Companion August 2014 Low Res

8/11/2019 Companion August 2014 Low Res

1/36

The essential publication for BSAVA members

companionAUGUST 2014

How ToDeal withthermal burnsP18

Legislation mapAnimal law in the UK

P4

A captivatingmessageWildlife workP14

Lameness andhaematuria inan Australian

Cattle Dog


2/362 | companion AUGUST 2014 | BSAVA 2014

Log on to www.bsava.com to accessthe JSAP archive online.

EJCAP ONLINE

To access the latestissue of EJCAP visitwww.fecava.org/EJCAP .

Find FECAVA on Facebook!

3 BSAVA NewsLatest from your Association

47 Legislation mapAnimal welfare laws in the UK

89 Movement of dogs in and out ofIrelandPaula Boyden explains

1013 Clinical ConundrumForelimb lameness and haematuria

1417 A captivating messageWildlife Vets International

1822 How ToDeal with thermal burns

2425 Decision making in woundclosureJohn Williams explains

2627 PetSavers and ear diseaseSue Paterson reports

2829 WSAVA NewsWorld Small Animal VeterinaryAssociation

3031 The companion interviewSteve Broomfield

33 Regional CPDLocal knowledge close to home

3435 CPD DiaryWhats on in your area

companion is published monthly by the BritishSmall Animal Veterinary Association, WoodrowHouse, 1 Telford Way, Waterwells Business Park,Quedgeley, Gloucester GL2 2AB. This magazineis a member-only benet. Veterinary schoolsinterested in receivingcompanion shouldemail companion @bsava.com . We welcomeall comments and ideasfor future articles.

Tel: 01452 726700Email: companion @bsava.com

Web: www.bsava.com

ISSN (print): 2041-2487ISSN (online): 2041-2495

Editorial Board

Editor Simon Tappin MA VetMB CertSAM DipECVIM-CAMRCVS

Past President Michael Day BSc BVMS(Hons) PhD DScDiplECVP FASM FRCPath FRCVS

CPD Editorial TeamPatricia Ibarrola DVM DSAM DipECVIM-CA MRCVSTony Ryan MVB CertSAS DipECVS MRCVSLucy McMahon BVetMed (Hons) DipACVIM MRCVSDan Batchelor BVSc PhD DSAM DipECVIM-CA MRCVS

Features Editorial TeamAndrew Fullerton BVSc (Hons) MRCVS

Design and ProductionBSAVA Headquarters, Woodrow House

No part of this publication may be reproducedin any form without written permission of thepublisher. Views expressed within thispublication do not necessarily represent thoseof the Editor or the British Small AnimalVeterinary Association.

For future issues, unsolicited features,particularly Clinical Conundrums, arewelcomed and guidelines for authors areavailable on request; while the publishers willtake every care of material received noresponsibility can be accepted for any loss ordamage incurred.

BSAVA is committed to reducing theenvironmental impact of its publications

wherever possible and companion is printedon paper made from sustainable resourcesand can be recycled. When you have finishedwith this edition please recycle it in yourkerbside collection or local recycling point.Members can access the online archive ofcompanion at www.bsava.com .

Additional stock photography:www.dreamstime.com Nicole Hrustyk

www.dollarphotoclub.com annette shaff; mysontuna; Quasarphoto

The objective of this PetSavers-funded study was to assess theprevalence of gastrointestinaltoxicity in dogs receiving

chemotherapy with vincristine andcyclophosphamide and the efficacy ofmaropitant in reducing these events.Dogs receiving chemotherapy withcyclophosphamide or vincristine wererandomized to either receive maropitant ornot in the period immediately aftertreatment and for four days afterwards.Owners completed a diary of adverseevents following treatment.

Adverse events occurred in 69% ofdogs in the vincristine group. Most ofthese adverse events were mild andincluded: lethargy (62%), appetite loss(43%), diarrhoea (34%) and vomiting(24%). Adverse events occurred in 81% ofdogs treated with cyclophosphamide.Most of these adverse events were mildand included: lethargy (62%), diarrhoea(36%), appetite loss (36%) and vomiting(21%). There was no difference in totalclinical score, or in vomiting, diarrhoea,appetite loss or lethargy score betweendogs treated with maropitant and non-treated dogs in either the vincristine orcyclophosphamide groups.

ALSO IN THIS MONTHS ISSUE

The effect of season and track condi onon injury rate in racing greyhounds

Intra-ar cular mepivacaine reducesinterven onal analgesia requirementsduring arthroscopic surgery in dogs

Inves ga on of the use of ne needleaspira on techniques in UK veterinaryprac ce

In vitro comparison of output uidtemperatures for room temperature and

pre-warmed uids Venous air embolism detected on

computed tomography of small animals

Whats in JSAP this month?

Gastrointestinal toxicity aftervincristine or cyclophosphamideadministered with or withoutmaropitant in dogs

Chemotherapy-related side effects arefrequent but usually mild in dogs receivingvincristine or cyclophosphamide. Theauthors conclude that prophylacticadministration of maropitant does notreduce the frequency of adverse eventsand maropitant should be administeredonly as required for individual cases.Adapted from Mason et al . JSAP 2014; 55: 391398.


3/36 BSAVA 2014 | companion AUGUST 2014 | 3

My first volunteer role was on thePetSavers Management Committee.I liked the idea of raising money tofind out more about animal diseases

with the eventual hope of providing bettertreatments. It was really interesting to learn moreabout the great work that PetSavers had doneand the vital studies that had been funded.

The PetSavers Management Committeediscusses new ways of raising money andraising the awareness of PetSavers. We havea stand at Congress and are able to talk to lotsof people about getting involved in thisimportant work.

I am now also on my local BSAVA RegionalCommittee as PetSavers representative. I raiseawareness of PetSavers locally and also help toorganize local CPD events for the members ofBSAVA in my area.

I find discussing ways of raising money for acause I believe in really very rewarding. I havemet lots of new and interesting people and ofcourse I got to go to BSAVA Congress. I wouldsay to other members that it is good to getinvolved in positive things that can shape theprofession for the future.

Get to knowyour BSAVAcolleagues

Volunteervoice

AlisonLiversey

Find out how you can get involved as aBSAVA volunteer, email Carole Haile [email protected] .

Ketamine and tramadolclassification changes

The Home Office has announced changes to the classification ofketamine and tramadol through the introduction of The Misuse of DrugsAct Amendment Order 2014, which came into effect on 10 June 2014.This means ketamine is now reclassified as a Class B drug under the

Misuse of Drugs Act 1971, but remains a Schedule 4 controlled drug under theMisuse of Drugs Regulations 2001. Although Schedule 4 drugs are not subjectto safe custody requirements, ketamine is a substance of abuse and so theRoyal College of Veterinary Surgeons (RCVS) advises that it should be stored inthe Controlled Drugs cabinet and its use recorded in an informal Register.

Tramadol is now classified as a Class C drug under the 1971 Act and as aSchedule 3 controlled drug under the Misuse of Drugs Regulations 2001,which means that it is subject to regulations on documentation, prescriptionwriting and supply on prescription, labelling and record keeping as well asdestruction of the drugs only in presence of an authorized person. Tramadol isalso being inserted into Schedule 1 to the Misuse of Drugs (Safe Custody)Regulations 1973, which means it is exempted from the safe custodyrequirements. Full details and a summary of the legal requirements can befound in the news section at www.bsava.com .

Take the lead for PetSavers

A reminder to all BSAVA members that PetSavers, the charitable divisionof the BSAVA, will be holding its first ever charity dog walk on Sunday26 October at the Bathurst Estate in Cirencester from10am. Dogs and their owners will have the choice of

participating in either a three mile or slightly morechallenging six mile walk through the picturesque estate.After collecting their medal and goody bag on completionof the walk participants will be able to enjoy refreshmentson what the charity hopes will be a perfect autumn day.Tickets for Walk your dog for PetSavers 2014 Sunday26 October are available at 10.00 per dog entry.Please visit www.petsavers.org.uk for more information.

Keep calm and Ceilidh

BSAVA Scottish Congress takesplace from 2931 August, atthe Heriot-Watt in Edinburgh. Sofar, 2014 is fast shaping up to

be our most successful ScottishCongress to date with over 150veterinary professionals already signedup to join us in Edinburgh and Exhibitionspaces are completely packed.

There is still time for you to registerfor 13 hours of CPD delivered through

morning lectures and afternoonseminars. You will also be able to enjoy

an extensive trade exhibition, interactivesessions, case reports, Friday Exhibitorled CPD and social activities, and ofcourse the fabulous gala dinner at TheDalmahoy, with Ceilidh dancing into theearly hours.

Further information is available atwww.bsava.com/scottishcongress or by emailing [email protected] . With weekend pricesstarting at just 209 for vets and 165

for nurses this is the year to get yourCPD in the Highlands.



The Veterinary Surgeons Act 1966 applies throughout the United Kingdom (England,Wales, Scotland and Northern Ireland). Animal welfare is covered by similar acts in each

of the four administra ons: The Animal Welfare Act 2006 applies in England and Wales The Animal Health and Welfare (Scotland) Act 2006 The Welfare of Animals Act (Northern Ireland) 2011.

All these Acts introduce a duty of care on the person responsible for the animalto ensure the welfare needs of the animal are met as well as making it an offence tocause unnecessary suffering. Veterinary surgeons and veterinary nurses will o en beresponsible for an animal on a temporary basis and should therefore consider theirresponsibili es under these Acts.

Five welfare needs are detailed in the Animal Welfare Acts:

The need for a suitable environment The need for a suitable diet The need to be able to exhibit normal behaviour pa erns The need it has to be housed with, or apart from, other animals The need to be protected from pain, suffering, injury and disease.

Dew claw removal

The Animal Welfare Acts also prohibit certain procedures and mu la ons.The removal of dew claws is considered to be an act of veterinary surgery andtherefore can, as a general rule, only be carried out by a veterinary surgeon.However, Schedule 3 to the Veterinary Surgeons Act 1966 allows anyone of orover the age of 18 to amputate the dew claws of a dog before its eyes are open.The Animal Welfare Acts allow removal of dew claws as a permi ed procedure,however they do not dene a dew claw. The RCVS provides some guidance on this inits suppor ng guidance to the Code of Professional Conduct (27.8-27.13) andstates that:

27.12 The removal of the rst digit of the hind limb (true dew claws) is jus ed in most circumstances 27.13 The removal of the rst digit of the fore limb is jus ed only if, in the veterinary surgeons professional opinion,

the par cular anatomy/appearance of the digits invites possible damage.

However, it concludes that Legisla on has not dened dew claws and, ul mately, it is for the courts to decide themeaning of dew claws applying to any specic legisla on.

The RCVS guidance also states that The removal of the whole or part of a dogs tail amounts to the prac ce ofveterinary surgery and therefore can, as a general rule, only be carried out by a veterinary surgeon (27.42).

UK

Legislation mapBSAVAs Head of Scientific Policy, Dr Sally Everitt, looks atcompanion animal health and welfare legislation in the UKT

here is a wide range of legislation that canapply to companion animals including thatrelating to the operation of pet shops (PetAnimals Act 1951); animal boarding

establishments (Animal Boarding EstablishmentsAct 1963) and dog breeding (The Breeding ofDogs Acts 1973 and 1991 and Breeding and Saleof Dogs (Welfare) Act 1999), as well as legislationthat applies to all animals, such as the animalwelfare legislation.

As veterinary surgeons we are not expected tobe experts in the law but some legislation doesaffect the work that we do. The situation is made

more complicated as responsibility for animal healthand welfare is now devolved to the fouradministrations, leading to variations between theregulations in England, Wales, Scotland andNorthern Ireland. We also need to be aware ofregulations in Europe both because of the effect thatit can have on regulations in the UK and because ofthe increasing movement of companion animalswithin Europe. This isnt a comprehensive review ofall the legislation but rather it aims to point out someof the legislation that is relevant to veterinarypractice. Full details of all the legislation in the UKcan be accessed at www.legislation.gov.uk .



Microchipping : The Sco sh Government has recently completed a consulta on into compulsorymicrochipping and other measures to promote responsible dog ownership. However, there are currently noplans to introduce compulsory microchipping in Scotland .

Tail docking: The Animal Health and Welfare (Scotland) Act 2006 prohibits the mu la on of animals and thereare no exemp ons in any regula ons for the non-therapeu c docking of dogs tails. It is also an offence to takea dog from Scotland for the purpose of having its tail docked. However, following research recently published inthe Veterinary Record the Sco sh Government may review this posi on.

Dog control: Sec on 10 of the Control of Dogs (Scotland) Act 2010 amends the Dangerous Dogs Act 1991 sothat it becomes a criminal offence to allow any dog to be dangerously out of control in any place. The deni onof dangerously out of control is slightly different from that in place in England and Wales and contains theprovision for a Dog Control No ce to be served where a dogs behaviour gives rise to alarm, or

apprehensiveness on the part of any individual, and the individuals alarm or apprehensiveness is, in all circumstances,reasonable. The apprehensiveness may be as to (any or all of) (a) the individuals own safety, (b) the safety of some otherperson, or (c) the safety of an animal other than the dog in ques on.

Microchipping : Compulsory microchipping will be

introduced in Wales from 1st March 2015. It is likely that theregula ons will be similar to those in England.

Tail docking: As in England, tail docking is banned under the Animal Welfare Act with exemp ons for certain working dogsunder the Docking of Working Dogs Tails (Wales) Regula ons2007. However, the details of exemp on are slightly different[see box on page 7].

Electronic collars : In 2010 the Welsh Assembly introducedlegisla on to prohibit the use of electronic collars in dogs andcats with the Animal Welfare (Electronic Collars) (Wales)regula ons. An offence under these regula ons carries amaximum period of imprisonment of 51 weeks, a ne, or both.

Microchipping: The compulsory microchipping of dogs will be required from 6th April 2016. Thelegisla on rela ng to this has not been nalized but is likely to include requirements for training of those whoimplant microchips as well as a legal requirement to report adverse reac ons and microchip failures.Veterinary surgeons and veterinary nurses working under the direc on of a veterinary surgeon are likely to be

exempt from the requirement to complete an approved training course.

Tail docking: The Animal Welfare Act 2006 banned tail docking in England other than for medical reasons andwith exemp ons for certain types of working dog under the Docking of Working Dogs Tails (England)Regula ons 2007. In par cular, the legisla on provides:

That any veterinary surgeon who docks a tail must cer fy that s/he has seen specied evidence that thedog is likely to work in specied areas and that the dog is of a specied type

The dog must be no older than ve days when docked and will also need to be microchipped before it isthree months old.

Dangerous dogs: Sec on 1 of the Dangerous Dogs Act 1991 makes it illegal to own certainbreeds of dog (Pit Bull Terrier, Japanese Tosa, Dogo Argen no, Fila Braziliero) unless they areregistered on the Index of Exempted Dogs. The Dangerous Dogs (Amendment) Act 1997 gavethe courts discre on in sentencing, such that they were not always required to order that the

dog be destroyed where an owner was found to have kept a dog in breach of the legisla on.Sec on 3 of the Dangerous Dogs Act applies to all breeds of dog and makes it an offence if the dog

is dangerously out of control, which is dened as any occasion on which there are grounds forreasonable apprehension that it will injure any person. Recent amendments have extended the actto cover private property as well as a acks or poten al a acks on assistance dogs.

Scotland

England

Wales

STOP PRESS: At the me of going to press the Na onal Assembly for Wales is nalizingthe details of The Animal Welfare (Iden ca on of Dogs) (Wales) Regula ons 2014 andThe Animal Welfare (Breeding of Dogs) (Wales) Regla ons 2014. Once the nal detailsare released we will make the informa on available on the BSAVA website.



The Animal Health and Welfare Act 2013 replaces a plethora of Acts rela ng to animal health and welfare. The Actunites all animal welfare policy under the auspices of the Minister for Agriculture, not just that rela ng to farm animals.

Veterinary prac ce in the Republic of Ireland is regulated by the Veterinary Council of Ireland established under theVeterinary Prac ce Act 2005 and amended by The Veterinary Prac ce (Amendment) Act in July 2012.

For the purposes of pet travel it is important to remember that the Republic of Ireland is a European MemberState more details of movements between the UK and ROI are included in the report by Paula Boyden thatfollows this ar cle.

Republic of Ireland

Microchipping: The licensing andmicrochipping of dogs are both compulsory inNorthern Ireland. It is an offence to own an unlicenseddog, unless the dog is:

A puppy under six months old and kept by the person whowas also the keeper of the bitch that gave birth to the puppy

An assistance dog used by a disabled person A dog kept, and on offer for sale, in a licensed pet shop A police dog A dog kept under a block licence, on the premises to which

the block licence relates.

Tail docking: The Welfare of Animals Act(Northern Ireland) 2011 banned dockingwith exemp ons for certain types ofworking dog and where docking is

performed as part of medical treatment or in anemergency to save the dogs life.

Dog breeding: The Welfare of Animals (DogBreeding Establishments and MiscellaneousAmendments) Regula ons (NI) 2013 set outminimum standards for breeding

establishments, which are dened as any establishmentbreeding, supplying or adver sing three or more li ers ofpuppies in any 12 month period, although there are exemp onsfor hunt clubs and chari es.

Puppies from a licensed establishment must be aminimum age of 8 weeks before being transferred to a

new owner and must have been microchipped by8 weeks of age.Bitches in a licensed establishment should

not be mated un l they are over 12 months ofage, or a er 8 years, except with a veterinarycer cate. A bitch should not give birth to morethan three li ers in any period of three years andshall not be bred in any consecu ve heat period.

Northern Ireland

Legislation map



There is no EU-wide legisla on on the welfare of pets, so animal welfare regula ons vary between Member States.However, the EU is currently undertaking a study about the welfare of dogs and cats in a commercial environment inorder to establish whether an EU-wide legal framework is necessary. This study is intended to report at the end of 2014.

The European Commission in proposing a single, comprehensive EU Animal Health Regula on. These regula onswill cover companion animals and their owners as well as produc on animals.

The movement of companion animals is covered by a range of legisla on depending on species and the type ofmovement. Dogs, cats and ferrets travelling with their owner are currently covered by the Pet Travel Scheme, Regula on(EC) no 998/2003 which will be replaced by EU Regula on (576/2013) which comes into effect on 29th December 2014.Any commercial movement which includes all movements that involve a transfer of ownership are covered by theBalai Direc ve 92/65/EEC.

Pet travel requirementsFor pets travelling to and from other EU Member States and approved non-EU countries, they must:

Be posi vely iden ed by means of a microchip Have an up-to-date vaccina on against rabies Be issued with an EU pet passport by an offi cial veterinarian Wait 21 days a er rabies vaccina on before travelling Travel into the UK on an approved route Dogs must be treated by a vet for tapeworm between 24 and 120 hours (one to ve days) before arrival into the UK

and the pet passport signed accordingly. No treatment is required for dogs entering from Finland, Ireland or Malta.

There are no requirements for pets travelling directly between the UK and either the Channel Islands or theIsle of Man.

Commercially traded dogs and cats will need to meet all the requirements of the pet travel scheme but inaddi on must come from a holding or business registered with the EU Member State of origin and be

accompanied by a cer cate in accordance with current requirements.Full details of import requirements are available from the Animal Health and Veterinary Laboratories

Agency website www.defra.gov.uk/ahvla-en/imports-exports/ .Where an animal does not appear to meet the import requirements, veterinary surgeons should

contact their Local Authority (o en the Trading Standards or Environmental Health departments).Contact details for local authori es (including a post code checker) can be found on the Trading

Standards Ins tute website.

TAIL DOCKING: SO WHICH DOGS CAN BE DOCKED?

In England, Wales and Northern Ireland legisla on species the types ofworking dogs which may be docked. The types of evidence that theveterinary surgeon will require to see before docking, and the wording

of the docking cer cate, should be checked before undertaking any taildocking. The ming of docking and microchipping may also be specied.England: dogs involved in law enforcement; ac vi es of the armed

forces; emergency rescue; lawful pest control or the lawful shoo ng ofanimals. Types of dog: hunt, point, retrieve breeds of any type; Spanielsof any type or Terriers of any type. Combina ons of breeds arepermi ed to be docked.

Wales: dogs involved in law enforcement; ac vi es of the armedforces; emergency rescue; lawful pest control or the lawful shoo ng ofanimals. The breeds which may be docked are specied and nocombina ons of breeds are allowed to be docked. The cer catewhich must be completed by both veterinary surgeon and clientrequires the client to specify the breed of the dog and its dam, and theveterinary surgeon must be sa sed that the dog and its dam are ofthe stated breed.

Northern Ireland: dogs involved in law enforcement; lawful pestcontrol or the lawful shoo ng of animals. The breeds specied are listedas: Spaniels of any breed or combina on of breeds, Terriers of any breedor combina on of breeds. Any breed commonly used for hun ng, or anycombina on of such breeds. Any breed commonly used for poin ng, orany combina on of such breeds. Any breed commonly used forretrieving, or any combina on of such breeds.

Europe



Movementof dogsin and out of Ireland

For the purposes of this article, movementrefers to the movement of dogs from theRepublic of Ireland (ROI) to Great Britain (GB).Northern Ireland is part of the UK and will be

discussed later.

The movement of dogs, cats and ferrets acrossEurope is governed by two key pieces of legislation:

Regulation (EC) no 998/2003 provides for thenon-commercial movement of dogs, cats andferrets

The Balai Directive 92/65/EEC provides for thecommercial movement of dogs and cats(among others)

These rules have been in place since 1 January2012, when the UK harmonized with EU rules for boththe non-commercial and commercial movement ofpet animals.

In order to move across Europe all dogs (cats andferrets) must comply with the veterinary preparationsrequired for travel under the EU pet travel scheme:microchip, vaccinate, 21 day wait, pet passport.

Article 3 of Regulation (EC) no 998/2003 states:

For the purposes of this Regulation:

(a) Pet animals means animals of the species listedin Annex I which are accompanying their ownersor a natural person responsible for such animalson behalf of the owner during their movement andare not intended to be sold or transferred toanother owner ;

Therefore the only animals that are permitted totravel under Regulation (EC) no 998/2003 are dogs,cats and ferrets which are accompanying their ownersor a natural person responsible for such animals onbehalf of the owner during their movement.

Paula Boyden, Veterinary Director ofthe Dogs Trust, describes the rulesregarding travelling with dogs betweenIreland and the UK

This means that dogs being moved for the purposeof change of ownership, including those for rescue/ rehoming , must comply with the Balai directive, as it isconsidered an economic activity. Therefore, dogs forrehoming need to comply with both the veterinary

preparations required for travel under the EU pet travelscheme (as above) plus:

Travel from a holding or business registered withthe EU member state of origin

Be accompanied by a fit and healthy to travelcertificate issued by a vet authorized by thecompetent authority confirming that a clinicalexamination was carried out no more than 24 hoursbefore travel (this will change to 48 hours from29 December 2014)

AHVLA must be notified of the movement and thepets will be subject to a risk-based inspectionregime at the place of destination. This means the

pets must remain at their point of destination in theUK for at least 48 hours in order to facilitateinspection visits by AHVLA

In addition, movement must also comply withCouncil Regulation 1/2005 (Welfare of AnimalsDuring Transport).

Owners moving their pets from the ROI into GBhave not experienced any change on the groundbecause no systematic border compliance checks arecarried out prior to entry to Great Britain. This wasagreed by both ROI and GB in recognition of thenegligible rabies risk associated with the movement ofpets between the countries, because they are bothfree of rabies. Equally, no treatment is required againstthe tapeworm Echinococcus multilocularis , due toequivalent (negative) disease status.

We are reminded that although border compliancechecks do not routinely take place, this does not mean



that the rules do not apply. In fact, Trading Standards

(who are responsible for enforcing the EU rules withinGreat Britain) have the power to detain and seize petanimals that are found to be non-compliant during thecourse of their inland investigations.

Whilst the legislation has not changed per se ,there does appear to be a change in implementation of the rules in respect of commercial movements intoGB. This includes dogs for rescue/rehoming. This maybe due in part to concerns expressed in Europe thatthe commercial aspect of this movement could lead toan unfair trade advantage between the UK andIreland. The impact is a reduction in the movement ofdogs for rescue/rehoming; many organizations do not

have the resources, financial or otherwise, to holddogs for 3 weeks.

Movement from the Republic of Ireland(ROI) to Northern Ireland (NI)Whilst there is a requirement in legislation for petsmoving between the Republic of Ireland and NorthernIreland to comply with the EU pet travel Regulation, theauthorities in both jurisdictions enforce theserequirements on the basis of risk. The risk of rabies isconsidered negligible on the island of Ireland fromdogs moving from north to south and vice versa; thereare therefore no border checks on animals movingfrom the Republic of Ireland to Northern Ireland.

New RegulationA new EU Regulation (576/2013) comes into effect on29 December 2014 and replaces Regulation (EC) no998/2003. It introduces a number of changesdesigned to strengthen enforcement regimes acrossthe EU, increase levels of compliance and improve thesecurity and traceability of the pet passport.

From 29 December 2014 all dogs, cats and ferretsprepared for travel will be issued with a new stylepet passport. This passport will include improvedsecurity features most notably laminated strips

to cover the pets details (including the microchipnumber) and each rabies vaccination entry. Thiswill help prevent anyone tampering with thisinformation once it has been completed by a vet.The vet issuing the pet passport will also need to

fill in their details on a new issuing of the

passport page and must make sure that all theircontact details are included when they certifyvaccinations. It is worth noting that any passportissued before the 29 December 2014 will remainvalid for the lifetime of the pet, or until thetreatment spaces are filled.

Any vet issuing a passport will need to keep arecord of the information entered into the passportrelating to: the microchip (number, location anddate of reading/application); the details of the pet(name, species, breed, sex, colour, date of birth,distinguishing features); the owners contact detailsand the pet passport number. This information willneed to be retained for at least three years.

A new 12 week minimum age of vaccination will beintroduced by the new Regulation to createconsistency across the EU and aid compliancechecking. Currently, there is no minimum age ofvaccination; rather the vaccine must beadministered in accordance with its marketingauthorization in the country in which it isadministered. This means that in some countriesthe rabies vaccine is licensed to be given topuppies from an unvaccinated dam at 4 weeks,which could lead to legitimate movement at8 weeks of age.

Owners travelling with more than

five pets will need to travel underthe rules laid down by the BalaiDirective unless the animals areaged over six months and aretravelling to attend a show/ competition/training event ortraining for such an event. They willneed to present written evidence oftheir registration.

The new Regulationwill also require all EUcountries to carry outsome documentaryand identity checks onpet movements withinthe EU.



Clinicalconundrum

Case presentationAn 8-year-old female neutered Australian Cattle Dog presented with

a 4-month history of lethargy, inappetance, right forelimb lameness,and a 6-month history of stranguria and haematuria. The dog hadreceived a 2-week course of non-steroidal anti-inflammatory drugs(NSAIDs), which had produced no clinical improvement in thelameness but had reduced the degree of stranguria. Radiographsobtained prior to referral revealed an area of bony lysis of the rightantebrachium. In addition, a lateral abdominal radiograph revealedmultiple large radiopaque cystouroliths. The dog had recentlymoved to the United Kingdom from Arizona in the United States ofAmerica, was currently vaccinated (leptospirosis, infectioushepatitis, distemper, parvovirus and parainfluenza) and wormedevery 3 months with a praziquantel, pyrantel and febantelcombination. No other significant medical history was reported.

Chiara Giannasi, Resident inInternal Medicine at Dick WhiteReferrals, invites companion readers to consider a case of rightforelimb lameness and haematuriain an Australian Cattle Dog

Physical examinationThe dog was alert, in good body condition and 8/10lame on the right forelimb. There was a firmcircumferential diffuse bony swelling over the rightcarpus, which was painful on palpation (Figure 1). Thebladder was small with multiple large uroliths palpablewithin the bladder. The remainder of the examinationwas unremarkable. On admission to the hospital,stranguria and haematuria were both evident (Figure 2).

Create a problem list based on the dogshistory and physical examination findings

1. Lethargy

2. Inappetance3. Stranguria4. Haematuria5. Cystouroliths6. Painful bony swelling with lysis of the right

antebrachium

Lethargy and inappetance were most likely due tothe pain induced by the right forelimb lameness andthe presence of cystouroliths causing the urinary tractsigns (stranguria and haematuria).

Pain and the lameness associated with the lyticforelimb swelling were considered the main presentingsign and investigations were centered on this problem.

Figure 1: On physicalexamination the dog was

lame on the rightforelimb and a bony

swelling was palpableover the right carpus Figure 2: Haematuria present on admission



of the nature of the cystouroliths; however, it is

important to remember that the presence of urinarycrystals does not always correlate to the origin ofcystouroliths present.

Repeat radiographs of both forelimbs wereperformed under general anaesthesia as it had been6 weeks since the initial images were obtained andboth the lameness and swelling had progressed inthat period.

What is your interpretation of theforelimb radiographs (Figures 3 and 4)?There is an extensive permeative osteolytic lesioninvolving the mid to distal portion of the right radius, as

well as the distal portion of the ulna. The accessoryand radial carpal bones also show evidence ofosteolysis. The lesions have resulted in marked corticalthinning of the affected bones. A well-definedperiosteal reaction and mild soft tissue swelling arevisible surrounding the right radius. The radiocarpaljoint also appears moderately swollen. The left limb

n Calcium oxalaten Struviten Cystnen Calcium phosphaten Silica

Table 1: Compositions of radiopaque uroliths

A cystotomy was planned to remove the cystourolithsafter these evaluations. The composition of radiopaquecystouroliths are listed in Table 1 with calcium oxalateand struvite uroliths being the most common typesseen in dogs.

List the possible differential diagnosesfor a painful lytic bony lesion in the rightantebrachiumn Neoplastic

Primary: osteosarcoma, haemangiosarcoma,chrondrosarcoma, fibroscarcoma, plasma celltumour (plasmacytoma, multiple myeloma),lymphoma

Metastatic diseasen Infectious

Bacterial or fungal osteomyelitisn Metabolic (unlikely at a single site)

Hyperparathyroidism (primary and secondaryrenal)

Hypovitaminosis D (rickets)n Ischaemic injuryn Trauma

What investigations would you performand why?A complete blood count and biochemistry wereperformed to screen for any systemic abnormalities,and specifically to evaluate for pancytopenia,circulating atypical lymphocytes, hypercalcaemiaand hyperglobulinaemia. The results wereunremarkable. Urinalysis and culture performed on avoided sample confirmed the presence of markedhaematuria. No crystals, renal casts or activesediment was identified on cytology; urine culturewas also negative. Urinalysis revealed alkaline urine(pH 8.0), which is more likely to favour the formationof struvite and oxalate uroliths. There was noevidence of crystalluria to assist in the identification Figure 3: Dorsoventral radiographs of both antebrachia


12/36



coccidioidomycosis prior to considering furtherevaluation of the cystouroliths. Cystotomy was

planned due to the number and unknown origin ofthe cystouroliths.Therapy of coccidioidomycosis includes the use

of azoles or amphotericin B. Treatment for aminimum of 46 months beyond clinical cure with amarked reduction or resolution of positiveserological findings is recommended. Withdisseminated disease, treatment can be prolonged(often >1 year) and in some cases lifelong therapy isrequired. Relapse occurs commonly and it isunknown whether previous infection provideslifelong immunity as in humans.

Azoles inhibit ergosterol synthesis, resulting in cellmembrane permeability and inhibition of fungal cellgrowth. Itraconazole was used in this case and ispreferred for animals with bony involvement; it mayalso be effective in cases that fail to respond tofluconazole. Other potential azoles that could be usedinclude ketoconazole and fluconazole. Ketoconazoleis no longer the drug of choice due to adverse effectsand lower activity. Fluconazole may be preferable forcases with central nervous system involvement.Periodic monitoring of liver enzymes is recommendedwith azole antifungal therapy due to the possiblehepatotoxicity (suggested after 46 weeks of therapyand then every 34 months). Amphotericin B wasavoided in this case due to the expense, narrowtherapeutic window and level of supportive carerequired to avoid nephrotoxicity and other associatedadverse effects. Treatment with amphotericin B shouldbe reserved for severe disease that does not respondto traditional azole therapy. All azole drugs arepotentially teratogenic, so should be avoided duringpregnancy. Specific advice should also be given toclients, with care being taken to warn women of childbearing age about the handling precautions as theuse of these drugs is associated with an increasedrisk of birth defects.

The dog commenced therapy with itraconazoleat a rate of 5 mg/kg p.o. q12h. Analgesia was provided

with meloxicam at a rate of 0.1 mg/kg p.o. q24h andtramadol at 3 mg/kg p.o q8h. This improved thelameness but the pain on palpation remained;the dogs stranguria resolved with the introduction ofthe meloxicam.

COCCIDIOIDOMYCOSIS: PATHOPHYSIOLOGY

The alkaline sandy soil of the southwestern USA, western Mexico and Central andSouth America is the normal habitat for Coccidioides fungal species, which growas vegeta ve mycelia during rainfall. As a result of this geographical distribu on,coccidioidomycosis is o en referred to as Ri Valley Fever.

The mycelia germinate and form arthrospores with soil drying, becoming airborneunder appropriate weather condi ons. In dogs and cats the major route of infec onis via inhala on. Cutaneous contamina on via a penetra ng wound occurs lesscommonly. Within the body it transforms in to the parasi c form, the spherule, andundergoes division later rupturing at maturity. The severity and extent of the diseasedepends on the immunocompetence of the host, and can range from a mild pulmonicform to fatal mul systemic dissemina on. Two species of Coccidioides have beeniden ed, Coccidioides posadasii and Coccidioides immits (isolated in this case), bothof which have similar manifesta ons and drug suscep bili es. Pulmonary infec onoccurs via the bronchioles and alveoli, through the peribronchial ssues, to theassociated lymph nodes. Disseminated disease extends beyond the tracheobronchialand medias nal lymph nodes to the axial and appendicular skeleton and overlyingskin (most commonly), central nervous system, abdominal viscera, pericardium,myocardium and prostate gland.

What are the long term concerns inthis case?There is a risk of forelimb fracture in this dog due to thebone lysis and cortical weakness. Stabilization of theleg may be difficult if a fracture occurs due to the largearea of bone destruction, therefore warrantingamputation of the limb; these risks were furtherdiscussed with the owner.

Given the presence of cystouroliths, urethralobstruction was a concern; however, the dogs urinarytract signs were long standing and only large urolithswere present on the radiographs. The owner waswarned regarding signs of obstruction.

OutcomeThe dog was discharged after 2 days of hospitalizationand appeared comfortable on the prescribedanalgesics. A repeat appointment was made for 2weeks time for reassessment. Cystotomy to removethe uroliths was planned for this time, with follow uplimb radiographs and assessment of liver enzymesplanned following 6 weeks of treatment. Unfortunately,the dog did not return for reassessment and was lostto follow up, having returned to the USA. n



Vets restoring wildlifeis a captivating message

Andrew Greenwood works for Wildlife VetsInternational (WVI) and sees the direct effectsof human intervention and environmentalmismanagement on animal species up close.

As a vastly experienced avian specialist with theInternational Zoo Veterinary Group (IZVG) he advisesimportant captive breeding and species reintroductionprogrammes alongside regular zoo work from thewildlife practices head office in Yorkshire.

Conservation, he admits, can be a hard sellwhen trying to raise funds even to veterinarysurgeons. Practices have a huge base of peoplewho care about animals, says Andrew. The onlyproblem is that it is much easier to sell the idea ofwelfare than conservation.

Yet if estimates of the rate of species loss arewhat the World Wildlife Fund suspects, then at thevery least 200 species are pushed into extinctionevery year. By conservative estimates, since WVIbecame a registered charity in May 2005 around1,800 species have become extinct, and the figurecould potentially be 10 or even 100 times more.

Life on the edgeThe WVI often operates with species that have beenpushed to the brink. For instance, amur leopards in theRussian Far East number less than 50 in the wild. Acombination of logging, deer hunting and opportunisticpoaching following the collapse of the Soviet Unionstretched cat numbers dangerously thin. Thanks toWVIs work with an international team there may behope. An intensive captive breeding and reintroductionprogramme is underway.

As you would expect, demand for expertise faroutstrips supply and the organizations portfolio is

Species conservation is one of the least wellunderstood, complex and important activitiesaffecting animal biodiversity today. Linked asit is with social and environmental effects on

wildlife, it rarely makes headlines in the waythat floods in the Somerset Levels or agovernment scandal does, but thoseinvolved would like to get your attention.Robin Fearon reports

Main image: JohnLewis auscultatingthe thorax of asedated tiger



extensive. Tiger projects in Bangladesh, Sumatra andRussia are coupled with Painted Dog Conservation inZimbabwe, primates in Vietnam, vultures and otherrare bird species in India and Mauritius.

Since 1994 Andrew has flown each year to theIndian Ocean islands to provide veterinary expertiseto restoration projects for reptile species and birdssuch as the Mauritius kestrel, the echo parakeet andpink pigeon.

Partner organization the Mauritian WildlifeFoundation is probably the most successfulendangered species restoration outfit in the world,says Andrew. Four of the last known surviving kestrelsin the area have been saved and the population hasbeen restored to more than 500. The echo parakeetand pink pigeon were down to about 20 birds eachand have now recovered to similar numbers.

There are some complex disease situationsassociated with these species, says Andrew, addingthat if it were not for captive falconry birds, pet parrotsand racing pigeons those problems would bemultiplied. Thankfully, we are working with problemsthat are well presented in captivity. It does not meannecessarily they are easier to manage in the wild, butwe know about them.

The problem and the solutionThe biggest problem for island birds has been humanintervention and the introduction of cats and rats.Logging to grow cash crops like sugar cane is another.If nest sites go, food resources disappear and thenpredators pick off the rest, it is unsustainable, saysAndrew. We are not at the stage with any of thosespecies where they can be lef t unmanaged.

Restoration work begins by taking a proportionof the population into captive breedingprogrammes. Gradually young birds arereintroduced to the wild under careful supervision:

nest sites are monitored, predators controlled andfood provided where necessary.Most of the parakeets have now been taught to use

nest boxes provided by wildlife biologists. All boxeshave access hatches and can be reached using aladder, making the job of monitoring eggs or chicksmuch easier. Put up boxes for wild birds and theywont use them, but if you release birds that have beenbred in nest boxes, they recognize them and startusing them, says Andrew. They then either partnerup with a wild bird or other birds copy them. It is a softrelease process and it is successful.

The way that the Mauritius Wildlife Foundationworks is typical of successful species reintroductionprogrammes the world over. Essentially, breedingprogrammes are moved into the wild. They work withwild birds as if they were captive, says Andrew. Theyincrease the number of clutches, rescue eggs andchicks so they maximize output from wild birds.

Captive-wild breeding speeds up the recoveryprocess in small populations, though it is expensiveand requires long-term work, especially in mammalreintroduction programmes such as that of the Amurleopard. Yet it offers hope for species that mayalready be extinct in the wild and it provides theperfect reason to maintain viable habitat andsupportive eco-systems. The Mauritian governmentrecognizes this and has created a huge forestreserve for pink pigeons so they have a place to liveonce reintroduced.

WVI provides crucial advisory and veterinarysupport to each project, plus specialist medicine andpathology services, as well as links to an academicresearch base at universities including Glasgow, EastAnglia, Reading and Kents Durrell Institute ofConservation and Ecology.

Its reports form the basis of ongoing field work.The guy in the field is at the tip of a pyramid and thebase is all the specialists and researchers workingbehind the scenes, says Andrew.

Repeated requests for help where there was aveterinary or disease problem were what led the vetsat the IZVG to set up WVI in the first place. Thepractice, set up in 1976, found itself in the privileged

position where it could allow clinicians leave to gooverseas for weeks or sometimes months at a time tohelp out; time that other zoo and wildlife organizationscould not afford.

Painted Dog ConservationWVIs foundation in 2005 led well-known vet SteveLeonard to throw his weight behind the charity andsign up as patron. He reasoned that a lot of the smallconservation projects he had encountered during BBC

Steve Leonard examines a dog as part of a distemper and rabies vaccination program tohelp protect African painted dogs against these diseases



Vets restoring wildlifeis a captivating message

Wildlife filming could really benefit from the charitysskills. One Painted Dog Conservation in Zimbabwe has become a headline WVI project.

Steve has been out to Zimbabwe twice setting upvaccination clinics around the Hwange National Park.Painted dogs are badly affected by distemper fromdomestic dogs so teams were sent out to rural villagesto ring vaccinate an area around Hwange and create aprotective barrier.

Using donated vaccines and veterinary drugs theproject was able to set up field treatment centres,administering vaccines and performing castrations. Ina five day period we managed to vaccinate around750 dogs, Steve recalls. We saw a lot oftransmissible venereal tumours and we would ideallylike to offer more neutering clinics.

Painted dogs are suffering pointedly from the samecombination of human intervention and complexdisease issues that typify endangered specieseverywhere. Part of WVIs response is to providevaccination resources, train local vets andconservationists on how to dart wild dogs, takebiological samples for analysis and create diseaseprotocols. That training tells them how to maximizetheir interaction with the dogs, says Steve.

The vets rolePublic understanding of conservation problems isgenerally good, thinks Steve; what is not understood isthe role vets have to play. People just assume thatvets are at the heart of a lot of this, when quite oftenthey are not, he says. There are a lot of smallendangered species projects all over the world wherethey cannot afford veterinary expertise.

Modern conservation has to involve sustainabledevelopment and support for local communities or itcannot work. All the time we are learning and that is

where vets have a role to play, in terms of monitoringthese animals and understanding the stresses.

Britains veterinary community could realize itspassion for conservation and wildlife by supporting thework of wildlife veterinary organizations, says Steve.Vets, nurses and receptionists are all passionateabout these things. We want to tell them this is anorganization they can get behind, who will take theirsupport and do amazing things with it.

Olivia Walter, WVI development manager, says allher efforts are now being targeted towards the

profession. All of our projects are long term, shesays. We dont do emergency veterinary care for ananimal that has been caught in a snare or injured in aroad accident. It is much more at a population level,looking at diseases and training vets, working withscientists and creating strategies.

Involving the profession and industryA core of around 10 practices has signed up to raisefunds and promote the WVIs conservation message.Olivia has high hopes that message will filter down tothe general public. We would like to get morepractices on board, raising funds for us and

increasing awareness of what we do among theirclients, she says. We are a small organization sothese things happen organically.

Board level talks have led to profitable links withthe veterinary industry and MSD Animal Health is oneof several companies to provide equipment andfinancial support. The company already supports theefforts of the Afyah Serengeti project and MissionRabies in India to vaccinate domestic dogs andprevent disease. It also provides vaccine to WVI forPainted Dog Conservation and Steve Leonard.

Ken Elliott is marketing manager for MSDscompanion animal business and an advocate ofconservation projects. WVI has got tremendouspotential, he says. What they are doing is just the tipof the iceberg. The limiting factor is funding. They arenot able to advertise on TV, but what they can do iswork with the British veterinary profession to make theirname and win support.

Community clinicwith partnersPainted DogConservation,ZimbabweanVeterinaryDepartment andWVI vets Steveand Tom

WVI vet Andrew Greenwood releases a male flycatcher.Within the first breeding season 4 chicks were fledged


17/36



How to deal witha patient withthermal burns

Immediate first aidSince the skin is very slow to cool, it ispossible for the burning process tocontinue for some time after removal ofthe patient from the heat source. Thus,the first treatment consideration shouldbe to stop the burning process. Therecommendation is that the burnedareas should be cooled with running tapwater (15C/59F) for 2030 minutes.The use of wet compress towels is not aseffective at reducing burn depth.Similarly, iced water is also notrecommended as this can rapidlydecrease the patients core bodytemperature, causing vasoconstriction,thereby contributing to increased wounddepth and reducing circulation to theimmediate area. Owners should be

advised to avoid hypothermia duringtransport, by wrapping the patient inclean, dry sheets or blankets. Thepatients temperature should be carefullymonitored to ensure hypothermia doesnot occur; if the patients temperaturedrops below 38C active warming will berequired to prevent any further drop.

Infection control considerationsBurns patients are at high risk of sepsis,therefore, it is recommended that allpersonnel wear examination gloveswhen handling the patient and strictaseptic technique (including sterilegloves, sterile swabs, etc.) must beused when performing any invasiveprocedure (e.g. placing catheters orcollecting blood).

Louise ODwyer, Clinical Director of thePetMedics Veterinary Hospital, helps usapproach the patient with thermal burns

Pain managementA multimodal analgesic protocol isrecommended for the management ofpain. In the acute phase of burn injuries,intravenous opioids should be theprimary method of analgesia. The degreeof pain associated with burn wounds isincredibly varied, and the use of painscoring systems, such as the GlasgowComposite Measure Pain Score, is highlyrecommended. Pure opioid agonists suchas methadone (0.10.25 mg/kg i.v.q26h) or morphine (0.10.5 mg/kg s.q.q26h) are recommended for veterinary

patients with moderate to severe pain.Ketamine is reported to be useful for thetreatment of somatic pain and can beused in conjunction with opioids as aconstant rate infusion at 0.150.6 mg/kg/ hr. Lidocaine may provide additionalanalgesia and may also have free radicalscavenging properties. Lidocaine is usedat a rate of 1.53 mg/kg/hr, but should beused with caution in feline patients. Ifusing a constant rate infusion, a loadingdose equal to the hourly rate shouldinitially be administered. Each patientshould be evaluated individually foroptimal analgesia, again using a painscoring system to ensure that ongoinganalgesia is adequate.

Primary surveyAs with any emergency patient, on initialpresentation the burns patient will require aprimary survey in order determine theextent of the injury and to commencetreatment as required. Priorities includeensuring the patient has a patent airway,and assessing the requirement forventilatory support, followed by fluid

therapy to treat hypovolaemic shock.Oxygen (100%) should be administered toany patient suspected to have smokeinhalation injury to accelerate theelimination of carbon monoxide. Intubation

Thankfully thermal burns are anuncommon presentation in smallanimal practice; however, dealingwith these injuries can be

challenging. This article provides a reviewand logical approach to the assessment

and management of a patient withthermal burns.

Extent of burnsIn human medicine thermal burnshistorically have been classified accordingto the extent (expressed as a percentage)of the body surface involved and the depthof injury to the skin. The most commonscale used for humans is the rule of nines,whereby the adult human body is dividedinto areas corresponding to 9% of the totalbody surface area, or multiples of 9%. For

example, individual thoracic limbscomprise approximately 9% of the totalbody surface area; each lower limb, 18%;the head and neck, 9%; the chest andabdomen, 18%; the back, 18%; and theperineum, 1%. The modern burnclassification system also classifies burnsaccording to their depth as superficial,superficial partial-thickness, deeppartial-thickness or full thickness.

In veterinary patients there is oftendifficulty in assessing the depth of theinjury at initial presentation, and serialexaminations over the first 24 hours areusually required to determine the extent ofthe injury. For some local burn wounds theinjury may not be immediately evident tothe owner, with the patient being presented2448 hours post-injury.



or emergency tracheostomy may be

required if the airway oedema is severe. Inthe event of orotracheal injury, endotrachealtubes should be carefully secured, asprogressive oedema may make emergencyre-intubation more demanding.

In patients injured during house fires,the effects of smoke inhalation will beevident on the upper respiratory tract withinthe first 24 hours and occur as a result ofdirect thermal injury. The adherence ofirritants to the upper respiratory tract resultsin the release of inflammatory mediatorsand reactive oxygen species (by-products

of respiration, which can cause damage tocell DNA), increased vascular permeabilityand oedema formation. This oedema canprogress to airway obstruction andbronchospasm that generally peaks ataround 24 hours post-injury, andsubsequently resolves over the followingdays. Haemorrhage, mucosal congestion,ulceration and laryngospasm may alsooccur within the first 24 hours. Additionalcomplications occur due to the adherenceof soot to the respiratory mucosa, whichallows other irritants to bind to the mucosa.

Vascular access can be complex in thehypovolemic, burnt patient. Ideally, shortperipheral catheters should be placed innon-burnt areas. Burnt areas may be usedin the first 24 hours; however, dressing thecatheters may be complex in theselocations, and the sites also becomerapidly colonized with bacteria, thuscatheters need to be removed within2448 hours. Intraosseous catheters arean alternative for patients where vascularaccess is difficult, but this technique canbe difficult in adults . Where burns over alarge surface area have been sustained,

central catheters may be the most suitableoption, as these patients may requireparenteral nutrition or central venouspressure monitoring. However, the use ofcentral catheters should be avoided

whenever possible due to the risks

associated with hypercoagulability inpatients with extensive burns.

Fluid therapyFluid resuscitation is a vitally importantstep in the treatment of severely burntpatients. The aim of fluid resuscitation isto maintain organ perfusion and avoidtissue ischemia using the least amount offluid required. In most burns cases, thereis little change in intravascular volume orhaemodynamics for the first 12 hoursfollowing the injury, but a delay in fluid

resuscitation beyond 2 hours of the burninjury reportedly results in complicationsin resuscitation and an increase inmortality. In patients with severe burns,after 12 hours there is generally a periodof haemodynamic instability (for 2448

hours) despite fluid resuscitation. During

this period neither preload nor cardiacoutput can be normalized using fluidresuscitation until 24 hours after theinjury. Severely burnt patients that alsohave concurrent inhalation injuries,commonly have a marked increase inhaemodynamic instability, with a 3050%increase in initial fluid requirements beingseen when compared with patients withburn injuries alone.

In human medicine the consensusformula (formerly referred to as theParkland formula) has become the most

widely used resuscitation guideline and isused to calculate the volume of crystalloidsrequired within the first 24 hours followingsevere burn injury. The formularecommends the administration of isotoniccrystalloids at a rate of 4 ml/kg per

Figure 1: Nasal oxygen catheter placed in a bulldog. Oxygen saturation monitoring is also beingperformed using a pulse oximeter



How to deal witha patient with thermal burns

percentage of total body surface areaaffected in the first 24 hours, with half ofthis volume being administered over thefirst 8 hours after presentation. Theremaining fluid is administered over thefollowing 16 hours. However, recent studieshave found that average fluid volumesadministered to burns patients significantlysurpass the formula predictions, frequentlyexceeding 67 ml/kg per percentage oftotal body surface area affected.

The use of both natural (e.g. albumin)and synthetic (e.g. hydroxyethyl starches)colloids in the resuscitation of burnspatients is controversial. This concern isdue to the potential for leakage of proteinsand large molecules throughcompromised capillary membranes. The

current recommendation is to wait at least812 hours post-injury before utilizingcolloids. The use of colloids may increasecolloid osmotic pressure (COP), which hasbeen reported to reduce oedemaformation in non-burnt tissue (but not inthe burn wound itself).

Secondary surveyFollowing initial stabilization of the patient,a secondary survey should be performedto identify any concurrent injuries. Patients

should be assessed for neurologicalinjuries secondary to trauma, hypoxaemiaand carbon monoxide poisoning; ideallythis should be performed once the patientis normovolaemic. The airways and thoraxrequire auscultation for stridor, crackles orwheezes, and the adequacy of ventilationshould be assessed, ideally via blood gasanalysis. The face, oral cavity and pharynxshould be examined for the presence ofburns or debris that may suggest inhalationinjury has occurred.

The eyes should be assessed forconjunctivitis, particulate material andcorneal ulceration. Corneal ulcerscommonly occur secondary to thermalinjury or abrasion by particulate material,so fluorescein staining should always be

performed. Topical anaesthetics such asproxymetacaine should be used tofacilitate examination behind the thirdeyelids for foreign material, and the eyesshould be copiously flushed with sterilesaline. Baseline radiographs ideally shouldbe obtained to assess for any changes asa result of smoke inhalation or traumaticinjury. It should be remembered thatthoracic radiographs may be normalinitially, although bronchial markings maybe present.

The development of pulmonaryinfiltrates or lobar consolidation maysuggest pneumonia. Arterial blood gasevaluation is useful to determineparameters related to ventilation,oxygenation and perfusion. However, itshould be remembered that both thepartial pressure of oxygen ( p O2) andoxygen saturation ( S pO 2) can bemisleading in the presence of carbonmonoxide inhalation. In this situation pulseoximetry will misread carboxyhaemoglobinas oxyhaemoglobin; co-oximetry should beperformed, if available, to determinecarboxyhaemoglobin levels as co-oximeters will directly measurecarboxyhaemoglobin and oxyhaemoglobin.

Baseline complete blood count, serum

biochemistry panel and urinalysis shouldbe performed on admission. Ifmyoglobinuria is noted, this may indicate aneed for higher fluid rates to avoid renaltubular damage. Coagulation testing isrecommended, as burnt patients maysuffer from hyper- or hypocoagulablestates. The abdomen should be assessedfor compartment syndrome (increasedintra-abdominal pressure due to underlyingdisease processes), gastric distension andother traumatic injuries.

Carbon monoxide toxicityCarbon monoxide is the most commonlyinhaled agent producing complications insmoke inhalation patients. The severity ofthe injury secondary to carbon monoxidetoxicity is directly dependent on theconcentration of inhaled carbon monoxide,the duration of exposure and theunderlying health status of the patient.Carbon monoxide is rapidly absorbedacross the alveolar membrane, binding tohaemoglobin with an affinity 200 to 250times greater than that of oxygen. Thisbinding of carbon monoxide prevents the

binding of oxygen to haemoglobinmolecules, resulting in a functionalanaemia. Additional detrimental effects ofcarbon monoxide toxicity include inductionof lipid peroxidation, direct cellular

Figure 2: Partial-thickness burn, involving lossof the epidermis and part of the dermis, due toa wet burn

Figure 3: The patient in Figure 2demonstrated a good recovery from theinjury with no scarring



damage, reperfusion injury and centralnervous system demyelination. Theadministration of supplemental oxygenimproves oxygen saturation and decreasesthe half-life of carboxyhaemoglobin(CO-Hgb). The elimination half-life ofcarbon monoxide is 5 hours at 21% oxygenor 1 hour at 100% oxygen. Oxygen may bedelivered by a variety of routes (e.g. facemask, nasal cannula, oxygen hood, oxygencage or via intubation), depending on theseverity of the respiratory compromise andpatient tolerance of the technique (Figure1). Nasopharyngeal burns may hinderoxygen supplementation via nasal cannula.

MonitoringSevere burns patients may require

continuous ECG, direct blood pressuremeasurement, pulse oximetry, frequentarterial blood gases, electrolytes andlactate (to assess and monitor perfusion),biochemical profiles (to monitor liver andkidney parameters) and complete bloodcounts (to assess for infection, anaemia,low platelets, etc.), as well as coagulationprofiles and a closed urine collectionsystem with a urinary catheter placedaseptically (i.e. using sterile gloves andsterile technique). Urinary catheterizationmay be useful to allow urine output to bemeasured, as this is commonly used inpatients with severe burn injuries to guidefluid therapy and resuscitation.

Figure 4: Full-thickness burn due to a dry burn (contact with aradiator pipe)

Figure 5: Extensive full-thickness burns in a German Shepherd Doginvolved in a house fire

An aseptic peripheral intravenouscatheter should be placed as the firstchoice in burns patients. Another option, insevere cases, would be the placement of acentral venous catheter; however, this isoften associated with a high incidence ofthrombosis and infection in these patients.Serial central venous pressure (CVP)measurements can also be performedwhen a central venous catheter is placed,and can be used to guide fluid therapy,allowing assessment of volume status andright-sided cardiac function. When CVPcannot be used, lactate can help guidetherapy, as lactate values increase asanaerobic metabolism increases, and, as itis a marker of perfusion, will decrease asperfusion increases. Once no longer

required, central lines should be removedas early as possible.

Wound managementAs mentioned, one of the priorities in burntpatients is to minimize contamination ofthe damaged skin. It is vital that thehandling of these patients, including forwound management, is performedcorrectly on every occasion. Handsshould be thoroughly washed, using anappropriate antimicrobial detergent, andexamination gloves worn, particularlywhen dealing with superficial burns andpartial-thickness superficial burns(Figures 2 and 3). If the patient has

sustained deep partial-thickness orfull-thickness burns then sterile glovesshould be worn (Figures 4 and 5).

The underlying cause of the injury willdetermine the initial type of woundmanagement required. Burns arising dueto scalds from hot liquids (wet burns) orcontact with a heat source (dry burns)generally result in minimal contamination,and therefore require standard lavageprocedures. Chemical burns (e.g. fromcaustic liquids) may require very extensivelavage, to remove the contaminant.

A standard flush can be set up using alitre of warmed lactated Ringers solution(LRS), a fluid administration set and astopcock with a 35 or 50 ml syringe andan 18 G needle attached, or alternatively a

litre of warmed LRS, an administration setand an 18 G needle and be placed into afluid pressure bag and then the baginflated. This allows for the optimalpressure (~8 psi) to be used to irrigate thewound. With burns wounds, since they aregenerally not heavily contaminated withorganic matter, the volume of fluid isrequired to reduce bacterial contaminationof the wound surface. Following lavage,the wound requires debridement. Thisprocedure may need to wait until thepatient has been stabilized, as it is likelythat sedation or general anaesthesia willbe required. So interim dressings may beapplied (see below).



How to deal witha patient with thermal burns

The eschar, the blackened, dead layerof skin seen following a burn, should beremoved via debridement (Figure 6) andthis can be carried out using a variety oftechniques: surgical debridement orapplication of debridement dressings (e.g.wet-to-dry dressings) are commonlyperformed techniques. Followingdebridement, open wound managementwill generally be performed before thewound is closed surgically, if this ispossible. Research has indicated that anearlier and more aggressive surgicalapproach to debridement results inattenuation of the hypermetabolic responseand reduced infection rates. The increasedpermeability of the burn eschar causesexcessive fluid, protein, immunoglobulin

and electrolyte loss. In addition, the escharpromotes bacterial growth. Escharectomyis the best means of preventing bacterialinfections and sepsis, and exposes aviable bed of tissue for skin grafting orpermanent wound closure; this is generallycarried out as part of the surgicaldebridement process.

The most common topical agents usedin the UK for the treatment of burn woundsinclude silver sulfadiazine and honey. Silversulfadiazine (SSD), a water-soluble creamsynthesized from silver nitrate and sodiumsulfadiazine, has long been considered thegold standard in topical burn treatment.Silver sulfadiazine has a broadantimicrobial spectrum and fair to goodeschar penetration with minimal adverse

side effects in people. Recently, sustainedsilver-releasing products have beendeveloped that combine a silver agent witha carrier dressing (e.g. a foam dressing).Such products can be applied to partial-thickness burns and can remain in placefor 37 days. This eliminates manipulationof the burn site and the pain associatedwith dressing changes. Care should betaken not to use silver sulfadiazine inpatients with kidney or liver failure, as it hasbeen shown to cause a transientleucopenia in human burns patients, whichresolves with discontinuation. It isrecommended to change to another topicalmedication if the white blood count beginsto fall.

Honey has been used for the

treatment of wounds for many years dueto its antimicrobial properties, but limitedinformation is available regarding its utilityin burn wounds. Antimicrobial propertiesarise due to its low pH, high osmolarityand the production of hydrogen peroxide.Honey acts by providing a physicalbarrier to invading organisms and alsoprovides a moist environment for woundhealing. The use of honey in open woundmanagement has demonstrated animproved healing rate, reducedcontracture, reduction in over-granulation,improved wound strength and a moresterile environment when compared withSSD. Medical grade manuka honey is theauthors topical treatment of choice forburn wounds.

Figure 6: Full-thicknessburn as a result ofcontact with a heat mat.The blackened eschar isclearly visible

Nutritional supportconsiderationsNutritional support is an importantconsideration for the burns patient. Burnpatients experience increased musclecatabolism and a negative nitrogenbalance, resulting in the loss of lean bodymass and often severe muscle wasting, sonutritional support should be addressed asearly as possible, ideally within 2448hours post-injury. Enteral nutrition isrecommended over parenteral nutrition asit helps maintain gut motility, decreasesplasma endotoxin and inflammatorymediators, preserves first pass nutrientdelivery to the liver and decreasesintestinal ischemia and reperfusion injury.Parenteral nutrition is only recommended

as a consideration in patients that do nottolerate enteral nutrition due to vomiting,oral ulceration, prolonged ileus or duringthe perioperative period. Even in thesesituations, enteral nutrition may beprovided via oesophagostomy orgastrostomy tubes.

ConclusionBurn patients can be very challenging,from initial management through to theirlonger term nursing care, because of thecomplexity of the multifactorial effects on

the major body systems. Despite thesechallenges, they are highly rewarding asthey allow us to put all our knowledge intoaction. Almost every aspect of the patientsmanagement needs to be considered fromfluid therapy, analgesia, nutrition andwound management, through to respiratoryand cardiovascular considerations.Although demanding from initialpresentation to recovery, with good nursingand appropriate treatment these casesshould have a rewarding outcome.

References are available online and ine- companion

MORE ONLINE


23/36



Decision making inwound closure

Wound closure andreconstruction should aim toreturn the patient to normalfunction as soon as possible.

To achieve this aim, the key questions that

must be addressed are when and how aparticular wound should be closed. Toanswer these, the veterinary surgeon musttake into account a number of factors:

The overall condition of the patient How the wound was caused The degree of trauma at the site of the

wound.

Failure to take such factors intoaccount may lead to local woundcomplications and dehiscence and, withsevere trauma, the consequences to the

patient could be catastrophic.

Timing of wound closureThe four options for closing a wound(Figure 1) are:

John Williams, editor ofthe BSAVA Manual ofCanine and FelineWound Managementand Reconstruction ,

takes companion readers through theconsiderations forwound closure

Closure op on Wound classi ca on Wound management

Primary closure Clean wound Immediate closure without tension. Mayrequire an appropriate ap or gra ing

techniqueDelayed primaryclosure

Clean-contaminated orcontaminated wounds, or wherethere is ques onable ssue viabilityor oedema, or skin tension is likely ifprimary closure is a empted

Lavage and debridement of open wound.Appropriate dressing used. Closureperformed 23 days a er wounding. Mayrequire an appropriate ap or gra ingtechnique

Secondaryclosure

Contaminated or dirty wounds Lavage and debridement of openwound. Appropriate dressing used. Closureperformed 57 days a er wounding. Mayrequire an appropriate ap or gra ingtechnique

Secondinten onhealing

Wound unsuitable for surgicalclosure technique: extensivecontamina on and devitaliza on.Do not consider over a joint surfaceas it may lead to joint contracture

Lavage and debridement of open wound.Appropriate dressing used. Allowed toheal by granula on, contrac on andepithelializa on

Figure 1: Closure options for traumatic wounds

Figure 2: Thin hairless skin of a chronicallymanaged wound on a cats leg

Primary closure Delayed primary closure (closed after

4872 hours, before granulation tissuedevelops)

Secondary closure (closed aftergranulation tissue develops, 57 days)

Second intention healing (contractionand epithelialization).

The degree of contamination and of

tissue viability play a major role in thedecision-making process. To be able toclose a traumatic wound primarily it mustbe possible to convert it from acontaminated to a clean-contaminatedwound, and there can be no evidence oftissue necrosis or foreign debris.

It is also important not to manage anopen wound for an excessive period oftime. The role of open wound managementis to create an environment that will allowwound closure and return to normalfunction. There is no merit in dressing awound for months on end with no clearplan as to how to reconstruct the wound.Such action frequently leads to contractureor formation of exuberant granulationtissue with tissue that is covered by thinfriable epithelium (Figure 2) and may

prove to be more expensive than earlysurgical reconstruction.

Early wound construction and closureshould be considered:

If vital tissues are exposed Where reconstruction of the tissue is

required for structural support(e.g. footpads)

Where wounds are located over the

flexor surface of a joint and prolongedopen wound management may lead tocontracture

For open wounds over tendons, as scartissue may form which will prevent thenormal gliding action of tendons


25/36


26/36

Sue Paterson talks ear disease

PetSavers isall ears

26 | companion AUGUST 2014 | BSAVA 2014

Celebra ng 40 YEARS of improving the health of pets

Antibiotic resistance has become a very

real problem for veterinary surgeons inboth primary care practice and referralpractice. The treatment of ear disease has

become especially challenging with the emergenceof increasing numbers of multiply resistantpathogens such as meticillin resistantStaphylococcus pseudintermedius (MRSP),Pseudomonas spp. and Enterococcus faecalis.Whilst the management of otitis involves much morethan purely treating infection, without the ability totreat infection appropriately other therapeuticmeasures become irrelevant.

It is not long ago that veterinary surgeons seized

upon any new paper on the use of third lineantibiotics such as ticarcillin, amikacin or ceftazidimeto treat multiply resistant otic isolates. More recentlywith the new guidelines on antibiotic usage urgingcaution and justification when using such drugs, theyare used less frequently. However, without viablealternatives to such topical therapy vets arefrequently faced with the difficult dilemma of havingto use an off licence third line antibiotic orcompromise the wellbeing of the animal.

There is no doubt that increasing numbers ofanimals undergo radical ear surgery because theirinfections cannot be managed medically. Antisepticsoffer an alternative to antibiotics but there is scantevidence of their efficacy in a clinical situation. Therehave been many excellent papers looking at the in vitro activity of different antibacterial agents (Farca 1991,Lloyd 2000, Cole 2003, Reme 2006, Cole 2007,Swinney 2008, Guardabassi 2010, Steen 2012, Mason2013) but no in vivo work.

It is well recognized that both antibiotics andantiseptics work differently in vitro compared within vivo . Organic debris, pus and wax can affect aproducts antibacterial action. Chlorhexidine isdescribed as being one of the few antibacterialproducts that is active in the presence of blood ororganic material but this information is mostly based

on in vitro human studies.To the authors knowledge there have been no

in vivo studies undertaken in the dog. The aim ofour application to PetSavers for funding wastherefore to allow us to look at the activity of a range



of different antibacterial agents in vivo using cases

in our clinic.Our aim was to assess the ability of different ear

cleaners to treat both routinely identified bacterialand yeast infections and also the more resistantpathogens often seen in chronic otitis cases in thepresence of purulent exudate, mucus and wax. Inaddition to assessing the ability of topicalantiseptics to kill pathogens, our study has alsolooked at the changing pH within the ear after theaddition of an ear cleaner.

There is a wealth of information in the literatureabout the way that pH affects antibiotic activity.Aminoglycoside and fluoroquinolone antibiotics workbest in a neutral or slightly alkaline environment.However, despite advice about appropriate periodsof time taken between application of an acidic basedproduct to an ear and subsequent topical antibioticadministration, there are no studies that actuallymeasure the changes in pH within the ear afterapplication of a cleaner.

What has been interesting and exciting about ourstudy is that it has given us essential informationabout the potential use of antibacterial agents, in theform of antiseptics, as therapy in cases of otitisexterna in the dog. Many of the results have revealedmarked differences between previously reported invitro data and our in vivo data. The study reinforces

the fact that although in vitro work is undoubtedlyuseful, in vivo studies in clinical cases provideinformation that can be used by veterinary surgeonsin practice to help in their management of caseswithout in some instances having to resort toantibiotic therapy.

PetSavers funding has provided a grant to financework that has been driven by a need to find alternativetherapies for difficult clinical cases. The results havemotivated us to go on to look at other topical productsto provide clinicians with more choice in therapy.

PetSavers is set to host its first eversponsored dog walk through the beautiful grounds of CirencesterPark, Bathurst estate, by kind permission of the 9th Earl ofBathurst and the Countess Bathurst.

In recent years PetSavers fundraisers have taken part in the VirginLondon Marathon and the Bath Half Marathon now, as we celebrateour 40th anniversary, we have decided to take charge and host ourvery own event.

Thanks to kind donations over the years PetSavers has been able tofund a huge number of important studies however, your help is stillneeded so that we can continue to support clinical research and trainingprogrammes that are vital if we are to understand more about theillnesses and diseases suffered by companion animals. So Walk your

dog for PetSavers 2014 provides the opportunity to raise both thenecessary funds and increase awareness of PetSavers.Chair of the PetSavers Management Committee, Pedro Martn

Bartolom, says the support PetSavers gets from its volunteers andfundraisers is truly extraordinary. PetSavers is diversifying itsfundraising activities across the UK to reach as many people from thisloyal and involved group as possible. I am sure that the charity dogwalk will be another success for PetSavers and a very rewarding eventfor all those taking part.

The Bathurst Estate and Cirencester Park, designed in the 18thcentury Lord Allen Bathurst and his friend, the poet Alexander Pope, willprovide what we hope to be the perfect Autumnal setting for what will nodoubt be a great day. The PetSavers team has mapped out two of themost scenic routes the estate has to offer, one 3 miles long and the otherslightly more challenging at 6 miles long, with highlights includingThe Popes Seat and Badger Roundabout.

We would love you to join us on this special day. For more informationand to register for the walk visit www.petsavers.org.uk .

Walk yourdog for

PetSavers2014

References are available online and in e- companion .

MORE ONLINE



The WSAVAs One Health Committee haslaunched its second three-year programme ofwork, which aims to highlight the role of smallcompanion animals in One Health. Plans for

the project were discussed during a two-day meetingat Duke Medical Center in Durham, North Carolinafrom 910 June 2014.

During the meeting, One Health CommitteeChairman Professor Michael Day, from the Universityof Bristol, UK, gave a public lecture entitled Cats,Dogs and Humans: One Medicine, One Health to takethe WSAVAs One Health message directly to thehuman medical community at Duke. Delegates thenplanned a three-year programme of work, visited the

WSAVA One Health Committee launches

Phase II Project

BSAVA Senior Vice-PresidentProfessor Michael Day reports

on the latest developmentswith the One Health initiative

comparative oncology research laboratories and metwith representatives of the North Carolina One HealthCollaborative and the US One Health Commission.

One of three focus areas for the One Health

Committee is comparative and translational clinicalresearch, explains Professor Day. Holding thismeeting at one of the major global human healthcentres was an important step forward in engagingwith the human medical community which remainsone of the greatest One Health challenges. We need totake every opportunity to promote the benefits tohuman medicine of investigating shared spontaneouslyarising diseases in dogs.

Later this year, the One Health Committee will hosta full-day programme on rabies control in Africa at theWSAVA World Congress. The fourth annual WSAVAGlobal One Health Award will also be presented atWorld Congress.

The work of the One Health Committee is madepossible through the generous sponsorship of aconsortium of seven industry sponsors, co-ordinatedthrough the WSAVA Foundation, the WSAVAscharitable Trust. n



START PLANNIN G FOR WSAVA 2015

WSAVA invites you to join them at the 40th World Small

Animal Veterinary Associa on Congress (WSAVA 2015),being held in exci ng Bangkok, Thailand 1518 May2015. WSAVA 2015 promises to harness the exper seof the worlds foremost veterinarians for a s mula ngexchange of knowledge and experiences. For full detailsvisit www.wsava2015.com .

Updatefrom theWSAVA President

One of the most rewarding aspects of being involvedwith the WSAVA is knowing that, by workingtogether, we are daily making a real and significantdifference to the health and welfare of companion

animals around the world.I particularly applaud the work of the WSAVAs Global Pain

Council on the publication of its ground-breaking Global PainTreatise, which has now been published in the Journal of SmallAnimal Practice (JSAP). No animal should have to suffer pain andthis publication marks a step forward towards our goal of creatinga pain-free environment globally for companion animals.

The Global Pain Treatise is the culmination of a huge amount

of work from Karol Mathews and her team, and I congratulatethem all. An aspect of it of which we are especially proud is that itprovides alternatives in circumstances when recommendeddrugs are unavailable. It is a sad reflection on the state of globalveterinary medicine that, because of restrictive local laws, not allveterinarians have access to opiates or to ketamine or to manyother pain-saving drugs. With this in mind, the global digitaledition of our journal, Clinicians Brief , will now attempt to listalternative drugs. It will not be easy as we are not aware of theavailability of a global database. One of our major tasks for thenext two years is to work with the leadership of the WorldVeterinary Association to develop a list of all recommendeddrugs, for all conditions. We hope our member associations canuse this to lobby their governments or industry for access.

Meanwhile, our thoughts are turning to World Congress a huge amount of planning and careful preparation has takenplace to ensure that it will be an inspirational showcase for cuttingedge thinking on all aspects of veterinary care for companionanimals. We look forward to seeing many of you there. n

Professor Colin Burrowshighlights one of the WSAVAsflagship initiatives to raise globalstandards of veterinary care

Dont forget your

runningshoes!Packing for World Congress?Bring your running shoes so youcan join us for the WSAVAFoundations second fun run

This unique event takes place on Thursday 18September and will raise vital funds for theAfrican Small Companion Animal Network(AFSCAN), an initiative launc

Companion August 2014 Low Res

Documents