Companion September 2014 Low Res

The essential publication for BSAVA members
companion
SEPTEMBER 2014
Obesity
Weight management
P12
Nation of Hope
Reservation welfare
P4
Clinical Conundrum
Regurgitating puppy
P8
How to manage
feline ureteric obstruction
01 OFC September 2014.indd 1 18/08/2014 12:28
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companion SEPTEMBER 2014
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BSAVA 2014
3 BSAVA News
Latest from your Association
47 Nation of hope
Veterinary services in American
Indian reservations
811 Clinical Conundrum
A 5-month-old puppy with
regurgitation
1213 Obesity and weight management
The approach to overweight patients
1418 How To
Manage feline ureteric obstruction
19 Seeing to the heart of things
Dr Mark Patteson on the EAVDI and
VCS joint meeting
21 PetSavers leading advances
in CKD
Tim Williams and Joy Archer report
2223 BSAVA Congress 2015
Congress creators offer sneak
preview
2425 WSAVA News
World Small Animal Veterinary
Association
2627 The companion interview
Caroline Yates
29 Regional CPD
Local knowledge close to home
3031 CPD Diary
Whats on in your area
Additional stock photography:
www.dreamstime.com
Andrei Malov; Brett Critchley;
Natallia Khlapushyna; Sarkao; Timpatimpa1
www.dollarphotoclub.com
biglama; Farinoza; Giuseppe Porzani;
MK10 Photography
Log on to www.bsava.com to access
the JSAP archive online.
EJCAP ONLINE
To access the latest
issue of EJCAP visit
www.fecava.org/EJCAP.
Find FECAVA on Facebook!
companion is published monthly by the British
Small Animal Veterinary Association, Woodrow
House, 1 Telford Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB. This magazine
is a member-only benet. Veterinary schools
interested in receiving
companion should
email companion@
bsava.com. We welcome
all comments and ideas
for future articles.
Tel: 01452 726700
Email: companion@
bsava.com
Web: www.bsava.com
ISSN (print): 2041-2487
ISSN (online): 2041-2495
Editorial Board
Editor Simon Tappin MA VetMB CertSAM DipECVIM-CA
MRCVS
Past President Michael Day BSc BVMS(Hons) PhD DSc
DiplECVP FASM FRCPath FRCVS
CPD Editorial Team
Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS
Tony Ryan MVB CertSAS DipECVS MRCVS
Lucy McMahon BVetMed (Hons) DipACVIM MRCVS
Dan Batchelor BVSc PhD DSAM DipECVIM-CA MRCVS
Features Editorial Team
Andrew Fullerton BVSc (Hons) MRCVS
Design and Production
BSAVA Headquarters, Woodrow House
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 .
P
robiotics are used frequently in the
treatment of gastrointestinal
diseases in pet rabbits, based
largely on anecdotal evidence
of a beneficial effect. However, there
has been little work performed to assess
any such benefit in health or disease.
The aim of this study from the Edinburgh
and Glasgow vet schools was to
determine the effect of probiotics on
faecal levels of four important candidate
gastrointestinal bacteria (Bacteroides
species, Enterococcus faecium,
Fibrobacter succinogenes and
Clostridium spiroforme). Additional
aims were to evaluate the effect of
probiotics on bodyweight and faecal
weight and diameter.
Two probiotic strains,
Saccharomyces
cerevisiae NCYC Sc47
and E. faecium NCIMB
30183, were
administered orally in
six healthy rabbits.
Levels of bacteria in
faecal pellets were
subsequently determined
by real-time quantitative
polymerase chain
reaction. Oral
administration of probiotic
E. faecium NCIMB 30183
was associated with a
significant increase in
faecal levels of E. faecium.
However, probiotic
treatment did not affect
faecal levels of
ALSO IN THIS MONTHS ISSUE
Measurement of the S-adenosyl
methionine (SAMe) content in a
range of commercial veterinary SAMe
supplements
Blood concentratons of D- and L-lactate
in healthy rabbits
Inammatory and oxidatve biomarkers
of disease severity in dogs with
parvoviral enterits
Final year veterinary students at tudes
towards small animal dentstry
Are the fabellae bisected by the femoral
cortces in a true craniocaudal pelvic limb
radiograph?
Whats in JSAP this month?
Probiotics in pet rabbits
Bacteroides species, F. succinogenes or
C. spiroforme, bodyweight, or faecal
weight and diameter.
The authors conclude that the
inclusion of dietary probiotic
supplementation using E. faecium NCIMB
30183 can increase faecal levels of certain
bacterial flora of healthy adult rabbits.
Further work is required to investigate the
effects of probiotics in animals affected
with gastrointestinal disease.
Adapted from Benato et al. JSAP 2014; 55: 442446.
BSAVA 2014
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M
y first volunteer role was as a South West
Region committee member. I took it on
as I was relatively free at that time (before
becoming a parent!) and wanted to
influence what CPD took place in the region as
well as getting free CPD for myself! I spent another
four or five years on the regional committee, three
as Chairman.
Im now a member of Education Committee
involved in planning where the focus of education
provision should be and what type of CPD is
important for BSAVA members. We also get involved
in other initiatives, like the Scooby Project that helps
dogs in Spain.
Apart from experiencing some excellent free CPD
during my time as a volunteer, I enjoy interacting with
other vets from different backgrounds and discussing
veterinary medicine and approaches in tackling
issues. It is really interesting how views can differ in
individuals all wanting to achieve the same goal of
providing the best veterinary medicine that we can.
When it comes to encouraging colleagues to get
involved with BSAVA as the famous sports slogan
says, JUST DO IT! Dont worry about whether there
will be time for volunteering, or that you may not have
anything to offer. If you are a vet or vet nurse and are
willing to spend some of your time to contribute, you
are more than qualified as a volunteer. If your situation
changes or you find it too hard in terms of time
commitment, you can stop but you will always have
support from staff too. If you never try, you never
know you may find that you possess much more to
offer than you thought and it will be valued.
Get to know
your BSAVA
colleagues
Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know
Volunteer
voice
Lennon
Foo
Find out how you can get involved as a
BSAVA volunteer, email Carole Haile
c.haile@bsava.com.
Last chance to nominate
G
o online today at www.bsava.com/awards
to nominate your colleagues and friends
for a 2014 BSAVA Award. The deadline is
18 September, so please nominate now
to honour the professions everyday heroes.
Final summer
membership
reminder
R
enewals for those with a
summer membership
plan are now overdue
so if you are a summer
member of BSAVA and youve
not yet renewed your
membership, you can do so
online via the MyBSAVA section
of the website. If you need help,
or if you have any queries, please
dont hesitate to contact the
Membership Services Team on
01452 726700 or email
administration@bsava.com.
Correction to the
BSAVA Formulary
M
embers should be aware
that there is an error in the
entry for tetracosactide on
page 383 of the printed
version of BSAVA Small Animal
Formulary, 8th edition. Under doses
for dogs, the first sentence should
read mg/dog, not mg/kg. This error
has already been corrected in the
online and PDF versions that
members can access from
www.bsava.com, but members
are requested to amend their print
copies accordingly. If you spot
any other errors in the Formulary,
please contact us via
formulary@bsava.com.
Changes to Statutory Sick Pay
W
hen a member of the practice falls ill, or is injured and unable
to work for a period of time, it can have a big effect on your
business in particular, following the abolishment of the
Percentage Threshold Scheme (PTS), which previously gave
employers relief when paying long-term sick pay.
The cost of long-term sick leave to businesses in the UK is around 9
million a year. Previously, under the Percentage Threshold
Scheme (PTS), employers had been able to recover State
Sickness Pay (SSP) costs if the total SSP paid in a tax
month was more than 13% of their gross Employers
(Class 1) National Insurance contributions in the
same month; however, this is no longer the case.
PG Mutual offers BSAVA Members
income protection with 20% discount
on their first 3 years cover visit
www.pgmutual.co.uk.*
*Please note that this offer is subject to
underwriting and PG Mutuals terms and
conditions, applies to new PG Mutual
Members only and excludes uplifts. It
cannot be used in conjunction with any
other offer.
News ash: Ketamine
There is a ketamine consultation on the website please visit
www.bsava.com/consultations to find out more
03 Page 03 September 2014.indd 3 20/08/2014 08:47
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Nation of
hope
For American Indian reservations the lack of
veterinary services needed a leap of faith.
Robin Fearon reports
N
ative American reservations are
home to the tribal nations of North
America. Created under historical
treaties, the tradition and culture
of the original peoples is kept alive there,
but outside of passing trade or fleeting
encounters most ordinary Americans or
visitors to the country have little or no
knowledge of them.
Some of the most geographically
remote and economically impoverished
reservations often suffer from a severe lack
of investment and basic services.
Veterinary provision can mean driving for
up to three hours to the nearest town, so
the efforts of the Humane Society
Veterinary Medical Association (HSVMA) in
providing outreach services to these
forgotten communities offers a vital lifeline.
The societys Remote Area Veterinary
Service (RAVS) programme ensures
regular clinics offering free spay-neuter
operations, vaccination and parasite
control for dogs and cats. On reservations
where unemployment rates average
between 50 and 70 per cent it can mean
life or death.
Senior staff veterinarian Paul
Breckenridge believes that helping animals
nobody else will help is the compassionate
thing to do. Reservations stretch from
coast to coast and the length of North
America. Culturally they are as diverse as
the tribal peoples living there, but they are
united in their need.
Outside of local animal control there
is often nothing. They are universally
poor and remote from veterinary or medical
care outside of what is brought in by the
federal government, says Paul. It is a
pretty sad situation.
Life changing
Paul first encountered RAVS while travelling
the country in support of his wifes career
as a coastguard. In California he
volunteered at one of the United States
many humane societies for high volume,
high quality spay-neuter work and found
out about RAVS. In the eight years prior to
joining RAVS he estimates that he did
15,000 spay-neuter operations.
After induction he spent time with the
international group in Ethiopia setting up a
prototype surgical curriculum at the Jimma
University vet school. It led to volunteering
in the domestic programme and my first
trip to the White Mountain Apache
reservation in Arizona, he recalls.
In Arizona there was a public health
problem with tick-borne Rocky Mountain
spotted fever. It affects both dogs and
people, says Paul. Suddenly they started
experiencing human fatalities because
there was so little preventive medicine for
either people or animals.
After the Centers for Disease Control
realized it needed to tackle tick control,
RAVS whose reservation efforts were
0407 American Nation.indd 4 18/08/2014 10:41
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already underway reduced the number of
strays through spay-neuter clinics. That
made a big difference to the San Carlos
reservation where we work, Paul says. It
was tragic for them. The reservation has a
large area but a small number of people.
To have people dying of this disease over
the period of a few years was devastating.
That would not happen anywhere else in
the United States.
Life saving
People eke out a living from the little
industry that takes place on the poorest
reservations and some make money from
cultural tourism. On those near large
towns, the casinos built under treaty
agreements each reservation is a
sovereign nation have been a boon, but a
tribe in South Dakota for example could not
make any money as they are too remote.
Remoteness simply compounds the
problem of access to veterinary services.
Even if they were able to get to a
veterinarian, frankly they could not afford
it, says Paul. We had to keep a dog
overnight once and the family said they
were sorry but they could not make the
return trip because they only had enough
gas money for one trip.
Overwhelmingly the clinics deal with
family dogs and hunting dogs. RAVS tries
to convince owners not to breed them and
talks as many as possible into spaying or
neutering. Breeds are a hodge podge of
mongrels but you can see any type of dog
on reservations, says Paul, including
St Bernards, Pekingese and Poodles.
How it works
Clinic schedules work on a rolling basis
with perhaps three days in one community
followed by two days in another, then a day
off and four days on another reservation.
All are arranged in advance with local
contacts. Days are long, typically 14 to
18 hours, starting at five oclock.
An hour or more of training for students
is followed by a stand up breakfast, with or
without coffee. Clinic doors might open at
seven but the line forms an hour before so
things start immediately. Waiting lists are
created and pre-surgical checks
performed, moving into anaesthesia and
then surgery.
By noon the noise level is deafening.
Dogs bark, everyone is talking. Patients are
going into surgery or from ops into
recovery. Surgeries wrap up in the evening
and owners pick up their animals to go
home with instructions for their care. A
quick dinner at eight is usual but surgeries
occasionally go late and rounds at 10pm
are not unusual. Lights out follows shortly
after, ready to do it all again the next day.
Understanding history
RAVS, with its momentum and energy, is
welcomed onto the reservations but the
history of conflict with European settlers
and consecutive governments means that
tribal politics plays a part. All reservations
have their tribal elders but they may also
have a mayor or civil leader and the two
sometimes clash.
Some civil groups work closely with the
Bureau of Indian Affairs (BIA), a federal
agency responsible for reservation
management. The BIA has a chequered
history in its dealings and that can set civil
officials against tribal elders. Talking about
these things with local contacts is critical to
the success of groups like RAVS.
Look even a little into the history of the
American Indian Wars and the presumed
manifest destiny of many settlers to take
over the natives territory and you get a
sense of the unequal settlement afforded
to many tribes. Even as late as the 1970s
there was a sense of injustice surrounding
the way the federal government made
decisions regarding land.
In Lower Brule, South Dakota, there
was a reservation of Lakota people living
in the bottomland around the Missouri
River. Their whole culture centred on its
fauna and flora. Yet to prevent flooding in
Omaha, Kansas and St Louis, the river
was dammed in the early 1960s and the
bottomland flooded. The entire tribe was
forced to move up into the hills.
Dislocation was followed by the loss of a
traditional habitat.
RAVS director Windi Wojdak
pronounced Woe-jack she says, though
she is doubtful her Polish ancestors would
approve is busy arranging final details for
field clinics in North and South Dakota.
On her first placement with RAVS she
considered what she found on the
reservations to be a wake up call.
It is the same for anyone sheltered from
the realities of world poverty, she says.
We work in some of the poorest
communities in the United States. It is a
level of poverty that we may know
intellectually exists but we have never seen
it: people living day to day in a kind of
survival mode.
She sees a lot of parallels between
villages where she has set up clinics in
Latin America and the Native American
reservations. That was what was most
Senior staff veterinarian Paul Breckenridge
Early start pre-clinic get together
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BSAVA 2014
Nation of hope
profound to me when I started doing
this work, the impacts of economic
poverty are exactly the same, she says.
Issues with access to care are what it
is about. Problems with physical or
economic access have the same
outcome for the animals.
Trying times
Right now issues are pressing. There are
around 40 volunteers meeting on site in
two days and last minute logistics mean
making sure local facilities are finalized for
the clinics, along with supplies. Windi
worked in shelter medicine putting together
spay-neuter and medicine programmes for
years prior to joining RAVS. She studied
psychology and ethology at university
before training as a veterinary technician
(equivalent to veterinary nurse) in 2000.
RAVS itself began life in 1995 as the
veterinary component of a human medical
programme named Remote Area Medical.
In 2002 it became part of the Humane
Society of the Unites States (HSUS) and
the programme gradually expanded to
serve 20 reservations a year alongside an
international programme.
Asked whether her interest in helping
animals was always there, Windi says that
looking back, the opportunity to become
manager at a small local shelter following
graduation was all it took. I got sucked
into animal welfare and the ability to help
the neediest animals. The need in the
reservations we serve is so great.
Economic depression has implications for
human and animal health. It can be
devastating. The need for just basic
veterinary care is huge.
Providing something as basic as tick
prevention directly saves human lives, she
adds. There are many related issues
such as overpopulation in free roaming
dogs, high numbers of dog bites and
parasite control that have immediate
human health impacts.
Vital volunteers
Despite all of the pressing issues facing
the reservations, nothing would change
without volunteers. They are the lifeblood
of RAVS and the programme could not
operate without them. RAVS asks all
student volunteers to help raise funds
through family and friends donations for
their trip. Around 200 to 225 students go
out into the field each year, along with
120 or so vets, technicians and lay
support volunteers.
Many are returning after previous trips,
back to working long hours and sleeping
on floors for no pay. For some folks it is an
adventure, says Windi. They do it once or
twice and then move on. For others it
changes their life. For some of the
professional volunteers it has reignited their
passion for veterinary medicine. To be able
to have an animal presented that
desperately needs care and not ask for
payment is really powerful.
Elizabeth Berliner is one such
professional. As a lead field veterinarian for
RAVS she describes her role lightheartedly
as like the incident commander at the
scene of a disaster but her love of the
work as a little bit of an addiction. She is
a full time faculty member at Cornell
University teaching shelter medicine and
works for RAVS between four and six
weeks each year.
Surgery underway
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to be able to have an
animal presented that
desperately needs care
and not ask for payment
is really powerful
RAVS RECRUITS
HSVMA-RAVS is keen to hear from anyone
oering to volunteer as a student or veterinary
professional. Full details of the roles,
expectatons and kit needed to take part are
on the website at www.ruralareavet.org and a
clinic schedule for 2015 will be published there
in the autumn.
Educational opportunities
Education is a key component for student
volunteers, revealing to them how animal
health and welfare can be improved given
limited resources. RAVS has grown as a
teaching programme in the past 10 years
and all students must review training
material and pass an exam online before
they are accepted.
On site they must pass certain practical
skills tests before assisting in surgery. We
get to educate the next generation of
veterinarians, says Elizabeth, and not
only in clinical skills but in communication
skills, cultural awareness and ingenuity.
Few come out unchanged. They go
back to their communities and get involved
in volunteer work with their local shelter or
they start their own outreach programmes.
The ripple effect from this is immeasurable.
I hear stories time and again from students
where it has affected their career path and
their lives.
Veterinary student Katie Pratt has just
finished her first year at the University of
Wisconsin Madison, but is a long-term
volunteer with the Peace Corps and RAVS.
In August she will head out to the Colville
Nation in Washington State then on to
clinics at the Quinault Nation on the Pacific
coast. As a student Ill be doing more on
the medical side and doing my first
surgeries, which is exciting, she says.
On her first trip with RAVS, pre-
veterinary student days, Katie worked as
an intake coordinator, kind of the
receptionist for the entire field clinic. It
taught her about client communication and
how to take a thorough and accurate
patient history.
This time shell be conducting wellness
exams and assisting with surgery. It
provides an amazing learning opportunity
and gives me the chance to work with
communities that really appreciate the
services, she says. I cant think of a
better way to get hands-on experience as
a veterinary student. Five or six years from
now I would love to come back as a
volunteer veterinarian and pass on
everything that has been given to me.
Volunteer vets like Paul Badeau, a
Connecticut native, cite the level of care
and the change RAVS makes in the
communities it visits year after year as the
reason for their return. Paul started on the
programme as a student and has done five
out of the past seven years as a vet.
Over the course of the past 10 years he
has watched education seep into the
culture of the reservations. At the end of
every trip you are a little bit in awe of the
difference and the change you have made
in these peoples lives, he says. The goal
is to have permanent or semi-permanent
facilities in place.
Ive been to Cheyenne River in South
Dakota since I was a student and they
have started their own animal shelter. They
do not have veterinarians on reservation
but they do have three or four animal
control officers trained to do basic
vaccinations against rabies and other
infections like parvovirus.
That is where the future lies for RAVS
now. Education, not just for community
liaisons but for students and volunteers
too. Social and economic issues that
impact animal health are not going to be
fixed in five or ten years. They are profound
challenges that are ongoing and will need
multi-agency support.
Whether Lakota or Ojibwe, Navajo or
Hopi, the people and the reservations
need groups like RAVS. We try to leave
the place with people knowing more about
taking better care of their animals, says
Paul Breckenridge. It has been a critical
need for a long time and so RAVS and
others are working on that. As the situation
evolves and more get involved then my
hope is that the community becomes more
sophisticated in its demands.
Reservation dog
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BSAVA 2014
Clinical conundrum
Andrew Craig, an intern at
Southern Counties Veterinary
Specialists, invites companion
readers to consider a 5-month-
old puppy with regurgitation
Create a problem list based on this
history and clinical exam
Regurgitation during and immediately after feeding
Occasional gulping noises
What differential diagnoses should be
considered?
In a young animal with regurgitation evident since
weaning, a congenital abnormality is considered most
likely. These can include:
Vascular ring anomaly
Congenital megaoesophagus
Cricopharyngeal dysphagia/achalasia
Other possible causes of regurgitation include:
Hiatal hernia
Pyloric stenosis
Focal myasthenia gravis
Focal myopathy/myositis
Oesophagitis
Oesophageal stricture
Oesophageal foreign body
How would you proceed initially?
Observation of the animal eating can often be helpful in
determining the events and timing of the regurgitation
and/or dysphagia. In this case, the patient was offered
food in a quiet environment and was recorded eating.
Review of the video revealed intermittent bouts of
swallowing difficulty and that there was some
discomfort even when swallowing was successful.
Can you further refine the
differential list?
Given the finding of occasional gulping sounds on
palpation of the pharynx and dysphagia, it was felt
that the regurgitation was unlikely to be gastric-related
(i.e. hiatal hernia or pyloric stenosis). Thus, the
primary differential diagnoses were limited to those
conditions associated with the pharyngeal and
oesophageal regions.
What initial investigations would
you consider?
Haematology, biochemistry and urinalysis were
performed to assess the general health of the patient
prior to the induction of general anaesthesia. These
were within normal limits. Conscious thoracic and neck
radiographs were also obtained (Figure 1).
Case presentation
A 5-month-old female Cocker Spaniel cross Poodle presented with a
4-week history of regurgitation. The owner reported that since being
in her possession the puppy had appeared to eat slowly, with
occasional gulping noises. Intermittent regurgitation was seen both
during and immediately after eating, with the passive return of
chewed food. The owner reported that the severity of the
regurgitation had improved following switching from a tinned diet to
a raw meat and bone based diet.
On clinical examination the puppy was extremely bright and alert
with a body condition score of 3/5. The general physical examination
was normal, although occasional gulping noises on palpation of the
pharynx were noted. A full neurological examination was conducted
and found to be within normal limits, with apparently normal cranial
nerve function and a good gag reflex.
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Can you further refine your differential
list based on the radiograph?
The plain radiographs revealed no thoracic
abnormalities. Specifically the oesophagus is not
visible, making the presence of megaoesophagus
or a vascular ring anomaly less likely, although
neither could be entirely excluded based on
these images. There is no evidence of aspiration
pneumonia.
How would you proceed with the
investigation?
Given the suspicion of pharyngeal dysfunction,
fluoroscopy to evaluate the passage of a barium
meal was performed (Figure 2). This allows
assessment of bolus formation and the passage of
food through the pharynx, into the oesophagus and
ultimately into the stomach.
Fluoroscopy revealed that the food bolus
failed to pass from the pharynx into the
oesophagus (Figure 3). The patient persistently
tried to swallow the bolus, which resulted in the
gulping sounds noticed by the owner. Once the
food bolus eventually passed through the upper
oesophageal sphincter, it continued in a normal
manner through the oesophagus to the stomach.
A concerning factor was that whilst the patient
was constantly trying to swallow the barium meal
there was a subtle amount of aspiration (Figure 4),
emphasizing the susceptibility to aspiration
pneumonia in these cases.
Figure 1: Conscious right lateral radiograph (obtained
during expiration)
Figure 2: Patient being prepared for fluoroscopy
Figure 3: Series of fluroscopic images
obtained as the patient ate a barium meal.
(A) The food bolus (green arrow) is present
in the oral cavity. (B) The food bolus has
passed into the pharynx. The
cricopharyngeal muscle is constricted, as
evidenced by the thin line of contrast
medium (red arrow). This physical
abnormality prevents food passage into
the oesophagus. Note that there is some
barium in the oesophagus from a previous
swallow (orange arrow). (C) The food bolus
is still unable to pass through the upper
oesophageal sphincter
A
C
B
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BSAVA 2014
Clinical conundrum
How would you interpret the
fluoroscopic findings?
The findings are typical of cricopharyngeal
achalasia. This is a condition where the
cricopharyngeal muscle fails to relax, or there is
incoordination between cricopharyngeal muscle
relaxation and pharyngeal constriction. This results
in the inability to swallow a food bolus. As with this
case, it is generally seen as a congenital defect in
young animals; however, it can occasionally be
found in adult dogs.
Normal passage of the food bolus through the
oesophagus to the stomach excluded a vascular ring
anomaly, hiatal hernia, oesophageal stricture and
oesophageal foreign body.
Figure 4: Positive contrast medium visible lining the trachea
(purple arrow)
How would you treat this condition?
The treatment of choice for this condition is
cricopharyngeal myotomy/myectomy. With the patient
in right lateral recumbency, a lateral approach to the
larynx (similar to that for an arytenoid lateralization
procedure) was performed. The cricopharyngeal
muscle originates from the lateral aspect of the cricoid
cartilage and encircles the oesophagus to insert on
the contralateral aspect of the cricoid cartilage. It lies
caudal to the larger thyropharyngeus muscle and the
muscle fibres blend with the fibres of the oesophagus
caudally (Figure 5).
Myectomy was performed, as was myotomy of the
thyropharyngeus muscle and the portion of muscle
removed was submitted for histology. Aspiration
pneumonia is a common sequalae, which if present
should be treated aggressively. Although there was no
pneumonia in this case, the potential risk of it
developing after identifying aspiration of the food
bolus meant that broad-spectrum oral antibiotics
(potentiated amoxicillin 20 mg/kg q12h) were
commenced pre-emptively.
Outcome
The patient started to show clinical improvement
within 24 hours following the surgery. One episode of
regurgitation was noticed; however, this appeared to
be different in character to the dysphagic episodes
prior to surgery and was felt to be a post-anaesthetic
complication. Histopathological analysis of the
resected tissue revealed muscle atrophy and mild
interstitial fibrosis. This supports the diagnosis of
cricopharyngeal achalasia. A week following the
surgery the owner reported a dramatic improvement
and there was no evidence of dysphagia,
regurgitation or gulping noises after eating or
drinking. Repeat fluoroscopy showed normal
passage of the food bolus from the pharynx into the
oesophagus (Figure 6).
Discussion
Regurgitation and dysphagia in general practice
are encountered on regular basis; however,
cricopharyngeal achalasia would be considered
an uncommon diagnosis. Surgery is the treatment
of choice. In this case a lateral rather than a ventral
approach was chosen asit is a familiar surgical
approach and does not require rotation of the
larynx. Although this is an unusual condition, it is
good to remember that, in general, the prognosis
for surgical treatment of uncomplicated
Hyopharyngeus
Thyropharyngeus
Cricopharyngeus
Oesophagus
Thyrohyoideus Sternohyoideus Sternothyroideus
Figure 5: Muscles surrounding the larynx
Reproduced from BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery
Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and printed with her permission
BSAVA 2014
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cricopharyngeal achalasia in young dogs is
thought to be good to excellent (Tobias and
Johnston, 2012).
It has been reported that the type of surgery
performed (myotomy/myectomy) has no effect on
the outcome; however, poor surgical outcome may
be due to incomplete transection of all the
cricopharyngeal muscle fibres (Warnock et al.,
2003). With this in mind it was felt that performing a
myectomy rather than myotomy would reduce the
risk of this occurring.
Figure 6: Fluoroscopic image showing normal passage of
the food bolus from the pharynx into the oesophagus
following surgery
Submit a Clinical
Conundrum
W
ith the Clinical Conundrum we hope to
offer accessible, thought provoking
CPD for the reader and to allow some
in-depth discussion of the intricacies
of the case presented. In particular it is hoped that
cases will challenge the reader to consider a
dilemma, be it a diagnostic challenge or a
treatment/surgical decision and to work through it
to a logical conclusion.
The aim of the Clinical Conundrum is to present
clinical scenarios which are encountered in small
animal practice and discuss briefly any poignant
features of the case. The Clinical Conundrum can
focus on the complete case management or one
aspect of the case management in more detail.
An unusual diagnosis does not necessarily
mean that a case will be a suitable to present as a
Clinical Conundrum. In fact the final diagnosis is not
the most important part of the feature. Indeed the
cases which make the best Clinical Conundrums
discuss a presentation thoroughly, logically progress
through a case and achieve a robust diagnosis or
treatment choice. It is the dilemma regarding
diagnostic or treatment progression which is
important rather than the diagnosis in and of itself.
The editorial team are more than happy to
advise potential authors and particularly
encourage submissions from those in
general practice.
In total authors should aim for a piece of
14002000 words in length with 15 illustrative
pictures. Given that the emphasis of this feature is
problem solving, references are not usually required
unless specific literature is mentioned or their use is
needed to support the approach taken. We are
particularly keen to have submissions that have
additional video content for use with our digital
versions of companion.
An honorarium is payable on final acceptance of
the article. If you have an idea for a Clinical
Condundrum please contact us at companion@
bsava.com and access the full submission
guidelines online at www.bsava.com.
References are available online and in e-companion.
See a video of the uoroscopic barium swallowing in
e-companion.
MORE ONLINE
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BSAVA 2014
Obesity and
weight management
O
besity is unfortunately an
increasing problem in veterinary
medicine. Today, approximately
50% of animals in the United
Kingdom are affected by this condition.
The long term effects can predispose
patients to a variety of other disorders,
including diabetes mellitus, hypertension,
heart disease, osteoarthritis and
cardiorespiratory problems. For these
reasons it is important for us as medical
professionals to be able to identify, monitor
and manage obesity in patients.
Identifying obesity
Obesity is an accumulation of excessive fat
within the body, which adversely affects
the health of the animal. The term obese is
used to describe animals weighing 30%
above their ideal weight; and the term
overweight applies to individuals weighing
15% above their ideal weight.
Currently the most practical way of
identifying obese and overweight animals
in the practice is by using a body condition
scoring (BCS) system. There are multiple
schemes used widely in veterinary
medicine, ranging from a five point to a
nine point scheme. All systems involve the
visual and physical examination of the
patient, along with an assessment of the
accumulation of fat deposits around the
surface of the body (e.g. the ribs, waist and
dorsal process). These systems work best
when only one is used throughout the
practice and if patients are scored when
they are weighed each time they visit the
practice for a consultation.
Prevention
Risk factors should be taken into
consideration when animals visit the
Ann Stanford, a veterinary nurse
based at Grove Lodge Veterinary
Hospital, takes companion readers
through the approach to
overweight patients
practice for vaccination appointments and
other routine consultations (e.g. following
surgery for neutering) to try and prevent
future problems. Neutering causes a
reduction in metabolism and owners
should be warned to become more
conscientious when feeding and to reduce
food intake if weight gain is seen.
The sex and breed of the animal can
be contributing factors in weight gain.
Information provided at puppy and
kitten parties should warn owners of the
consequences of weight gain and
advise at what stage(s) it may occur
during the lifetime of their animal. In
dogs, it is seen to be the females that
are more prone to obesity, and breeds
such as the Cocker Spaniel, Beagle,
Labrador Retriever, Golden Retriever
and Rottweiler are particularly
susceptible. In cats, males and mixed
breeds are more susceptible to obesity
compared with pure breeds.
Management
Weight clinics
As an aid to client communication, weight
clinics are ideal. As a practice they give
you the chance to spend time speaking to
owners and for them to be honest and
answer questions in depth. The type of
questions that should be asked include:
How much do you feed your pet and
how many times a day?
What type of food do you feed?
Are any treats given?
What type and how often?
How often do you walk your dog?
Is your cat an indoor or outdoor cat?
How many people feed your pet?
Figure 1: Regular checks of weight and girth
should be made
During the first appointment, all of the
relevant questions should be asked and
weight and BCS should be taken and
recorded in the patients record. Waist size
(Figure 1) is another helpful tool to help
gauge weight loss, especially if the animal
is likely to put on muscle as fat is burnt off.
Once all measurements have been
taken, a target weight can be set. Target
weights should be established through the
history of the animal, if possible. For
example, the patients record should be
checked to determine the animals weight
prior to neutering or before turning 2 years
of age. In the absence of a full history, the
BCS can be used by estimating the
percentage weight gain and using that
percentage to set the target weight.
Weight, waist size and BCS should be
obtained at every visit to monitor progress
and to ensure the correct rate of reduction.
Body fat should not be lost at a rate higher
than 1% per week. The owner should
always be informed that weight reduction is
a long process and that it can take months
to see a good result. Owners should also
be advised that following reduction the
animals weight must be maintained.
Photographs are another useful tool as
they provide the owner with a visual record
of their pets progress and can help aid
owner compliance.
Exercise programmes
As most patients with weight problems
also have poor cardiorespiratory fitness
and other conditions such as
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osteoarthritis, the patients exercise
regime should be designed with these
considerations in mind.
For dogs, increasing the number of
short walks per day and then building up
the distance and time spent on each
walk as the animals muscles and fitness
level improves can prevent injuries.
Once the fitness level has improved,
other exercises such as fetch, jogging
and hill work can be added. Patients with
severe mobility problems should be
referred to a physiotherapist and
hydrotherapy (Figure 2) can be
considered as a weight loss tool.
Designing exercise programmes for
cats is more difficult, but how often the
animal goes outdoors should be
considered. Stimulating play with multiple
toys and using activity feeders so cats have
to work for their food are often successful.
Diet
There are multiple veterinary prescription
diets available that contain fibre and
protein as the key ingredients. These diets
give the animal the feeling of being
satisfied with the amount fed and also help
prevent extra weight gain, whilst the protein
helps to build and maintain muscle mass.
All of these diets now come with a guide
on how to feed the patient, depending on
the severity of the weight gain.
For patients that are always asking for
food, the owners should be advised to
consider dividing up the daily food
allowance into multiple smaller meals and
only allowing one person in the house to
feed the animal. Novelty feeders, activity
balls and scattering food for the animal to
find are helpful tips to make the animal take
longer over feeding.
It is important to discuss the giving of
treats with the owners. The best thing to
suggest is that the owner uses some of the
animals daily food allowance as treat
items, which can help prevent the potential
for over-feeding. However, alternatives
such as fruit and vegetables for dogs and
low fat treats for cats can also be given.
The owners should be reminded that
calories provided by these treat items
should still be deducted from the animals
total daily requirement.
Monitoring progress
The first check-up appointment should be
arranged for approximately 2 weeks after
the initial consultation, to monitor change
and ensure the weight is not being lost too
rapidly. In addition, this meeting can be
used to discuss the change of exercise
plan and to check whether the owner is
finding the plan achievable. Client
communication is vital in ensuring
compliance. If the owner finds the task too
difficult, or is unable to find the time
required, other routes should be explored
otherwise the owner can lose faith with the
plan and compliance may be lost.
The interval between sessions can be
increased once both you and the owner
are happy with the patients progress, but it
is best not to extend the time between
appointments to more than 4 weeks in
order to ensure the continuation of good
communication. When the target weight
and BCS have been achieved, it is
important that contact is still made with the
owner and animal to help maintain the
VETERINARY NURSING SERIES
From animal care for nursing assistants
to advanced veterinary nursing, these
ttles provide a comprehensive and
practcal resource.
To purchase these ttles visit www.bsava.com
or call our Membership & Customer Services
Team on 01452 726700.
Figure 2: Hydrotherapy taking place on an
underwater treadmill
weight loss. Owners often find it helpful to
keep a weight and food diary between
visits to the practice; this encourages
compliance as the owner is able to see
day-to-day success.
Hormonal imbalance
When diet and exercise seem unsuccessful
in generating weight loss, other causes of
obesity should be eliminated.
Hypothyroidism causes a reduction in the
production of thyroxine, which is a
hormone that amongst other things
controls metabolism. However, it must be
noted that this disorder is only reported in
1% of obese dogs. Thus, although this
should be considered, hypothyroidism is
infrequently the cause of obesity.
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BSAVA 2014
How to manage
feline ureteric
obstruction
Aetiology
Calculi are the most common cause of
ureteric obstruction in cats. Other causes
reported include neoplasia, strictures,
trauma and iatrogenic ligation following
ovariohysterectomy.
The majority (>98%) of ureteral
stones are formed from calcium oxalate.
Calcium oxalate stones that do not pass
spontaneously need to be removed
surgically as they cannot be dissolved
medically. Some cats are persistent
stone formers and approximately 35%
of cats with calcium oxalate stones are
hypercalcaemic.
Acute complete obstruction or severe
partial obstruction results in potentially fatal
post-renal azotaemia. Hydronephrosis
develops following ureteric obstruction
and, if the obstruction is not relieved,
fibrosis and irreversible damage results.
The sooner the obstruction is relieved, the
less nephron damage occurs. Partial
obstructions result in less severe damage
compared with complete obstructions.
Often cats have bilateral ureteric
obstruction at the time of presentation.
When the initial ureter becomes
obstructed, the glomerular filtration rate
increases in the contralateral kidney and
the cat may not show any clinical signs
and may not be azotaemic. There is initial
hydronephrosis on the affected side, but
the kidney eventually shrinks and has
significantly reduced function. If the
contralateral kidney becomes similarly
obstructed, severe post-renal azotaemia
may develop and the cat may show
clinical signs.
Presenting signs
Clinical signs associated with ureteric
calculi can be vague and of variable
severity. Signs of unilateral ureteric
obstruction in the absence of chronic
kidney disease may go unnoticed by the
owners. Many cats present with a
non-specific history of lethargy,
inappetence and recent or chronic weight
loss. If the cat has concurrent significant
kidney disease then signs may be more
severe and can include polyuria,
polydipsia, vomiting and generalized
weakness. Cats can also be pyrexic if
pyelonephritis is present. In addition,
ureteric obstruction is painful and some
cats react to palpation of the overlying
spine or abdominal wall.
Diagnosis
Abdominal palpation may reveal signs of
pain over or around the kidneys. One
kidney may appear to be enlarged (the
obstructed side) while the other may
appear small (atrophied following a
previous episode of ureteric obstruction),
giving rise to the big kidney, little kidney
presentation. Such a finding warrants
immediate investigation and/or renal
imaging.
Serum biochemistry in affected cats
can vary from being normal (e.g. in cats
with a unilateral obstruction and without
chronic kidney disease (CKD) to revealing
signs of severe azotaemia, including raised
urea, creatinine, phosphate and potassium.
Urine specific gravity is often <1.035.
Anaemia (e.g. due to CKD) is commonly
seen in affected cats. Urine should be
collected by cystocentesis for sediment
examination and bacterial culture/
sensitivity testing.
It is not possible to differentiate a cat
with combined CKD and ureteric
obstruction from a cat with acute on
chronic renal failure (uraemic crisis) using
blood and urine analyses alone. Abdominal
imaging techniques are required to confirm
the diagnosis.
Ultrasonography is useful as it is widely
available, non-invasive and can detect
hydroureter, hydronephrosis (Figure 1) and
often the site of obstruction . Examination
of the remainder of the urinary tract should
always be carried out as multiple
ureteroliths, nephroliths and cystoliths are
Nicola Kulendra of
The Royal Veterinary
College and Tim
Charlesworth of
Eastcott Referrals take
us through the
approach to this tricky
feline problem
U
reteric obstruction is an
increasingly diagnosed condition
in cats. Calcium oxalate
urolithiasis is the most common
cause. Cats often present with vague
clinical signs, so diagnosis can be
challenging. One ureter can often be
obstructed without causing any significant
clinical signs, and cats are presented in an
advanced stage of disease when the other
ureter becomes obstructed. The condition
is often misdiagnosed as acute on chronic
renal failure as cats may have a sudden
worsening of their azotaemia and without
abdominal ultrasonography it is impossible
to differentiate the two conditions.
Traditional therapeutic options have been
associated with high complication rates,
but recent improvements in surgical
implants have been associated with better
long-term success rates.
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common. Abdominal radiography is also
useful, as the majority of feline ureteroliths
are calcium oxalate and thus radiopaque
(Figure 2). The sensitivity of
ultrasonography for the detection of feline
ureteroliths is 77%, that of abdominal
radiography is 81%, and when the two
modalities are used together they have a
sensitivity of 90%.
If abdominal ultrasonography is
equivocal and there is a high clinical
suspicion of ureteric obstruction, other
techniques, such as positive contrast
antegrade pyelography, can be used.
A long 22 G needle is directed into the
renal pelvis under ultrasound or
fluoroscopic guidance and the attached
syringe and three-way tap can be used
to obtain a urine sample for bacterial
culture and sensitivity testing and then to
inject iodinated contrast agents to
highlight the affected ureter. More
advanced imaging modalities, including
computed tomography (CT), magnetic
resonance imaging (MRI) and nuclear
scintigraphy, have been described but
are not usually required.
Treatment
Medical management
Most cases of ureteric obstruction benefit
from a period of medical management,
although this is only successful at fully
resolving the ureteric obstruction in a
Figure 1: Ultrasonogram of a kidney with
hydronephrosis secondary to ureteric
obstruction
Figure 2: (A) Lateral and
(B) ventrodorsal radiographs of a cat
with multiple irregularly shaped and
sized mineral opacities within the
renal pelvis and left ureter
A
B
minority of cases (17% of cats). Cats that
present with significant hyperkalaemia are
usually best treated surgically after an
initial 2448 hours of stabilization; those
cats unresponsive to medical management
may undergo surgery sooner.
Medical management includes
analgesia (usually opioids), appropriate
intravenous fluid therapy and
pharmacological intervention. Multiple
drugs (e.g. amlodipine, amitriptyline,
glucagon and diuretics such as mannitol)
have been used with the aim of relieving
ureteric spasm, encouraging ureteric
dilation or increasing urine production.
However, it must be stressed that evidence
to support the use of these drugs is lacking
and potential adverse effects in severely
sick cats must be considered. Cats need
to be closely monitored during this initial
stabilization period and have their weight,
hydration status, blood pressure,
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BSAVA 2014
How to manage feline ureteric obstruction
respiratory rate, electrolytes, creatinine and
PCV checked regularly (at least daily).
Renal imaging should be repeated at
4872 hours a decrease in renal pelvis
dimensions together with resolution of the
azotaemia would suggest resolution of the
ureteric obstruction.
Other non-surgical techniques that
can be used include extracorporeal shock
wave lithotripsy, although this has met
with mixed success in feline cases and is
not widely used or available. Nephrostomy
tubes can be placed and will rapidly
resolve the azotaemia and decrease
intra-ureteric/pelvic pressure but can be
associated with complications, including
urine leakage, dislodgement and
infection. They are also very challenging
to place percutaneously in cats and
provide only short-term palliation,
requiring the ureteric obstruction to be
removed using other techniques.
Surgical management
Traditional techniques
Surgical removal of an obstructing
ureterolith is achieved via a midline
coeliotomy. Full exploration of the urinary
tract is mandatory as multiple ureteroliths
may be present. Once the obstruction has
been localized a decision as to how to
remove it must be made.
Proximal calculi can be flushed back to
the renal pelvis by performing a cystotomy
and catheterizing the affected ureter. The
calculi can then be removed via pyelotomy,
which is technically easier and may be less
likely to result in significant ureteral
stenosis. Distal ureteric obstructions can
be managed by transection of the affected
portion (ureterectomy) and re-implantation
of the remaining ureter into the apex of the
bladder (neoureterocystostomy; Figure 3).
This can be accomplished using either
intra-vesicular (the bladder is incised and
the ureteral mucosa is directly sutured to
the bladder mucosa) or extra-vesicular
(the ureter is dropped in to the bladder
via a stab incision and sutured without
performing a cystotomy) techniques.
Both techniques require magnification
and are technically challenging. Loss of
ureteric length can create tension, but
this can often be offset by caudal
mobilization of the kidney (renal
descensus) or cranial anchoring of the
bladder apex (e.g. psoas cystopexy).
Other surgical options for mid-ureteric
obstructions include ureterotomy (Figures 4
and 5) or resection and anastomosis.
Ureteronephrectomy is rarely a viable
option as >80% of cats are azotaemic at
the time of presentation, implying
dysfunction of the other kidney, thus as
much renal function as possible needs to
be preserved in these patients.
Complications may be seen in
approximately 30% of cases and include
oedema/inflammation at the
Figure 3: Close-up view of
neoureterocystostomy
being performed in a
dog. Ureterectomy has
been performed and the
remaining dilated ureter
has been pulled through
an apical stab incision
visualized via a separate
cystotomy incision. The
ureter has been
catheterized
Figure 5: Ureterolith
removed via
ureterotomy
Figure 4: Intraoperative photograph of
a feline ureterotomy being closed.
A length of 2M polypropylene has been
placed into the ureteric lumen to help
preserve orientation during closure
ureterovesical junction, stenosis, urine
leakage (uroabdomen) and persistent
obstruction. Urine leakage is the most
common complication and is seen in
<16% of cases. Recurrence of ureteric
obstruction has been reported in <40%
of cats that undergo surgical
management, 85% of which had
identifiable nephroliths at the time the
original procedure was performed.
Mortality rates of approximately 20%
have been reported for cats undergoing
surgical management for ureteric
obstruction. However, survival rates for
surgical management are better than those
for medical management, with 91% cats
who survived the first month following
diagnosis alive after 12 months compared
with 66% of cats who received medical
management alone.
Stents
The relatively high incidence of
uroabdomen and stricture formation
following ureterotomy and ureterectomy
has prompted the development of new
surgical techniques. Stents are
polyurethane tubes that contain multiple
fenestrations (Figure 6). There is a pigtail
at either end; one end sits in the renal
pelvis and the other end sits in the
ureteric opening at the bladder trigone.
These stents provide passive ureteric
dilation and urine can flow either through
or around them.
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Figure 6: Double pigtail polyurethane stent
Initially, a catheter is placed through
the kidney parenchyma into the renal pelvis
and a hydrophilic guidewire is passed
though the catheter, down the ureter and
into the bladder. The catheter is then
removed and a dilator is passed over the
guidewire. The dilator is subsequently
removed and a stent is placed over the
guidewire with one pigtail in the renal
pelvis and the other in the bladder trigone
(Figure 7). However, it is not always
possible to place the stents passed the
obstruction and in these cases ureterotomy
or ureterectomy is often necessary; these
cats are still at risk of uroabdomen
postoperatively, so it is advisable to place
a Jackson-Pratt abdominal drain. The drain
allows for urine drainage during the period
of postoperative diuresis where urine
production can be >20 ml/kg/hr.
Stents can be challenging to place and
surgery times can be prolonged. In
addition, there is a high rate of dysuria
because of the position of the pigtail in the
trigone. Other complications include stent
fracture, migration and encrustation
leading to blockage.
Subcutaneous ureteric bypass (SUB)
system
This is an extra-anatomical device
consisting of a pigtail nephrostomy tube
and a cystostomy tube, which are
connected via a subcutaneous access
port (Figure 8).
Intraoperative fluoroscopy is needed
at multiple stages during the procedure.
The nephrostomy tube is placed first.
A guidewire is placed in the renal pelvis via
a catheter, which is then removed. The
nephrostomy tube is placed over the
guidewire and, once the correct position
has been confirmed using fluoroscopy, the
pigtail is locked, securing its position.
Figure 7: Postoperative lateral radiograph of a cat with bilateral ureteric stents
A
B
Figure 8: (A) Lateral and (B) ventrodorsal radiographs of a cat
with bilateral SUB systems 1 year following placement. Note
the two nephrostomy tubes that enter the subcutaneous
port caudally and the single cystostomy tube that exits the
port cranially
A Dacron cuff is glued to the renal capsule
using sterile cyanoacrylate glue.
The cystostomy tube is placed in the
bladder via a small stab incision and
through a purse string suture and secured
via sutures placed through the Dacron cuff
to the bladder wall at the apex (Figure 9).
These two tubes are then passed
through the body wall and connected to
the subcutaneous port using sterile
cyanoacrylate glue (Figure 10). The
system is checked for leakage via a
contrast study; the contrast medium is
injected using a Huber needle placed in
the subcutaneous port. The Huber
needle is the only needle compatible with
the SUB system as it is non-coring and
thus will prevent leakage when removed.
The SUB system is technically simpler
to place than stents, with shorter surgery
times and less severe dysuria noted.
However, potential complications include
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BSAVA 2014
Figure 9: Intraoperative photograph showing a
nephrostomy tube placed in the right kidney
and a cystostomy tube
Figure 10: Intraoperative photograph of the
subcutaneous port
Picture courtesy of Zoe Halfacree
Figure 11: Lateral radiograph of the cat in
Figure 8 undergoing a contrast study to ensure
patency of the SUB system. Contrast medium is
visible in both renal pelves and the bladder.
Following relief of the obstruction, the right
ureter has become unobstructed
urine leakage, tube kinking leading to
obstruction, infection and encrustation.
The SUB system should be checked every
36 months to ensure patency (Figure 11).
Prognosis
The main factor affecting outcome in these
cats is the severity of the kidney disease as
a result of the obstruction. One study found
that cats with an International Renal
Interest Society (IRIS) CKD stage of 1 or 2
had a good long term outcome and those
with a score of 3 or 4 had a median life
expectancy of 272 days. To date, no
factors associated with survival have been
identified and so it is impossible to
ascertain the outcome of these cats prior
to treatment.
Conclusion
Ureteric obstruction is a potentially
life-threatening condition with a relatively
poor prognosis in cats with variable renal
function. There is no one ideal surgical
option; however, currently, the SUB system
may be the best solution in these cats,
where appropriate facilities for its
placement are available.
Higher resoluton images and references are
available online and in e-companion
MORE ONLINE
34 October 2014
AVSTS/SAMSoc AUTUMN MEETING
The Association of Veterinary Soft Tissue Surgeons is a
satellite group of BSAVA. Members include specialist
surgeons and general practitioners. In October AVSTS is
running a joint scientific meeting with the Small Animal
Medicine Society. The topic will be Organ Failure and the
meeting will be held in the Queens Hotel in Chester. As
always, this promises to be a thought-provoking and
entertaining meeting with world-class speakers.
Visit www.avsts.org.uk for full details and to book online.
Email avstsadmin@fsmail.net for more details.
Organ failure
A medical and
surgical approach
How to manage feline ureteric obstruction
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T
wo of BSAVAs affiliated groups,
the European Association of
Veterinary Diagnostic Imaging,
British & Irish Division (EAVDI-
BID) and the Veterinary Cardiovascular
Society (VCS), are hosting a joint
meeting on 1415 November at Burleigh
Court in Loughborough.
With 12 hours of accredited CPD, the
meeting centres on advances in cardiology
and thoracic imaging and is aimed at
general practitioners with an interest in
imaging or cardiology, as well as
established group members. On the Friday
the groups will host their individual
meetings, before coming together for a
dinner with live entertainment in the
evening. The following day they will
combine their expertise, with presentations
from veterinary speakers from across the
UK and internationally, and medical
speakers who will highlight advances of
comparative interest.
Youre welcome
Both societies welcome non-members.
This weekend offers a golden opportunity
for non-members to get a taste of what
both groups can offer. Youll meet other
vets with shared interests often
members feel that they discover lots of
new ideas over
coffee or lunch,
as well as learning
new skills from the lectures.
A commercial exhibition allows
delegates to see what the industry has to
offer, and their generous sponsorship
contributes to the low registration rates.
Both societies have a reputation for being
open and friendly and no doubt will be
living up to that billing at the dinner, which
is always a really enjoyable event.
A problem shared
The joint meeting of two groups with
overlapping areas of interest will be a
good opportunity to share ideas and
discuss new developments. It is a great
chance for younger vets with an interest
in cardiology or imaging to meet leading
lights in a convivial atmosphere without
feeling intimidated. It has been the
starting point for many vets considering a
certificate, an internship or residency.
And for many it is a chance to catch up
with old friends.
Friday sessions
On Friday the EAVDI meeting will include
An introduction to interventional radiology
in people by Dr Paul Crowe, The coughing
dog with Jerry Shimali, Advances in
thoracic CT: More to see but more to know
with Randi Drees, Imaging thoracic
oncology from Chris Warren-Smith, Non
cardiac thoracic ultrasound by Dr Thomas
Maddox, and clinical research abstracts.
The VCS programme includes: I like
hearts, so why do I have to know about
kidneys? with Geoff Culshaw, Prediction of
outcome in dogs with mitral valve disease
by Adrian Boswood, Troponin and outcome
in feline cardiomyopathy from Inigo Sanz,
and Hyperaldosteronism and hypertension:
the endocrinopathy youve missed with
Chris Little. In addition there are reviews of
the key cardiology presentations at this
years ECVIM and ACVIM Congresses, as
well as case presentations where
radiographs of interesting cases will be
displayed for delegates to review.
Saturday sessions
The joint programme on Saturday includes
Randi Drees speaking on CT imaging of
the chest in small animals, and Paul
Mahoney will discuss What it could be
when its not lungworm. There will be a
review of MRI imaging of the heart the
human perspective. Rebecca Stepien will
give delegates an Introduction to imaging
congenital heart disease in small animals,
Mike Martin presents When does it need
an angiogram?, and Virginia Luis Fuentes
will review Adult heart disease, when do
I need to measure what. The day will finish
with a film reading session, going through
the radiographs displayed during the
weekend, compred by Mike Martin and
Paul Mahoney.
Engaging atmosphere, enticing
environment
The groups provide a good environment to
ask questions, lacking the formality of
larger meetings and bringing a range of
expertise together. The combination of
imagers and cardiologists will foster
different angles of approach to similar
problems and it is always good to hear
different voices and see new faces.
The venue, Burleigh Court in
Loughborough, is a four star hotel just
a mile or so from the M1. There is a
leisure suite and spa and the central
location has been chosen to make the
meeting within easy reach of as many
people as possible.
The rates are outstanding value at
110 per day for members and 140 for
non-members. Residents and interns
get a specially discounted rate.
Dr Mark Patteson on
the EAVDI and VCS
joint meeting where
cardiologists and
imagers will join forces
with keen general
practitioners
Seeing to the
heart of things
For further information and registration
contact the individual groups: Imaging
at www.eavdi.org/events and
Cardiology at www.bsava.com/vcs.
Spaces are limited so book early .
19 VCS.indd 19 18/08/2014 12:31
For more information or to book your course
www.bsava.com/cpd
Learn@Lunch
webinars
These regular monthly lunchtime (12 pm) webinars are
FREE to BSAVA Members just book your place through
the website in order to access the event. The topics will
be clinically relevant, and particularly aimed at those in
first opinion practice. There are separate webinar
programmes for vets and for nurses.
This is a valuable MEMBER BENEFIT
Coming soon
26 November Otitis for nurses
03 December Pharmacy management for nurses
10 December Feeding tubes for vets
Book online at www.bsava.com
All prices are inclusive of VAT.
Dispensing
Course
9 October
The BSAVA Dispensing Course helps
veterinary practices manage their
dispensaries with up-to-date information
on the medicines regulations.
This course meets the RCVS Practice
Standards Veterinary Hospital pharmacy
course requirements.
SPEAKER
P. Sketchley, F. Nind, P. Mosedale,
M. Stanford, S. Everitt, M. Jessop, J. Millward
VENUE
Frimley Hall, Surrey
FEES
BSAVA Member: 240.00 inc. VAT
Non BSAVA Member: 360.00 inc. VAT
Controversies in
feline cardiology
Navigating the nightmare
of feline heart disease
9 October
Cardiac problems in cats are confusing and
challenging, and unfortunately very
common. A practical approach will be
outlined for dealing with the frequent
frustrations of managing feline heart disease.
SPEAKER
Virginia Luis Fuentes
VENUE
Woodrow House, Gloucester
FEES
Controversies in
canine cardiology:
data or dogma?
Dispelling myths in
canine cardiology
8 October
This course will review the diagnostic and
treatment options available for common
clinical scenarios, examining the evidence
behind each approach.
SPEAKER
Virginia Luis Fuentes
VENUE
FEES
20 CE Advert September.indd 20 18/08/2014 12:32
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References are available online and in
e-companion
MORE ONLINE
C
hronic kidney disease (CKD) is a
common condition of ageing
dogs and cats. CKD is usually
diagnosed by blood testing,
however blood testing can only detect
CKD once approximately 75% of the
nephrons in the kidney have been
destroyed. Early diagnosis of CKD would
be advantageous as it would allow
therapies to be instituted at an earlier stage
of disease, when they might be more
effective at preventing or delaying the
progression of CKD.
Urine is easily obtainable and
provides a fluid biopsy of the kidney.
Excretion of urinary biomarkers of renal
damage and dysfunction should occur at
an earlier stage of dise ase (than their
increased concentrations in the blood),
thus facilitating the early diagnosis of
CKD in dogs and cats. The detection of
small amounts of albumin in urine is
abnormal, and reflects either glomerular
damage and/or tubular dysfunction.
An automated method for measuring
albuminuria in dogs has been validated in
our laboratory; however, an automated
method for the quantitative measurement
of urinary albuminuria in cats has not yet
been validated.
Cystatin C is a low molecular weight
protein which is freely filtered at the
glomerulus and mostly reabsorbed and
catabolized by the proximal tubular cells of
the kidney. The detection of high
concentrations of cystatin C in the urine
would thus be expected to correlate with
renal tubular damage which is a common
feature of CKD, particularly in cats.
Cystatin C as a marker
In our PetSavers funded study we
proposed to evaluate the utility of urine
cystatin C as a marker of CKD in dogs
and to evaluate the utility of urinary
albumin and cystatin C to detect the
presence of CKD in cats.
In a recent paper from our laboratory,
a human immunoturbidmetric assay for
cystatin C was validated for canine urine.
The assay performance was good and a
small clinical study demonstrated that
Celebratng 40 YEARS of improving the health of pets
increased urinary cystatin C indexed to
creatinine (urine cystatin C:creatinine ratio)
was markedly elevated in dogs with CKD
compared to normal dogs or dogs with non
renal illnesses. The results of this small,
preliminary study demonstrated that urine
cystatin C could be a promising marker for
the early detection of CKD in dogs. Further
studies are therefore warranted to confirm
these findings in a larger population of
dogs and to establish if urinary cystatin C
is a good indirect marker of glomerular
filtration rate.
Work to validate the automated human
immunoturbidimetric assays for albumin
and cystatin C in feline urine is now
ongoing, and an initial clinical study
evaluating the utility of these markers for
the detection of CKD in a clinical
population of cats is underway. We hope to
present the preliminary findings of these
studies at the 2014 ECVIM Congress in
Mainz, Germany.
If these methods are confirmed as
useful for the diagnosis of early CKD in
dogs and cats, they could allow
therapeutic interventions to be instituted at
an earlier stage of disease which might
delay the progression of disease, thus
improving the quality of life and life
expectancy of dogs and cats with CKD.
Tim Williams and
Joy Archer from the
Department of
Veterinary Medicine,
University of
Cambridge discuss
novel urinary
biomarkers for the
early diagnosis of
chronic kidney disease
in cats and dogs and
highlight how a
PetSavers funded
study is advancing
veterinary knowledge
PetSavers
leading
advances in
CKD
21 PetSavers.indd 21 18/08/2014 12:33
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BSAVA 2014
Congress912 APRIL 2015
Congress creators offer
sneak preview
With a Scientific Programme as diverse and detailed as BSAVA Congress is
famous for, it is hard to pick just a few highlights so over the coming months we
will be looking at as many as we can. The people in the know the vets and nurses
who make up our Congress Committees and who choose over 300 lectures for you
each year offer their highlights
(LR) Nick Bexfield (Chair, Congress Programme Committee), and Committee Members: Paula Hotston Moore, David Walker, Ian Ramsey, Molly Varga,
Samantha Fontaine and Louise ODwyer
Nick Bexfields highlights
Practicals
We are putting on a range of new hands-on
veterinary practicals at Congress 2015,
enabling delegates to learn new skills
under the guidance of world-leading
experts in a relaxed small group
environment. An exciting new addition will
give delegates the opportunity to test
themselves with the experts, by bringing
case material previously examined in
practice. These opportunities to get closer
to the experts are always very popular at
Congress and here are some of them.
Ophthalmic surgery
Here, delegates can gain practical
training in the application of
keratotomies, cauteries and diamond
burr debridements, removal of small lid
masses, and also how to perform the
Hotz-Celsus procedure for the
management of lower lid entropion.
Cytology workshop
Delegates can master the basics of
cytology enabling them to perform this
essential technique confidently when
back in practice.
Supporting the trauma patient
Have the opportunity to practice a
range of life-saving techniques, such
as the placement of both trocar and
guide-wire chest drains into models.
Delegates will also be guided through
the placement of oesophagostomy
tubes, when and how to give essential
colloids and blood products, and
practice the application of wound
products onto customized models.
SAMSoc
We are very excited to announce, that for
the first time, the Small Animal Medicine
Society (SAMSoc) will be holding a stream
within the main Congress Programme.
This stream, containing the very latest
updates on a range of internal medicine
topics, will be given by leading national
and international speakers from both the
human medical and veterinary fields.
Designed for practitioners with a particular
interest in internal medicine or those
holding further qualifications, this stream
is guaranteed to be popular.
How to
Back by popular demand, these 20-minute
sessions are designed to provide
delegates with essential skills and
confidence to perform a wide variety of
diagnostic and therapeutic techniques
in practice.
Emergency medicine
Designed by leading experts, this stream
has been introduced to give delegates the
confidence to handle some of the more
commonly encountered emergencies in
general practice. If you want to find out the
best way to deal with the collapsed dog,
diagnose and treat emergency arrhythmias
and much more, this is the stream for you.
Rehabilitation
New for Congress 2015, and in
conjunction with the British Veterinary
Rehabilitation and Sports Medicine
Association, this stream is a must for
anyone wishing to learn about
rehabilitation. Topics include making a
pain plan, novel pain management
options, and physiotherapy techniques.
What is the optimal diet for
Veterinary nutrition can be a confusing and
sometimes neglected field. Therefore, this
stream has been introduced to allow
delegates to make sense of the dietary
recommendations for a wide range of
conditions. In these 20-minute sessions,
veterinary nutritionists will explain the
rationale behind the nutritional
management of canine liver disease,
chronic renal failure, canine pancreatitis
and many more conditions.
Interactive multidiscipline
case-based presentations
These double-length sessions are
something new for Congress 2015.
In each session, three speakers from
different specialist fields will guide
delegates through the work up and
management of a selection of real life
clinical cases. Delegates will also have
the opportunity to use state of the art
anonymous voting software at key
decision making stages.
2223 Congress.indd 22 18/08/2014 12:33
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Congress912 APRIL 2015
Nursing highlights
Samantha Fontaines highlights
Nursing practicals
An exciting new development for Congress 2015
sees these linked in to specific lectures on the
same day as the practical is running. This will
allow delegates to practice some skills based
around some of the theory they may have learned
(or will learn) in the corresponding lectures.
Moving into management stream
With lectures such as From nurse to manager,
What veterinary assistants need to know about
managing the practice and Feeling stuck
career paths in veterinary practice, this stream
will be very useful for those nurses considering
moving into practice management/ownership.
Pharmacology stream
Particularly useful for VNs that are (or are
training to become) SQPs, this stream includes
Lungworm is it still an issue and The
rational use of antibiosis.
Louise ODwyers highlights
Top speakers from the US coming to
talk to you
We are very excited to be welcoming Megan
Brashear, who won PetPlans 2014 Veterinary
Technician of the Year, to Congress in 2015.
Megan will be speaking on a number of
topics for Nurses including Calculating
CRIs, Environmental enrichment for the
in-patient and Triage and assessment of the
emergency patient .
Nursing How to stream
For those looking for useful snippets and
refreshers on aspects of veterinary nursing such
as medical mathematics, calculating CRIs and
care of a thoracic drain, amongst others, this will
be the perfect stream.
Infectious diseases stream
With increased coverage of topical issues such
as leptospirosis and Alabama rot, and with Lyme
disease often in the publics mind during spring
and summer months, it is important for nurses to
ensure that they are up to date. We hope that this
stream will help.
The full Scientific Programme will be available to
view online from 29 September and registration
will open in October.
Visit www.bsava.com/congress for further
information. Keep in touch with us on Twitter
(@BSAVACONGRESS) using #BSAVA15
David Walkers highlights
A new and exciting addition to Congress 2015 is a stream on practical aspects
of dog breeding featuring a wide range of lectures including:
Gene genie: getting to grips with avoiding inherited disease
Delegates can learn about the basics of inheritance, including how to use
DNA test results and understand complex inherited diseases.
Advising the dog breeder
Delegates will be shown tools and techniques to help advise clients
interested in breeding and where to get quality up-to-date information.
Delegates will also have the chance to assess the literature available whilst
making the most of available online tools.
Understanding the modern dog breeder
This is a great opportunity to learn about health and welfare (ABS) and the
complex considerations of modern breeders.
The right dog for the right home
Delegates will be shown how to advise clients and the general public on
choosing the right dog for them, and the importance of a good fit.
The other role of the veterinary scientist in dog health
How vets can benefit through contributing to dog health and welfare
beyond the practice.
Ian Ramseys highlights
Cutaneous renal glomerular vasculopathy: Alabama rot
in the UK
For the specialist or advanced practitioner in medicine, this talk from David
Walker is sure to be overflowing!
Infectious diseases stream
We are very lucky to once again have the world renowned Mike Lappin talking
on a number of topics including Lyme disease in the UK and USA and
Update on the management of feline upper respiratory infections. Mike brings
with him a dry sense of humour, clear explanations and great photos so this is
a must see stream.
Paula Hotston Moores highlights
Medicine on a budget
A daily dilemma for many vets in practice and back by popular demand, this
topic is very applicable for the average vet in an average practice who often
has clients in with a limited budget and therefore need to alter possible
treatments accordingly.
Shelter medicine
Many practices deal with animal shelters, and those shelters are facing
financial constraints due to more members of the public giving them pets as a
result of personal financial issues. Therefore, this stream will provide useful
information and knowledge with lectures including Where are we now,
Capacity for care and Prepubescent neutering.
Molly Vargas highlights
Exotics
After the success of the rabbit lectures in 2014, we have Dr Tom Donnelly
talking on advanced rabbit medicine. Tom has been very active in small
mammal and rabbit medicine over the last 30 years and is widely published, so
arrive early for this lecture! Along with these lectures, the small group sessions
on advances in rabbit medicine should be an amazing learning experience.
2223 Congress.indd 23 18/08/2014 12:33
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BSAVA 2014
D
uring 2013 and 2014 I have been
privileged to be involved in some
groundbreaking CE being
provided by WSAVA member
Associations in South East Asia to
familiarize their members with the problem
orientated approach (POA). POA is a
structured form of clinical reasoning that
can enhance a veterinarians ability to
solve clinical cases and gain the most
value from their most important clinical
resource their brain!
Clinicians around the world use several
methods to solve clinical cases. Pattern
recognition (or development of an illness
script) is the most common what
diseases do I know that would cause the
clinical signs I am seeing in this patient?
This works best for common disorders after
typical presentations:
If a disorder has a unique pattern of
clinical signs
When all clinical signs have been
recognized and considered and the
differential list is not just based on one
cardinal clinical sign and the
signalment of the patient presented
If there are only a few diagnostic
possibilities that are easily remembered
Taking a problem-
oriented approach to
clinical reasoning
Jill Maddison, Chair of the WSAVA
CE Committee, explains a new form of
clinical reasoning she has been
teaching in South East Asia
or can easily be ruled in or out by
routine tests.
Pattern recognition has the advantage
of being quick and cost effective so long
as the diagnosis is correct. However, it can
be unsatisfactory for instance:
When the clinicians knowledge base is
poor
If they are inexperienced and have
therefore seen very few patterns
If they only consider or recognize a
small number of factors
If they are unaware that pattern
recognition is mainly driven by
unconscious processes that might
need to be reflected upon if they fail.
Even for an experienced clinician,
pattern recognition can be flawed for
uncommon diseases or common diseases
presenting atypically, when the patient is
exhibiting multiple clinical signs that are
not immediately recognizable as a specific
disease, or if the pattern of clinical signs is
suggestive of certain disorders but not
specific for them.
Acknowledging that pattern recognition
is not perfect and requires the use of
diagnostic tools that may not be available,
several WSAVA member associations in the
South East Asian region, including Thailand,
the Philippines, Sri Lanka and Myanmar, are
embracing the concept of POA. It is a
concept that David Church and I also teach
at the Royal Veterinary College in London.
POA focuses around key steps,
including defining and refining the
problem, system, location and lesion. It
does not replace pattern recognition but
complements it by providing an alternative
form of clinical reasoning when required
one that has a sound pathophysiological
basis allowing the clinician to:
Make maximum use of information
gained from the history and clinical
examination
Plan more focused and cost effective
diagnostic procedures
Communicate more clearly with the
client.
POA seeks not just to provide a robust
form of clinical reasoning that will never go
out of date, but also to enhance
understanding of the principles of clinical
medicine and pathophysiology. It develops
skills in problem solving and reflection that
are essential for successful case
assessment and management.
Teaching POA takes time and requires
commitment from the participants as they
must think and reflect on the issues, not
just passively listen to expert lectures. The
recognition of the value of POA by the
WSAVA Associations is visionary and will
provide a solid base for the development
of excellent companion animal practice in
these countries.
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T
he WSAVA Renal Standardization
Project, which aims to improve the
diagnosis and clinical outcomes of
dogs with glomerular disease, has
achieved a significant milestone with the
completion of the first phase of its study.
The Projects specific goals are to:
Develop two diagnostic referral
pathology centres, one in the USA and
one in Europe
Develop a prototype classification
scheme for glomerular disease
Renal Standardization
Project success
The WSAVA Renal
Standardization Project
has completed the first
phase of its study
Evaluate the ability of a clinical-
pathological diagnosis to predict
clinical outcomes and facilitate
treatment.
The Project team was
led by Dr David Polzin from
the College of Veterinary
Medicine, University of
Minnesota, USA and Dr
Larry Cowgill from the
School of Veterinary
Medicine and the University of California
Veterinary Medical Center, University of
California Davis, USA. It made significant
progress in advancing the proposed
infrastructure; in defining the discipline of
nephropathology; in characterizing the
pathological expression of canine
glomerular disease, and in establishing a
prototype classification system that will be
subject to prospective validation.
(LR) Dr Matti Kiupel, Dr Rebecca Smedley, Classification Scheme Editors, and Thomas Wood,
Histology Laboratory Supervisor
WSAVA donates Aperio
scanning machine
T
o facilitate the Renal
Standardization Project WSAVA
acquired an Aperio digital
scanner, a piece of equipment that
enables the scanning and storage of high
quality digital histopathological images to
facilitate global collaboration in their
interpretation. It was installed at the Texas
A&M University, USA, under the
supervision of Professor George Lees and
was instrumental to the Renal
Standardization Groups work. With the
conclusion of the first stage of the project,
WSAVA has now donated the machine to
the WSAVA Tumor Classification initiative.
Under the oversight of Professor Matti
Kiupel at Michigan State University, the
WSAVA Tumor Classification Initiative
brings together experts on neoplastic
conditions of dogs and cats from around
the world and aims to generate a tumour
classification scheme similar to the World
Health Organisations scheme in people,
but dedicated to companion animals. The
scanner has been installed at Michigan
State University and will facilitate the
development of the soon-to-be released
WSAVA Tumor Classification Scheme.
A complete description of the
prototypical pathological classification
scheme, based on statistical assessment
of intrinsic glomerular lesions using light,
immunofluorescence and electron
microscopy, is soon to be released while
the clinical features of canine glomerular
disease are currently under review and will
complement the pathological foundations.
Dr Larry Cowgill commented: The
Renal Standardization Project uniquely
serves as a proof-of-concept for visionary
applications of distant technologies to
facilitate the delivery of veterinary services
and expertise to any location in world. It
has proved the potential for international
collaboration and worked at the frontiers of
telehealth. Members of the WSAVA Renal
Standardization Project wish to express
their thanks to sponsors Hills Pet Nutrition
and Bayer Animal Health for their
contribution to their work.
Dr David Polzin
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BSAVA 2014
Caroline Yates grew up in Manchester and studied
Russian Language & Literature at Exeter University,
spending a year in what was then the Soviet Union in
19834. She graduated in 1985. Whilst working in the
world of metal trading in Moscow, Caroline volunteered
her language skills to the International Fund for Animal
Welfare (IFAW), igniting a desire to work full time in
animal welfare. She returned to London and, after
initially working at The Mayhew Animal Home as a
volunteer, she was offered a position in the fundraising
team in 2003. In 2007 she became CEO.
Q
How did you arrive at your role at
The Mayhew?
A
I was living and working in Moscow
and was fascinated by the pack of
street dogs that lived below my flat.
So I started volunteering for the Moscow
office of IFAW, mostly translating, but did
spend time with the mobile spayneuter
team, whose vets had received some
training at The Mayhew. I met the CEO of
Humane Society International, Neil Trent, at
the opening of the CITES area at Moscow
International Airport, and he encouraged
me to leave the cut and thrust of the metal
trading world and get a role in animal
welfare. I translated for the Russian vets at
the Humane Society of the United States
that time. We still operate as a rescue and
rehoming centre for dogs and cats, but the
organization now does much more. The
Mayhew is also all about community and
has a team of three Animal Welfare Officers
out and about every day in London,
dealing with the animal welfare issues that
arise. Amongst many outreach
programmes, we work with the homeless
who have dogs, assist others to care for
their pets responsibly in their own homes
and respond to welfare and hoarding
cases as and when they arise.
Although we do not support the trade
in pets from shops, puppy mills and online
sources, a project we hope to develop is
working with petshop employers and
employees to ensure that staff have a basic
knowledge and understanding of the
needs of the animals they are dealing with.
The Mayhew rehomes around 600 animals
every year and ensures that all animals are
neutered before being rehomed. We are
very much aware of the large numbers of
unwanted and abandoned animals in our
society and we do not want to take the
chance of adding to them.
As well as rehoming, The Mayhew
also runs a veterinary clinic. How
does this work?
The Mayhew has a community veterinary
clinic onsite, with a team of four vets and
eight nurses at the moment. The clinic
provides comprehensive veterinary care for
the companion interview
Caroline
Yates
Animal Expo that year and enjoyed it so
much I decided to take the plunge. I gave
up my job and returned to the UK to seek a
suitable position. As I was living in London
I made contact with The Mayhew Animal
Home to volunteer and within a week was
offered a job in fundraising that was
2003. I worked for three years in the
Fundraising and Marketing Department,
eventually heading it up and covered
maternity leave for the General Manager.
In 2007 I became CEO of the organization.
Tell us about the aims of The Mayhew.
The Mayhew Animal Home was
established in 1886 and has been working
from the same site in Kensal Green for over
128 years. Obviously a lot has changed in
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all the animals going through the rehoming
process, but we also offer free and
low-cost preventative clinics for the general
public. So you dont have to be on income
support or live within a certain area. What
we want is for the animals to be neutered
and free from disease and infection. These
clinics include our flagship Free Bull Breed
neutering programme which we initiated in
2006, low-cost neutering, vaccination and
nurses clinics. Over recent years we have
regularly neutered more than 2000 animals
a year and the veterinary team are
experienced in high volume and early
neutering techniques.
What are the specific challenges of
running a welfare centre in London?
Being in central London, The Mayhew is at
the cliff face of urban animal welfare issues
an overpopulation of bull-breeds, dogs
misused and mistreated, backstreet
breeders, unwanted kitten litters and a
prolific feral cat population. We work closely
with Brent Council, operating as their
reception centre for stray dogs found in the
London Borough of Brent, and collaborate
with them on various outreach projects to
promote responsible pet ownership.
It is estimated there is some half a
million feral cats in London and The
Mayhew operates a Trap Neuter Release
programme to try to stem and contain the
growing numbers. Trapping can be a time
consuming business and our Animal
Welfare Officers can be out in the early
hours or late evening setting the traps or
picking the traps up to bring the cats in for
neutering. Healthy adult feral cats are
released back to their colony area within
2448 hours post neutering and health
checked, as they are not suitable for
rehoming, but should we get feral kittens
under 5 weeks of age, they are young
enough to be socialized and then go up for
adoption. Sometimes we get very young
kittens handed into us or dumped at our
doors and this can mean that our staff
spend some weeks handrearing the kittens
with round-the-clock feeds.
Tell us about your veterinary team.
Our veterinary team has grown over recent
years. When I first started at The Mayhew
there was one vet and now we have a team
of four, with eight nurses all very busy!
We hope to expand in 201516 with a new
clinic extension at our north London
facilities. The work of the vet team is
fundamental to ensuring the animals we
rescue and rehome are in tip-top health
and neutered before going to their new
homes, and also as a resource for those
animals that need that extra bit of care with
ongoing conditions or aftercare. The
Mayhew vet team see some of the worst
and some of the best of what we deal with
on a daily basis and sometimes have to
make difficult decisions. Working in The
Mayhew Clinic is demanding, fast-paced,
cutting edge and you will certainly get a
huge amount of experience in preventative
veterinary care and surgery that you dont
necessarily get in private practice. Added
to that we are also a place of learning. We
are a registered training practice for
veterinary nurses and also coach and
mentor animal nursing assistants and vet
clinic receptionists. We host several EMS
vet students throughout the year, many of
whom want to come back to us, and offer
an intensive training programme for
overseas vets working or volunteering with
street/stray animal population issues in
their own countries. We have welcomed
vets from countries as far afield as Russia,
Georgia, India, Tanzania, Romania and
Japan who are enthused by our work and
the concept of charitable veterinary clinics
which they take back home.
Why did The Mayhew begin an
international initiative?
When I joined The Mayhew in 2003, the
organization was already involved to some
extent in projects in Afghanistan and
Russia, through the efforts of one of the
Trustees. I was interested in joining The
Mayhew because of their links with Russia.
The international work is something dear to
my heart and it has expanded over recent
years. We wanted to share what we do well
with those less fortunate than ourselves, to
empower local vets and animal welfare
workers with knowledge and resources to
address the sometimes overwhelming
issues they are facing. So our international
work has evolved to concentrate on
veterinary training and the support of
animal birth control and rabies vaccination
projects, through funding of core veterinary
costs and training and development of
community education programmes in the
countries where we work. We work in some
challenging places, challenging not only
from an animal welfare perspective, but
from a national and local government
perspective as well but we relish the
challenge and will persevere.
What role do you think the veterinary
profession can play to lessen the
likelihood of animals ending up in places
like The Mayhew?
Participation of the veterinary profession is
crucial in the improvement of animal
welfare and in addressing the issues of
overpopulation and disease control. Vets
and nurses are in one of the best places to
explain the root causes of why street/stray
animal populations occur and grow and
they are fundamental to controlling and
containing them not only by practical
neutering and vaccination programmes,
but in educating others in the ways of
prevention in an evidenced-based
scientific and objective manner. The
profession also needs to lead the way in
demonstrating an understanding of animal
welfare science. I would like to think that
our strategies in addressing these issues
at The Mayhew contribute to that.
What is the most important lesson life
has taught you?
Be patient and try to be non-judgmental.
I have seen some horrible things in my time
but you need to remember what the
circumstances are and what resources are
available before being over critical.
Caroline on a trip to Kabul, Afghanistan
visiting one of the shelters helped by
The Mayhew
The Mayhew is at the
cliff face of urban animal
welfare issues
26-27 Interview September 2014.indd 27 18/08/2014 12:48
BSAVA MANUAL OF CANINE AND FELINE
Ultrasonography
Thoracic Imaging
Logically organized, clearly
and concisely written,
extensively illustrated, and
appropriately referenced
JOURNAL OF THE AMERICAN
VETERINARY MEDICAL ASSOCIATION
BSAVA Member Price
55.00
Price to non-members: 89.00
Should have a place near
every ultrasound machine
EUROPEAN JOURNAL OF
SMALL ANIMAL PRACTICE
Highly recommended
MIDWEST REVIEW OF BOOKS
BSAVA Member Price
45.00
For more information or to order
www.bsava.com/publications
BSAVA reserves the right to alter prices where necessary without prior notice.
BSAVA Publications
COMMUNICATING VETERINARY KNOWLEDGE
Abdominal Imaging
Extremely useful for the
general veterinary practitioner
AUSTRALIAN VETERINARY JOURNAL
An excellent book
EUROPEAN JOURNAL OF SMALL
ANIMAL PRACTICE
An excellent, concise guide
VETERINARY RECORD
BSAVA Member Price
49.00
More than
skin deep
BSAVAs series of imaging Manuals
give you in-depth coverage of body
systems and modalities
Musculoskeletal Imaging
Suitable to expand the
knowledge base of veterinary
students and general
practitioners, yet also reaches
the needs of specialists
JOURNAL OF THE AMERICAN
VETERINARY MEDICAL ASSOCIATION
BSAVA Member Price
45.00
Includes
DVD
28 Publications Advert September 2014.indd 28 18/08/2014 12:49
Local
News from BSAVA Regions
knowledge
BSAVA 2014
|
|
29
West Midlands CPD is
set to inspire
On 16 September at The Three Pears, Worcester, West
Midlands members will meet Stuart Ellis from the VDS who
will discuss communication issues during his talk entitled
Complaints, catastrophes and the College. The Three Pears
is easily accessed as it is near junction 6 of the M5.
We are also looking forward to the full day CPD event on
Saturday 4 October Veterinary examination, handling and
husbandry of reptiles, small mammals and cage birds a
hands-on day with the animals at Solihull College and a
return of the extremely enthusiastic Sarah Pellett and
Nathalie Wissink-Argilaga. The cost is 120 for members and
199 for others and it will be suitable for vets and nurses.
Please book on the website or phone Woodrow House.
Remember all evening CPD in West Midlands is free to
BSAVA members in 2014 and 2015 thats both vets and
nurses and is only 20 for non-members. Book via the
BSAVA website and why not bring a car full of your work
colleagues? Our last free evening CPD for members in 2014
will be on Monday 17 November at Willows Veterinary Centre
and Referral Service in Solihull. We have Emma Scurrell
presenting Back to basics cytology practical tips and
common pitfalls.
Father and son share
neurology expertise
On 26 October North East Region will host a
unique neurology meeting in Harrogate,
featuring well known local vet Nigel Harcourt-
Brown of Crab Lane Vets and his son Tom,
who works at Langford lecturing together for
the first time and they say it might be the
one and only time!
The talk, entitled Neurology in practice
and beyond, will show how the neurological
examination can be accessible during busy consultations, which
neurological conditions can be managed within practice, and how to get
the most out of referring more complicated cases.
Both speakers want to encourage North East GPs to come along, and
are keen to make this useful to those at all levels from the vet student up
to the experienced practitioner who wants to add to their skills.
Go West for fertile felines,
worrisome whelpings and
poorly puppies
Do consultations with breeders make you shiver? Dont sweat the
South West region has persuaded one of the worlds foremost
experts in veterinary reproduction, Professor Gary England, to come
and share his wisdom with us. Despite reproductive problems,
neuterings, dystocias and pyometras being relatively common
presentations in general practice, it is often a much neglected area
of CPD but not anymore.
Come along to our day meeting on Friday 21 November in
Exeter and you too can go away confident and knowledgeable
enough to hold your own in front of a valuable bitch and her
intimidating owner. Or perhaps you are already confident but would
like to refresh the basics and go into a little more depth perhaps
how to approach infertility or how best to treat fading puppies.
This course will cover everything you need to know about canine
and feline reproduction: from normal reproduction and fertility
including an introduction to canine A.I. through management of
pregnancy and parturition and problems of the neonatal period. This
course is aimed primarily at vets but will also be useful for veterinary
nurses who are often at the forefront of giving advice on breeding
and reproduction. We are grateful for the s upport of Virbac who are
kindly sponsoring this meeting.
Free AHT
talk in Wales
Cymru/Wales Region
return to Glyndwr
University, Wrexham for
the meeting on
Wednesday, 1 October,
with Mayank Seth, Head of Internal Medicine from The
Animal Health Trust. Mayank will give us an insight into
the work of the AHT and discuss how to avoid
complications during hospitalisation, so were looking
forward to lots of handy, practical tips for forgetful vets,
meticulous nurses and slick students! So please join us
for another informative and relaxed evening at
Wrexham, which is FREE to members registering at
least 72 hours in advance, so do drop us an email to
cymru.wales.region@bsava.com or register via the
BSAVA website.
29 Regions.indd 29 18/08/2014 12:50
30
|
|
BSAVA 2014
CPD diary
DAY MEETING
EAST ANGLIA REGION
Sunday 21 September
Interactive decision-making when
treating eyes
Speakers: Christine Heinrich and
David Gould
The Animal Health Trust, Newmarket
Details from eastanglia.region@bsava.com
AFFILIATE WEBINAR
BSAVA & AVA
Tuesday 16 September
20:0021:00
Making sense of breathing
systems
Speaker: Susannah Taylor
Online
Details from courses@bsava.com
AFFILIATE WEBINAR
BSAVA & BVRSMA
Thursday 18 September
20:0021:00
Chronic pain: 20 myths and
misconceptions
Speaker: Gwen Covey Crump
Online
Details from courses@bsava.com
LUNCHTIME WEBINAR
Wednesday 24 September
13:0014:00
Behaviour and fireworks
Speaker: Daniel Mills
Online
Details from administration@bsava.com
October
September
DAY MEETING
IN CONJUNCTION WITH BVOA
Tuesday 2 September
Scared of orthopaedics? Building
confidence and skills in practice
Speaker: Peter Attenburrow
Oulton Hall, Leeds
DAY MEETING
IN CONJUNCTION WITH VCS
Getting the most from cardiac
diagnostics
Speaker: Mike Martin
DAY MEETING
SOUTH WEST REGION
Defusing the veterinary stress
time bomb
Speaker: Jenny Guyat
Exeter Court Hotel, Exeter
Details from southwest.region@bsava.com
WEEKEND MEETING
SOUTH EAST REGION
JOINT MEETING WITH BVDA
Saturday 20 and
Sunday 21 September
Practical dentistry:
extractions and radiography
Speakers: John Robinson, Matthew Oxford
Brinsbury College, West Sussex
Details from southeast.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Defusing the veterinary stress
time bomb
Speaker: Jenny Guyat
Hilton Bristol, Bradley Stoke
DAY MEETING
Good grief my patient is all fur and
teeth: Handy tips on nursing small
exotic mammals
Speaker: Wendy Bament
Twycross Zoo
EVENING MEETING
NORTHERN IRELAND REGION
Inside the ear
Speaker: Sue Paterson
Hilton Templepatrick, Belfast
Details from nireland.region@bsava.com
EVENING MEETING
CYMRU/WALES REGION
Pain management:
an update
Speaker: Matt Gurney
Welshpool Livestock Market
Details from cymru.wales.region@bsava.com
DAY MEETING
METROPOLITAN REGION
Friday 5 September
Emergency surgery
Speakers: Dan Brockman and
Lindsay Kellett-Gregory
Holiday Inn, Elstree, London
Details from metropolitan.region@bsava.com
EVENING MEETING
SOUTHERN REGION
Tuesday 9 September
Reptiles: work smart and
stay safe
Speaker: Matthew Rendle
The NEW Community Centre Bursledon,
Southampton
Details from southern.region@bsava.com
DAY MEETING
NORTH EAST REGION
Sunday 28 September
Its all about sex!
Speaker: Gary England
Blackwell Grange Hotel, Darlington
Details from northeast.region@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
The PUB Clinical Club:
a practical approach to the
canine cancer patient
Speaker: Shirley Van Lelyveld
The Royal Oak, Ockbrook
Details from eastmidlands.region@bsava.com
DAY MEETING
IN CONJUNCTION WITH BrAVO
Wednesday 1 October
Advanced ophthalmology: just
above basics and problem cases
Speaker: Jim Carter
Chilworth Manor, Southampton
EVENING MEETING
WEST MIDLANDS REGION
Complaints, catastrophes and
the College
Speaker: Stuart Ellis
The Three Pears, Worcester
Details from westmidlands.region@bsava.com
LUNCHTIME WEBINAR
13:0014:00
Different diagnosis of
haematuria
Speaker: Rob Foale
Online
30-31 CPD Diary.indd 30 18/08/2014 12:51
BSAVA 2014
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31
DAY MEETING
Tuesday 7 October
Interactive endocrinology
Speaker: Nick Bexfield
EVENING MEETING
SOUTH WEST REGION
Wednesday 22 October
Fracture planning in practice:
interactive case discussions
Speaker: Kevin Parsons
The Vassall Conference Centre, Bristol
EXCLUSIVE FOR MEMBERS
Extra 5 discount on all
BSAVA publicatons for members
atending any BSAVA CPD event.
All dates were correct at tme of going to print; however, we
suggest that you contact the organizers for confrmaton.
LUNCHTIME WEBINAR
13:0014:00
PUO
Speaker: Nat Whitley
Online
LUNCHTIME WEBINAR
13:0014:00
Nursing the hospitalized
seizure patient
Speaker: Laurent Garosi
Online
OTHER UPCOMING BSAVA CPD COURSES
See www.bsava.com for further details
BSAVA & BAVECC
Goal directed therapy in
emergency and critcal care
Metropolitan Region
Sunday 2 November
Abdominal ultrasound
Cymru/Wales Region
Thursday 6 November
Minimizing stress for cats in the
veterinary practce
BSAVA in conjuncton with BVZS
Friday 7 November
What you need to know for the frst
opinion reptle consult. Shells, scales and
slithering things: now what?
East Anglia
Sunday 9 November
Rabbits: update on the top ten clinical
presentatons in practce
EVENING MEETING
CYMRU/WALES REGION
Wednesday 1 October
What happens after they come
through the doors of the AHT?
Speaker: Mayank Seth
Glyndwr University, Wrexham
DAY MEETING
WEST MIDLANDS REGION
Saturday 4 October
Veterinary examination, handling
and husbandry of reptiles,
small mammals and cage birds:
a hands-on day with the animals
Speakers: Sarah Pellett and
Nathalie Wissink-Argilaga
Animal Care Department, Solihull College
Details from westmidlands.region@bsava.com
DAY MEETING
Wednesday 8 October
Controversies in canine
cardiology: data or dogma?
Speaker: Virginia Luis Fuentes
DAY MEETING
EAST ANGLIA REGION
Sunday 19 October
The art and science of internal
medicine
Speakers: Ian Battersby and Rob Foale
The Cambridge Belfry, Cambridge
Details from eastanglia.region@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Tuesday 21 October
The PUB Clinical Club: Dos and
donts of cytology
Speaker: Emma Scurrell
The Royal Oak, Ockbrook
Details from eastmidlands.region@bsava.com
AFTERNOON MEETING
SOUTHERN REGION
The colourful consultation
Speaker: Brian Faulkner
Holiday Inn, Basingstoke
Details from southern.region@bsava.com
DAY MEETING
Thursday 9 October
Controversies in feline cardiology
Speaker: Virginia Luis Fuentes
EVENING MEETING
SOUTH EAST REGION
Practical blood transfusions
Speaker: David Walker
Leatherhead Golf Club, Surrey
Details from southeast.region@bsava.com
DAY MEETING
Thursday 9 October
BSAVA Dispensing Course
Speakers: Fred Nind, Phil Sketchley,
Sally Everitt, Mike Jessop, Pam Mosedale,
John Millward, Mike Stanford
Aldwark Frimley Hall, Surrey
EVENING MEETING
NORTHERN IRELAND REGION
Thursday 23 October
Rabbits
Speaker: Anna Meredith
Hilton Belfast Templepatrick Golf and
Country Club
Details from nireland.region@bsava.com
DAY MEETING SCOTTISH REGION
Sunday 26 October
Orthopaedics
Speaker: Dylan Clements
Cumbernauld Hotel, Dunkeld
Details from Scottish.region@bsava.com
DAY MEETING
NORTH EAST REGION
Sunday 26 October
Neurolocalization: how to stop
worrying and love the neuro exam!
Speaker: Tom Harcourt-Brown and Nigel
Harcourt-Brown
Cedar Court Hotel, Harrogate
Details from northeast.region@bsava.com
DAY MEETING
METROPOLITAN REGION
Sunday 5 October
Chronic feline gastrointestinal,
pancreatic and hepatic disorders
Speaker: Martha Cannon
De Vere Denham Grove Hotel,
Buckinghamshire
Details from metropolitan.region@bsava.com
DAY MEETING
Tuesday 7 October
Making the complicated
straightforward: surgery for
common hind limb orthopaedic
joint conditions
Speaker: Richard Meeson
Oulton Hall, Leeds
EVENING MEETING
CYMRU/WALES REGION
Tuesday 7 October
Part 1 of a 2 part series Wound
reconstruction from the simple to
the complex: a practical guide
Speaker: Stephen J Baines
Brynamlwg Clubhouse, Aberystwyth
30-31 CPD Diary.indd 31 18/08/2014 12:51
Dont miss your opportunity to recognize
the inspiring work of your colleagues.
Why not nominate a vet and/or a vet nurse
who has made exceptional contributions
to the profession?
The awards will be presented at BSAVA Congress 2015
You can nd out more about award categories
and nominate online at
www.bsava.com/awards
Closing date
18 September 2014
32 OBC.indd 1 18/08/2014 12:52

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