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The essential publication for BSAVA members Feline Amputation Report on a new study P4 How To… Perform a successful joint tap P12 companion APRIL 2010 Discospondylitis and Self Trauma A case study in patient care P20 Investigation of an inappetent, ascitic cat
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Companion April2010

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Page 1: Companion April2010

The essential publication for BSAVA members

Feline AmputationReport on a new studyP4

How To…Perform a successful joint tapP12

The essential publication for BSAVA members

companionAPRIL 2010

Discospondylitis and Self TraumaA case study in patient care P20

Investigation of an inappetent,

ascitic cat

01 OFC.indd 1 18/3/10 15:38:29

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companion

3 BSAVA CPDCourses from the BSAVA

4–7 Feline Amputation StudyJohn Bonner meets Lyn Forster who is studying the effects of leg amputation on feline patients

8–11 Clinical ConundrumInvestigation of an inappetent ascitic cat

12–16 How To…Perform a successful joint tap

17–19 GrapeVINeFrom the Veterinary Information Network

20–23 PublicationsDiscospondylitis – a case study in patient care

23 Congress Podcast LibraryMake the most of your access to the archive of lectures

24 International Delegation at Congress 2010The Slovenian Small Animal Veterinary Association

25 PetsaversLatest fundraising news

26–28 WSAVA NewsThe World Small Animal Veterinary Association

29–30 The companion InterviewJohn Bower

31 CPD DiaryWhat’s on in your area

Additional stock photography Dreamstime.com© Adisa; © Eriklam; © Haneck; © Ileanaolaru; © Matt Trommer; © Poutnik; © Talltrevor; © Vitali Dyatchenko

companion is published monthly by the British Small Animal Veterinary Association, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB. This magazine is a member only benefit and is not available on subscription. We welcome all comments and ideas for future articles.

Tel: 01452 726700Email: [email protected]

Web: www.bsava.com

ISSN: 2041-2487

Editorial BoardEditor – Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVSSenior Vice-President – Ed Hall MA VetMB PhD DipECVIM-CA MRCVS

CPD Editorial Team ■Ian Battersby BVSc DSAM DipECVIM-CA MRCVSEsther Barrett MA VetMB DVDI DipECVDI MRCVSSimon Tappin MA VetMB CertSAM DipECVIM-CA MRCVS

Features Editorial Team ■Caroline Bower BVM&S MRCVSAndrew 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 .

Volunteer’s voice

Since 2007, I have had a most enjoyable role within BSAVA – as Regions Co-ordinator. I have met many very enthusiastic BSAVA members in their regions and then

passed their views to Council. Regional Officer meetings have also been a really good way to get to know other Regional Officers (ROs) and to discover that common problems within our profession are reflected throughout the regions – then finding ways to address them as an Association.

Each region has an elected Chair, Treasurer and Secretary plus a number of committee members in order to organise relevant, quality CPD within the region. Woodrow House provides as much admin support as a region requires and organising duties are shared amongst the volunteers – we all lead busy lives!

Each region gets a quota of complimentary Congress registrations and so we also have a meeting at Congress. All committee positions within BSAVA carry a three-year time frame and then we all have to move on. Susan Macaldowie took over my role in April and I have taken on the challenge of being Chair of Petsavers’ Grants Awarding Committee (GAC). Money raised by Petsavers is distributed by GAC to people researching vital research projects, and the committee assesses applications for new grants and reviews reports of ongoing projects and programmes. Further information on Petsavers GAC and instructions on grant applications are available on the Petsavers website or by request from [email protected]. It is vital that we all maintain fundraising and donations to Petsavers in order to continue awarding grants for this research. ■

As one of your member benefits BSAVA has negotiated a valuable ongoing 10% discount for its members joining WPA´s individual health and dental plans. WPA is a

not-for-profit health insurer with a heritage of over 100 years – and is offering another special where you can cover your partner (or another family member) free of charge in year one when you take up private medical insurance, then get your 10% discount in year two. This is exclusive to BSAVA members and ends 30 April 2010. For details email [email protected] or call 07919480159. ■

Health insurance offer for members

Victoria Roberts explains what it means to be one of the volunteers that run the BSAVA

02 Page 2.indd 2 18/3/10 15:41:10

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CPDCPD

In a BSAVA day CPD course, Dr Sue Shaw of Bristol Vet School’s Acarus Unit will discuss how climate change, companion animal travel and increasing

wildlife reservoirs of infection are resulting in emergence of unfamiliar companion animal diseases in the UK. Angiostrongylosis, leishmaniosis, mycobacterial diseases, babesiosis and borreliosis were previously either not present in the UK or were rarely diagnosed . The recognition of clinical disease in such cases can be a challenge – as can the diagnosis, because many of these diseases may be sub-clinical or chronic in partially immune animals. The recent development of PCR adds an essential component to diagnosis and its interpretation compared to serological methods will be discussed.

Even after diagnosis, treatment of these diseases can be a real problem as several drugs are unlicensed

in the UK, are expensive and are not easily available. Once obtained, there are toxicities and side-effects associated with treatment. Knowing your way around the practicalities and legalities of importing drugs is essential when treating this group of diseases.

At present no vaccinations for these diseases are available in the UK. In the vector borne disease, control is directed at decreasing exposure to infected arthropods using ectoparasiticides, Combining the appropriate ectoparasiticides to control transmission of infection presents a major challenge for practising vets and will be discussed in detail.

The recognition of the importance of intermediate or reservoir hosts such as ticks, fleas, flies, molluscs, wild rodents and foxes in disease epidemiology is coming increasingly clear. Where intermediate hosts are present in the environment, control of companion animal disease also requires understanding of the biology and epidemiology of the intermediate hosts, whether they be rodents or slugs. As vets we need to be aware that most cats/dogs are innocent bystanders in a story which spans multiple scientific disciplines.

Dr Shaw will weave together all these interesting aspects at the course in June. For more information or to book visit www.bsava.com or call 01452 726700. ■

Emerging, infectious and parasitic diseases in the UK

The three mini-modules will together cover various aspects of care of the anaesthetised and perioperative patient. The first will focus on pain

management and analgesia; in the second, individual sessions will examine different

patient conditions and how they affect anaesthetic management; and in the third

a temporal approach to anaesthesia will be discussed, working from initial

assessment and stabilisation through to the recovery period. Lectures will be illustrated with clinical examples and there will be

ample opportunity for discussion of points raised by delegates.

For more information or to book visit www.bsava.com

or call 01452 726700. ■

Anaesthesia mini-modulesIn May, June and July you can cover every angle of anaesthesia with the BSAVA mini-modular course in Gloucester

In a BSAVA CPD day held in Leeds on 24th June, Dr Sue Shaw will weave together some of the issues regarding diseases of emerging significance to the UK practitioner

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AMPUTATIONAMPUTATION

Feline amputation study

Four legs goods, two legs bad – three legs, err, probably OK, really. That is about as much as we currently know about the impact of a limb

amputation on the affected animal. Due to the inability of cats to tell us what they are thinking, we have no idea whether the patient experiences any serious physical or psychological distress. However, the anecdotal evidence from the owners of tripodal cats and their veterinary surgeons suggests that a cat will usually adapt fairly rapidly to its changed circumstances.

New studyIn her PhD studies at the RVC’s Centre for Animal Welfare, Lyn Forster is investigating whether or not cats experience the same tingling or burning sensations

Up to 80% of people who have suffered the amputation of an arm or leg will experience phantom pain from the missing limb. Increasing numbers of dogs and cats are undergoing similar surgery to remove limbs damaged by trauma or disease. So do these animals feel the same painful sensations from the nerves that served their lost limb? John Bonner met Lyn Forster, a PhD student at the Royal Veterinary College, who is studying the effects of leg amputation on feline patients

AMPUTATION

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AMPUTATION

reported by human amputees. “I am trying to discover whether phantom limb pain exists in other species but that is not the whole story. I will be looking at how the owners think the quality of life of their animal has changed, how they cope generally with severe orthopaedic trauma, and how issues such as pain management are dealt with.”

Her first goal was to try and get some idea of the numbers of cats surviving on three legs. As there are not even any reliable figures on the total feline population in the UK, it is no surprise that this statistic is also lacking. But the results of a questionnaire survey completed by the owners of 204 feline amputees should be a step in the right direction. She asked them to provide details of their cat’s age/sex/breed, the circumstances of the injury, the treatment provided and the animal’s postoperative response.

Groundbreaking feline investigationHer initial findings have been submitted for publication in a leading veterinary journal. As far as she knows, this will be only the second ever paper to assess the views of owners on the effects of this type of surgery on their pet’s quality of life. A study by the Dutch veterinary surgeon Jolle Kirpensteijn in 1999 looked at owner satisfaction in the case of 44 dogs treated by surgical amputations.

Lyn’s group is not only another species; the underlying problem in her cases is also different from the animals in the Dutch study. Kirpensteijn’s dogs were mainly bone cancer cases; her cats are predominantly traumatic fracture or nerve damage cases. It is likely that these will have been the result of road traffic accidents (RTA) but in most cases there were no witnesses. Lyn notes that there are many other potential causes – not only tumours but gunshot wounds, dog attacks, firework injuries, and congenital damage.

Statistics on RTA cases show that cats under 4 years old are particularly vulnerable to this sort of injury. Her sample shows a similar bias but the results are also skewed towards cats with very recent injuries, suggesting that vets and owners were more inclined to reply to the survey if the details were fresh in their minds.

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AMPUTATION

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Feline amputation study

There is also a statistically significant excess of hindlimb amputations in the sample. This is something that Lyn will be investigating further during her study, to assess whether this reflects the type of injuries seen or the willingness of vets and owners to go ahead with this procedure. “But it is quite reassuring that so far there doesn’t seem to be much difference in the cats’ responses. So removing a forelimb isn’t something that appears to cause any particular problems.”

Lyn is due to complete her doctorate in 2012 and the questionnaire survey is only the initial phase of the study. She now wants to dig a little deeper into how owners perceive their cat’s experiences. Making indirect assessments of welfare creates some difficulties, and Lyn needs to avoid asking leading questions that produce the sort of answers that owners believe that she wants. So she is looking for what her PhD supervisor Professor Christopher Wathes calls ‘iceberg indicators’.

These are factors that may not appear significant to the owner but which demonstrate an underlying problem – postoperative changes in the amount of time that the cat spends grooming, for example. Unfortunately, it is often difficult for the owners to make accurate comparisons if, for example, the injury occurred at an early age or before they acquired the pet.

Future focusAn obvious focus for future studies will be the biomechanical effects of moving around on three legs. Analysing postoperative gait changes in companion animals is the main research interest of Dr Sandra Corr, who shares responsibility for supervising Lyn’s project. Extended follow up of the cases identified in the preliminary survey may also reveal any chronic effects. There are few current data on the effects of amputation on longevity but Lyn has found several cats that have survived into a respectable old age; the current record is 16 years post surgery.

The key question, of course, is whether or not a tripodal cat lives a pain-free existence. Again the initial results look encouraging. Most of the cats

included in the survey received standard postoperative analgesia but in many

cases the owner could not remember all the relevant details. However, only a few owners reported any signs of long-term pain and it is not clear whether they are describing neuropathic effects or just normal postoperative discomfort.

Human connectionIf significant species differences

do exist in the mechanism and experience of phantom limb pain,

this research will be of potential interest in guiding human healthcare.

Lyn does point out that the majority of human amputations are carried out for very

different reasons to those in her study. Diabetic neuropathy is the major problem that necessitates

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AMPUTATION

…the key question, of course, is whether or not a tripodal cat lives a pain-free existence…

amputation in UK citizens and so the human patient population is mainly older and with underlying vascular and neurological problems. Yet, with so many conflicts occurring around the world there is never any shortage of younger and otherwise healthy trauma victims to provide a basis for comparative studies.

Those studies published in the human literature show that complex psychological factors may influence the patients’ experiences. In essence, those people suffering from depression are more likely to have more severe problems with chronic pain. So investigations into how a cat may perceive its past experiences and current situation – and how this influences their pain levels – will be a challenging topic for future research.

Analysing owners’ anecdotesIn the meantime, however, Lyn is carrying out further analyses of the information provided by the owners of the 204 cats included in her study. Their responses have produced intriguing hints as to how amputation affects the cat’s behaviour and whether they still feel any sensation from the missing limb. “There is a lot of interesting anecdotal material in the survey results which has not been included in the initial paper. Many owners describe how their cat appears to be trying to use the missing limb to groom itself. We cannot tell at the moment whether that is because it still feels a sensation from the limb or whether it is just force of habit. Certainly, one owner did report that their cat seems to be frustrated that it could not groom itself properly but then again there was another owner who stated that their cat would try to scratch its ear with the missing hindlimb – and showed every sign of enjoying the experience.” ■

BSAVA MANUAL OF CANINE AND FELINE MUSCULOSKELETAL DISORDERSEdited by John E.F. Houlton, James L. Cook, John F. Innes and Sorrel J. Langley-Hobbs

Conditions of joints, bone, ■

tendon and muscleAssessing and treating ■

lamenessFocus on arthritis ■

Postoperative rehabilitation ■

Step-by-step illustrated ■

Operative Techniques

‘…a great tool for anyone who is interested in the diagnosis and treatment of musculoskeletal disorders in dogs and cats’ Veterinary and Comparative Orthopaedics and Traumatology

Member price: £59.00Price to non-members: £89.00

For more information or to buy the manual visit www.bsava.com or call 01452 726700

AMPUTATION

CONTRIBUTE TO companionBSAVA wants companion to be a useful and valuable resource for BSAVA members – it is your publication. So if you have any ideas for editorial subjects, have a “How To…” article you would like to see, or even want to submit your own clinical conundrum, then we want to hear from you.

Email [email protected] or call 01452 726718 during office hours to speak to Kay Pringle.

companion

companion to be a useful and valuable resource for

BSAVA members – it is your publication. So if you have any ideas for editorial subjects, have a “How To…” article you would like to see, or even want to submit your own clinical conundrum, then we want to

or call 01452 726718 during

companion

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CLINICAL CONUNDRUM

Clinical conundrumconundrum

Kirsty Roe of Willows Referral Service invites companion readers to consider the investigation of an inappetent ascitic cat

Case presentationA 5-year-old male neutered DSH cat presented with a 4-week history of weight loss, inappetence and abdominal distension. On presentation the cat was quiet but alert and responsive (BCS 3.5/9). Rectal temperature was 38°C, heart rate was 180 beats per minute and respiration rate was 30 breaths per minute. Thoracic auscultation was unremarkable. Abdominal palpation revealed a fluid thrill. Fundic exam was unremarkable.

neoplasia, right-sided congestive heart failure, inflammatory disease, pancreatitisExudate:■■

Non-septic: FIP, lymphocytic cholangitis, –amyloidosis, pancreatitis, steatitis, neoplasiaSeptic: penetrating wound, intestinal –perforation, ruptured abscess, migrating foreign body

Uroperitoneum■■

Bile peritonitis■■

Chyloperitoneum: neoplasia, congestive heart ■■

failure, steatitis, ruptured lymphatic vessel or obstructed lymphatic drainageHaemoperitoneum: ruptured vessel or organ ■■

secondary to trauma or neoplasia, ruptured liver secondary to amyloidosis, coagulopathy.

Congestive heart failure could not be ruled out by the absence of any abnormalities on cardiac auscultation, although ascites is an unusual presentation of congestive heart failure in a cat. If haemoperitoneum were present, the cat would be expected to show signs of hypovolaemic shock.

Construct an initial diagnostic and treatment plan, justifying the reasons for each investigationHaematology, biochemistry and urinalysis were performed to evaluate protein levels and liver parameters. Hyperglobulinaemia may be present with FIP and hypoalbuminaemia could result in transudate formation. Test results are shown in Tables 1–3.

ELISA tests for FeLV antigen and anti-FIV antibody were performed, as immune dysfunction and neoplasia can occur secondary to infection with either or both viruses. FeLV and FIV serology was negative.

Abdominocentesis was performed to collect a diagnostic sample of peritoneal fluid, rather than to drain the abdomen: 2 ml of a clear colourless fluid were obtained (Figure 1) with a protein level of 10 g/l and a nucleated cell count of < 1 x 109/l. Culture of the fluid was negative.

Intravenous fluid therapy (Hartmann’s supplemented with KCl 20 mmol/l) was initiated at 2 ml/kg/h for maintenance requirements.

Create a problem list and consider the differential diagnoses for these problems, prioritising those differentials that are most pertinent

Problem list:Weight loss and poor body condition■■

Inappetence■■

Abdominal distension■■

Ascites.■■

The weight loss and inappetence were considered likely secondary to the underlying disease process and the abdominal distension was probably due to the presence of ascites, suggested by the abdominal fluid thrill. The major problem was therefore ascites.

Differentials for ascitesTransudate: hypoalbuminaemia.■■

Modified transudate: portal hypertension/ ■■

obstruction of caudal vena cava, abdominal

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CLINICAL CONUNDRUM

Parameter Day 1 Reference range Units

WBC 9.34 5.5–19.5 x109/l

Neutrophils 7 2.5–12.5 x109/l

Lymphocytes 1.87 1.5–7 x109/l

Monocytes 0.0 0–1.5 x109/l

Eosinophils 0.47 0–1.5 x109/l

RBCs 5.6 5.5–8.5 x109/l

Hb 8.2 5–10 x109/l

HCT 27 25–45

MCV 44.9 39–55 fl

MCHC 35.1 30–36 g/dl

Platelets 220 200–800 x109/l

Smear Normal red and white blood cell morphology

Table 1: Haematology results

Parameter Day 1 Reference range Units

Albumin 13 28–42 g/l

Globulin 30.1 28–42 g/l

Sodium 157.7 153–162 mmol/l

Potassium 5.00 3.8–5.3 mmol/l

Chloride 121.8 110–121 mmol/l

Calcium 1.93 2.07–2.8 mmol/l

Phosphorus 1.75 0.92–2.16 mmol/l

Urea 11.1 6.1–12 mmol/l

Creatinine 158 107–193 µmol/l

Cholesterol 5.1 2.2–6.7 mmol/l

Bilirubin 0.2 0–3 mmol/l

ALT 40 25–130 IU/l

CK 149 52–506 IU/l

ALP 22 11–58 IU/l

Glucose 5 3–5 mmol/l

Table 2: Biochemistry results (abnormal results in bold)

Parameter Result

Specific gravity 1.035

pH 6.5

Nitrite Negative

Protein +++

Glucose Negative

Ketones Negative

Bilirubin Negative

Blood Negative

Sediment Unremarkable

Table 3: Urinalysis results

Figure 1: Abdominocentesis fluid sample

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CLINICAL CONUNDRUM

Clinical conundrum

How does interpretation of the test results help refine the differential diagnosis?The marked hypoalbuminaemia was consistent with excessive protein loss (protein-losing enteropathy or protein-losing nephropathy (PLN)) or decreased production (liver failure). It was too severe to be due to decreased protein intake or secondary to chronic effusion. Liver failure was unlikely, as other biochemical markers of decreased liver function such as hypoglycaemia or hypocholesterolaemia were not present. A bile acid stimulation test could have been performed to assess liver function more accurately. Hypocalcaemia was secondary to the hypoalbuminaemia due to a decrease in the circulating protein-bound calcium fraction.

Proteinuria was present that could be due to pre-renal (overload), intrinsic renal or post-renal disease. Pre-renal (or overload) proteinuria was unlikely with a normal globulin level and the degree of proteinuria was too severe to be functional such as following exercise or stress. As the urine sediment was inactive, a post-renal cause such as a UTI was unlikely, so the proteinuria was most likely secondary to intrinsic renal disease.

The ascitic fluid was a transudate secondary to hypoalbuminaemia, which was consistent with the biochemistry results.

What further investigations may be helpful at this stage?Urine protein:creatinine ratio (UPCR) was assessed and urine culture performed to quantify the proteinuria and rule out occult UTI. UPCR was 12.3 (reference range <0.4) and culture was negative, consistent with PLN.

Since PLN can be triggered by infectious, inflammatory or neoplastic disease, thoracic radiography and abdominal ultrasonography were performed to look for evidence of underlying diseases. Abdominal radiographs were not taken, as poor serosal detail would have been present due to the ascites. If the ascites had been a septic exudate or urine, radiographs may have been useful to reveal free abdominal gas associated with GIT rupture, or positive contrast radiography of the urinary tract may have indicated a urinary tract rupture.

Thoracic radiographs were unremarkable. Abdominal ultrasonography (Figure 2) revealed a hypoechoic, enlarged left limb of the pancreas with a hyperechoic appearance to the surrounding fat. The kidneys were ultrasonographically normal.

What are the most likely differential diagnoses considering all the results so far?PLN and pancreatitis were considered the most likely differential diagnoses. It should however be noted that peri-pancreatic oedema could occur due to pressure from the ascites, and pancreatic oedema has been associated with hypoalbuminaemia and portal hypertension: the ultrasonographic abnormalities could therefore have not been due to pancreatitis. PLN was likely caused by glomerulonephritis (primary/idiopathic or secondary). Although proteinuria can occur with defective renal tubular resorption or glomerular capillary hypertension in the absence of classic primary glomerular disease, typically only low-level proteinuria (UPCR 0.4–2) results. Pancreatitis could be triggering PLN or could be a concurrent and unrelated disorder.

What further investigations would you perform?Feline pancreatic lipase was measured to help confirm the diagnosis of pancreatitis and was 30.6 µg/l (reference range 4.1–12.9 µg/l). Non-invasive Doppler blood pressure measurement revealed a systolic blood

Figure 2: Abdominal ultrasound image showing enlarged left pancreatic limb with hyperechoic surrounding fat

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CLINICAL CONUNDRUM

pressure of 152 mmHg; systemic hypertension may occur as a consequence of glomerular disease. Antithrombin was 100% normal. This was measured because antithrombin is approximately the same size as albumin and its loss, along with other factors, contributes to the propensity for thromboembolism to occur with PLN. It is important to investigate thoroughly for underlying disease that can trigger glomerulonephritis. Diseases reported in association with glomerular disease in cats are listed in Figure 3.

InfectiousBacterial: chronic bacterial infection (G), –Mycoplasma polyarthritis (G)Viral: FIV (G), FIP (MN), FeLV (G, MN) –

InflammatoryPancreatitis (G) –Cholangiohepatitis (G) –Chronic progressive polyarthritis (G) –Systemic lupus erythematosus (MN) –Other immune-mediated disease (G) –

NeoplasticLeukaemia (MN) –Lymphosarcoma (MN) –Mastocytosis (G) –Other neoplasms (G) –

MiscellaneousMercury toxicity (MN) –Familial (MN) –Idiopathic (MN) –Amyloidosis (G) –

Figure 3: Diseases associated with glomerular disease in cats (G, glomerulonephritis, uncharacterised; MN, membranous nephropathy

examination with immunofluorescent microscopy and electron microscopy of the glomeruli from a biopsy specimen of the renal cortex. Biopsy may suggest the underlying cause of glomerular disease and allow institution of a more directed treatment plan. There is a significant risk of haemorrhage associated with renal biopsy and the main question that must be addressed to warrant the risk is whether the histopathological findings would substantially alter the treatment plan. Since a potential underlying trigger of glomerulonephritis had been found, biopsy was not performed in this case.

A medical management planTreat any underlying infectious, inflammatory or ■■

neoplastic disease.Angiotensin-converting enzyme inhibitor ■■

(benazepril 0.5–1 mg/kg orally q24h) to decrease proteinuria. Serum creatinine should be monitored as azotaemia can occur as a side effect.Low-dose aspirin (5–10 mg orally once every ■■

3 days) to reduce glomerular inflammation and inhibit platelet aggregation*.Protein- and phosphorus-restricted diet if ■■

concurrent chronic kidney disease; although if hypoalbuminaemia gets worse, protein restriction should be assessed on an individual case basis.Omega-3 polyunsaturated fatty acids (reduced ■■

proteinuria and slowed progression of renal disease in canine studies).Amlodipine (0.625–1.25 mg orally q24h) if ■■

systemic hypertension is present that persists despite ACE inhibitor.Immunosuppressive therapy may be indicated ■■

in non-azotaemic cats with primary/idiopathic membranous nephropathy diagnosed by histopathology.

*Inhibition of prostacyclin synthesis by aspirin could decrease the acute vasodilatory effect of angiotensin-converting enzyme inhibition although theoretically, low-dose aspirin can selectively inhibit platelet cyclooxygenase without preventing beneficial prostacyclin (vasodilator and platelet aggregation antagonist) formation. ■

DiagnosisA diagnosis of glomerulonephritis secondary to pancreatitis was made. Idiopathic glomerulonephritis and concurrent pancreatitis could not be ruled out however. Different forms of glomerulonephritis include membranous glomerulopathy, membranoproliferative glomerulonephritis and proliferative glomerulonephritis, based on histopathological appearance. Membranous glomerulopathy is most common in cats and amyloidosis, in general, is uncommon.

Are there any further diagnostics you might discuss with the owner and how would you manage this case?A definitive diagnosis requires histological

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HOW TO…

How to…

Perform a successful joint tap

Alasdair Renwick of Willows Referral Service, Solihull, points us in the right direction

A joint tap, or more correctly arthrocentesis, refers to the surgical puncture of a joint cavity for aspiration of synovial fluid. It is a vital tool in the investigation of joint disease allowing gross examination, cytology

and bacterial culture of synovial fluid. It can be used in the investigation of any arthropathy, but should be considered to exclude sepsis in cases with chronic osteoarthritis presenting with an acute deterioration, in cases presenting with single inflamed joints, and is essential in the diagnosis of immune-mediated polyarthritis. In addition, arthrocentesis allows instillation of contrast media for contrast arthrography and also allows injection of medications directly into the joint cavity.

In most cases heavy sedation or general anaesthesia is required. The joint to be aspirated should be clipped of hair and prepared aseptically. The operator should scrub their hands and wear sterile surgical gloves. A variety of needles should be available: 21 G 1" or 1.5" needles are appropriate for most joints. 23 G needles may be needed for smaller joints such as the carpus or tarsus and may be needed for smaller dogs and cats. 3" spinal needles may be required for the hip joint in large dogs. Glass slides should be available to make direct smears, and fluid collection tubes are required if samples are to be submitted to an external laboratory. These tubes should be either plain or with EDTA, depending on the individual laboratory’s preference. If sepsis is suspected, blood culture medium should be available as synovial fluid frequently shows no bacterial growth in the presence of infection when cultured directly on agar plates.

Figure 1: Arthrocentesis of the left shoulder joint. The dotted line outlines the scapular spine and the solid line the greater tubercle

Figure 2: Arthrocentesis of the left elbow (lateral view). The dotted line outlines the lateral aspect of the humeral condyle. The solid line outlines the proximal extent of the olecranon and the dot marks the position of the lateral epicondyle

Shoulder jointThe needle is inserted approximately 5–10 mm distal to the acromion (for a medium sized dog) and aimed slightly proximally until it is felt to enter the joint (Figure 1). If no fluid is obtained, an assistant can apply gentle traction on the distal limb to open up the joint space.

Elbow jointTechnique 1: Extend the elbow to allow the capsule to distend caudally. The needle is inserted lateral to the olecranon or triceps tendon and aimed into the olecranon fossa (Figure 2). Alternatively, with the elbow flexed, the needle can be inserted into the caudolateral aspect of the joint between the olecranon and the lateral epicondylar ridge.

Technique 2: With the medial surface of the elbow uppermost, palpate and then draw an imaginary line from the greater tubercle and through the medial epicondyle of the humerus. The caudodistal edge of the medial aspect of the humeral condyle can be palpated approximately 1 cm (for a medium sized dog) on this line distal to the medial epicondyle. A neurovascular bundle (ulnar nerve and recurrent ulnar artery) can usually be palpated subcutaneously and avoided. The needle is inserted at this point and aimed in the same line about 30–45 degrees from vertical until the needle is felt to enter the joint (Figure 3).

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HOW TO…

Figure 4: Arthrocentesis of the left carpus (craniolateral view). The dotted line outlines the distal aspects of the radius and ulna and the solid line marks the cranioproximal aspect of the radial carpal bone

Figure 3: Arthrocentesis of the left elbow (medial view) using the alternative technique. The broken line marks the medial aspect of the humeral condyle and the circle marks the position of the medial epicondyle

CarpusBy palpating the dorsal aspect of the distal radius, the level of the radiocarpal joint can be identified on flexion and extension of the joint. With the joint flexed the needle is inserted into the radiocarpal joint (Figure 4). Tendons and vascular structures on the dorsal aspect of the carpus should be avoided.

Figure 5: Arthrocentesis of the left hip (lateral view). The dotted line outlines the greater trochanter

Figure 6: Arthrocentesis of the right hip using the alternative technique (ventral view). The dotted line outlines the pectineus muscle. Great care must be taken with this technique

HipTechnique 1: The needle is inserted cranial and proximal to the greater trochanter and directed slightly ventrally and caudally (Figure 5). This technique can be difficult in large, well muscled breeds due to the distance of the joint from the skin.

Technique 2: With the animal in dorsal recumbency allow the hindlimbs to abduct. The ventral aspect of the hip joint can be palpated caudal to the band of the pectineus muscle. The femoral artery and vein can be palpated cranial to this muscle. The needle is inserted in line with the long axis of the femur, with the tip of the needle angled slightly medially from the sagittal plane (Figure 6). Care must be taken with this technique to identify the femoral artery. There is a slight risk of injury to deep femoral artery and vein.

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Figure 10: Arthrocentesis of the left hock (cranial view). The dotted line outlines the talocrural joint

Figure 7: Arthrocentesis of the left stifle (craniolateral view). The solid lines outline the patella and the tibial tuberosity and the dotted line outlines the lateral aspect of the patellar tendon

Figure 8: Arthrocentesis of the left stifle (cranial view) using the alternative technique. The solid lines outline the patella and the tibial tuberosity and the dotted line outlines the patellar tendon

Perform a successful joint tap

Figure 9: Arthrocentesis of the left hock (lateral view). The solid line outlines the lateral malleolus of the fibula

Stifle joint

Technique 2: With the stifle partially flexed, digital pressure is applied either medial or lateral to the patellar tendon. The needle is inserted on the opposite side of the patellar tendon and directed proximally towards the patella, aiming to enter either the medial or lateral recess (Figure 8). Alternatively, the needle can be directed into the femoropatellar space. Fluid can often be more reliably obtained with this method.

Technique 1: With the stifle partially flexed, the needle is inserted medial or lateral to the patellar tendon half way between the patella and tibial tuberosity and is directed caudally (Figure 7). Fluid frequently cannot be obtained with this method as the needle tip lies within the fat pad or cruciate ligaments.

HockTechnique 1: Hyperflex the hock joint. The needle is inserted perpendicular to the long axis of the tibia, medial to the lateral malleolus of the fibula (Figure 9). If the joint is more effused dorsally, try technique 2.

Technique 2: Palpate the talocrural joint space on its cranial aspect and insert the needle perpendicular to the long axis of the tibia (Figure 10). It is best to insert the needle slightly off the midline so that it enters the medial or lateral tibial sulcus.

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HOW TO…

Collection and analysisOnce the needle has been inserted into the joint space, apply gentle suction via a 2.5 or 5 ml syringe. Once fluid is obtained, release the negative pressure and remove the needle. If blood is obtained withdraw the syringe immediately and try again with a new syringe and needle at an adjacent site. Blood contamination is unavoidable in some cases. While this will increase the cell counts, a relative increase in leucocytes can usually be appreciated when present. Once the needle is withdrawn a visual estimate of viscosity can be made by the string test (Figure 11), with a normal joint giving a 2.5–5 cm or more string. In diseased joints this may be reduced to 1–2 cm. Viscosity is related to hyaluronan concentration or hyaluronan chain length, which can vary with dilution due to effusion or reduced production due to synovitis. However, normal viscosity can be maintained in some osteoarthritic joints. In cats and small dogs, only a few drops of synovial fluid may be obtained, which should be used to make direct smears. If greater volumes are obtained these should be placed into collection tubes as above. A visual estimate of fluid quality can be made; fluid should be clear and colourless or very pale straw coloured. Abnormal synovial fluid may be turbid or contain visible clots of purulent exudate (Figure 12). Inability to read printed text through a sample indicates increased turbidity.

Cytology of synovial fluid is often the most useful test. This can be done in house, on stained smears, for example with “Diff Quik”, or by an external laboratory. External laboratories offer the advantage of accurate

cell counts as long as sufficient volumes of fluid have been obtained. Normal synovial fluid contains < 3 x 109

cells/l, which should be > 90% monocytes (see Table 1 overleaf). Osteoarthritic joints usually contain < 5 x 109

cells/l which contains > 90% monocytes (Figure 13), but effusion often allows aspiration of greater volumes of fluid; in addition, the fluid is often slightly more discoloured than normal fluid. In some cases, such as traumatic arthritis, a greater proportion of polymorphonuclear cells may be seen (20–30%); however, total cell counts are generally < 5 x 109/l in these cases. Septic joints will have increased numbers of leucocytes (> 5–10 x 109/l) with a high proportion (usually > 90%) of polymorphonuclear cells, and bacteria may be visualised (Figure 14). Cases of

Figure 11: Visual estimate of viscosity of synovial fluid from a normal joint

Figure 12: Synovial fluid from a septic joint. The fluid is turbid

Figure 13: Monocytes in synovial fluid from a joint with osteoarthritisCourtesy of Cytopath Diagnostic Veterinary Pathology Laboratory

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BSAVA MANUAL OF CANINE AND FELINE CLINICAL PATHOLOGYEdited by Elizabeth Villiers and Laura Blackwood

Member price: £50.00Price to non-members: £89.00

For more information or to buy the manual visit www.bsava.com or call 01452 726700

Perform a successful joint tap

Figure 15: Synovial fluid from a dog with immune-mediated polyarthritis. The cells are predominantly polymorphonuclear leucocytes

In summary, arthrocentesis is a quick and relatively straightforward procedure that can provide vital information in obtaining a definitive diagnosis and should be considered in any animal presenting with an arthropathy. ■

Figure 14: Mixed cells but predominantly polymorphonuclear leucocytes in synovial fluid from a septic joint. Intracellular bacteria can be seen (arrowed)Courtesy of Cytopath Diagnostic Veterinary Pathology Laboratory

immune-mediated polyarthritis have variable total white cell counts (generally > 5 x 109/l) but those present are predominantly polymorphonuclear cells (Figure 15). It is important to realise that there is considerable overlap of these values between different conditions. Thus a normal and an osteoarthritic joint can be very similar. Likewise septic joints and those affected by immune-mediated polyarthritis can be difficult to differentiate on cytology. Correlation with clinical findings is thus

Cell count (x 109) cells/l

Cell types

Normal < 3 >90% monocytes

Osteoarthritis < 5 Usually >90% monocytes

Immune-mediated polyarthritis

Variable Predominantly polymorphonuclear cells

Septic > 5–10 Predominantly polymorphonuclear cells

Table 1: Typical cell counts from various arthropathies

important. A single joint with increased polymorphonuclear cells is more likely to be septic, whereas multiple joints with similar cytology are more likely to be associated with immune-mediated polyarthritis. If sepsis is suspected, synovial fluid should be placed in blood culture medium for transport to an external laboratory. In this situation it is especially important that aseptic technique is used as sample contamination and false positive cultures may be seen.

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Jackie Kirby – Waukesha Small Animal Hospital, Waukesha, WI

I have a 6 1/2 YO MN greyhound with a history of elevated BUN/CR and proteinuria. We first noted the elevated BUN/CR twelve months ago with some screening lab work. His BUN at that time was 13.2 mmol/l (2.5–9.6) and his CR was 190 umol/l (30–137). His CBC showed a decreased neutrophil count. A UA revealed an SG of 1.022 and 2+ protein. A urine PR:CR ratio was 0.85 (at that time the normal range was <1).

We repeated lab work in six months ago and his BUN was 15 mmol/l and his CR was 183 umol/l –fairly stable values. Advised repeating first of am urine and rechecking Pr:cr ratio. Today the Owner dropped the dog off first thing this AM urine: SG was 1.018 and 2+ protein. His urine Pr:cr ratio was 0.81-stable but the reference range is now <0.5.

Repeated bloodwork. BUN 19 mmol/l, CR 229 umol/l. Still low neutrophil count-normal for him? Also T4 is low at 5.1 nmol/l (11.6–50.0). He has no PU/PD and is doing well.

He has been recently switched to raw diet because he has had a long history of soft stool that did not seem to improve with diet changes but responded fairly well to Tylan (tylosin).

She is currently feeding Canine carnivore brand diet-and he gets 14 OZ BID and she just started adding in 1 OZ of fruit and veggies. His weight is down about 2 pounds. She says his stools are great-best they have ever been and does not want to change diet if poss. I expressed concern for his kidneys with this high protein diet. She also gives ivermectin orally as a heartworm preventative.

My concerns/questions are:

1) Is there a raw diet out there that would be good for renal disease? The owner is certain that the “grains” in the dry foods are responsible for his GI issues.

2) Since this has been going on for at least 1 year- is there any benefit to doing further diagnostics. I have discussed work-up with owner but she hasn’t wanted to pursue because he is clinically doing so well. I was thinking that a BP was indicated and will try to get her to do that at least. Do you advise starting these guys on an ace inhibitor???

3) Do greyhounds commonly run low Total T4’s and WBC counts? I am having trouble finding any references.

Sherri Wilson DVM, VIN ConsultantAnimal Critical Care and Emergency Svcs, Seattle, WA

Before being able to interpret the UPC we need to culture the urine first (via cysto, automatically, even if the sediment is quiet, as the urine is too dilute to ‘see’ a UTI in all dogs)

Also measure blood pressure, as hypertension can result in a mild degree of proteinuria (and vice versa)…

Also we should start Calcitriol–are you familiar with using this? Parathyroid hormone is the primary toxin of renal disease and controlling it clearly prolongs survival in humans with renal failure. We can start it now if the phosphorus is 1.95mmol/l… if the phosphorus is higher than this, we need to decrease it (by using low-protein food ± aluminum hydroxide to bind it), then use the Calcitriol once it is low enough.

You’re right–a low protein diet would be called for here… and it should be cooked. See http://www.vin.com/Link.plx?ID=4423725

And yes greyhounds have T4 levels and neutrophil counts that are lower than in other breeds…

GrapeVINeThe Veterinary Information Network brings together veterinary professionals from across the globe to share their experience and expertise. At vin.com users get instant access to vast amounts of up-to-date veterinary information from colleagues, many of whom have specialised knowledge and skills. In this regular feature, VIN shares with companion readers a small animal discussion that has recently taken place in their forums

Discussion: Greyhound with kidney disease

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Mark Taylor MA, DVM, Blacksburg, VA

I would strongly discourage feeding raw. I believe that anyone who aids, assists, or encourages a client to feed raw might be liable for anything that happens in that family, whether it is to the humanoids or the critters. Might be a good legal question!!!

Jackie Kirby

I do discourage raw and make sure they are aware of the risks but I can’t prevent them from being used and was wondering if anyone knew of one that would be appropriate for renal disease. I think she may consider doing a home cooked diet so if anyone knows of a good recipe- I think I have the Hills clinical nutrition recipe but was wondering if there was anything else out there. I will try to get her onto a RX renal diet but I have a feeling it won’t happen. His phosphorus is 1.07 mmol/l (0.68–2.03), so it sounds like using the Calcitiol would be an option. I will try to get the BP and Culture done.

Joe Bartges DVM, PhD, DipACVIM, DipACVN, Professor of Medicine and Nutrition & Acree Endowed Chair of Research, The University of Tennessee

For what it’s worth:

– I don’t discourage raw – but do talk about potential issues of balance, hygiene, etc

– Greyhounds normally run “high” on creatinines because of muscle mass – so a creatinine of 190–230 umol/l or so, is not unusual or necessarily abnormal for a greyhound

– hard to interpret the BUNs because depends on dietary protein intake – and higher protein, raw food diets are associated with “higher than normal” BUN values

– the dilute urine, though, is a concern – but again, hard to interpret depending on water mixed in with the diet (expedially the veggies – and particularly if a puree of veggies)

– dog is a clinically normal (other than stools – which are normal now) 6 + 1/2 year old dog – treat the patient, not the paper… treating for “renal disease” may be an overinterpretation of his blood work given his history and dietary intake.

– need to recheck the UP;UC and potential for UTI – but UTI sounds less likely and he is a male which makes it less likely. Is his albumin concentration normal? Cholesterol?

Jackie Kirby

His albumin is 2.9 (2.5–3)- stableCholesterol is 229 (112–328)I guess the concern is the proteinuria/dilute urine.

Would you leave the diet alone?? This one is a tough call because his stools are normal finally.

Mark Taylor

No, I would have a balanced diet that is low in protein in order to prevent or exacerbate further damage to the mesangium.

See the front of this folder (VIN Clinical nutrition) for a list of services that can help. Whether or not the client cooks the ingredients will fall on them.

Unlike others, I think raw should be discouraged until we find a way to make the meats pathogen free. :)

Rebecca Remillard PhD, DVM, Diplomate of ACVN, VIN Consultant, Veterinary Nutritional Consultations, inc, Holliston, Ma & MSPCA Angell Animal Medical Center, Boston, Ma 02130& Erin Scaglione 4th vet student Iowa State

The increased renal values combined with dilute urine and proteinuria are likely real and indicate the start of renal insufficiency. A urine culture would be a good idea to rule out post-renal disease that may be influencing the proteinuria. Pre-renal azotemia should be ruled out as well as BUN often increases with a high protein diet. Have you considered pyelonephritis since a raw meat diet has been fed? This often causes the combination of protein loss through the kidneys as well as increased BUN and creatinine and the loss of concentrating ability.

GrapeVINe

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Considering pre and post renal disease ruled out, this dog needs to be on a lower phosphorus and protein diet. Changing the diet will not likely change the present renal values, particularly the proteinuria, creatinine and concentrating ability of the kidneys. However, BUN may decrease with a lower protein diet and the lower phosphorus will slow the progression of the disease.

Greyhounds are often fed a raw meat diet while they are racing. Their diets are very low in carbs which changes the microbial population and decreases the diet inducible carbohydrate enzymes in the gut mucosa. Without eating carbohydrates, these enzymes are no longer functioning. When carbs are reintroduced into the diet, the small bowel cannot digest them initially. The small intestine lacks the enzymes to digest the carbohydrates so readily available carbohydrates end up in the large bowel and result in diarrhoea. Considering this, it makes sense that this dog has solid stools on a predominantly meat diet, however this diet is not helping his kidneys. Diets high in protein are also usually high in phosphorus unless they are specially formulated. In order to lower the protein content of a diet, the carbohydrate content will inadvertently have to be increased.

There are a few options in this case in switching to a low-protein, low-phosphorus diet. In either case, slowly transitioning will be a key factor. It will take time to change the microbial population as well as the mucosal enzymes in the gut mucosa. This transition should be done over 4 to 8 weeks and any time there is loose stool, back off on the new diet. The first week, feed 25% new food to 75% previous meat diet. The next week, feed 50% of the new diet and the third week feed 75% of the new diet. The following week, feed 100% of the new diet. This is a rough schedule that will have to be adjusted depending on the dog’s response to the new diet.

K/D, or similar therapeutic diets (NF or LP) would be the commercial diet of choice for this case. Based on texture and moisture content, the canned may be a better choice since this dog is used to eating a diet higher in moisture and the higher water intake would benefit his kidneys. The new canned diet would have to be slowly added as previously described.

Another option would be a homemade diet. The dog can eat the same meat source that he is currently eating but cooked would be preferred. A carbohydrate would have to be added in increasing amounts to decrease the amount of protein. A fat source would be added as well since the final diet will consist of a lower proportion of meat and therefore lower fat as well. Since the owner seems opposed to the grains in commercial dog food, a carbohydrate source such as sweet potato or yams may be more appealing. Both of these also contain a moderate amount of fiber which would bind up water, change the microbial population and therefore help with any loose stool. Sweet potato does contain carbohydrates and will still need to be slowly transitioned based on the GI tract of this Greyhound, clients often view such foods differently than the grains in commercial dog foods. Recipes for balanced homemade diets can be found on websites such as BalanceIT.com. This particular website also provides a supplement for renal patients that is low in phosphorus.

There would be two ways to transition to a homemade diet. One would be to make the diet and add 25% of it to the old diet the first week and continue with the previously described schedule. Another way would be to slowly increase the proportion of carbohydrate and fat sources to the meat that the dog is already consuming, which should be cooked. Each stage of the transition would need to be complete and balanced. A nutritionist could come up with the different proportions of meat, fat and carbs to feed during the course of this dog’s transition to a new diet. Links and phone numbers for nutrition consults can be found on the VIN clinical nutrition homepage or the “About this folder” link.

You can continue to monitor a renal panel and a urine protein creatinine ratio for this dog every 6 months or so. As mentioned before, a most of the blood values will not change but, according to current thinking, the renal disease will not progress as quickly with a lower phos diet.

Erin – (This made a great teaching case because there are several things to consider. Thanks!)& Rebecca

Mark Taylor

Hi Erin, good report. Rebecca is fun to work with!!! I would add that if transitioning, definitely cook the meat. There is no sense in taking any chances!!!

VIN

All content published courtesy of VIN with permission granted by each quoted VIN Member. For more details about the Veterinary Information Network visit vin.com. As VIN is a global veterinary discussion forum not all diets, drugs or equipment referred to in this feature will be available in the UK, nor do all drug choices necessarily conform to the prescribing rules of the Cascade. Discussions may appear in an edited form.

This thread appears in an edited form. To read the full thread and access the links mentioned visit http://www.vin.com/Link.plx?ID=4423723

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Case history

A 2-year-old intact female English Mastiff was presented with a 1-month history of back pain and paraparesis. She had initially responded to dexamethasone and amoxicillin but had been paraplegic for the last week, managed at home due to financial limitations. Physical examination revealed: exudative superficial pyoderma over the ventral abdomen and inguinal region; severe flea infestation; and urine scalding in the perineal region. Extremely malodorous urine was expressed whenever the dog moved. There was a profuse growth of Escherichia coli on urine culture, which was resistant to most broad-spectrum antibiotics but sensitive to ciprofloxacin, amikacin and imipenem.

The dog had autoamputated the nail and last phalanx of two digits on her right hindfoot (Figure 1) and constantly licked at abrasions on the dorsal aspect. Neurological examination revealed paraplegia, with reduced pain sensation in both pelvic limbs. Neurological signs were localized to the thoracolumbar (TL) junction, based on spinal reflexes. Focal pain was elicited at the TL junction. Discospondylitis was diagnosed from spinal radiographs.

Discospondylitis – a case study in patient care

Major advances in veterinary practice mean that there is a growing population of companion

animals undergoing previously uncontemplated treatments and surviving what would once have been rapidly fatal conditions. This is cause for celebration, but there are some concerns. After major spinal, soft tissue and orthopaedic surgery the need for rehabilitative medicine is great, but it is not a subject generally covered in the veterinary curriculum, and it tends to be seen as less important than the procedures that may require its subsequent use.

Chronic conditions such as musculoskeletal pain or chronic visceral disease cause prolonged suffering but can be frustrating to treat. This Manual is aimed at the whole veterinary team, drawing on all their skills to help patients achieve as full a

The forthcoming BSAVA Manual of Canine and Feline Rehabilitation, Supportive and Palliative Care takes a new look at patient management. The editors, Penny Watson and Samantha Lindley, introduce this exciting new publication

function and quality of life as possible after surgery, trauma or disease, and to manage chronic conditions effectively for the benefit of animal, owner and the practice team. Principles of pain control, clinical nutrition and physical therapies are detailed, with reference to the increasing numbers of published studies supporting their efficacy and/or effectiveness in the rehabilitation and palliation of our patients.

A unique feature of the Manual is the case-based scenarios, such as the one below. If you, as a member of the practice team, had easy access to experts in each field within palliative and rehabilitative care, you would be able to construct a complete plan of care for your patient, utilising the skills within the practice and providing practical support for the owner. This book is your access to that expertise.

DISCOSPONDyLITIS IN A DOgThe information in this case has been contributed by the neurologist Natasha Olby together with specialist authors on pain management, adjunctive therapies, and nursing/homecare. Photographs illustrate the modes of care to be considered for similar cases; they do not all feature the initial patient described.

Figure 1: Mutilated third and fourth digits and severe decubital ulcers on the right hindfoot

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Agreed medical/surgical management

Oral ciprofloxacin* was prescribed for an in initial period of 4 weeks. Note: it would not be wise to use imipenem; its use is restricted in humans to avoid build-up of resistance. If progress is satisfactory, an additional 8 weeks of antibiotic will be required (longer term therapy may be needed).

The pyoderma was treated with a dilute chlorhexidine shampoo. An antibiotic cream could be applied to the lesions but care should be taken to avoid creams containing steroids; significant cutaneous absorption can occur, and this dog has a multiresistant infection so should not be immunosuppressed. A topical ectoparasiticide was used for the flea infestation.

The mutilated digits were treated with sugar once a day, under a light bandage (Figure 2), until a healthy bed of granulation tissue developed. An Elizabethan collar was fitted to prevent further mutilation.

Figure 2: The foot wounds were treated with sugar; manuka

honey would be an alternative

Figure 3: Paraplegic or paraparetic animals can be walked with sling support, using

something as readily available as a towel (left). A custom-made sling (right) has the advantage of supporting the dog’s entire

pelvis and is more comfortable, so the dog is more likely to try to walk

Acute/chronic pain management

Acute painThe acute spinal pain was managed with carprofen and a fentanyl patch. It is important to monitor renal function in this dog because the UTI may also involve the kidneys; NSAIDs should be avoided if renal function appears to be compromised.

Chronic painIf pain continues, an alternative NSAID could be considered (but monitor renal function). Tramadol could also be used, together with NSAIDs if necessary. The dog may be sensitized around the areas where she has amputated part of her digits; if so, gabapentin, amitriptyline or amantadine may help this. Amitriptyline may provide additional benefit via its antihistaminic and sedative effects. Secondary muscle pain in the spine might be treated with acupuncture.

Fear, stress, conflict concerns

As well as being caused by understimulation or frustration, persistent licking and self-mutilation may be a displacement activity precipitated by anxiety or emotional conflict in response to external factors, or a consequence of pain. The situation in which the behaviour occurs should be carefully investigated to distinguish these causes. Meanwhile, it would be sensible to move the dog to an area in the hospital where she has a lot of human contact during the day. She may also be walked several times a day, with sling support (Figure 3).

Nutritional requirements

Feeding in the hospitalThe dog is in poor body condition (BCS 3/9), has a serious inflammatory condition and significant skin disease. All these are likely to increase her protein and calorie requirements, so it is important to feed a digestible high-calorie diet with a good protein content. The ideal diet would be one for small animal critical care use. These relatively low-residue diets reduce faecal volume and thereby help nursing.

Daily food intake should be carefully recorded and bodyweight monitored on a daily basis. Calorie intake should be increased if the dog is losing weight; if she fails to meet her calculated energy requirement (RER) for 2–3 days, assisted feeding should be considered. In this dog, the need for tube feeding is likely only to be short term. A naso-oesophageal or oesophagostomy tube would therefore be most appropriate.

Feeding at homeThe dog is likely to take several months to regain normal body condition, so a high-quality, high-calorie diet should be fed at home.

*Editors note: Under the Cascade there must be appropriate justification for use of an unlicensed product when a licensed product exists (in this case enrofloxacin which is metabolised to ciprofloxacin).

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Financial considerations make it unlikely that these owners will be able to feed her on a critical care diet for months, but they should be encouraged to feed the highest quality diet they can afford. A diet formulated for large-breed puppy growth could be considered, as long as this does not lead to diarrhoea through its relatively high fat content.

NutraceuticalsCranberry juice capsules might be beneficial: there is some evidence that cranberry juice protects against infectious cystitis in humans, although evidence of effectiveness in dogs is currently only anecdotal.

Physiotherapy

Financial constraints limit the amount of physical therapy that can be performed on this particular patient. Initially, passive range of motion (ROM) exercises can be performed on both hindlimbs four times a day for 5 minutes per leg. The hindlimbs should be massaged for 5 minutes twice a day. The dog can be walked outside four times a day using a sling and quad cart, with booties to protect her hindfeet.

Additional therapy in the early stages could include assisted standing, assisted ‘sit-to-stands’, and assisted walking. Standing exercises should be coupled with balance work to improve core stability, as well as improving speed and effectiveness of reaction. Balance exercises should be introduced into both walking and standing activities to improve dynamic and static balance. NMES (applied to appropriate muscle groups) can also be a useful therapy to help maintain muscle activity and provide valuable sensory stimulation (Figure 4).

Land treadmills can be effective in rehabilitation (to aid gait patterning and increasing strength) when the dog is walking better; but in the early stages the danger of knuckling and damaging paws remains and, for large dogs, hydrotherapy would be preferable.

Figure 4: Application of NMES – shown here to the quadriceps and hamstrings – with the aim of achieving co-contraction of the two muscle groups

Hydrotherapy

It might not be possible to perform hydrotherapy in this particular case – initially, because of the UTI and pyoderma; and subsequently, because of financial constraints on the owners. However, in patients with fewer complicating factors, hydrotherapy (underwater treadmill or pool) should be used once or twice a day when some strength has returned to the hindlimbs. This is preferable to a land treadmill because of the dog’s size. Hydrotherapy may allow more freedom of movement, improve coordination, provide more confidence in limb usage, and provide more effective strengthening of weakened muscles.

Acupuncture

Acupuncture is unlikely to be useful in the early stages but may be considered if the dog does not respond to other forms of analgesia or has unacceptable side effects from them. Areas of infected skin should be avoided, as should areas without sensation. The most painful areas should be targeted locally.

Other nursing and supportive care

Clean and dress digital lesions.■■

Prevent decubitus ulcer formation.■■

Daily sling-supported walking – to promote recovery of a normal gait, maintain interest, prevent understimulation and provide an opportunity ■■

for urination and defecation. Use protective boots when outside.Regular contact with the owner to help improve the dog’s mental status; encourage daily visits unless the dog becomes very upset after the ■■

owner leaves. The owner can also learn how to care for their pet.

WARNING: This dog has a multiresistant E. coli infection. Precautions must be taken to prevent infection transmission. PPE (personal protective equipment) must be worn for handling and nursing.

MonitoringThe dog should be assessed for pain regularly (preferably using some type of scoring system) and analgesia administered as necessary. Neurological signs should be regularly reassessed. Fluid and food intake should be recorded.

IncontinenceThe dog is incontinent and requires manual bladder expression several times a day. In a dog with urine scalding, the use of a urinary catheter with a closed collection system might be considered. This would assist with monitoring fluid balance, help to keep the animal comfortable and reduce the need for manual expression of the bladder. However, because this dog has a multiresistant E. coli infection, use of a urinary catheter would be unwise. A catheter could increase the risk of persistent infection and of ascension into the kidneys.

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Figure 5: The owners of this chronically paralyzed dog express their pets bladder regularly. To prevent small ‘accidents’ in the house, the dog wears

this velcroed waist band on a daily basis. An absorbent pad is placed in the waistband over this dog’s penis and is changed regularly

The perineal and inguinal regions should be clipped and the urinary scalds treated. ‘Nappy rash’ cream can help to soothe affected areas. A waterproof barrier should be applied to clean dry skin to protect it from further urine scalding. Absorbent disposable pads can be placed under the dog’s hind end and disposed of whenever she urinates or defecates (Figure 5).

FeedingIf the dog is inappetent, it is important to encourage food intake using measure such as: feeding small meals frequently; adding moist food to a dry diet; warming food to body temperature; adding chicken or other palatable foodstuff; or finding out what her favourite food at home is, and feeding that.

Owner advice and homecare recommendations

Teaching the owner how to treat the dogBecause of the size of the dog and the need for regular bladder expression and skin/wound care, this dog will remain in the hospital until she can walk with sling support and can urinate on her own. The owner may visit to learn how to perform a ranger of appropriate exercises and how to treat the skin wounds. The patient should be discharged with an Elizabethan collar, that should be placed if the owner has to leave her for protracted periods. The owner should be educated about the importance of long-term flea and worm control.

Follow-upThe patient should be reassessed at 2 and 4 weeks after presentation:■■

If there is no improvement by 2 weeks, urine culture and spinal radiographs should be repeated■–If the dog is improving, the ciprofloxacin should be prescribed for an additional 8 weeks and urine culture then repeated to ensure that the ■–therapy is being effective.

The patient should be reassessed at 12 weeks and spinal radiographs repeated.■■

If the patient is doing well clinically, and there is no evidence of additional lesions radiographically, antibiotics can be discontinued.■■

A urine culture is repeated 2 weeks later to confirm resolution of infection.■■

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CONgRESSCongress Podcast LibraryMake the most of your access to the four year archive of lectures

Member access to the Congress podcast library is proving massively popular with members in the UK and overseas. Indeed, BSAVA has seen a 60% increase in our international colleagues joining the Association, and many

cite the MP3s as one of the most attractive reasons for joining because they can’t always travel to Birmingham for Congress itself.

However, even if you do attend Congress for these superb four days in April, access to the podcast library means that you can make your experience last throughout the year – downloading those talks you missed or even listening again to the talks that inspired you most. As a BSAVA member you can also go back to any lecture from the last four years – to listen to your favourite speaker or remind yourself of something you heard and want to refresh your memory on.

This resource is entirely free to all BSAVA members and the Association hopes that you continue to take advantage of this facility – whether you come to Congress or not – this is free CPD available to you day or night – at the touch of a button. ■

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CONgRESS

Podcast Libraryember access to the Congress podcast library is proving massively popular with members in the UK and overseas. Indeed, BSAVA has seen a 60% increase in our international colleagues joining the Association, and many

cite the MP3s as one of the most attractive reasons for joining because they can’t

However, even if you do attend Congress for these superb four days in April, access to the podcast library means that you can make your experience last throughout the year – downloading those talks you missed or even listening again to the talks that inspired you most. As a BSAVA member you can also go back to any lecture from the last four years – to listen to your favourite speaker or remind yourself

This resource is entirely free to all BSAVA members and the Association hopes that you continue to take advantage of this facility – whether you come to Congress or not – this is free CPD available to you day or night – at the touch of a button. ■

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CONGRESS

SZVMZ was established in 1989 and now has 130 members. It became a member of FECAVA and WSAVA in

1992. The current President is Alenka Seliskar DVM MSc PhD. Each year, SZVMZ organises an annual two-day congress on small animal disease, where most of the delegates are Slovenian, but they are hoping to encourage delegates from neighbouring countries, such as Italy and Austria to attend in the future.

A progressive associationLast year, the pre-congress day was organised by the dermatology section of the SZVMZ. In March 2008, SZVMZ organised a diagnostic imaging symposium which attracted 300 delegates, 220 vets and 80 students – the speakers were Virginia Luis Fuentes and Eran Lavy. SZVMZ has also participated in the WSAVA Eastern Continuing Education Project and organised several symposia in collaboration with the Croatian Small Animal Veterinary Section (CSAVS ) at the Croatian Veterinary Chamber; previous topics have included feline medicine and diseases of the liver and pancreas. So it is an association with a progressive and ambitious programme.

2010 visitorsThe visit is organised by BSAVA volunteer Wolfgang Dohne, who sits on IAC, and

International delegation from SloveniaEach year, the BSAVA International Affairs Committee (IAC) invites a small group of veterinary surgeons from an emerging veterinary association to attend BSAVA Congress as our guests. This year, the vets come from the Slovenian Small Animal Veterinary Association (Slovensko Združenje Veterinarjev za Male Živale – SZVMZ)

© Remy Musser | Dreamstime.com

helps to organise BSAVA’s attempt at sharing the excellence of the international expertise at Congress with an association and fellow professionals who would most benefit from the experience, and who can take it back to share with their national colleagues. Two of the vets who will be attending BSAVA Congress this year are Iztok Valentin i and Bernik Stanislav.

Iztok Valentin i qualified from the Veterinary Faculty in Ljubljana in 1990. He holds a Masters degree and is interested in internal medicine and soft tissue surgery. Iztok worked for three years at the Veterinary Faculty before moving into private practice in Ljubljana for five years. At the end of 2000 he returned to his home town of Maribor, which is the second largest city in Slovenia, and s`et up Klinika Maribor, which employs five veterinary surgeons and five veterinary technicians. The clinic sees up to 14,000 patients per year, mostly dogs and cats, though more recently they have started to see ferrets too.

Bernik Stanislav qualified in 1989, also from the Veterinary Faculty in Ljubljana. He has owned his practice, Klinika Loka, since 1996 and employs three veterinary surgeons and three veterinary technicians. Business must be good because he is building a new clinic, and hopes to move into it later this year, once he’s returned from his visit to BSAVA Congress. n

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PETSAVERS

Improving the health of the nation’s pets

Petsavers is the charitable division of the BSAVA and exists to improve our understanding and treatment of the

diseases affecting our pets. It has donated over £1.7 million to fund numerous clinical research projects and clinical training programmes since its beginnings in 1974.

If Petsavers is to continue its vital work then the support of veterinary practices in the UK is essential. There are many ways that practices can help, some of which are detailed below.

Spread the wordMany of your clients will want to donate to a charity which aims to improve our understanding and treatment of the conditions and diseases that affect their pets. So please help us to help their pets by spreading the word and letting your clients know who we are and what we do. An easy way to do this is to hold Petsavers information leaflets in your practice reception.

Petsavers can also supply an A3 information poster for display on your practice wall. Petsavers also produce the Petsavers Bulletins, which are client-friendly newsletters. Displaying our bulletins is very helpful as they are an excellent way for Petsavers to showcase the work that we fund. If you would like to

display Petsavers Bulletins, leaflets or posters then please contact us and we can supply them free of charge.

Holding a collection boxCollection boxes are a valuable source of income for Petsavers. If you would like to have a Petsavers collection box in your reception area, then please get in touch.

Petsavers cardsEach year Petsavers produce a new range of Christmas cards. Petsavers Christmas cards are a great way for you and your clients to spread the season’s greetings, while at the same time donating to a worthy cause. Petsavers Christmas cards can be ordered online or by post. You can help us by displaying Petsavers Christmas card order forms in your reception area.

Petsavers also produce sympathy cards, which are intended for practices to send condolences to clients upon the sad occasion of losing a much-loved pet. The Petsavers range of sympathy cards can be viewed at www.petsavers.org.uk

Petsavers needs you!How you can help Petsavers in practice

CONTACT USWe are always looking for new and innovative ways of fundraising, so you have an idea then please feel free to share this with us. Petsavers can be reached by:

Email: [email protected]

Tel: +44 (0)1452 726723

Fax: +44 (0)1452 726701

Post: Petsavers, BSAVA, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB

Sponsored daysHolding a sponsored event in your practice is a great way for you to support Petsavers and bring new visitors into the surgery. It’s also a chance to educate and engage with your local community. This could be something as simple as a sponsored coffee morning or cake sale. In the past, practices have held open days or sponsored dog walks in aid of Petsavers. The days are always enjoyable for the staff and public as well as raising funds for a worthwhile cause. Petsavers can provide support in arranging a sponsored day, including friendly advice, providing posters, sponsorship forms, advertising the event online and providing promotional materials such as balloons and dog leads. If you have an idea for or would like to hold an event, then please get in touch and see what we can do to help you. ■

PETSAVERS

Improving the health of the nation’s petsImproving the health of the nation’s petsImproving the health of the nation’s petsImproving the health of the nation’s petsImproving the health of the nation’s pets

income for Petsavers. If you would like to have a Petsavers collection box

then please get in touch.

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View from the topSome highlights from the recent WSAVA Executive Board meeting

The WSAVA Executive Board held its mid-year meeting in Geneva, Switzerland from 10–13 February. Discussions included updates on the

initiatives that stemmed from the 2009 Assembly meeting, including establishment of the WSAVA as an incorporated not-for-profit entity in Canada, the Congress Strategic Plan and recently struck Congress Steering Committee, and establishment of a WSAVA Foundation. Other initiatives discussed, which will be forwarded to the Assembly, include an expanded Central Secretariat to assist in the day-to-day administrative needs of the WSAVA, and several

Update on standardization

Reports from the WSAVA Standardization Groups including two important publications from the GI GroupNew publications from the GI Standardization GroupThe diagnosis and treatment of companion animal gastrointestinal tract disorders have long been complicated by the absence of clinical, diagnostic, histopathological, and therapeutic standards. The WSAVA International Gastrointestinal (GI)

Standardization Group was convened in 2004 for the purpose of developing standards for the following in dogs and cats with gastrointestinal disease:

History taking ■

Physical examination ■

Laboratory diagnostic tests ■

Imaging procedures and reports ■

Endoscopic procedures and reports ■

Biopsy procedures and reports ■

Histopathological interpretation ■

Immunohistochemistry ■

Treatment trials ■

Patient response and outcome. ■

proposals for additional WSAVA Standardization projects. The WSAVA 2010 Assembly meeting will take place on Tuesday 1 June and will also examine bids for the 2014 Congress.

As part of the Executive Board meetings, the WSAVA had the opportunity to meet with the 2010 Congress Organizers, and visit the Congress venues. The Board was very impressed with the preparations, the scientific programme and social events planned, the design and functionality of the Palexpo facility, including its ease of access from the airport and hotels, and most of all, the beauty, vibrancy, and accessibility of Geneva as a city. Considering that June will see Geneva basking in early summer weather, attendees can look forward to an exceptional event from both a learning and tourist perspective! ■

Standardization Group was convened in 2004 for the

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WSAVA NEWS

GENEVA 2010 UPDATEMore scientific lectures have been added to an already impressive scientific programmeWSAVA Award winner lecturesThese will be presented in a plenary session on Friday 4 June between 11:35 and 12:20:

WSAVA Hill's Excellence in Veterinary ■

Healthcare Award: Jan RothuizenCutting edge veterinary liver research in tune with the One Health conceptWSAVA Hill's Pet Mobility Award: Peter Muir ■

Role of stifle synovitis in development of cruciate rupture in the dogWSAVA International Award for Scientific ■

Achievement: Ian DuncanInherited and acquired disorders of myelin in the dog and cat

One Medicine LecturesThese will be presented at various times throughout the programme:

Dr Day: One World One Medicine ■

Dr Weese: Meticillin-resistant staphylococcal ■

infectionsDr Lloyd: Recognizing and controlling risk ■

factors for antimicrobial resistanceDr Mateus: Stewardship of antimicrobial usage ■

in dogs and cats – are we there yet?Dr Argyle: Modern molecular therapies in ■

oncology – promises, promises, promisesDr Baneth: Canine leishmaniasis ■

Dr Baneth: ■ Ehrlichia and Anaplasma infections

The WSAVA Scientifc Programme may be downloaded from www.wsava2010.org

During Phase I (2004–2008), the GI Standardization Group published proposed standards for endoscopy, biopsy, and histopathological evaluation of inflammation in endoscopic biopsies of the gastrointestinal tract of dogs and cats. A final summary of Phase I studies was presented at the WSAVA Congress in Dublin in 2008.

In 2008, the Group was invited to develop an ACVIM Consensus Statement on “Endoscopic, Biopsy, and Histopathologic Guidelines for the Evaluation of Gastrointestinal Inflammation in Companion Animals”. This was presented at the 26th Annual ACVIM Forum and was subsequently posted to the ACVIM website for additional commentary from the membership of the ACVIM Internal Medicine Specialty. Following further review and revision this was submitted to the Journal of Veterinary Internal Medicine and was published in the January/February issue.1

The Group hopes that this Consensus Statement will prove of value to clinicians and pathologists working in the field of canine and feline gastroenterology and will facilitate the reporting of microscopic changes in biopsy samples, reducing variation among the interpretations of different pathologists and, consequently, among different published studies.

A further study on the effect of tissue processing on assessment of endoscopic biopsy has also been published.2 Prior studies have failed to detect a significant association between hypoalbuminaemia and small intestinal histopathology. It was hypothesized that use of standardized pictorial templates would enhance consistency of inter-pathologist interpretation, and identify intestinal lesions associated with hypoalbuminaemia. In the study, histopathology slides from sequential cases undergoing gastrointestinal endoscopic biopsy were examined by pathologists. Pathologists were blinded to site of origin and clinical findings and evaluated samples for nine microscopic features as defined by guidelines developed by the WSAVA GI Group. Changes were recorded as normal, mild, moderate or severe, and 2- and 4-point scales were tested for consistency of interpretation. Forward selection logistic regression models were used to determine odds ratios of histological lesions associated with hypoalbuminaemia, and Kappa statistics were used to determine agreement between pathologists on histological lesions.

1. Washabau, Day, Willard, et al. ACVIM Consensus Statement. Endoscopic, Biopsy, and Histopathologic Guidelines for the Evaluation of Gastrointestinal Inflammation in Companion Animals. Journal of Veterinary Internal Medicine 2010; 24: 10–26.

2. Willard, Moore, Denton, et al. Effect of Tissue Processing on Assessment of Endoscopic Intestinal Biopsies in Dogs and Cats. Journal of Veterinary Internal Medicine 2010; 24: 84–89.

Renal Specialization Project exploits new technologyThe WSAVA Renal Standardization Project exploits new technologies to establish far-reaching visions for the clinical and pathological assessment of glomerular disease in dogs and cats and innovative benchmarks for the worldwide sharing of veterinary expertise. High-tech diagnostic renal pathology centres in Texas

and Utrecht use recently developed whole-slide digital scanning technology to lead the profession into the age of digital pathology, permitting global sharing of high-resolution diagnostic imagery.

Sophisticated data management platforms and web-based conferencing facilitate the international sharing of clinical information and digital imagery to establish novel paradigms for:

A consensus-based clinical/pathological ■

classification scheme for canine and feline glomerular diseaseStandardized lesion description and severity ■

scoring for renal histopathologyInnovative approaches for distance education and ■

clinical trainingPotential for worldwide clinical/pathological ■

consultation and access to authoritative consensus and expert opinionVisionary opportunities for therapeutic trials and ■

outcomes assessment.

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WSAVA NEWS

Major conferences in 2010BSAVA Congress 8–11 April, Birmingham, UKNACAM Congress 22–24 April, Amsterdam, NetherlandsWSAVA Congress 2–5 June, Geneva, SwitzerlandACVIM Congress 9–12 June, Anaheim, California, USAAVMA Convention 31 July–3 Aug, Atlanta, Georgia, USAECVIM Congress 9–11 September, Toulouse, FranceVÖK Congress 17–19 September, Salzburg, AustriaSEVC Congress 1–3 October, Barcelona, SpainDVG–DGK Congress 21–24 October, Düsseldorf, GermanyAFVAC Congress 10–13 December, Paris, France

CE UPDATEThe very first of the South America “CE tour” is ready to go

Dr Andres Zavala will speak on ophthalmology in Peru (19 March), Ecuador (21 March), Colombia (24 March) and Venezuela (26 March)

WSAVA President Dr David Wadsworth receiving the AFVAC medal

Dr Colin Burrows receiving his honorary fellowship of the RCVS from Jill Nute, outgoing RCVS President

HONOURS AND AWARDSWSAVA President awarded the AFVAC medal WSAVA President Dr David Wadsworth was honoured and awarded the AFVAC medal for his ongoing contribution to the small animal veterinary profession.

Burrows honoured by British Veterinary Group Dr Colin Burrows BVetMed PhD DipACVIM (Small Animal Internal Medicine) has been named an honorary fellow of the Royal College of Veterinary Surgeons. Dr Burrows has delivered WSAVA global continuing education presentations in more than 50 countries and is also an honorary member of both the Austrian and Russian Small Animal Veterinary Associations.

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THE companion INTERVIEW

John Bower MBE BVSc MRCVS

QWhat do you consider to be your most important achievement during your career?

ABuilding up a practice with an excellent team around me from just one vet and one nurse to a Veterinary Hospital Group with 12 vets, 65 staff,

5 premises, and a dedicated night team of vets and nurses serving Plymouth.

John Bower grew up in New Ollerton, then a mining village 20 miles north of Nottingham. Both his parents were shoe retailers, with two shops in the area. He has one younger brother who is a retired dentist. John is married to Caroline (AKA Boony), also a veterinary surgeon and has five children, Becky, Tom, Jack, Sophie and Rachel.

John graduated from Liverpool in 1965 and began his career as an assistant in London working with Frank Beattie, before purchasing his practice in Plymouth, Devon. This began as a single-handed operation in 1969 and by the time John retired in 2007 was a 12 vet, five-centre practice with a veterinary hospital base. John has also had a huge impact in veterinary politics: he was President of BSAVA in 1984/85 and then went on to be President of BVA, WCVA, and VMPA; he has also been a Trustee of the BVA’s Animal Welfare Trust, the Petplan Charitable Trust and Hearing Dogs for Deaf People. He is also widely published and a highly respected speaker.

In 1991 John was awarded the BSAVA Melton Award in recognition for his meritorious contributions to small animal practice, and in 2010 he deservedly received an MBE in the New Years Honours List.

What has been your main interest outside work?Apart from my involvement in the veterinary profession (BVA, BSAVA & VPMA), from a young age, encouraged by a favourite uncle, I have always been fascinated with the natural world – especially birds. I have visited or stayed on many of Britain’s offshore islands from Skomer to the Farnes, Scolt Head to Bardsey, Arran to Lundy, and many many more.

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THE companion INTERVIEW

…be honest, work hard and treat people as you would like to be treated yourself – and have fun!

…be honest, work hard and treat people as you

yourself – and have fun!

When and where were you happiest?Camping on Skye with Boony in 1982 with my Lotus Sunbeam and our two windsurfers, while watching otters, Ringed Plover chicks hatching, and collecting and cooking mussels.

Who has been the most inspiring influence on your professional career?Frank Beattie MRCVS, my first employer

What is the most significant lesson you have learned so far in life?Be honest, work hard and treat people as you would like to be treated yourself – and have fun!

What do you regard as the most important decision that you have made in your life?There are two – to buy the single handed practice in Plymouth, and to spend my life with Boony.

What was the most frustrating aspect of your work?Getting a consensus from the other four partners in the practice on management decisions!

If you were given unlimited political power, what would you do with it?Ensure the UK didn’t become any more overcrowded.

Which historical or literary figure do you most identify with – and why?Alf Wight – James Herriot – he had the same approach and compassion to his clients and their animals as I hope I did.

THE companion INTERVIEW

HANDS UP IF YOU’D LIKE TO FOLLOW IN JOHN’S FOOTSTEPSWorking with BSAVA as a volunteer adds a rewarding and rich dimension to your veterinary careerJohn Bower is one of the many key veterinary professionals to have worked with BSAVA as a volunteer, making a massive impact on both the Association and the profession at large. BSAVA is the success it is because it is run by members for members. It is only with the passion and commitment of these volunteers that the BSAVA can continue to find new ways of supporting colleagues in practice and fulfil its remit – to promote excellence in small animal practice through education and science.

There are a number of opportunities for you to get involved, from working with us in your own region to develop practical, quality CPD for your local colleagues, to being involved in one of our Standing Committees overseeing our publications, CPD, membership benefits, Congress or Petsavers. To find out more about how to influence the future of your Association and your profession email [email protected] or speak to your regional representatives at your next local meeting (see the website or regional calendar on the inside back page for details).

If you could change one thing about your appearance or personality, what would it be?Improve my memory for people’s names.

What is your most important possession?As dogs are not possessions, my 1953 MG TF.

What would you have done if you hadn’t chosen to work in the veterinary sphere?A warden on an island bird observatory. ■

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CPDdiary

12 MayTuesday

The yellow catSpeaker Sarah CaneyLeatherhead Golf Club, Kingston road, Leatherhead, Surrey KT22 0EESurrey & Sussex Regiondetails from Jo arthur, 01243 841111, [email protected]

EVENINGMEETING

11MayTuesday

From large kidney to small bladder: urogenital tract surgerySpeakers Dan Brockman & Mickey TiversWoodrow House, Quedgeley, Gloucestershiredetails from [email protected] or call 01452 726700

DAYMEETING

27 MayThursday

Logic and common sense in treating the cardiac patientSpeaker Jo Dukes McEwanThorpe Hotel & Spa, LeedsNorth East Regiondetails from [email protected] or call 01452 726700

DAYMEETING

18 MayTuesday

Effective feeding for the critically ill patient: enteral vs parenteral nutritionSpeaker Daniel ChanPotters Heron Hotel, romsey SO51 9ZFSouthern Regiondetails from [email protected]

EVENINGMEETING

19 MayWednesday

Pain managementSpeakers Elizabeth Chan & 2nd speaker TBCWoodrow House, Quedgeley, Gloucestershiredetails from [email protected] or call 01452 726700

DAYMEETING

16 MaySunday

Chronic V&DSpeaker Clive ElwoodHoliday inn, Haydock, M6 Junction 23, Lodge Lane, Newton le Willows, Merseyside Wa12 0JGNorth West Regiondetails from Simone der Weduwen, [email protected], 01254 885248

DAYMEETING

19 MayWednesday

An update on canine cruciate diseaseSpeaker Gareth Arthursrussell Hotel, 136 Boxley road, Maidstone, Kent ME14 2aEKent Regiondetails from Hannah Perrin, 01304 206989, [email protected]

EVENINGMEETING

20 MayThursday

Introduction to cytologySpeaker Michael DayWoodrow House, Quedgeley, Gloucestershiredetails from [email protected] or call 01452 726700

DAYMEETING

10 JuneThursday

Management of congestive cardiac failureSpeaker Geoff CulshawKingsmill Hotel, inverness. Scottish Regiondetails from dermot Mullen, [email protected]

DAYMEETING

a broad network of regional branches gives you the potential to meet like-minded colleagues in your area and delivers high-quality CPd on your doorstep. Visit the CPd section at www.bsava.com to find dates for local courses and details for your regional committee.

NEW FOR MEMBERS – extra 10% discount on all BSaVa publications for members attending any BSaVa CPd event.

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

3–5 SeptemberFriday–Sunday

Scottish Region Congress25th AnniversarySpeakers Derek Flaherty, Sue Paterson and Amanda BoagEdinburgh Conference Centre, Heriot-Watt University, riccarton, Edinburgh EH14 4aS16 hours of quality CPd in a stunning city.

Topics:■ anaesthesia/analgesia■ dermatology■ Nurse topics:

– anaesthesia/analgesia – Emergency/Critical care

details from Barbara-ann innes, Congress Co-ordinator, telephone 07931152121, email [email protected]

WEEKEND

TBC MaySaturday

Stertor and StridorSpeaker TBCLeatherhead Golf Club, Kingston road, Leatherhead, Surrey KT22 0EESurrey & Sussex Regiondetails from Jo arthur, 01243 841111, [email protected]

EVENINGMEETING

17 JuneThursday

The five- (or ten-) minute neuro examSpeaker Clare Rushbridgerussell Hotel, 136 Boxley road, Maidstone, Kent ME14 2aE. Kent Regiondetails from Hannah Perrin, 01304 206989,[email protected]

EVENINGMEETING

9 MaySunday

Selected topics in infectious disease: a broad-ranging day helping you make responsible decisions on the “hot topics” in infectious disease like resistant infections and imported diseaseSpeakers Kate Murphy and Jon WrayCambridge Belfry, Cambourne, Cambridge, Cambridgeshire CB23 6BWEast Anglia Regiondetails from Graham Bilbrough,[email protected]

DAYMEETING

23 JuneWednesday

Soft tissue surgery: a step beyondSpeakers Dan Brockman and Stephen BainesrCVS, Belgravia House, Horseferry road, London. Metropolitan Regiondetails from Pedro Bartolomé, [email protected]

DAYMEETING

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British Small Animal Veterinary AssociationWoodrow House, 1 Telford Way, Waterwells Business Park,

Quedgeley, Gloucester GL2 2ABTel: 01452 726700 Fax: 01452 726701

Email: [email protected] Web: www.bsava.com

For more information or to book visit www.bsava.com, email [email protected] or call 01452 726700

3 steps toanaesthesiaexpertise

BSAVA’s anaesthesia mini-modular programme in Gloucester will together cover various aspects of care of the anaesthetised and perioperative patient.

1. Pain management2. Challenging cases3. Pre-anaesthetic assessment to anaesthetic recovery

Wednesday 19 May – Liz ChanWednesday 23 June – Liz ChanWednesday 7 July – Louise Clark

Full series Individual courseMember – £579.83 inc. VAT Member – £203.28 inc. VATNon-member – £869.72 inc. VAT Non-member – £304.91 inc. VAT ©

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