid from the pleural space. This fluid
is blood tinged, with moderate protein, high
cellularity (lymphocytes), high lipid content
and high specific gravity. The fluid is most
likely to be:
a. Blood
b. Chyle
c. Exudate
d. Modified transudate
e. Transudate
5
Nasal neoplasia typically occurs in
older, medium to large breed dogs.
Which of the following is not true.
a. Discovery of distant metastases is a
poor prognostic indicator
b. The majority of nasal tumours are
carcinomas
c. Dogs which are treated with surgery
live longer than those who receive no
treatment.
d. Without definitive treatment dogs tend
to live 36 months after diagnosis
e. Megavoltage radiotherapy is the
preferred treatment modality
RESPIRATORY
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CPD
RESPIRATORY
DISEASES OF THE
DOG AND CAT
A comprehensive review
Tuesday 26 April 09:3018:00
Woodrow House, Gloucester
Brendan Corcoran will explore
respiratory diseases that are relatively
common in companion animal practice
but can prove problematic, not least
because of their shared features with
cardiovascular diseases. Delegates will
get a complete overview of our
understanding of the common
respiratory diseases, methods of
diagnosis and most effective forms of
therapy. The course will emphasise
clinical information relevant to and
achievable in a general practice setting,
but will also cover more advanced
diagnostic techniques and treatments
that can better inform clinical practice
decision making.
BSAVA Member: 213.83
Non-member: 320.74
ENDOCRINOLOGY II
Endocrine emergencies,
collapse and effect on blood
pressure
Thursday 28 April 09:3018:00
Radisson Blu Hotel, Manchester
Airport
Mike Herrtage will deal with three
important problems in veterinary
endocrinology: management of the
unstable diabetic dog and cat; the
approach to episodic collapse,
concentrating particularly on the
endocrine and metabolic causes of
collapse including
hypoadrenocorticism, insulinoma,
diabetic ketoacidosis and calcium
disorders; and the endocrine effects on
blood pressure. There will be a series of
tutorials interspersed with case
examples for participants to work
through in order to have as much
interaction as possible and to provide
veterinarians with practical information
and useful tips that can help them in
their clinical practice.
BSAVA Member: 213.83
Non-member: 320.74
Images taken from the following Manuals: BSAVA
Manual of Canine and Feline Cardiorespiratory
Medicine, 2nd edition; BSAVA Manual of Canine
and Feline Endocrinology, 3rd edition; BSAVA
Manual of Canine and Feline Head, Neck and
Thoracic Surgery; BSAVA Manual of Canine and
Feline Oncology, 3rd edition
ENDOCRINOLOGY II
6
Which of the following statements
about hypoadrenocorticism is
not true?
a. Acute hypoadrenocorticism is not
life-threatening
b. Chronic hypoadrenocorticism in the
dog commonly results in anorexia,
vomiting and/or weakness
c. Chronic hypoadrenocorticism is far
more common than the acute disease
in dogs
d. Hypoadrenocorticism is predominantly
a disease of the young to middle-aged
dog
e. Hypoadrenocorticism is rare in cats
9
Insulinomas are functional islet cell
tumours. Diagnosis may be based
upon a combination of:
a. Clinical signs associated with
hyperglycaemia
b. High plasma insulin concentration
c. High serum fructosamine concentration
d. Low fasting glucose concentration
e. Low insulin : glucose ratio
(Tick all that apply)
7
Diabetic ketoacidosis is a medical
emergency associated with:
a. Dehydration
b. Electrolyte imbalance
c. Hyperglycaemia
d. Ketonaemia
e. Metabolic alkalosis
(Tick all that apply)
8
Which of the following would be
unlikely to explain inadequate
glycaemic control in an unstable diabetic
dog or cat?
a. Access to tit bits or scavenging
b. Concurrent hypoadrenocorticism
c. Incorrect or inconsistent administration
of insulin
d. Insulin-induced hyperglycaemia
e. Low bodyweight
10
Which of the following statements
relating to hyperparathyroidism is
not true?
a. Aggressive intravenous fluid therapy is
indicated to combat the
hypercalcaemic crisis
b. Clinical signs relate to hypercalcaemia
and include polyuria/polydipsia,
anorexia and depression
c. Primary hyperparathyroidism is an
uncommon disease in older cats and
dogs
d. Prolonged increases in circulating
calcium cause renal function to
deteriorate
e. Secondary hyperparathyroidism may
occur as a result of acute renal failure
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HOW TO
How to
Approach the
anorexic rabbit
A
norexia is a very common presenting sign in the
rabbit, and it is exactly that, a clinical sign. It is
not a single disease entity nor, generally, the
primary issue. Identifying the reasons for the
development of anorexia is vital, in order to approach
and successfully treat such a case. Successful
management of the anorexia is needed during the
diagnostic process to avoid the anorexia becoming a
fatal problem in its own right.
Anorexia, in its strictest sense, refers simply to
inappetence. This may be total or there may be a
reduction in general food intake or an alteration in food
preferences, with some items still being eaten and
others not. The lack of food intake may go hand in
hand with altered gastrointestinal motility, and may or
may not include an alteration in faecal consistency
and/or volume.
Recognising the early signs
The onset of clinical signs may have been subtle and
gradual, or acute. Whilst some rabbits are extremely
well cared for by highly attentive and observant owners,
many rabbits are poorly observed due to their outdoor
lifestyle. Thus the premonitory signs of a problem
developing may not always be noted. Furthermore the
ideal grouping for rabbits is as a pair housed together.
Whilst this is perfect from a social and welfare
perspective, it can obscure the initial subtle stages of a
gradually reducing food intake and faecal output.
Finally, rabbits are a prey species; this has given them
an evolutionary incentive to hide signs of illness, as
predators select the potentially weakest animal.
Initial examination
The initial approach to any anorexic rabbit involves
taking a detailed history, bearing in mind the possibility
that the problem is longer standing than the owner
may imagine. In fact, it is important to recognise this
potential and ensure that anorexic rabbit cases are
seen with greater urgency than the equivalent
domestic carnivore case.
Current and past husbandry, with particular
emphasis on diet, should be evaluated. Quantitative
descriptions of the diet are necessary to avoid
inaccurate assumptions. It is common for owners to
describe a diet superficially as being ideal, and only
on further investigation is it apparent that the hay and
grass given is inadequate in quantity and/or quality,
and that the amount of concentrate diet is in vast
excess of what is necessary.
The physical examination is an extremely important
part of the diagnostic evaluation of any anorexia case,
as a wide range of disorders may cause anorexia. The
aim is to identify clues as to primary cause(s) as well
as the degree and consequences of anorexia.
The mouth is the most common site of problems
leading to anorexia (Figure 1). It is vitally important to
examine the mouth, and particularly the teeth, carefully
and thoroughly. Simple lack of prehension of food, due
to incisor malocclusion, is common, and easily
identified. More subtle cheek tooth abnormalities are
equally likely, but will require more thorough evaluation
using otoscopic or other visualization. Anaesthesia or
sedation, sufficient to fully open and examine the
mouth, is necessary for complete assessment (Figure
2). Oral endoscopic examination facilitates
visualization of the interdental spaces, and the very
caudal area of the mouth. Imaging is vital to assess
lesions involving reserve tooth crown, or boney
structures, and is also helpful in diagnosing nasal
cavity lesions (see Further diagnostics).
Although dental causes of anorexia are common,
the entire rabbit should be thoroughly assessed.
Attention should be paid to the signs of respiratory
disease (Figure 3). Rabbits with upper respiratory
problems may find eating difficult due to their
anatomical preference for nasal breathing, and so
nasal cavity lesions (tumours, abscessation or
infection) may lead to inappetence. In particular, the
Richard Saunders of the
University of Bristol/Rabbit
Welfare Association & Fund
Rabbit Referral Clinic helps
us get to grips with this
frustrating problem
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HOW TO
abdominal cavity should be gently but thoroughly
palpated. As well as detection of abnormal masses or
identification of painful foci, the general degree of gut
fill and tympany gives clues as to the chronicity and
severity of the problem.
Any source of pain may initiate anorexia; common
pain sites (apart from the mouth) include the abdomen,
perineal region and feet. Remember that
gastrointestinal stasis, causing gas to accumulate in
the intestine, leads to distension and painful stimulation
of stretch receptors. This pain further depresses
appetite and activity, reducing gut motility and
perpetuating the problem.
Other common sources of abdominal pain include
the urogenital tract. In the un-neutered female, uterine
Figure 1: Dental trauma or disease is a common
cause of anorexia
Figure 2: Cheek tooth spurs may cause significant
mouth pain and prevent eating
Figure 3: Upper respiratory tract disease makes
eating and breathing at the same time difficult
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Approach the anorexic rabbit
adenocarcinoma is a common finding, and should be
considered high on the differential list. In the neutered
female, adhesion formation following spaying may lead
to (often intermittent) episodes of gastrointestinal
stasis, occurring several months or even years
afterwards. In either sex, the presence of large
amounts of crystalline material in the bladder, so called
sludgy urine syndrome, may lead to waxing and
waning anorexia due to the discomfort of passing
urine, and the associated secondary cystitis. Passage
of large amounts of thick, toothpaste-like urine from
time to time may occur, giving temporary relief from
clinical signs.
The presence of urine scalding around the perineal
region (Figure 4) is a common consequence of urinary
tract disorders. As well as being a direct source of
pain from inflamed and infected skin, this will
predispose to fly strike. Indeed, fly strike may be the
first indication of a problem. It is therefore vitally
important when presented with a fly strike case to
investigate the underlying cause.
Further diagnostics
A differential list should be constructed and will
include sources of stress or pain and changes of
environment or food. Transient stress or pain may be
sufficient to initiate anorexia, but unless it is of
significant duration the problem should be easily
identified and should rapidly resolve once treated.
More chronic cases may require further diagnostic
investigation.
Radiography is invaluable for the further
investigation of dental disorders, particularly those
occurring at the very caudal areas of the mouth, or
under the gum line. It therefore complements the
physical examination (with or without endoscopy). It
also allows assessment of the nasal cavity for
investigation of upper respiratory disease.
Survey radiography is helpful for evaluating the
thorax and abdomen, identifying musculoskeletal
problems and assessing the urinary tract for
crystalluria and urolithiasis. Abdominal radiography is
also helpful for distinguishing between obstructive and
non-obstructive ileus, the former typically
characterized by a build-up of gas proximal to the site
of obstruction, and the latter showing a typical
halo-shaped accumulation of gas around ingesta in
the stomach, with intestinal gas either largely absent,
or relatively evenly distributed throughout the rest of
the GI tract. In extreme cases, gut rupture will be
evident, with free gas and/or fluid (a ground-glass
appearance) in the abdomen.
Ultrasonography is an incredibly helpful technique,
complementing radiography. Although the presence of
gas limits the information that may be obtained, it is
superior to radiography in evaluating the liver and
uterus, and is often more sensitive than radiography in
detecting urinary tract disorders.
More advanced imaging modalities have a place,
with CT and MRI being increasingly utilized. CT
provides high quality images of the skull and teeth, in
particular, and MRI is highly effective at identifying
soft tissue lesions within the skull, such as nasal
cavity masses.
Haematology and serum biochemistry have a role in
identifying underlying disorders such as chronic renal
failure, and are probably under-utilised in practice.
Figure 4: Urine scalding is a common source of pain
in the rabbit, potentially leading to anorexia
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HOW TO
Figure 5: Appropriate fibre rich items such as grass
and hay should be offered to all in-patients
Figure 6: Obese rabbits are at particular risk of
hepatic lipidosis developing with starvation
Figure 7: Syringe feeding a commercially available
recovery diet is helpful in anorexic rabbits
Treatment
Treatment of the specific underlying problem obviously
depends on a specific diagnosis. It should be noted
that rabbits commonly have multiple problems, often
arising from a common cause; dental disease, urinary
scalding, and caecotroph accumulation around the
perineum may all be interlinked, with an inappropriate
diet as the initiating cause, and all aspects must be
addressed. However in addition to specific therapies,
inappetence requires supportive and general
treatment, including fluid therapy, nutritional support,
analgesics and gastrointestinal prokinetics.
Fluid may be supplied parenterally, but the old
adage if the mouth works, use it, applies particularly
well to rabbits, as hydration of the gut and its contents
is especially important. During inappetence a mixture
of food material and fur (often present to some degree
in the stomach, and usually a sign of slow motility
rather than its cause), becomes dehydrated and forms
a solid matrix, which further impedes stomach
emptying. Rehydration of gastric contents is vital to
reverse any effect on appetite.
Nutritional support is vital (Figure 5). Rabbits,
especially those suffering from obesity (which is
common and under-recognised), rapidly develop
hepatic lipidosis following starvation (Figure 6). As well
as fluid, a source of energy to maintain enterocyte
viability and prevent hepatic lipidosis developing is
important (Figure 7). Commercial products, such as
Oxbow Critical Care Formula and Supreme Science
Recovery, are palatable and widely available.
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Approach the anorexic rabbit
Gut distension is painful and, even if no other
source of discomfort is present, analgesia is
indicated. This may be in the form of opioids (e.g.
buprenorphine) or NSAIDs (e.g. meloxicam), or both.
Concerns over opioid effects on gut motility are
generally unfounded at the doses and durations
used, and poorly controlled pain is a far more potent
GI motility depressor.
Gastrointestinal prokinetics definitely have a
place in the management of anorexia and ileus in
rabbits. Their use, as with most pharmaceuticals in
the rabbit, is based on a small amount of scientific
trial data (often performed on laboratory rabbits, with
little individual variation in size and breed), and mainly
on anecdotal experience. There are few licensed
products available for the rabbit (as is also the
case with analgesics), and fully informed, written,
owner consent is therefore required, following the
Cascade appropriately. This author has used
metoclopramide, ranitidine and domperidone, and
generally uses ranitidine syrup as a first line
treatment, with domperidone a useful adjunctive or
alternative option in more severe cases. Suggested
doses are given in Table 1.
Prognosis
Prognosis depends on the precise diagnosis, and the
likelihood of full resolution of the underlying cause. In
addition, the duration of clinical signs is an important
prognostic indicator, with every day of anorexia
bringing with it an increasingly dehydrated gut content,
and a more and more bloated and painful abdomen,
reducing the chances of a successful resolution. Early
intervention is always better than late!
Ranitidine 35 mg/kg orally q812h
Metoclopramide 0.51.0 mg/kg s.c. or orally q612h
Domperidone 0.250.5 mg/kg q12h
Buprenorphine 0.050.1 mg/kg i.m. q68h.
Anecdotally, this drug appears
efficacious given across the oral
mucosa
Meloxicam 0.30.6 mg/kg s.c. or orally q24h
Table 1: Authors suggested drug doses
AVAILABLE FROM
THE BSAVA
For more information on
clinical problems in rabbits,
consult the BSAVA Manual of
Rabbit Medicine and
Surgery, edited by Anna
Meredith and Paul Flecknell.
Includes:
Nursing and hospital
care
Diagnostic imaging
Cardiovascular
disorders
Dentistry
provides a large amount of
information you will require
on a daily basis and has
a very easy access
formulary. Nurses,
veterinarians and
students alike will
benefit from a read
Journal of Small
Animal Practice
Member: 49
Non-member: 75
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PETSAVERS
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P
etsavers has traditionally been heavily
reliant on the income from legacies.
However this income is very sporadic
and Petsavers needs to obtain a more
consistent income from the fundraising
activities of individuals and groups. There
are many ways to raise funds for Petsavers
and not all have to be as difficult or
arduous as climbing a mountain, which is
what I did.
In September 2004 I embarked on a
trek to the north face of Mount Everest, and
I decided to take the opportunity to raise
money for Petsavers. This piece has been
written to hopefully inspire anybody
embarking on an adventurous trip to do the
same. My trip involved a trek to advanced
base camp on Everests north side, with
the option of climbing a technically easy
7000m (23,000 foot) peak nearby. I had
previously visited Everest base camp on
the southern, Nepalese side, and I wanted
to go higher and to see the northern,
Tibetan side.
Getting started
We began in Kathmandu, the capital city of
Nepal and the starting point for most
Himalayan expeditions. Chaotic and noisy,
Kathmandu is a wonderfully colourful,
vibrant and exotic city with friendly,
welcoming inhabitants. From here we flew
to Lhasa, Tibets capital, which at 3600 m
is one of the highest cities in the world. It is
common to suffer from altitude sickness
here, so we took a few days to acclimatise.
Once one of the worlds most forbidden
and holy cities, Lhasa has succumbed to
Chinese modernisation and is now an ugly
mass of shopping malls and high-rise flats.
It is impossible to visit Tibet and not get
caught up in its political history.
Despite their precarious political
position, pockets of old Lhasa still exist, and
the spiritual heart of the city is the Barkhor
Square. Pilgrims from all over Tibet come
here to make a clockwise circumambulation
of the square and visit the holy Jhokang
Temple, the most revered religious structure
in Tibet dating back to the seventh century.
There is a curious mixture of spiritualism
and capitalism, with pilgrims and colourfully
dressed monks mixing with numerous
Tibetan and Chinese market traders. In stark
contrast is the Potala, the famous palace
once occupied by the Dalai Lama. From the
outside it is one of the most beautiful and
striking pieces of architecture in the world;
however, since the Dalai Lamas exile, the
inside has become a sterile museum.
Aiming high for
Petsavers Improving the health of the nations pets
Mark Pertwee, Petsavers Management
Committee Chairman, looks back at his trip to
Everest in aid of Petsavers
From the bottom up
From Lhasa, we boarded rickety land
cruisers and made the long dusty
journey to the Rongbuk Monastery, from
which it is a short hike to Everest base
camp at 5200m. Base camp is an
unprepossessing place made up of a
few semi-permanent Tibetan tea tents
and various expedition groups, arranged
on the barren rocky valley floor of the
Rongbuk Glacier. However the view to
the south is mesmerising, with the vast
north face of Everest rising impossibly
high into the sky and totally dominating
the horizon. We spent another three
days here, acclimatising to the 1200 m
altitude gain, before making the two-day
trek to camp two, carrying day sacks
whilst a team of yaks carried the bulk
of our equipment.
Camp two is stunningly located at the
foot of the Miracle Highway, a natural
Everest at sunrise from
advanced base camp
Potala Palace
PETSAVERS
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depression between the East Rongbuk and
Changtse glaciers. It is so named because
it makes for a relatively easy path to the
foot of Everests north face. On either side
of the highway, endless rows of enormous
ice formations called penitentes line the
glaciers, looking like huge blue and white
teeth glistening in the sunshine. From this
point the trek really starts to get difficult.
The views are incredible, but the endless
trudging up and down the rocky moraine in
the oxygen-depleted atmosphere takes its
toll physically and mentally. It is hard to
explain how difficult it is to exert oneself at
extreme altitude; the only way to
understand it is to experience it. However it
is worth it to reach advanced base camp at
an altitude of 6350 m. Ahead the mighty
north face of Everest dominates, with the
summit only 6 km away, yet still 2
1
/
2
km
above. To the east, on the other side of the
glacier, we could see the elegant peak of
Lhakpa Ri, whose summit at 7045 m was
our ultimate goal.
Roughing it worth it
Life here is not particularly comfortable.
We slept on small rocky platforms cleared
amongst the boulders, although sleep is at
best fitful. Night-time temperatures drop
below 20C, whilst during the day the
fierce ultraviolet radiation and the blinding
light from the glacier make glacier goggles
a must; and exposed skin must be
protected by a high factor sunscreen. Lips
are blistered and bleeding and most
people have a dry hacking cough due to
the dry atmosphere. However, for me the
discomforts were outweighed by the
magnificent and stark scenery on a scale
hard to comprehend, and the privilege of
being in a place few people ever see. The
altitude took its toll and half the group
returned to base camp leaving the rest of
us to prepare for the ascent of Lhakpa Ri.
We began at 2 am, as it is safer to climb
at night in the sub-zero temperatures
because snow bridges across the
crevasses remain frozen and there is less
chance of avalanches. The pace was slow
and the only sounds were our breathing
and the crunch of crampons and ice axes
in the frozen snow. All I could see was the
small area lit up by my head torch and I
soon slipped into a world of my own as I
concentrated on forcing myself upwards. At
points we crossed snow-covered
crevasses, given away by the disconcerting
hollow sound beneath our feet. Dawn broke
as we crested the final summit ridge and
the whole east face of Everest was lit up by
an orange glow. To the west we could see
Cho Oyu and Lhotse, both 8000m peaks,
whilst to the north hundreds of miles of the
Tibetan plain were visible.
At this point I was really struggling and
had lost the feeling in my fingers and toes.
I was as cold as I have ever been and in
my hypoxic state I started to worry about
frostbite, and reluctantly decided to turn
back about 60m from the summit.
The way back
The journey back was along the Friendship
Highway which links Lhasa and
Kathmandu; an important trade route and
one of the most spectacular road journeys
in the world. From high on the Tibetan plain
it descends to the border town of Zhangmu
which hugs an endless succession of
hairpin bends, jammed with Chinese and
Indian lorries carrying goods across the
border. This lively dirty town, filled with
moneychangers, traders and the scents of
curry and incense, was a cultural shock
after the arid isolation of the Tibetan
plateau. Once in Nepal the road drops into
a verdant gorge with waterfalls cascading
down its walls and on to the road, which is
little more than a bumpy muddy track with
dizzying drops to the river far below.
Back in Kathmandu the next few days
were spent acclimatising to the luxuries of
baths, good food and bars serving decent
beer before finally boarding the plane to
England. This was an incredible trip and I
would like to thank the companies who
sponsored me.
For more information on ways to raise
money for Petsavers please visit the
website at www.petsavers.org.uk or if
you would like to discuss organising a
fundraising trip like Marks then please get
in touch: email info@petsavers.org.uk or
telephone 01452 726723.
Advanced base camp with Lhakpa Ri in the background
Everest and
Rongbuk Glacier
Everest from Rongbuk Monastery
PETSAVERS
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T
his first meeting addressed a number of
initiatives stemming from the 2010 Assembly
meeting, including the establishment of a
Congress Strategic Plan. Since the establishment and
implementation of the Central PCO strategy for WSAVA
World Congress, WSAVA has already received bids for
the 2015 Congress, reflecting the vibrant growing
nature of the WSAVA and its global standing in
different continents. The WSAVA Executive Board also
had the opportunity to meet with the NAVC Board of
Directors to exchange ideas on continuous education
within the veterinary profession.
Additional initiatives that were discussed and will
be forwarded to the Assembly included an expanded
Central Secretariat service to assist in
the day-to-day administrative needs of the WSAVA
and several proposals for further WSAVA
Standardisation projects.
The One Health committee, the V5 committee, and
the Welfare & Wellness committee of the WSAVA
Standardisation projects also held their meetings at
the Marriott World Center Hotel in Orlando during the
WSAVA
Executive
Board gets
together in
Orlando
WSAVA Board and NAVC Board members (left to right: Drs. Richard
LeCouteur, David Wadsworth, Peter Ihrke, Laurel Kaddatz, Walt Ingwersen,
Jolle Kirpensteijn, Earl Rippie Jr., Shane Ryan, Colin Burrows). Not in
photograph: Veronica Leong
The first meeting of the executive
board was held during the North
American Veterinary Conference
in January
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WSAVA NEWS
NAVC conference. A session was held with the
committees, sponsors and WSAVA Board together to
foster mutual understanding of the progress and
updates of different projects and share common
missions, visions and goals.
As part of the Executive Board meetings, the
WSAVA had the opportunity to meet with the
organisers of the 2011 Korea and 2013 New Zealand
World Congresses to keep up to date with their
progress. WSAVA would like to thank the NAVC board
for their kind support in offering exhibition areas to the
WSAVA 2011, 2012 and 2013 Congress organisers as
well as promoting the forthcoming WSAVA Congress in
Jeju, Korea at the opening ceremony.
Promoting WSAVA
Congresses at
NAVC, Orlando
W
SAVA
2
0
1
1
W
SAVA
2
0
1
2
W
SAVA
2
0
1
3
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WSAVA NEWS
P
articipants are encouraged to
register early to take advantage
of the discounted rate and to
ensure that their accommodations and
requirements are met. All those
wishing to attend must complete the
registration on the official 2011
WSAVAFASAVA World Congress
website at www.wsava2011.org, with
full payment, as indicated on the site.
You may also submit your registration
form by fax (+82 2 3461 1340) or
email (registration@wsava2011.org).
Please complete the registration form
and return it to the Congress
Secretariat along with the
appropriate fees.
Get registered!
5000 participants from 78 countries are expected
to gather at Jeju, Korea, for the 2011
WSAVAFASAVAKAHA Congress
KEY DATES
Early-bird registration:
3 January30 April 2011
The first 200 people to register
may attend the Gala Dinner free
of charge
Pre-registration:
1 May30 September 2011
On-site registration:
1317 October 2011
Standard registration fees apply
after 30 September 2011
2011 WSAVAFASAVA
WORLD CONGRESS
SECRETARIAT
Tel: +82 2 3461 1160
Fax: +82 2 3461 1340
Email: wsava2011@unineo.com
Website: www.wsava2011.org
A special discount is available for
groups of 30 people or more (on condition
that the related information and invoice are
from a single source). To benefit from this
special offer, please contact the secretariat
by email: registration@wsava2011.org.
You may also apply and pay for any of
the other activities (including social
programmes, the WSAVA Golf Tournament,
and tour programmes) when you register
for the Congress.
The official airline of the Congress is
Star Alliance. Discounts of up to 20% on air
fares are available depending on the
airline. Please visit www.wsava2011.org
for details of how to receive this discount
and terms and conditions.
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THE companion INTERVIEW
Steve
Tasker
BVSc MRCVS
Steve Tasker was born in Birkenhead, Wirral, the son of two teachers. He was
educated at Birkenhead School and got a place at Bristol Vet School following a
year out to re-sit a single A level. He spent a fair bit of that year under the bonnet of
a Morris Minor Van which he restored and eventually drove off to Bristol. He
remembers keeping a small iron bar under the drivers seat to apply corrective
surgery to the fuel pump when it misbehaved. His one sister stayed closer to home,
graduating from Liverpool University with a degree in mathematics. He is married to
Sverine Tasker who is also a vet, and they live in North Somerset with their two
children. Steve is currently charged with the challenge of organising the Exhibition
at BSAVA Congress.
Q
Why did you want to be a vet?
A
The vet connection was sparked
during frequent holidays in the
Yorkshire Dales where our family
friends have a hill farm. It was all very
important for a 6-year-old; I had to get up
in the dark, put on my wellies and
waterproofs and walk off up the lane to
help with milking. Lambing time, summers
climbing hay barns, tinkering around the
farm, I loved it. I wanted to be James
Herriott, and if truth be told, drive around in
his Austin Seven.
Where did you start your career?
I left Bristol in 1993, after a slight difference
of opinion with an external examiner
delayed my departure to October. My first
job was in a rural mixed practice in Tenbury
Wells, a lovely part of the world. In at the
deep end stuff; the boss walked out on day
one to do his farm work and wished me luck
with my first bitch spay, a fat Labrador as
luck would have it. Lots of lambings,
calvings and assorted fire brigade stuff,
often in the middle of the morning surgery.
Land Rovers and trailers lined up outside
the surgery all the way up the road. Pull up
your sleeves and get on with it stuff.
And then?
From there I moved to Gloucestershire and
started the drift towards small animal work
within a mixed practice framework. I was
allowed a great deal of clinical freedom in a
well supported, relaxed environment and
thoroughly enjoyed this time. A move to
Scotland followed two years later (the six
months of GloucesterEdinburgh weekend
commute had become too much) where
Sverine had secured a Feline Advisory
Bureau residency at Edinburgh University.
I got a job in a mixed practice, again with
emphasis on the small animal side. The
boss did test me out fairly quickly though:
I was sent off on a small TB test. No
problem; I had been doing lots of TB
testing in Gloucestershire. When I got there
I found out they were Highland cattle,
completely wild, totally unused to handling,
and on several occasions I nearly had my
head taken off by their horns.
Where are you now?
Sv and I married in 1998 and soon moved
back to Bristol, again following my wifes
academic career. Serendipitously I took an
assistants job at a two-vet small animal
practice. I was offered a partnership within
a year, bought in a year later, and the
practice has steadily grown, and we are
now a three-site, five-vet practice.
What is your role in BSAVA?
My job is Exhibition Chair, sitting on
Congress Committee. I am two years in
now, and it has been a great role. There is
a lot to be said for adding another string to
the bow, and a lot of satisfaction from
giving something back, and working with
the BSAVA team at Woodrow House and
the other volunteers has been a very
rewarding experience.
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THE companion INTERVIEW THE companion INTERVIEW
dont take yourself too
seriously, do what you care
about, care about what you
do, and treat others like you
would want to be treated
How did you first become involved with
the Association?
I was asked. Several times, as it happens.
Andrew Ash is a very persuasive character.
Actually, my wife was involved with BSAVA
before me, as chair of the Scientific
Programme Committee for a number of
years, and it was she who recommended
Andrew in the first place. So, indirectly, I
am blaming her.
Managing the commercial exhibition
sounds like a massive job?
It is a big job but its made a lot easier by
having a great group of people around me.
I always look forward to committee meeting
dates as we do actually all seem to get on
and have a good time! A lot of the time
commitment these days is via e-mail,
though we have a good number of
meetings spread through the year and
certain specialist days such as when we
meet up with our main exhibitors to discuss
the next Congress, etc. Congress itself
takes up a full seven-day week away from
work and family but is great fun and bloody
hard work at the same time.
What do you consider to be your most
important achievement during your
career?
Growing the practice, raising the standards
and developing the practice team without
any doubt. We (my business partner, Liz,
and I) have put an awful lot of effort and
hard work into it and are very proud of what
we have currently.
What has been your main interest
outside work?
I have enjoyed sport all my life, I sorely miss
playing rugby (a hard, physical team game
using a combination of skill and gritty effort
there seem to be some similarities to
running a practice here dont there?).
Currently fill the gap with five-a-side football
and occasional gym stuff. We love our
bikes and take the family out as much as
we can. Time, as always, seems to be the
limiting factor. The young family doesnt
leave a whole load of time for outside
activities at the moment, unless you count
Peppa Pig, princess or pirate parties.
When and where were you happiest?
Last summer on holiday in France in a
brilliant rural farmhouse gite: going back
next year. It was the first three-week holiday
since our honeymoon 12 years ago. Actually
I am generally happy with life, although
there have been some very challenging
times, with the juggling of home life, clinical
work and practice development, oh yes and
BSAVA involvement!
Who has been the most inspiring
influence on your professional career?
Two names spring to mind. A former boss
called John Hunter at Bowbridge in
Gloucestershire, who led his team with
such a reassured, relaxed manner it
seemed effortless, and Iain Butt in
Edinburgh who led by the opposite
example of utter hard work and dedication
to his practice. I hope I have gleaned a
little from each of them to give me the
balance I would like to think I have now.
What is the most significant lesson you
have learned so far in life?
Dont take yourself too seriously, do what you
care about, care about what you do, and
treat others like you would want to be treated.
What do you regard as the most
important decision that you have made
in your life?
In chronological order, firstly, deciding to
re-sit the errant A level and not go to
medical school instead. Secondly,
marrying Sv. The two are linked of course
as we met at vet school.
What is the most frustrating aspect of
your work?
I dont get that frustrated really. I do get
annoyed with myself if I havent managed
my time particularly well. I like to tick stuff
off and if I dont achieve what I set out to
that can be a little frustrating I suppose.
I dont like it when other parties dont turn
up or do what they said on time. (I am sat
here waiting for the gas man who didnt
ring as arranged!)
If you were given unlimited political
power, what would you do with it?
Sort out greed and corruption in politics
worldwide. There you go, easy. But you
did ask.
Which historical or literary figure do
you most identify with and why?
I am currently reading the complete literary
works of Roger Hargreaves. His character
I most identify with is Mr Busy, although
several others fit the bill too.
If you could change one thing about
your appearance or personality, what
would it be?
I need a haircut as I write. I feel like Leo
Sayer on a bad day. Also, I could do with
another 50% patience quota when trying to
stop my 2-year-old son from climbing out
of his cot. It was eight times the other night;
that was his Personal Best.
What is your most important
possession?
My family. We have two wonderful children,
each providing us with a glorious array of
emotions from total love to total
exasperation, mixed with a decent chunk
of sleep deprivation. And Boris the cat
does a great trick, sitting up to beg waving
his paws.
28-29 Interview.indd 29 21/02/2011 13:59
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companion
REGIONS

Lennon Foo Chair
Lennon qualified from RVC, London, in 2004 and has been
working in Devon ever since. After spending a year in mixed
practice, he moved to small animal practice. Lennon is
interested in the first opinion aspects of small animal medicine
and surgery and has a special interest in exotics medicine
and acupuncture. Outside work, Lennon is usually busy
dancing salsa, bachata, cha cha and kizomba.

Andrea Lynch Secretary
Andrea graduated from Bristol in 2001 and spent 3 years in
mixed practice before working as a locum in South Wales and
the south west. Now studying for a PhD at Bristol, Andrea is
interested in canine internal medicine but would rather be on a
horse, on the hockey pitch or in the water.

Rachel Sekules Treasurer
Rachel graduated from Liverpool in 2004 and worked in a
small animal first opinion and referral practice in Cheshire for
3 years. After 18 months working and travelling abroad she
decided to settle in Somerset, initially locuming, and now back
doing what she loves best, in a small but busy first opinion
practice. Apart from number-crunching for BSAVA SW, Rachel
enjoys twitching, snowboarding and chutney-making.
As part of a continuing series, this
month companion features South West
Region. BSAVA members in this region
benefit from a very active committee
Meet
Your
Region
South West
2011 SOUTH WEST CPD
Please visit www.bsava.com for more information or email
southwestregion@bsava.com
Thursday 17 March Day meeting
Management of the joint disease patient
Speakers: Helen Mathie and Stuart Carmichael

Communal Building, University of Bristol, Langford
Monday 9 May Day meeting
Medical and surgical management of tumours:
two sides to every story
Speakers: Tom Cave and Prue Neath

Redwood Hotel and Country Club, Bristol
Monday 23 May Evening meeting
Itchy dogs and cats and what to do with them
Speaker: Natalie Perrins

Room 011, Roland Levinsky Building, Plymouth University
Thursday 9 June Evening meeting
Digital radiography is it worth it?
Speaker: Nicolette Hayward

Communal Building, University of Bristol, Langford
BSAVA South West Regional evening CPD prices:
Full BSAVA Members: 20
Non BSAVA Members: 30
Nurses/Students: 10
For further information on events in the South West Region,
email southwestregion@bsava.com, or visit the website.
New for 2011
Cant make it out after evening surgery? Is there a subject you
really want to get your teeth into? Want to know more than just one
aspect of a particular topic? Got burning questions on clinical
issues where previous courses dont seem to have encompassed
all aspects of YOUR patients care?
Come to our Two Sides to Every Story series, where two
distinguished speakers will discuss complementary aspects of
one condition. With at least 6 hours of CPD, our foray into
providing day meetings is designed for the busy practitioner who
needs a rounded and practical approach to everyday dilemmas.
Bring your nurses and speak with the orthopod and physio,
who will be discussing all aspects of managing your joint disease
patients and your spinal cases. Update your knowledge on a
medley of tumours, with the surgeon and medic discussing when
to cut and when to use drugs. The acute abdomen with all you
need to update your medical and surgical management of these
demanding cases. For your fat cats and dumpy dogs and their
tricky complicating features, find out more with the internal
medicine and behavioural specialists. Also, enjoy the expertise of
Victoria Roberts, who will take us through a day on Backyard
Poultry, an ever-increasing visitor to our surgeries. If you have a
topic you would like to see covered in a day meeting, please
contact the committee.
Also on the South West Regional Committee
Gabriele Habacher graduated from University of Veterinary
Medicine, Vienna, Austria in 2003.
Clare Main graduated from the RVC in 1992 and is currently
doing the RCVS Certificate in Advanced Veterinary Practice.
Colin Whiting graduated from Liverpool in 1998 and has spent
9 years in practice in Cheshire, including one year residency
at Liverpool.
Frances Dunn graduated from Bristol in 2001 and has worked
in small animal practice every since.
Nicolette Hayward is a 1986 Edinburgh graduate and spent
several years in general practice before specialising in
diagnostic imaging at Cambridge University.
Michelle Stead graduated from Pretoria in 2002 and works in
small animal practice in Exeter.
30-31 Diary.indd 30 21/02/2011 13:58
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31
CPD diary
EVENING MEETING
SOUTH WEST REGION
Thursday 10 March
Infectious diseases and client
advice for overseas travel
Speaker: Sue Shaw
Woodlands Castle, Ruishton, Taunton,
Somerset TA3 5LU
Details from southwestregion@bsava.com
DAY MEETING
SURREY AND SUSSEX REGION
Thursday 21 April
Body cavity effusions
Speakers: David Walker and David Killick
Leatherhead Golf Club, Kingston Road,
Surrey KT22 0EE
Details from surreyandsussexregion@bsava.com
EVENING MEETING
NORTH EAST REGION
Thursday 5 May
The downside of foreign travel
Speaker: Susan Shaw
IDEXX Laboratories Wetherby,
Grange House, Sandbeck Way, Wetherby,
West Yorkshire LS22 7DN
Details from northeastregion@bsava.com
DAY MEETING
METROPOLITAN REGION
Sunday 8 May
Feline endocrinology
Speakers: Hattie Syme and Lucy Davison
Royal Veterinary College Camden Campus,
Royal College Street, London NW1 0TU
Details from metropolitanregion@bsava.com
DAY MEETING
SOUTH WEST REGION
Monday 9 May
Medical and surgical management
of tumours: two sides to every
story
Speakers: Tom Cave and Prue Neath
Redwood Hotel and Country Club,
Bristol BS8 3TG
Details from southwestregion@bsava.com
EVENING MEETING
MIDLAND REGION
Tuesday 17 May
Surgical update
Speaker: John Williams
The Hilton Warwick, A429 Stratford Road,
Warwick, Warwickshire CV34 6RE
Details from midlandregion@bsava.com
EVENING MEETING
SOUTHERN REGION
Wednesday 4 May
Practical tips on emergency
procedures
Speaker: Dominic Barfield
Potters Heron Hotel, Romsey SO51 9ZF
Details from southernregion@bsava.com
EVENING MEETING
MIDLAND REGION
Wednesday 4 May
A practical approach to collapse
and exercise intolerance in
small animals
Speaker: Malcolm Cobb
Best Western Premier, Yew Lodge Hotel,
Kegworth, Derby DE74 2DF
Details from midlandregion@bsava.com
DAY MEETING
NORTH EAST REGION
Sunday 13 March
Making the most of the practice
microscope: a day of practical
cytology
Speaker: Michael Day
Pavillions of Harrogate,
Great Yorkshire Showground, Harrogate,
North Yorkshire HG2 8NZ
Details from northeastregion@bsava.com
DAY MEETING
SOUTH WEST REGION
Thursday 17 March
Management of the joint disease
patient
Speakers: Helen Mathie and
Stuart Carmichael
Ashton Court Mansion, Ashton Court Estate,
Long Ashton, Bristol BS41 9JN
Details from southwestregion@bsava.com
EVENING MEETING
SOUTHERN REGION
Wednesday 23 March
Rational antimicrobial therapy and
treatment of respiratory disease
Speakers: Jill Maddison and David Church
Potters Heron Hotel, Romsey SO51 9ZF
Details from southernregion@bsava.com
EVENING MEETING
NORTHERN IRELAND REGION
Thursday 10 March
Dentistry
Speaker: Norman Johnston
VSSCo, Lisburn BT28 2SA
Details from nirelandregion@bsava.com
DAY MEETING
Tuesday 8 March
Emergency medicine part I:
assessment and stabilisation of
the collapsed patient
Speakers: Sophie Adamantos and Dan Chan
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Tuesday 26 April
Respiratory diseases of dog and
cat: a comprehensive review
Speaker: Brendan Corcoran
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Thursday 5 May
BSAVA Dispensing Course
Speakers: Phil Sketchley, Steve Dean,
John Hird, Fred Nind, Pam Mosedale and
Mike Jessop
Park Plaza Hotel, Belfast Airport
Details from administration@bsava.com
DAY MEETING
Tuesday 10 May
Emergency medicine part II:
trauma patients
Speakers: Sophie Adamantos and Dan Chan
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Thursday 12 May
Seizures: managing you epileptic
nightmare
Speaker: Mark Lowrie
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Thursday 28 April
Endocrinology II: endocrine
emergencies, collapse and effect
on blood pressure
Speaker: Mike Herrtage
Radisson SAS, Manchester Airport
Details from administration@bsava.com
EVENING MEETING KENT REGION
Wednesday 4 May
CSI for vets: forensics and the law
Speakers: John and Margaret Cooper
Hilton Maidstone Hotel, Bearsted Road,
Weavering, Maidstone, Kent ME14 5AA
Details from kentregion@bsava.com
DAY MEETING SCOTTISH REGION
Sunday 27 March
Exotic animals, surgery of birds,
reptiles and small furries
Speaker: Romain Pizzi
Glasgow Vet School, 464 Bearsden Road,
Glasgow G61 1QH
Details from scottishregion@bsava.com
EVENING MEETING KENT REGION
Wednesday 16 March
Techniques for the critical patient
Speaker: Dan Lewis
Best Western Russell Hotel,
136 Boxley Road, Maidstone ME14 2AE
Details from kentregion@bsava.com
30-31 Diary.indd 31 21/02/2011 13:58
For more information or to
book visit www.bsava.com,
email administration@bsava.com
or call the Membership and Customer
Services Team on 01452 726700
Be better in an
emergency
Trauma patients
10 May, Gloucester
Bleeding, anaemia and
transfusion medicine
7 June, Gloucester
Sepsis, SIRS and support
5 July, Gloucester
Fees for each course:
BSAVA Member: 213.83
Non-member: 320.74
These Emergency Medicine courses
offer you the chance to improve your
skills and increase your condence in
dealing with a wide range of emergency
medicine disciplines
With Sophie Adamantos
and Daniel Chan
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