The essential publication for BSAVA members

companion
APRIL 2013
The life of
a veterinary
forensic scientist
How To
Recognise common
ECG abnormalities
P12
SAVSNET People
Meet the team
P4
Clinical Conundrum
Exophthalmos in
a spaniel
P8
01 OFC April.indd 1 15/03/2013 13:17
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Wolbachia, lariae and Leishmania
coinfecton in dogs from a
Mediterranean area
This study highlights the increased
sensitvity of PCR in the diagnosis of
lariasis, conrms the presence of
Wolbachia in dogs from the Mediterranean
basin, shows the increased severity of
clinical signs when Leishmania larial
coinfecton is present and suggests
a protectve role for Wolbachia in
leishmaniosis.
The e cacy of n-butyl-cyanoacrylate
tssue adhesive for closure of canine
laparoscopic ovariectomy port site
incisions
This study suggests that n-butyl-
cyanoacrylate is an acceptable method for
closing laparoscopic port sites in dogs.
Comparatve accuracy of several
published formulae for the estmaton
of serum osmolality in cats
Multple formulae to calculate serum
osmolality can be used, but they result in
signicantly dierent osmole gaps. The
authors recommend the formula [2(Na
+
) +
glucose + BUN].
companion is published monthly by the British
Small Animal Veterinary Association, Woodrow
House, 1 Telford Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB. This magazine
is a member-only benet. Veterinary schools
interested in receiving
companion should
email companion@
bsava.com. We welcome
all comments and ideas
for future articles.
Tel: 01452 726700
Email: companion@
bsava.com
Web: www.bsava.com
ISSN: 2041-2487
Editorial Board
Editor Mark Goodfellow MA VetMB CertVR DSAM
DipECVIM-CA MRCVS
CPD Editor Simon Tappin MA VetMB CertSAM
DipECVIM-CA MRCVS
Past President Andrew Ash BVetMed CertSAM MBA
MRCVS
CPD Editorial Team
Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS
Tony Ryan MVB CertSAS DipECVS MRCVS
Lucy McMahon BVetMed (Hons) DipACVIM MRCVS
Dan Batchelor BVSc PhD DSAM DipECVIM-CA MRCVS
Eleanor Raffan BVM&S CertSAM DipECVIM-CA MRCVS
Features Editorial Team
Andrew Fullerton BVSc (Hons) MRCVS
Mathew Hennessey BVSc MRCVS
Design and Production
BSAVA Headquarters, Woodrow House
No part of this publication may be reproduced
in any form without written permission of the
publisher. Views expressed within this
publication do not necessarily represent those
of the Editor or the British Small Animal
Veterinary Association.
For future issues, unsolicited features,
particularly Clinical Conundrums, are
welcomed and guidelines for authors are
available on request; while the publishers will
take every care of material received no
responsibility can be accepted for any loss or
damage incurred.
BSAVA is committed to reducing the
environmental impact of its publications
wherever possible and companion is printed
on paper made from sustainable resources
and can be recycled. When you have finished
with this edition please recycle it in your
kerbside collection or local recycling point.
Members can access the online archive of
companion at www.bsava.com .
3 BSAVA News
Latest from your Association
45 SAVSNET People
Meet the team
67 Forensic expertise
Congress speaker reveals life of a
veterinary forensic scientist
811 Clinical Conundrum
Exophthalmos in a young spaniel
1221 How To
Recognise common ECG
abnormalities
22 Join us in Dublin
BSAVA/Veterinary Ireland
host FECAVA
2425 Minimize the risk of surgical
infection
Preparing for surgical procedures
2627 PetSavers
Genetic analysis of canine uveal
melanomas
2829 WSAVA News
The World Small Animal
Veterinary Association
3031 The companion Interview
Paula Boyden
33 Postcards from the Regions
News from your local groups
3435 CPD Diary
Whats on in your area
Additional stock photography:
www.dreamstime.com
Daniel Gilbey; Imagery Majestic; Luis Santos;
Radovan Mlatec
Whats in
JSAP
this month?
Here are just a few of the
topics that will feature in
your April issue:
Potental role of Alternaria and
Cladosporium in the pathogenesis of
canine lymphoplasmacytc rhinits
The results of this study suggest that these
fungi are probably not involved in the
pathogenesis of lymphoplasmacytc rhinits.
Evaluaton of accuracy of the Finnish
elbow dysplasia screening protocol in
Labrador retrievers
A single mediolateral exed radiograph is
reliable in diagnosing mild elbow dysplasia
in Labrador retrievers. However, the
craniocaudal oblique projecton increases
the specicity of the diagnosis, and the
authors propose that it be included in the
radiographic protocol in this breed.
Log on to www.bsava.com to access
the JSAP archive online.
SPECIAL ISSUE
OF EJCAP NOW
AVAILABLE
Dont forget that
as a BSAVA member
you are enttled to
free online access
to EJCAP register
at www.fecava.org/EJCAP to access the
latest issue.
Find FECAVA on Facebook!
02 Page 02 April.indd 2 18/03/2013 13:06
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S
urveillance is currently a topic of much
discussion. Sally Everitt, BSAVA Scientific
Policy Officer, attended a meeting at the
Veterinary Medicines Directorate in
February to discuss the surveillance requirements
for antibioticresistance for food-borne and
veterinary pathogens. The overall aim of the day
was to considerwhat a sensible surveillance
scheme for antibacterial resistance would
comprise of. It was agreedthat surveillance is
most appropriate when it is producing information
for action or monitoring an intervention, the data
needs to be robustbut it is also important that the
right questions are asked.
The afternoon included a session which
examined surveillance approaches in companion
animals. Although the remit was primarily related
to antimicrobial resistance the discussion in the
group ranged more broadly. There are essentially
two reasons for carrying out surveillance in
companion animals: to provide information about
health and disease in companion animals in
order to aid clinical decision making; and to
provide information relevant to human health,
especially with regard to zoonotic disease and
antimicrobial resistance.
Although there is currently very little
companion animal surveillance it was agreed that
there was a wealth of information that could be
accessed for this purpose and that advances in
IT systems, epidemiological approaches and a
willingness to collaborate all mean that it is now
possible to extract and analyse practice and
laboratory data.
BSAVA are delighted to be contributing to the
development of companion animal surveillance
through their involvement in SAVSNET.
BSAVA have also responded to the AHVLA
consultation on the future delivery of scanning
surveillance for animal-related threats in
Englandand Wales, making clear the
importanceof including companion animals in
disease surveillance.
M
any students and newly qualified nurses carry around a
notebook and write down information they can refer to on a daily
basis. As time goes by, many of these little pearls of wisdom are
forgotten. The BSAVA Pocketbook for Veterinary Nurses
compiles all of these useful nuggets of information into one handy
pocket-sized book. With sections on fluid therapy, anaesthesia,
radiography, laboratory tests, nutrition and critical care, to name but a few,
the Pocketbook will save time in practice when a procedure is needed to be
performed quickly and accurately. The quick reference format will
undoubtedly be useful for both student and qualified nurses, and early
reviews show that vets might like to take a sneaky peek. *If you cant collect
at Congress, well post you a copy in May.
Download Congress
lectures
T
he ability to remind yourself of lectures you
loved or to catch up on those you missed
means BSAVA Congress lasts all year
round for members. We hope to have all
the talks from 2013 available online in the podcast archive
from 15 April. You will need to be registered with the website
as a member in order to access this exclusive content. If you
have any problems then email administration@bsava.com
or call 01452 726700 (MondayFri 95).
Antibiotic
surveillance
meeting
Financial news
E
nclosed with this edition of companion you will find the
highlights from BSAVAs Annual Report. In March we sent
the full document to those who have not opted out of
receiving it. This is a large document, which is available
online, so if you got one and want to help us save money and the
environment next year then email administration@bsava.com or
complete the opt-out form that came with the full Annual Report.
Exclusive VN Member
pocketbook
The new BSAVA Pocketbook for
Veterinary Nurses will be available
for all eligible BSAVA VN Members
to collect from the BSAVA Balcony
at Congress*
03 Page 03 April.indd 3 15/03/2013 13:42
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SAVSNET people
T
hanks to the partnership between
BSAVA and the University of
Liverpool, SAVSNET will be able to
take the achievements of the pilot
project to fulfil its mission to monitor the
current and future disease status of the UK
small animal population.
As well as a commitment from BSAVAs
Board to provide this invaluable information
to the profession, there is an impressive
team working at Liverpool University that
will ensure the success of SAVSNET. Their
expertise will soon be complemented by a
database developer and epidemiologist.
The current team testify to their enthusiasm
for the work that lies ahead
Professor Ros
Gaskell
In the early 2000s, we
started to discuss with
Defra the need for
disease surveillance
in the small animal
sector. For many
years, the Small
Animal Infectious Diseases Group at
Liverpool has been at the forefront of
knowledge on a number of diseases such
as feline respiratory disease and canine
enteric disease. However, it was becoming
increasingly apparent that the actual
prevalence and importance of both
infectious and non-infectious diseases
across the UK was not being addressed in
any systematic way.
The people at the frontline of one of the most
ambitious companion animal projects talk about
their involvement and how they hope the impact of
SAVSNET will promote the health and welfare of
companion animals
Eventually, in 2008, we had put
together a consortium of very supportive
pharmaceutical companies, together with
Defra and the University of Liverpool, to
fund the first 3-year development phase of
SAVSNET. Additional support was kindly
given by NOAH, the AHT and BSAVA, and
Vetsolutions were and still are highly
valued collaborators in this initiative.
The 3-year pilot of SAVSNET
demonstrated the tremendous scope for
generating important surveillance data for
all types of diseases and conditions. We
now look forward to the next exciting and
rapidly expanding phase of SAVSNET in
partnership with BSAVA.
Dr Alan Radford
My background in
science, with a
veterinary degree and
PhD in virology, has
made me passionate
about rigorous
scientific exploration
of the world around
us. But I also learnt quickly that science is
very expensive, and as a consequence
many of the questions remained
unanswered. For example, are their more
canine parvovirus cases now than before?
We all want to know, but no one can afford
to answer the question. And even if you did
design the epidemiological survey needed
and managed to fund it, it would be out of
date as soon as it was completed.
It is in this context we came up with the
methodology of SAVSNET. Huge amounts
of data are already recorded by vets in
labs and practices, and these data have
huge value as part of an individual animals
clinical record. However, collate these data
on a large scale, and this gives it an
additional value for surveillance.
Imagine a map of the UK that visitors to
the SAVSNET website can produce for
their disease of interest, for example
parvovirus. The map is shaded based on
where disease has been diagnosed.
Graphs show how this rate of diagnosis
has changed over time. Further
interrogation of these data will allow us to
begin to work out whether certain breeds
are predisposed to developing disease.
This is where we want SAVSNET to be in
3years and this will empower our
profession, allowing us all to work out
disease patterns in our local area, rather
than relying on a study published in
another country years before.
Dr Peter John
(PJ) Noble
As a veterinary clinical
teacher SAVSNET
offers the really
exciting opportunity to
put into context the
subjects we teach. For
instance, when
discussing a case of diarrhoea or
polydipsia or pruritus I might turn to my
students and say How often does a dog
present with this?. While many of us have
a gut-feeling as to how common specific or
otherwise specific presentations are, we
will soon be able to tell our students exactly
who and what is likely to come through
their door and how often, based on
wide-scale surveillance data.
I can review the treatments most often
used for any given presentation and
04-05 SAVSNET.indd 4 15/03/2013 13:49
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identify whether there are aspects of my
teaching that will ensure well informed
choices are made in diagnosing and
managing these cases.
SAVSNET will provide foundation data
on key topics from obesity to euthanasia,
and from diarrhoea to neoplasia, helping
us promote informed discussion about
these in our teaching.
Dr Philip Jones
SAVSNET provides an
exciting opportunity to
deliver real-time
surveillance of
diseases in
companion animals.
At the moment, we are
at the beginning of a
very exciting journey. Over the next few
years, SAVSNET will be rolled out to
ever-more practices to provide
comprehensive, national disease
surveillance.
SAVSNET is a child of the times,
drawing on the widespread availability of
high-speed internet access, powerful
computers running advanced practice
management systems and cutting-edge
statistical techniques to process and
analyse vast amounts of data and present
the results in meaningful and useful ways.
As a veterinary epidemiologist, access
to such large volumes of data provides
some very exciting possibilities. In the
future, SAVSNET will be able to monitor
common endemic disease syndromes and
identify, and predict, localised hot-spots
of disease.
The same system will also be able to
monitor the spread of an epidemic around
the country and evaluate the effectiveness
of any implemented control measures. But
SAVSNET will not be static. It will grow and
develop in tune with technological
advances and the demands of its users. In
the future, we hope SAVSNET will become
a permanent feature of veterinary practice
in the UK and will be a world-leader in
companion animal disease surveillance.
Dr Susan
Dawson
Having spent over
20years researching
infections and disease
in animals we are
often frustrated by the
lack of basic data
how common is the
disease that we are considering? What
type of animals are more likely to be
involved? and so forth. Recognising that
the source of all this valuable information
are the veterinary surgeons working in
practice, the SAVSNET team has come
upwith a user-friendly way of tapping into
this resource.
This fundamental data will be able to
be accessed by research scientists
focussing in detail on particular diseases.
Another important aspect of SAVSNET is
giving information back to the profession.
We will be generating benchmark
reports,allowing people to compare their
practice to anonymised peers. By
amalgamation of information from a very
large number of consultations, SAVSNET
will contribute to the evidence base
underpinning clinical practice.
A particular area of interest of mine is
antimicrobial use and stewardship, and
antimicrobial resistance. SAVSNET is
ideally placed to set a baseline
describingthe current veterinary use of
individual drugs to inform the discussions
on policy as to what is prudent use.
Matching the drug use data to the trends
inresistance patterns will allow models
tobe developed to identify the effect
ofdrug use on the development of
resistance.
SAVSNET BOARD OF DIRECTORS
The Board of SAVSNET includes enthusiastc
representaton from both BSAVA Board
members and the team at Liverpool
University:
Andrew Ash BVetMed CertSAM MBA MRCVS
Susan Dawson BVMS PhD MRCVS
Mark Johnston BVetMed MRCVS
PJ Noble BSc BVM&S PhD MRCVS
Alan Radford BSc BVSc PhD MRCVS
Stephen Torrington MSC DIPMS CIMS CIMD
For more information about SAVSNET
visit www.savsnet.com
Suzanna
Reynolds
Project
Coordinator
I see SAVSNET
providing a visual aid
to help clients make
decisions, providing
the evidence for the
best treatments for diseases and providing
clinical benchmarking for veterinary
practices also so I am very enthusiastic
to be coordinating the project as we roll out
SAVSNET in partnership with the BSAVA.
In the future, I hope SAVSNET will spark
ideas for research in people both in
research and in practice, and that the
SAVSNET team, with our epidemiologist,
database developer and administrative
support, will be able to facilitate that
research and really open up possibilities of
collaboration between anyone interested in
small animal health and academia.
04-05 SAVSNET.indd 5 15/03/2013 13:49
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Congress 47 APRIL 2013
Tell us a little about your
background.
I am originally from Texas but lived
mostlyin Michigan and went to Michigan
State University. I became involved in
forensics when I joined Georgia Legal
Professionals for Animals a group that
was formed to provide free education to
law enforcement, prosecutors and
veterinarians on animal cruelty
investigations and prosecutions. I worked
with state and local medical examiners,
death scene investigators and studied
human forensic science. This was all to
apply these established sciences to
animals. There was very limited
informationin animals, only from
theMunros in Scotland, who had published
a series of papers after conducting a
survey of UK veterinary surgeons.
Forensic
expertise
at Congress
Dr Melinda Merck is a leading American expert
on veterinary forensics, with considerable
experience working on animal cruelty cases.
Before she set off for the UK to deliver a lecture
at BSAVA Congress on evidence collection, she
spoke to John Bonner about her work
What were your professional interests
before working in forensics?
I owned my own feline practice in Atlanta
and worked with animal shelters around
the city. I had always been involved in
dealing with animal cruelty cases and
started doing forensic work in 2002,
primarily around Atlanta, Georgia.
Eventually, I co-authored a textbook on
forensics and then wrote the first veterinary
textbook on veterinary forensic medicine in
2007; the 2nd edition came out in
December 2012.
You were formerly senior director of
veterinary forensic sciences for the
American Society for the Prevention
of Cruelty to Animals. What are you
doing now?
I resigned from the ASPCA in April 2011 to
go back to doing private consulting on
animal cruelty work. This allowed me to do
more for animals and work on an
international basis.
TV shows like CSI have been very
popular on British television are
there any myths about forensic
science that these shows tend to
generate or are they reasonably
accurate scientifically?
It depends on the show for the most part,
they try to be scientifically accurate to a
degree, with some changes to fit the script
scenario. Time of death is an example
there are several variables to consider and
it can be very difficult to determine.
What particular professional skills are
important for a successful career in
this field?
Keeping an open, objective mind and
having a love of solving puzzles. This is
what we do in diagnostic veterinary
medicine so I think most vets are perfect
for this area of medicine.
Is a strong stomach also an asset?
Of course! But that is the case for
anyone working in veterinary medicine,
right? You need to be very good at
compartmentalising, maintaining distance
in order to maintain objectivity. Again,
veterinarians tend to be good at
compartmentalising we have to function
in the middle of chaotic days and
circumstances in order to focus and save
an animal. You also need to have a good
life balance to deal with these sort of cases.
In your Congress talk you will
emphasise the importance of
maintaining a chain of custody for
the evidence collected at a crime
scene. Are you aware of occasions
when mistakes in this process led to
the collapse of a criminal
investigation?
It is being called into question more and
more. If it is not maintained, ultimately the
06-07 Congress Merck.indd 6 15/03/2013 14:03
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Congress 47 APRIL 2013
DR MELINDA MERCK
AT CONGRESS
Friday 5 April
14.0514.50, Hall 7
Evidence collecton
from animals
15.0015.45, Hall 7
Veterinary forensic
medicine: part 1
16.5017.35, Hall 7
Veterinary forensic medicine: part 2
17.4518.30, Hall 7
Final analysis: consideratons for the
forensic report
Remember, there is no need to miss these
lectures members can download the
podcast of the talk at www.bsava.com
afer 15 April.
evidence may not be allowed in or the test
results may be deemed inadmissible.
What are the other obvious
mistakes that a beginner will need
toavoid?
The biggest mistake is not documenting
the animal or a crime scene accurately.
Photography is crucial, starting from the
beginning and documenting findings on
paper and diagrams. A good forensic
report is also critical to accurately and
convey the findings without bias.
What type of cases are becoming
increasingly important in your work?
I tend to be called in on the more heinous
cruelty cases torture, gunshots,
mutilations, mass burials. It has been
extremely helpful to have studied crime
scene investigation and to have worked
with investigators so I can assist them
better. The most common cases that are
reported are neglect in the States we are
seeing more and more rescue groups
being prosecuted for cruelty for having
massive amount of animals and not
takingcare of them. So large-scale cruelty
seems to have become a big issue,
especially for those groups that refuse to
euthanase any rescued animals, the
no-kill movement.
You must see some pretty
unpleasant incidents of cruelty to
animals to what extent can these
be blamed on ignorance and how
much on truly ghastly human
behaviour?
The majority of cases I work with are not
due to ignorance. Most investigators can
recognise where that is the issue and work
with the animal owners to deal with the
problem.
You must work closely with the police
and other agencies. Has the
publicity given to the Link concept*
(the connections between animal
and human abuse) helped to
strengthen the working relationship
with such bodies?
I think so, and the increase in media
coverage of the abusers being charged
with additional crimes. The link of drugs
and illegal firearms associated with blood
sports (animal fighting) certainly has
caught the attention of local and federal
law enforcement agencies. More
importantly, when I work with them I can
convey an understanding of their world,
their rules, and earn their respect and
acceptance. This allows us to work as a
team and they want to learn what I can
show them and vice versa.
But are there still occasions when
animal abuse is treated less
seriously than you would wish by the
law enforcement authorities?
Sure, I hear complaints from frustrated
individuals or veterinarians. But this is
usually because the authorities do not
know what to do or how to do an animal
case. When the public hears of animal
abuse there is usually a huge outcry for
justice and that reaches the elected
officials. The solution is education and
support for law enforcement.
What would you like the key
take-home messages of your
Congress presentation to be?
I would like colleagues to understand how
to recognise and document suspected
abuse so that the evidence is not lost. That
will often mean that they should collect
evidence just in case it is needed later.
Iwould also want them to have the
confidence to report suspected abuse. So
I would want them to walk away from the
session with a plan to develop a standard
operating procedure to handle suspected
abuse cases and to establish the
necessary contacts in their local area and
further afield who can provide them with
the resources that they will need.
*For readers not familiar with Link
www.americanhumane.org/interaction/
support-the-bond/fact-sheets/
understanding-the-link.html
06-07 Congress Merck.indd 7 15/03/2013 14:03
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Clinical conundrum
Cleo Guerreiro, an Intern at Southern
Counties Veterinary Specialists, invites
companion readers to consider
exophthalmos in a 1-year-old English
Springer Spaniel
Case presentation
A 1-year-old female English Springer Spaniel
presented with a 3-day history of unilateral
right periocular inflammation, exophthalmos
and ocular discharge, following a suspected
traumatic incident involving her right eye
during a walk in the forest. Initial oral
examination under general anaesthesia had
revealed a swelling caudal to the last right
maxillary molar tooth. Surgical exploration
was attempted but was unrewarding.
Treatment with non-steroidal anti-
inflammatory and antibiotic therapy was
commenced. No clinical improvement was
noted following 3 days of treatment.
On general clinical examination
exophthalmos, with lateral deviation of the
optic axis of the right eye, was evident.
Severe pain upon opening of the mouth
prevented a full oral examination. Examination
of the right eye revealed marked periocular
swelling, pain and resistance on retropulsion
of the globe, marked chemosis and
conjunctival hyperaemia, protrusion of the
third eyelid and a linear 3 mm superficial
corneal ulceration. Intraocular examination
of the right eye was within normal limits and
the left eye was normal on examination.
Regional lymphadenopathy was not
detectable, and the remainder of the clinical
examination was unremarkable.
Create a problem list
Exophthalmos right eye
Resistance to retropulsion of the right globe
Pain upon opening the mouth
Chemosis and conjunctival hyperaemia right eye
Corneal ulcer right eye
Create a differential list
1. Exophthalmos with decreased retropulsion and
pain upon opening of the mouth
Peribulbar foreign body
Peribulbar abscess/cellulitis
Tooth root infection
Peribulbar neoplasia
Periorbital fracture with or without associated
emphysema or haemorrhage
Zygomatic mucocele
Sialadenosis/Sialadenitis
Unilateral masticatory muscle myositis
2. Corneal ulcer with conjunctival hyperaemia
Trauma
Cilia abnormalities
Tear film abnormalities
Infectious (bacterial, viral, fungal)
Chemical injury
Exposure keratopathy
Prioritised list
Owing to the acute onset and history of a young dog
playing in undergrowth, that it is a unilateral lesion and
marked pain is evident upon opening of the mouth, a
foreign body (FB) and/or retrobulbar abscess were felt
to be the most likely differential diagnoses.
Given the clinical signs, what diagnostic
procedures would you perform?
Routine haematology and serum biochemistry
were performed to look for evidence of systemic
disease and as a baseline, prior to a general
anaesthetic. Results were within normal limits
(Tables 1 and 2).
08-11 CLINICAL CONUNDRUM.indd 8 15/03/2013 14:15
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9
Intraoral examination, under general
anaesthesia, revealed a firm swelling in the right
palatine fossa, displacing the soft palate ventrally.
Diagnostic imaging:
In the present case, computed tomography
(CT) of the skull was chosen and revealed a
7cm tract extending from the right orbit, deep
to the globe into the pterygoid muscles, ending
close to the right stylohyoid bone (Figure 1).
Magnetic resonance imaging (MRI) could
also have been considered; however it was
Parameter Result Reference interval
RBC 6.78 5.08.5 x 10
12
/l
Hb 14.9 12.018.0 g/dl
HCT 45.5 37.055.0
MCV 67.0 60.080.0 f
MCH 22.1 19.026.0 pg
MCHC 32.8 31.537.0 g/dl
Platelets 304 160500 x 10
9
/l
WBC 6.7 6.015.0 x 10
9
/l
Neutrophils 4.22 3.011.5 x 10
9
/l
Lymphocytes 1.81 1.04.8 x 10
9
/l
Monocytes 0.54 0.01.3 x 10
9
/l
Eosinophils 0.13 0.01.25 x 10
9
/l
Table 1: Haematology results
Parameter Result Reference interval
Total protein 67 54.077.0 g/l
Albumin 27 26.040.0 g/l
Globulin 40 22.052.0 g/l
Sodium 147 139154 mmol/l
Potassium 4.2 3.56.0 mmol/l
Na:K rato 35 25.035
Chloride 113 99125 mmol/l
Total calcium 2.50 2.03.0 mmol/l
Phosphate 1.19 0.81.6 mmol/l
Urea 4.5 2.09.0 mmol/l
Creatnine 72 40.0106.0 mol/l
ALP 35 0.050.0 IU/l
ALT 22 0.025.0 IU/l
Total bilirubin 6 0.09.0 mol/l
Glucose 6 2.06.6 mmol/l
Creatne kinase 158 0.0190.0 IU/l
Cholesterol 6.6 3.77.0
Triglycerides 0.6 0.451.9
Amylase 393 0.01800
Lipase 28 0.0250
Table 2: Serum biochemistry results
A
B
Figure 1: Sagittal (A) and dorsal (B) oblique CT
reconstructions revealing a 7 cm linear hypoattenuating area
from the retrobulbar space, ventromedial to the right globe,
extending in a ventrocaudal direction to the right stylohyoid
bone. Note the non-axial exophthalmos of the right globe
visible in the dorsal reconstruction
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Clinical conundrum
believed that CT would provide sufficient
information and was a more readily accessible
imaging modality.
While advanced imaging techniques provide
superior and more accurate information
regarding location, possible aetiology and
surgical planning, ultrasonography can also
prove a very useful diagnostic tool for
assessing soft tissues within the orbit and to
guide further diagnostic procedures, such as
fine-needle aspiration.
Given the results of procedures, how
would you refine your differential
diagnosis?
Previous investigations are highly suggestive of a
retrobulbar foreign body. Given the trajectory on the
CT images, the most likely point of entry of the
foreign body was at the medial canthus of the right
eye, travelling medial to the globe and becoming
lodged in the pterygoid muscles. The swelling seen
in the area caudal to the ipsilateral last upper molar
was most likely an extension of the soft tissue
swelling or a draining sinus from a retrobulbar
FB/abscess.
Which procedure would you consider
next?
Surgical exploration of the swelling in the right palatine
fossa, with careful blunt dissection dorsally towards
the retrobulbar space did not reveal signs of an FB or
a draining tract, and the inflammation was therefore
considered secondary. The area observed on CT was
accessed via an alternative approach, by making a
lateral skin incision over the right pterygoid region.
This revealed a wooden foreign body, which was
removed (Figure 2). A bacteriology swab was
collected and submitted for aerobic and anaerobic
bacterial culture and sensitivity, prior to extensive
lavage of the area and placement of a closed
suctiondrain.
Medical treatment was started with systemic
antibiotics (potentiated amoxicillin, 20mg/kg i.v. q8h),
NSAIDs (meloxicam, 0.1mg/kg q24h) and opioids
(methadone, 0.3mg/kg i.m. q4h).
Figure 2: Removal of
wooden foreign
body via a lateral
skin incision over
the right pterygoid
region
What are the postoperative
considerations?
Postoperative monitoring should include:
Assessment of pain and administration of
analgesia as appropriate.
Regular assessment of the surgical site, as
significant swelling could lead to upper airway
compromise.
Drain management: The quantity of fluid produced
was recorded every 6 hours. The drain was
removed 36 hours following surgery as it was no
longer actively draining inflammatory fluid.
Prior to surgery, the location of the FB and
associated inflammation were not compromising the
patients ability to eat. Consequently it was considered
that postoperative nutritional support would not be
required in this case. However, placement of a feeding
tube and an appropriate fluid therapy plan should
always be considered in planning cases where the
ability to ingest food and or fluids may be
compromised.
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11
CONTRIBUTE A CLINICAL CONUNDRUM
If you have an unusual or interestng case that you
would like to share with your colleagues, please submit
photographs and brief history, with relevant questons
and a short but comprehensive explanaton, in no more
than 1500 words to companion@bsava.com
All submissions will be peer-reviewed.
Figure 3: Patient two days after surgery. There is mild third
eyelid protrusion and epiphora due to remaining mild tissue
swelling deep within the orbit
Postoperative medications:
Systemic postoperative medications were
continued as preoperatively.
Topical ophthalmic treatment included an NSAID
(ketorolac trometamol, Acular
TM
, right eye q8h) and
antibiotic (gentamicin and hypromellose,
Clinagel
TM
, right eye q8h), to treat the secondary
conjunctivitis and corneal ulceration.
Two days after surgery the dog was comfortable
and bright. The exophthalmos and chemosis had
resolved (Figure 3) and the dog was discharged. No
growth was detected from the bacterial culture, most
likely due to the administration of antibiotics prior to
sampling; however, a 2-week course of oral
potentiated amoxicillin was continued, in addition to a
7-day course of meloxicam. Topical ophthalmic
treatment was continued as before.
Prognosis
Although thorough lavage of the area was performed
prior to closure, there was still potential for residual
fragments of the FB to remain in situ and cause
recurrence of clinical signs and/or formation of a
retrobulbar abscess.
Follow-up
At re-examination, 3 weeks after surgery, the globe
position of the right eye had returned to normal and the
remainder of the ophthalmic examination was normal
in both eyes. The dog was no longer on any
medication and the owner had not reported recurrence
of clinical signs.
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How to recognise
common ECG
abnormalities
I
t is important to remember that the primary purpose
of the ECG is to define rhythm disturbances and that
the ECG does not provide information about
myocardial function, whether heart failure is present,
or about the heart valves or endocardium. It is
relatively insensitive to changes in chamber
dimensions and some degree of misinterpretation is
possible if the patients body conformation is not taken
into consideration.
Abnormalities of complex amplitude,
duration or configuration
Unless indicated otherwise, this refers to lead II.
Increased P-wave amplitude (Figure 1)
P-wave amplitude >0.4mV (dog) or >0.2mV (cat).
Usually associated with right atrial enlargement
(due to cor pulmonale or congenital heart disease
such as atrial septal defect or tricuspid valve
dysplasia) or pulmonary disease.
In cats also sometimes seen with hyperthyroidism
and hypertrophic cardiomyopathy.
Increased P-wave amplitude may also be seen at
rapid heart rates.
Sometimes P-wave amplitude increases due to
right atrial enlargement are also accompanied by
an atrial T-wave (a T
A
wave) manifested as a
negative deflection of the baseline in the PR
segment.
Increased P-wave duration (Figure 2)
P-wave duration >0.04 seconds (dog or cat).
Usually associated with left atrial enlargement,
most commonly due to acquired mitral valvular
insufficiency but may also be seen with conduction
abnormalities between SA node and AV node.
Also sometimes seen in congenital defects such as
aortic stenosis, ventricular septal defect (VSD) and
patent ductus arteriosus (PDA).
Jon Wray of Dick White Referrals continues
last months discussion of ECG evaluation by
taking us through common abnormalities
Figure 1: Tall P-waves (0.5 mV) of normal duration in a West
Highland White Terrier with cor pulmonale secondary to
idiopathic pulmonary fibrosis. Note also the deep S-waves.
Lead II, paper speed 25 mm/s, 10 mm = 1 mV
Figure 2: Wide P-waves (and tall T-waves) in a dog with
myxomatous mitral valve disease (MMVD) and marked left
atrial enlargement. P-wave duration is approximately 0.06
seconds and a notched appearance is noted. The tall T-waves
in this patient were not due to hyperkalaemia but may have
been due to an increased left ventricular repolarisation
vector or possibly myocardial hypoxia. Lead II, paper speed
50 mm/s, 10 mm = 1 mV
Increased P-wave amplitude and duration
Usually indicates bi-atrial enlargement.
Increased R-wave amplitude (Figure 3)
Great care must be taken to interpret R-wave
amplitude in conjunction with the conformation of the
patient, bearing in mind that the principal determinants
of potential difference measured are not only the size
of the potential difference generated by cardiac tissue
but also the effects of electrical impedence caused by
the distance between recording electrodes and the
cardiac surface and the amount of body fat present
(as well as any fluid e.g. pleural or pericardial
effusions).
R-wave amplitude >2.5mV or >3mV in
thin-chested breeds (dogs) or >0.9mV (cats).
Usually indicative of left ventricular enlargement
and often accompanied by prolonged QRS
duration.
Usually associated with eccentric hypertrophy due
to left ventricular volume overload due to acquired
mitral valve disease, primary myocardial disease
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such as dilated cardiomyopathy or congenital heart
defects leading to left ventricular volume overload
(e.g. PDA, VSD) or concentric hypertrophy due to
pressure overload (e.g. aortic stenosis).
Decreased R-wave amplitude
The lower limit for R-wave amplitude is highly
variable in cats and dogs, without strict limits; to a
certain degree experience with normal ECGs from
various breeds (especially of dogs) is helpful in
determining whether R-wave amplitude is lower
than expected. Arbitrarily R-wave amplitude
<0.5mV in all of leads I,II and III in dogs is often
taken as indicative of low R-wave amplitude. Dogs
with giant, barrel-shaped conformation (such as
StBernards) may normally have a surprisingly
small R-wave amplitude due to the degree of
electrical impedence present.
Pathological conditions resulting in decreased
R-wave amplitude include pleural and pericardial
effusions.
Electrical alternans
Variation in R-wave amplitude increasing and
decreasing in a cyclical fashion may be seen in
animals with pericardial effusion and is considered
Figure 4: Increased QRS complex duration (0.08 seconds) due
to left ventricular enlargement in a Dobermann with dilated
cardiomyopathy. P-waves are also wider than normal,
suggesting that left atrial enlargement is also present, and
the R-wave slurs into the T-wave, a feature commonly seen
with left ventricular enlargement. Lead II, paper speed
50 mm/s, 10 mm = 1 mV
Figure 3: (A) Increased R-wave amplitude (2.3 mV) in a cat
with severe left ventricular hypertrophy due to hypertrophic
cardiomyopathy. Lead II, paper speed 25 mm/s, 10 mm =
1 mV. (B) Increased R-wave amplitude (3.5 mV) in a dog with
left ventricular volume overload due to patent ductus
arteriosus. Lead II, paper speed 25 mm/s, 10 mm = 1 mV.
In this case the dog was a young adult of normal body
condition/conformation; in many puppies with PDA
increased R-wave amplitude may also be due to lack of
electrical impedence caused by small body size/lack of fat
A
B
to be due to alteration in the principal
depolarisation vector as the heart swings back
and forth within a fluid-filled pericardial sac.
Increased QRS duration (Figures 4 and 5)
QRS duration >0.05 s (>0.06 s giant breeds)
(dogs), >0.04 s (cats).
Increased QRS duration signifies prolonged
depolarisation of ventricular muscle tissue or a
conduction disturbance, or both. This may result
from three circumstances:
The origin of the depolarising stimulus is a
normal sinus beat but EITHER
An increased ventricular (principally left
ventricular) muscle mass is depolarised
e.g. with left ventricular hypertrophy
(Figure4) OR
The sinus beat is conducted abnormally
(slowly) upon reaching the ventricular
conducting system by an intraventricular
conduction defect such as in the case of a
bundle branch block (Figure 5).
The complex is an ectopic one, arising from
outside the specialized conduction system of
the heart and below the level of the AV node.
Therefore, when increased QRS duration is
recognised it is important to evaluate whether a
P-wave is associated with the QRS complex (i.e. if
there is a P-wave for every QRS and a QRS for
every P the diagnosis is most likely a sinus beat
conducted with a block or increased left ventricular
muscle mass).
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How to recognise
common ECG abnormalities
S1, S2, S3 pattern (Figure 6)
In the dog S-waves are usually only seen in lead III
but may sometimes be seen in lead II. Presence of
an S-wave in leads I, II and III, however, is usually
indicative of right ventricular enlargement. Note
that this can be a normal finding in cats.
variations are quite normal. In general T-waves
should be <25% the R-wave amplitude but this
does not hold true at low R-wave amplitudes.
T-waves may be normally positive, negative or
biphasic in lead II in dogs and cats.
Tall, spiky T-waves (Figure 7) which are >25% the
R-wave amplitude are classically seen in patients
with hyperkalaemia, though caution should be
exercised in trying to draw clinical parallels
between T-wave morphology and severity of
hyperkalaemia as is implied in some textbooks. In
the authors experience severe hyperkalaemia may
exist in the absence of T-wave abnormalities, and
abnormalities are frequently inconsistent in their
magnitude in the same individual at different
severities of hyperkalaemia.
Figure 5: In this dog a normal sinus origin beat is conducted
with a right bundle branch block (BBB) resulting in a wide
and bizarre QRS complex, even though the rhythm is
supraventricular. Lead II, paper speed
25 mm/s, 10 mm = 1 mV
Figure 7: Tall, spiky T-waves in a canine patient with
hyperkalaemia of 7.4 mmol/l due to hypoadrenocorticism.
Lead II, paper speed 25 mm/s, 10 mm = 1 mV. Such
abnormalities are, however, inconsistent in hyperkalaemic
patients and severity of ECG changes does not necessarily
mirror severity of hyperkalaemia
Figure 6: S1, S2, S3 pattern in a Miniature Schnauzer with
pulmonic stenosis. Leads I, II, III, paper speed 25 mm/s,
10 mm = 1 mV
Deep Q-waves in I, II, III and aVF
In smaller breeds of dog may signify right
ventricular enlargement but can be a normal
finding in large breeds and in cats.
QRS splintering
Splintered QRS complexes are notched in a way
that produces at least 2 R-waves in a Rr, RR, rR
or rr configuration and are most commonly seen in
dogs with tricuspid valve abnormalities, especially
in Labrador Retrievers with tricuspid valve
dysplasia.
T-wave
The T-wave represents ventricular repolarisation.
There are very few restrictions of interpretation on
T-wave morphology and size, since many
Abnormalities of inter-complex segments
PR interval
The PR interval comprises the P-wave and the PR
segment and represents the period from initiation
of atrial depolarisation to the initiation of ventricular
depolarisation. The majority of this time interval, the
PR segment, is due to the slowed conduction
through the atrioventricular (AV) node (which
occurs at 0.050.1m/s in the upper part of the AV
node compared with 0.51m/s in atrial
myocardium and 24m/s in the Purkinje network).
PR interval prolongation >0.13s (dogs) or >0.09s
(cats) represents first-degree AV block (Figure 8).
This may occur with increased vagal tone, atrial
myocardial or AV nodal disease, hyperkalaemia,
endotoxaemia and drug therapy (digitalis
glycosides, calcium channel blockers, beta
blockers and class I anti-arrhythmics).
ST segment
The ST segment is a time of early repolarisation but
should be isoelectric in healthy animals.
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Slurring of the ST segment such that the end of
the S-wave slews into the T-wave without return to
a steady baseline is usually indicative of left
ventricular enlargement.
ST segment elevation (>0.15mV) or depression
(>0.2mV) (Figure 9), when compared with the
pre-P-wave baseline, is frequently taken to be
indicative of myocardial hypoxia or ischaemia,
though it may also be seen with myocarditis,
pericarditis, hypertrophy and calcium abnormalities.
Caution must be applied in avoiding
overinterpretation of QT intervals in dogs and cats
as much normal variation is seen.
Prolonged QT intervals may be seen in
hypocalcaemia, hypokalaemia, hypothermia,
ethylene glycol toxicity and in the presence of
intraventricular conduction defects.
Shortened QT intervals may be seen in
hypercalcaemia, hyperkalaemia and in digoxin
toxicity.
Abnormalities of relationship between
P-waves and QRS complexes
P-waves are present without associated
QRS complexes
The presence of non-conducted P-waves usually
indicates second-degree or higher atrioventricular
block. It may occasionally be seen in non-
conducted atrial premature complexes (see below)
which arise whilst the AV node is still in its
refractory period.
Second-degree AV block
Second-degree AV block is characterised by
intermittent failure of AV conduction (by definition if
constant failure were to occur atrial and ventricular
depolarisation would occur at independent rates
and complete AV block would be occurring) and
may be classified as Mobitz type I (Wenckebach
phenomenon) or Mobitz type II, but confusingly
may also be described as Type A (normal QRS
duration)/Type B (prolonged QRS duration) and
low-grade/high-grade (high grade usually being
defined as any block of 2:1 relationship or greater)
Mobitz Type I (Wenckebach) second-degree
AV block is characterised by a regularly
irregular rhythm in which the RR interval
shortens and the PR interval prolongs until a
blocked P-wave occurs. The heart rate may be
slow but is often normal. Both the P-wave and
QRS complex are usually normal in duration
and morphology.
Mobitz Type II second-degree AV block
(Figure 10) is characterised by a constant PR
interval when P-waves are conducted in a fixed
relationship between atrial and ventricular
conduction (e.g. 2:1, 3:1, 4:1). Bradycardia
normally exists. QRS morphology is often
abnormal, indicating the involvement of the
bundle of His or proximal bundle branches.
Figure 8: First-degree AV block
with PR interval of 0.36
seconds in a canine patient
with no evidence of structural
or functional cardiac disease
but with severe
gastrointestinal signs. Lead II,
paper speed 50 mm/s, 10 mm
= 1 mV
Figure 9: Marked ST segment depression of 0.3 mV in a
Greyhound which had suffered prolonged seizure activity
and suspected consequent myocardial hypoxia. Atrial
standstill is also present. Leads I and II, paper speed
50 mm/s, 10 mm = 1 mV
QT interval
The QT interval represents the time taken for
complete ventricular depolarisation then
repolarisation (i.e. the whole of electrical systole)
and will vary inversely with heart rate, shortening at
higher rates.
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Low grade and type I second-degree AV block
may be associated with elevated vagal tone
(especially due to gastrointestinal or respiratory
disease); reassessment of an ECG after
administration of a vagolytic such as atropine may
be used to confirm this.
Higher grade/type II second-degree AV block is
usually associated with degenerative or
inflammatory processes involving the AV nodal
conduction tissue, and a form of hereditary AV
nodal stenosis is seen in Pugs. Digoxin toxicity
may cause a variety of AV nodal conduction
abnormalities. High grade/type II second-degree
AV block often is progressive and leads to
symptomatic bradydysrhythmias necessitating
pacemaker implantation. The prognosis with type I
second-degree AV block is generally more
favourable.
Third-degree AV block is described below under
There is no relationship between P-waves and QRS
complexes.
QRS complexes are present without
associated P-waves
The presence of QRS complexes without
preceding P-waves usually indicates one of:
Atrial fibrillation
Atrial standstill
Ventricular premature or escape complexes
AV nodal premature or escape complexes
Ventricular tachycardia.
Atrial flutter may have P-waves that are visible
more as a saw-toothed baseline and so may be
seen without typical associated P-waves, though
they are present.
Assessment of the QRS complex morphology,
especially in determining are the complexes tall
and narrow or wide and bizarre?, is useful in
differentiating between these. Tall and narrow
complexes are always supraventricular in origin.
Wide and bizarre complexes are usually ventricular
in origin but some circumspection must be applied
since supraventricular complexes accompanied by
an interventricular conduction disturbance such as
a bundle branch block may appear wide. This is
easily identified if P-waves are present and their
relationship with the QRS obvious but in some
tachydysrhythmias in particular the P-waves may
be hidden in the preceding QRST arrangement
and difficult to isolate.
There is no relationship between P-waves
and QRS complexes
Most commonly this occurs when there are
separate pacemakers controlling atria and
ventricles and/or where there is complete
(third-degree) AV block. The term atrioventricular
dissociation has often unfortunately been used
synonymously with third-degree AV block but
whilst third-degree AV block is a form of
atrioventricular dissociation it is not the only one.
Third-degree AV block (Figure 11)
In third-degree AV block there is no conduction
between the atria and ventricles and whilst the
sinus node depolarises at its own inherent rate,
producing P-waves, the ventricles depolarise in
a fashion and rate dictated by a subsidiary
(failsafe) pacemaker, usually in the AV node or
Purkinje fibres.
There is no relationship between P-waves and
QRS complexes and the PR interval is
variable.
Third-degree AV block is usually considered a
degenerative/destructive condition of the AV
conduction fibres, though occasional cases
may be associated with inflammatory disorders
(myocarditis) and very occasionally apparent
spontaneous resolution may be seen.
Isorhythmic AV dissociation (Figure 12)
This is an unusual arrhythmia, sometimes
termed accrochage or synchronisation, in
How to recognise
common ECG abnormalities
Figure 11: Third-degree AV block in a canine patient.
Ventricular depolarisation rate is of 36/min, atrial
depolarisation rate is of 176/min. Lead II, paper speed
50 mm/s, 5 mm = 1 mV
Figure 10: Both first-degree (PR interval 0.16 seconds) and
Mobitz type II second-degree AV block are present in this
canine patient with aortic stenosis and secondary left
ventricular concentric hypertrophy. Lead II, paper speed
50 mm/s, 5 mm = 1 mV
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which atria and ventricles are depolarised by
separate and electrically discontinuous
pacemakers at rates which approximate one
another, but where no precise relationship
exists between atrial and ventricular
depolarisations.
This usually occurs when a ventricular, or more
usually an AV nodal ectopic, pacemaker is
depolarising at a rate which is slightly faster
that the sinus node rate
We see this most commonly in feline patients
under anaesthesia, both with and without
echocardiographically identifiable structural
heart disease, and in these cats the rhythm
usually resolves with attainment of normal sinus
rates upon cessation of anaesthesia.
Isorhythmic AV dissociation is characterised by
P-wave and QRS complex rates which
approximate one another but are not precisely
the same; whilst the PP and the RR intervals
are constant, the PR interval varies slightly
with the result that the P-waves appear to
march in-and-out of the QRS complexes.
Supraventricular rhythm disturbances
Sinus arrhythmia
Although this is a physiologically normal
phenomenon its irregularity classifies it as an
arrhythmia as, whilst the rhythm originates from the
sinus node, the rhythm is regularly irregular. This
raises an important issue, that sinus arrhythmia will
only be recognised as such (i.e. an important
normal physiological finding) if (a) the patient is
auscultated or an ECG performed for long enough
for a pattern to be established and (b) the
examiner interprets the heart rhythm in concert
with the respiratory pattern.
Sinus arrhythmia is a normal finding in dogs but is
unusual in cats without respiratory disease. It may
be particularly exaggerated in brachycephalic
breeds and in those with enhanced vagal tone due
to respiratory or gastrointestinal disease.
During inspiration the heart rate accelerates and
decelerates or pauses during expiration due to
fluctuations in vagal tone. It may also be
associated with a wandering sinus pacemaker, in
which P-wave amplitude varies cyclically, usually
becoming peaked during inspiration and flatter
during expiration. Occasionally non-respiratory
sinus arrhythmia may be encountered in which
there is no relationship with respiration.
Sinus bradycardia
Sinus bradycardia is a rhythm originating from the
sinus node at <60 beats/min (dogs) and <100
beats/min (cats). However, care should be taken to
interpret it in the light of the animals level of fitness
(especially in dogs).
Common causes include hypothermia, increases in
vagal tone (especially due to respiratory and
gastrointestinal disease), neurological lesions
(especially of the brainstem, and in tonsillar
herniation and raised intracranial pressure), severe
systemic metabolic conditions, preceding cardiac
arrest, sinus node dysfunction (such as sick sinus
syndrome) and drug intoxication (especially
opiates, digoxin, calcium channel and beta
blockers). It should be remembered that in many
cats shock results in bradycardia rather than
tachycardia.
On the ECG the P-wave morphology and
measurements, QRS morphology and
measurements, timing intervals between
complexes and association are all normal, but the
rate is slow.
Sinus arrest (Figure 13)
Sinus arrest is caused by failure of impulse
formation within the sinoatrial node. Sinus arrest
occurs when there is a pause in sinus node activity
Figure 12: Isorhythmic AV dissociation in a 10-year-old
Domestic Shorthair cat under general anaesthesia for an
orthopaedic surgical procedure. The ventricular
depolarisation rate is approximately 115/min and the atrial
depolarisation rate is approximately 107/min when
instantaneous rates are calculated. No structural heart
disease was found to be present and a normal sinus rhythm
with rate of 168/min was recorded after recovery from
anaesthesia. Leads I,II,III, paper speed 25 mm/s, 20 mm =
1 mV
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for more than two normal RR intervals, though
there may be some overlap with exaggerated sinus
arrhythmia, where pronounced pauses may also
be seen.
In dogs this is usually due to either sinus node
dysfunction (e.g. in sick sinus syndrome), severe
disease of the atria, severe hyperkalaemia or
digoxin intoxication or as a result of increased
vagal tone, and administration of a vagolytic such
as atropine may be used to determine the latter.
A period of sinus arrest is often terminated by an
escape beat which may be either nodal or
ventricular.
Sinus (sinoatrial) block (Figure 14)
Sinoatrial block occurs where the sinoatrial node
depolarises normally but fails to conduct through
tissue surrounding the node, therefore failing to
depolarise the atria.
Although sinoatrial block and sinus arrest may be
difficult to distinguish, when the length of pause
before a subsequent beat is an exact multiple of a
normal RR interval a sinoatrial block is strongly
implicated.
Sinoatrial block is usually caused also by sinus
node dysfunction, severe disease of the atria or
increased vagal tone.
Persistent atrial standstill (Figure 15)
In persistent atrial standstill the sinoatrial node is
inactive and the rhythm is a regular
supraventricular escape rhythm characterised by
lack of P-waves and by regular QRS complexes
which are tall and narrow in morphology.
Persistent atrial standstill has been recognised
most commonly in English Springer Spaniels
and in dogs with severe muscular heart disease
or generalised muscular dystrophies but is
also seen in severe hyperkalaemia and in
digoxintoxicity.
How to recognise
common ECG abnormalities
Figure 13: A period of sinus arrest lasting approximately 6.5
seconds in a 7-year-old female entire Irish Terrier. After the
period of arrest a supraventricular escape beat occurs from a
site outside the SA node in which the P-wave occurs
between the QRS complex and the T-wave. Leads I, II, III,
paper speed 25 mm/s, 5 mm = 1 mV
Figure 14: Sinus block in a canine patient. Lead II, paper
speed 50 mm/s, 10 mm = 1 mV. Note that the RR-2 interval
(48 small squares) is an exact multiple, x2, of the RR-1
interval (24 small squares)
Figure 15: Lead II LED display from a continuous monitor of a
5-year-old Springer Spaniel with collapse due to persistent
atrial standstill. A regular, wide-complex escape rhythm of
50/min is present
Atrial premature complexes (atrial
premature depolarisations)
APCs arise from an ectopic focus within the atria
and are characterised by:
A shortened RR interval
A P-wave which is premature (P) which
disrupts the normal rhythm. The P-wave is
often different in morphology from the normal
P-waves and may be positive negative or
biphasic
Normal QRS complex morphology and
duration
If a P-wave occurs early enough that the AV
node is still in its refractory period it may be
non-conducted.
Atrial premature complexes, if occurring in
isolation, are usually unassociated with clinical
signs though they may indicate atrial enlargement,
atrial disease, drug therapy or be associated with
systemic conditions.
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Supraventricular escape rhythms
Escape complexes follow an RR interval that is
longer than the normal RR interval and occur at
an (instantaneous) heart rate that is equivalent to
the intrinsic rate of the pacemaker from which the
escape complex originates. In the case of
supraventricular escape beats, this is usually the
AV node and is known as a junctional escape. This
rate is usually 4060 beats/min, though may be
faster (enhanced).
Atrial fibrillation (Figure 16) and atrial
flutter
Atrial fibrillation is characterised by absence of
P-waves, by QRS complexes which are usually tall
and narrow (though occasionally may be wide and
bizarre if a concurrent conduction disturbance
such as bundle branch block is seen) and by a
completely irregular RR interval. The baseline
may contain large oscillations (F-waves) though
more commonly these are small and appear as a
more shuddering baseline.
Most commonly atrial fibrillation occurs with high
QRS rates of 180240/min (dogs) or 200260/min
(cats) and usually accompanies severe structural
heart disease (Figure 16A). However, in some
patients (usually dogs without heart failure) lower
ventricular depolarisation rates are seen, in the
120180/min range, due to fewer fibrillating
potentials reaching the ventricles. The lower rate in
these patients is because they have higher vagal
tone compared with patients in heart failure and
this influences the refractory period of the AV node.
Presence of atrial fibrillation without underlying
identifiable cardiac morphological changes is often
termed lone or primary AF and is most often
seen in giant breed dogs (Figure 16B). In cats
atrial fibrillation is uncommon and is almost always
associated with structural cardiac disease.
Atrial flutter is rare and is a very fast
supraventricular tachycardia in which atrial
depolarisation rates are so high that the PP cycle
length is short enough that atrial depolarisation
reaches the AV node whilst the latter is still in its
refractory period. This results in functional
second-degree AV block P-waves are non-
conducted because they reach the AV node during
this refractory period. ECG characteristics of atrial
flutter are irregular RR intervals and a rapid
saw-toothed baseline to the ECG, representing
very rapid, only intermittently conducted, P-waves
at rates which usually exceed 350400 beats/min
in the dog.
Supraventricular tachycardia (Figure 17)
A full discussion of supraventricular
tachydysrhythmias is beyond the scope of this
article but supraventricular tachycardia is
characterised by recurrent supraventricular
premature depolarisations.
These may occur within the atria or nodal tissue
and most commonly have a normal (tall and
narrow) QRS morphology, though confusion with
ventricular tachycardias may arise in those patients
with co-existing bundle branch block.
P-waves may or may not be present, depending on
the site of origin of the supraventricular tachycardia.
Figure 16: (A) Atrial fibrillation in an Irish Wolfhound with
dilated cardiomyopathy (DCM). The ventricular rate is 200/
min. Note the fine fibrillation potentials (F-waves) of the
baseline, no discernible P-waves and completely irregular RR
intervals. Lead II, paper speed 25 mm/s, 10 mm = 1 mV.
(B) Primary or lone atrial fibrillation in a giant breed dog
without evidence of structural heart disease or clinical signs
of heart failure. The ventricular rate was 156/min. Lead II,
paper speed 50 mm/s, 10 mm = 1 mV
A
B
Figure 17: Supraventricular tachycardia of approximately 300
beats/min. Note the tall and narrow QRS complexes. In this
example the P-waves are frequently seen between the QRS
complex and T-wave of the preceding beat. Lead II, paper
speed 25 mm/s, 10 mm = 1 mV
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How to recognise
common ECG abnormalities
Supraventricular tachycardia usually occur
secondary to organic heart disease and, broadly,
may be caused by re-entrant circuits as a result of
diseased tissue, presence of an accessory
conduction pathway or may be initiated by
abnormal automaticity of supraventricular tissues.
It is very important, before embarking on any
therapeutic decisions relating to documented
tachycardias, to establish that the rhythm is not in
fact a sinus tachycardia which may be
physiologically appropriate (in fearful, stressed or
painful patients), a normal adaptation to a systemic
disease state (e.g. fever, anaemia) or a life-
preserving response (e.g. in compensatory shock
states), as inappropriate interpretation and
anti-arrhythmic treatment may at best be
unnecessary and at worst cause acute
decompensation of the patient.
Ventricular rhythm disturbances
Ventricular rhythm disturbances are characterised by
wide and bizarre QRS complexes though some
caution should be exercised, as supraventricular
originating complexes that are conducted abnormally
(for instance with bundle branch block) may also have
wide and bizarre morphology.
Ventricular escape complexes and
idioventricular rhythm
Escape complexes (Figure 18) follow an RR
interval that is longer than the normal RR interval
and occur at an (instantaneous) heart rate that is
equivalent to the intrinsic rate of the pacemaker
from which the escape complex originates. In the
case of ventricular escape beats, this is usually
the Purkinje apparatus and the rate is usually
2040 beats/min. In the case of junctional
escapebeats this is usually at a rate of 4060
beats per minute.
When both sinoatrial node depolarisation fails and
the next highest-rate subsidiary pacemaker (the
junctional tissue) also fails, the ventricles may be
depolarised at a rate consistent with the intrinsic
rate of the Purkinje apparatus, producing an
idioventricular rhythm. We recognise this most
commonly in severe disease states causing atrial
standstill, such as in hyperkalaemia produced by
hypoadrenocorticism or urinary tract obstruction.
Itis important to recognise idioventricular rhythm
as a life-saving failsafe and to promptly correct the
underlying cause. Suppression of the rhythm with
anti-arrhythmics may be fatal.
Ventricular premature complexes
(ventricular premature depolarisations)
VPCs are characterised by a wide and bizarre QRS
complex with a T-wave which is opposite in polarity,
occurring without a P-wave and after an RR
interval that is shorter than the normal RR interval.
VPCs usually originate from the right ventricular
tissue if they are predominantly positive in leads I,
II, III and aVF and from the left if they are
predominantly negative in these leads.
VPCs may be seen in normal animals at a rate of
up to 50 per 24 hours but most commonly in
veterinary patients are associated either with
structural cardiac disease or with systemic
diseasestates and intoxications. It is useful to
consider the mnemonic think AHEAD! when it
comes to recalling non-cardiac causes of
ventricular rhythm disturbances:
Autonomic neurological disturbances
Hypoxaemia
Electrolyte and acidbase disturbances
Abdominal diseases, especially of the spleen,
stomach and pancreas
Drugs and intoxicants, especially in the
peri-anaesthetic period.
Presence of ventricular premature complexes,
however isolated, attains a greater level of
significance in those breeds in which
arrhythmogenic sudden death due to occult
cardiac disease is well documented (the
Dobermann and the Boxer) and when VPCs are
multiform in nature.
Ventricular tachycardia (Figures 19 and 20)
Ventricular tachycardia is defined as three or more
consecutive ventricular premature complexes.
The rate at which a ventricular tachycardia is
determined is not well established but it is often
considered a tachycardia at rates exceeding
180bpm and an accelerated idioventricular rhythm
(see below) at rates below this.
Figure 18: A wide and bizarre QRS complex without
preceding P-wave occurs in this patient after a period of
sinus arrest. This complex is a ventricular escape. Lead II,
paper speed 25 mm/s, 5 mm = 1 mV
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Like VPCs (above) ventricular tachycardia may be
caused by cardiac and non-cardiac causes and
consideration of the components of the think
AHEAD menemonic is always recommended in
patient evaluation.
The degree of malignancy or perspicuity required
in treatment of ventricular tachycardias is often
based on consideration of:
Absence of AHEAD criteria as defined above
Association with clinical signs of reduced
cardiac output (syncope, collapse, poor
peripheral pulse quality, hypotension), which
tends to be determined by the absolute rate of
the tachycardia and thus the time available for
diastolic ventricular filling and subsequent
output
Occurrence in a breed, such as a Dobermann
or Boxer, with a known risk of arrhythmogenic
sudden death
Morphology of the ventricular premature
complexes being:
Multiform rather than monomorphic
Having R-on-T phenomenon the
absence of a baseline interval between the
T-wave of the preceding QRST wave with
start of the QRST of the next, resulting in
the R-wave being continuous with the
preceding T-wave (see Figure 19).
Accelerated idioventricular rhythm
Defined as a constant ventricular origin rhythm that
is above the rate expected for an idioventricular
rhythm (see above) but below the level at which
ventricular tachycardia is recognised.
Most dogs with accelerated idioventricular rhythm
have rates between 150 and 180/min and a regular
wide and bizarre QRST complex with no visible
P-waves.
The rhythm is usually not highly haemodynamically
significant, as the ventricular rate is such that
adequate diastolic filling can occur, and it is rare
that such rhythms are associated with any
decrease in cardiac output.
Accelerated idioventricular rhythms are most
commonly seen in the first 2448 hours after
surgery for splenic pathology (especially
ruptured splenic mass lesions) and for gastric
dilatationvolvulus.
Whilst it is tempting to give anti-arrhythmic
therapy, in the majority of cases this is not
required and the rhythm will resolve with time
and with provision of adequate fluid support,
attention to correction of arrhythmia-
potentiating electrolyte disturbances
(particularly hypokalaemia and
hypomagnesaemia) and analgesia.
The author recommends caution in these
circumstances as it is his experience that
such a rhythm disturbance often distracts
the veterinary care team, causing
concentration on the ECG in isolation from
the rest of the patient, rather than interpretation
in the context of historical, medical and,
most importantly, physical examination
findings!
Conclusion
Provided that a logical and systematic approach is
used to both obtain a diagnostic ECG and to interpret
it in a stepwise manner, most common ECG
abnormalities can be readily identified. In particular,
evaluating critically the relationship between the
P-and QRS-waves and taking the time to measure
and record findings, rather than to merely eyeball an
ECG, will result in more accurate diagnosis and less
reliance on pattern recognition.
Figure 20: Ventricular tachycardia in a 5-year-old MN Sphynx
cat presenting with syncope. The complexes are wide and
bizarre, without preceding P-waves, and the rate of the
ventricular tachycardia is about 272/min. A single normal
sinus complex is seen in the centre of the trace (complex 9).
Lead II, paper speed 50 mm/s, 10 mm = 1 mV
Figure 19: Frequent non-sustained ventricular tachycardia.
In this patient there are several criteria which would suggest
that this rhythm is malignant and that sudden death is a
risk, including the multiform nature of the ventricular
premature depolarisations and the frequent occurrence of
R on T phenomenon (within black ovals). Leads I, II, III,
paper speed 25 mm/s, 10 mm = 1 mV
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Join us in Dublin
T
his October you can gain up to 22 hours of continuing education with
27 topic sessions, State-of-the-Art lectures and international speakers,
plus experience the true Irish Cad mile filte (one hundred thousand
welcomes).
The FECAVA EuroCongress with support from BSAVA and Veterinary
Ireland will take place in Dublin offering a great location, value for money and
first-class science, making it an event worthy of a place in your CPD diary.
The full programme can be seen online and register now through
www.fecava2013.org.
Lecture highlights
The basics of surgical oncology, including taking a proper biopsy
JolleKirpensteijn
The visual axis: conditions which affect vision from the corneal surface to
the visual centre of the brain Ellen Bjerks
Algorithms in orofacial injuries Jan Schreyer
Gastroenterology: imaging the vomiting dog Emma Tobin
Myxomatous mitral valve disease in dogs: recent research findings
including newly discovered genetic locus for the disease
Jens Hagstrm
Mast cell tumours: where are we now? Laura Blackwood
Husbandry advice for the exotic pet owner Anna Meredith
Ultrasonographic identification of portosystemic shunts Manuel Pinilla
BSAVA and Veterinary Ireland invite you to
attend the 19th FECAVA EuroCongress
taking place in the Convention Centre in the
heart of Dublin from the 25 October
Programme is subject to
change so ensure to visit
www.fecava2013.org for
the latest details.
Please email
info@fecava2013.org
forfurtherinformaton.
SOCIAL EVENTS
Welcome Evening on Wednesday 2 October
Join us the evening before the sessions begin, to meet
colleagues old and new. This is included for delegates.
Gala Evening on the Thursday 4 October
Acelebratonofmusic,dance,sport,goodfoodand
friends.TakingplaceinCrokePark,thehomeofGaelic
sport,withampleopportunitytoseeandexperience
thepowerofthegames.95 per tcket.
Great optonal social tours and booking optons
available online
REGISTRATION FEES
EARLY BIRD RATES AVAILABLE UNTIL 30 APRIL
FECAVA/BSAVA/VetIrelandMembers 475
Non-Members 585
Students 305
NursesSaturdayStream 125
Special Group Registraton Discounts available. Ensure to
check with the registraton team before you book.
22 FECAVA.indd 22 15/03/2013 15:18
For more information or to book your course
www.bsava.com
Learn@Lunch
webinars
These regular monthly lunchtime (12 pm) webinars are
FREE to BSAVA members just book your place through
the website in order to attend. The topics will be clinically
relevant, and particularly aimed at vets and nurses in
first opinion practice. There will be separate webinar
programmes for vets and for nurses
This is a valuable MEMBER BENEFIT
Coming soon
Surgical management of aural disease for vets
13 March
Chemotherapy for nurses 20 March
Geriatrics clinics in cats for nurses 24 April
All prices are inclusive of VAT. Stock photography: Dreamstime.com. Barna Tanko; Kristina Stasiuliene; Vriesela
Simple, safe, effective
physiotherapy and
rehabilitation
2 May
This course will give you
knowledge and skills which you
will be able to apply to patients
in your practice, supplementing
the medical and surgical skills
you already use.
SPEAKER
Brian Sharp
VENUE
Dogs Trust, Haresfield
FEES
BSAVA Member:
338.00
Non BSAVA Member:
507.00
Crusty canines and
festering felines
23 May
This practical and interactive course for GPs
will cover investigation and treatment of
common dermatological conditions in dogs
and cats and will also include a practical
cytology workshop.
SPEAKER
Natalie Barnard
VENUE
Crabwall Manor,
Chester CH1 6NE
FEES
BSAVA Member:
227.00
Non BSAVA
Member: 340.00
Imaging the
abdomen
20 June
This course is designed to include points of
interest for both general practitioners and
nurses with an interest in diagnostic imaging.
SPEAKERS
Andrew Parry and Lizza Baines
VENUE
Willows Veterinary Centre and Referral Service,
Solihull B90 4NH
FEES
BSAVA VN
Member: 167.00
Non BSAVA VN
Member: 250.00
BSAVA Member:
233.00
Non BSAVA
Member: 350
23 CE Advert April.indd 23 15/03/2013 15:18
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Minimizing the risk
of surgical infection
T
he aim of aseptic technique is to
ensure that surgery can be
performed with minimal risk of
contamination by microorganisms.
The patient is a major source of
contaminating organisms; however, any
wound open to the atmosphere will
become contaminated and, with time,
those contaminant organisms may colonize
the wound and establish an infection.
During surgery a wound is exposed to:
The environment of the operating
theatre
The patients own bacterial flora
Theatre personnel, equipment and
instruments.
Whilst instruments can be sterilized
and hard inert surfaces treated with
disinfectants, the reduction of bacterial
flora of the patient and theatre staff must
be balanced with the potential damage to
their tissues that removing these bacteria
may cause.
Patient preparation
Endogenous staphylococci and
streptococci from the skin of the patient are
the organisms most frequently cultured
from wound infections.
Transient microorganisms are usually
easy to remove from the skin via
physical scrubbing and can be almost
completely eliminated with effective
antiseptics (Figure 1).
Resident microorganisms are more
difficult to eliminate, as organisms
that have been present within the
patients tissues for a significant
amount of time can form
complicatedbiofilms.
Clinically significant biofilms pose a
challenge because:
Normal skin residents do not
immediately trigger an immune
response, so the infection is not readily
identified
The efficient metabolism of bacteria
within a biofilm matrix means that their
uptake of antimicrobial agents is
reduced and doses greater than the
normal minimum inhibitory
concentration of time may be required
for a longer period.
Adequate preparation of the patient and theatre
personnel for surgical procedures is mandatory for
reducing the incidence of wound infection. Tim
Hutchinson, co-editor of the BSAVA Manual of Canine
and Feline Surgical Principles, gives companion
readers some pointers on how this can be achieved
Figure 1: Applying skin scrub. Using cotton wool,
gauze swabs or sponges, the skin is cleaned
gently, working from the site of the incision to
the periphery with a circular motion
PROTECT
For more informaton
of the responsible use
of antbacterial drugs,
visit the Advice secton on the BSAVA website
(www.bsava.com/advice) and the special
editon of companion October 2011.
PROTECT
Thus, it is of paramount importance
that every effort is made to ensure that
exposure of the wound to contaminating
microorganisms is kept to a minimum
through careful hair clipping, thorough skin
preparation and appropriate draping.
Personnel preparation
The surgical team can potentially
contaminate the patient both directly (by
contact) and indirectly (through increasing
the level of airborne bacteria in the
operating theatre). The level of bacteria in
the theatre air is directly proportional to the
number and movement of people in the
room. Thus, personnel should be kept to a
minimum and traffic in and out of the
operating theatre should be restricted.
Various methods can be used by the
theatre team to minimize wound
contamination by direct contact, including:
Wearing appropriate general theatre
clothing (scrub suits, footwear, hats
and masks)
Following a recognized scrub
technique (Figure 2)
Maintaining aseptic technique when
donning gowns (Figure 3) and gloves
(Figure 4).
Figure 2: The
scrubbing brush
is still a valuable
tool for cleaning
the nails, but its
role on the skin of
the hands and
arms is now being
questioned
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Maintaining aseptic technique
during surgery
Provided appropriate patient and
personnel preparation has been observed,
the surgical team should be able to
approach the draped, scrubbed patient
with clean, dry sterile gowns and gloves.
However, it should be remembered that
attention to detail and discipline are
required to maintain the integrity of the
surgical field during the procedure. The
surgical field comprises:
The properly prepared and draped
patient
Theatre personnel in sterile gowns
Instrument trolleys completely covered
in sterile, impervious drapes.
It is important for every practice,
regardless of its size, to establish strict
protocols (local rules) aimed at minimizing
the risk of surgical wound contamination
and to enforce them.
MAKE SURE YOU
KNOW THE BASICS
BSAVA has recognised
that in this increasingly
specialised world there
is a need for texts
that provide clear,
indepth consideraton
of basic principles.
Many textbooks skip
over these building
blocks, assuming that the informaton will be
learned from elsewhere, but untl now, that
elsewhere has been missing.
Surgical facilites and equipment
Perioperatve consideratons for the
surgical patent
Surgical biology and techniques
The BSAVA Manual of Canine and Feline
Surgical Principles: A Foundaton Manual
encompasses everything the surgeon should
know before beginning surgery and is an
invaluable tool that every vet should own
and read before wielding a scalpel.
Visit www.bsava.com to order online or call
01452 726700 if you have an enquiry.
1. Gowns should be folded such that the
body of the gown (but not the sleeves) is
insideout. The sterile pack should be opened
on a surface away from the operatng table.
2. Afer drying
their hands,
the scrubbed
surgeon should
grasp the gown
by the inside of
the neck and
allow the rest of
the gown to fall.
3. Touching
only the inside
surface of the
gown, the arms
are inserted
into the sleeves,
keeping the
hands covered.
4. An assistant then pulls the gown over the
shoulders (touching the inside surface of the
gown only) and fastens the rear tes. With
hands stll within the sleeves, the surgeon
passes waist te to the side, allowing the
tp of the te to dangle for the unscrubbed
assistant to grasp. If wraparound disposable
gowns are used, they are ted by the surgeon
afer donning gloves.
Figure 3: Gowning technique Figure 4: Closed gloving technique
1. The inside surface of the cuf of the lef
glove is grasped by the lef hand through the
fabric of the gown, so that the fngers remain
covered at all tmes.
2. The right hand (which remains inside the
sleeve) is used to draw the cuf over the lef
hand.
3. The fngers of the lef hand are allowed
through the sleeve of the gown and into the
glove.
4. The process is repeated for the right
glove.
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I
ntraocular melanoma is the most common primary
intraocular tumour in the dog. The melanoma can
arise from melanocytes present in the uveal tract,
which comprises the iris, ciliary body and choroid.
Whilst the choroid is the most frequent site for the
development of uveal (choroidal) melanoma in
humans, the development of melanomas in dogs
commonly affects the anterior uveal tract (iris and the
ciliary body).
In addition to the risk of losing vision due to the
consequences of a progressively expanding mass
within the eye, major concerns arise from the potential
systemic spread of the uveal melanoma in both dogs
and humans. Macrometastases are commonly absent
at initial presentation, but these can develop in the liver
and/or lungs in the following three months. Death due
to metastatic disease, or to euthanasia, is reported
during the six months following enucleation of a
metastasising malignant melanoma.
Although only a small percentage (between 4 and
8%) of canine uveal melanomas have the ability to
metastasise, the lack of prognostic clinical features
when presented with an intraocular neoplasia, and the
concerns over potential metastatic disease, lead to
enucleation in an attempt to increase survival.
Histopathology of the enucleated globe usually reveals
the melanocytic growth to be benign, and therefore in
retrospect that the enucleation was unnecessary.
Histopathological features (mitotic index, cellular and
nuclear pleomorphism and atypia) are able to
differentiate benign from malignant uveal melanomas,
but predict neither tumour metastasis nor prognosis for
a given patient.
Investigation of genetic expression
The lack of a prognostic test for canine uveal
melanoma prompted a multicenter team of clinical
veterinary ophthalmologists, pathologists and a
geneticist to look for molecular markers of uveal
melanoma metastasis. In essence, we wished to
investigate whether the gene expression patterns of
naturally occurring uveal melanomas could be
correlated with clinical outcome. The multidisciplinary
study was performed at the Animal Health Trust and
was designed to compare the gene expression of
uveal melanomas that had metastasised with those
that had a benign outcome. The expression of 14
genes currently used in a prognostic test for human
uveal melanoma were measured in histopathological
canine uveal melanoma specimens. We found a
significant difference in the genetic expression of
fourgenes between the two populations of canine
uveal melanomas.
Ultimately, we aim to differentiate between
metastasising and non-metastasising uveal
melanomas by measuring the expression of such
biomarkers in fine-needle aspirate samples obtained
from eyes in situ. Potentially, this could result in the
development of a practical clinical prognostic test
which could prevent the unnecessary enucleation of
dogs affected by non-metastasising uveal melanomas.
Uveal melanoma samples
Archival paraffin-embedded tumour samples are a
valuable source of uveal melanomas, but a major
disadvantage is the lack of follow-up for most of the
dogs that bore these tumours. For our study, we
determined the outcome of each clinical case
retrospectively. This was only possible due to the
Genetic analysis of
canine uveal melanomas
PetSavers has funded a study into
prognostic biomarkers of uveal melanoma
in dogs. Pedro Malho, recipient of the
ClinicalScholarship grant, reports
Uveal melanoma.
Note the raised dark
brown mass affecting
the dorsolateral
quadrant of the iris
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collaboration of several referring veterinary surgeons
that kindly provided the ocular samples and the
clinical follow-up required to establish the two
populations of uveal melanomas with dissimilar
outcomes. The samples of primary uveal melanoma
belonged to dogs that had no evidence of a primary
tumour located elsewhere, nor metastases (excluded
by imaging modalities), at the time of enucleation.
Dogs that developed later metastases were subject to
a confirmatory necropsy or imaging modalities.
The use of paraffin-embedded tissue samples
formeasuring gene expression is technically difficult
due to the effects of formalin fixation on cellular RNA.
Demonstrating that we could isolate RNA from
paraffin-embedded uveal melanomas, and use this
RNA to assay gene expression, was a prerequisite for
the release of funding by the Petsavers Clinical
Research grant review committee. We were able to
provide the assurances required at the beginning
ofthe study.
Current practice
At the moment, in the absence of clinical features that
distinguish uveal melanomas with metastatic potential,
the attending veterinary surgeon is faced with two
options when presented with a visual and comfortable
eye with a progressing pigmented intraocular mass.
The surgeon either elects for close monitoring of the
ocular lesion or advises enucleation of the affected
eye to prevent a potential metastatic spread.
Regardless of the final clinical decision, a complete
physical examination, which includes examination of
the oral cavity and digits, and imaging modalities such
as thoracic radiography and abdominal
ultrasonography, should be performed at time of the
presentation to rule out a primary tumour located
elsewhere, or the presence of metastases.
Late presentations of eyes with uveal melanoma
may reveal intractable uveitis, hyphaema, retinal
detachment or glaucoma, and should be enucleated
and submitted for histopathology. These non-
salvageable globes can still provide a prognosis on
the basis of the gene expression pattern characteristic
of malignant uveal melanoma.
Clinical relevance
A genetic prognosis in early cases of uveal
melanomas would allow eye-sparing treatment
modalities such as diode laser photocoagulation and
iridectomy. Dogs affected by metastasising uveal
melanomas could be subjected to alternative
treatments such as the xenogeneic DNA vaccine in an
attempt to delay the metastatic disease.
The results of this preliminary study were submitted
for publication. Future work may include whole
genome profiling of metastasising and non-
metastasising uveal melanoma samples. This could
reveal additional gene expression differences between
the two uveal melanoma populations and potentially
result in the development of a prognostic gene
signature specific for canine uveal melanomas.
We also plan to verify the differences in gene
expression between metastasising and
non-metastasising uveal melanomas in a controlled
prospective study using ex vivo fine-needle
aspiratesamples.
Ocular oncology is given its first steps in veterinary
medicine. Molecular genetic analysis of canine uveal
melanomas can also provide new insights into tumour
pathogenesis and aberrant biochemical pathways.
Identification of the molecular signatures of melanoma
progression can also be used to develop effective
targeted therapies. n
For more informaton about the work PetSavers funds, or about applying for grants
visit www.bsava.com/petsavers.
Increased iridal pigmentation at the dorsomedial quadrant
and between the 6 and 7 oclock positions. Note the flat and
rough appearance of the pigmented iridal areas
PEDRO MALHO
PetSavers Clinical Scholar in Veterinary Ophthalmology
Pedro Malho graduated from UTAD, Portugal, in 2002.
Immediately afer graduaton Pedro underwent a one year
rotatng internship in Small Animal Medicine and Surgery
at a multdisciplinary referral centre. In 2009, afer four
years in general practce and completon of the Certfcat
dtudes Suprieures en Ophtalmologie Vtrinaire
at ENV Toulouse (France), Pedro moved to the Animal
Health Trust to undergo an internship in Comparatve
Ophthalmology. In 2010 Pedro started an ECVO-approved
residency at the Animal Health Trust with the support of a
Petsavers Clinical Scholarship grant.
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W
SAVA Global Pain Council (GPC)
launched its Global Pain Treatise at the
World Congress in March. This is a
comprehensive resource which will, for the
first time, provide practitioners globally with clear pain
management protocols. Following the World Congress,
youll be able to download it from www.wsava.org and
it has been submitted for publication in the Journal of
Small Animal Practice.
About the WSAVA Global Pain Council
The WSAVA Global Pain Council aims to improve the
quality of pain management given to small animals
around the world. Its mission is to raise global
awareness and give a call to action, based on the
understanding that all animals are sentient and can
feel and suffer from pain. Through the identification of
appropriate educational resources, it aims to elevate
confidence and competence in applying pain
treatment globally. Its key goals are to:
Engage veterinarians worldwide to recognise,
anticipate, alleviate and terminate pain in cats
anddogs
Develop a collaborative network of like-minded
colleagues and associations to help accomplish
shared educational goals
Create a document which compels readers to
evaluate each patient for the presence of pain,
regardless of the initiating reason for the
consultation.
The GPC has the vision of creating an empowered,
motivated and globally unified profession that
recognises pain in our patients and minimises its
prevalence and impact. So far, it has carried out a
range of activities, including a survey of existing pain
management products and building relationships with
global veterinary organisations that share its goal.
Members of the GPC have a huge range of diverse
experience in the field of pain management and are
excited at the prospect of sharing this with colleagues
around the globe and learning from their experience
too. Many but by no means all veterinary surgeons
have the benefit of the availability of all relevant drug
classes and modalities. The challenge is to extend this
state to all of our colleagues, helping them obtain
governmental licensure for access to controlled drugs
in areas where there is limited availability of
analgesics. In countries where veterinary analgesics
COMMITTEE FOCUS: WSAVA GLOBAL PAIN COUNCIL
The worlds first
Global Pain
Treatise
A big step forward in the treatment of
companion animal pain will happen when
the WSAVA Global Pain Council launches its
Global Pain Treatise
The Global Pain
Council. Left to right:
Duncan Lascelles,
Paulo Steagall,
Peter Kronan,
Karol Mathews,
Bonnie Wright,
Kazuto Yamashita,
Andrea Nolan,
Sheilah Robertson
2829 WSAVA News April.indd 28 15/03/2013 15:34
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are not available, the GPC will assist in obtaining
regulatory approval for veterinary analgesics based on
their licensing in other countries, so without the cost
and animal use for repeat trials. By increasing the
availability of analgesics and analgesic classes, pain
management in our veterinary patients will be
improved globally.
GPC Chair Professor
Karol Mathews says: We
know that pain occurs more
commonly than it is treated
but that analgesic
availability varies greatly
around the world. We are
the first group to have
looked at the clinical
implications of this fact and
to make recommendations
which take it into account.
The GPC thanks its sponsors Boehringer Ingelheim,
Elanco, Novartis Animal Health, Pfizer Animal Health
and Vtoquinol for making the opportunities happen
and the challenges easier to overcome.
Key activities
Our activity plan has three phases:
20122013: Phase I the development of the
Global Pain Treatise, together with a global
inventory of products, and attitudes associated
with aspects of pain. The GPC has been working
on this for the past year.
2013: Phase II the GPC has been working on
additional resources that will be available later
this year from www.wsava.org. It is also working
on a pain assessment and management CE
programme in partnership with regional academic
institutions/associations. Finally, it is implementing
lobbying strategies to help the professional
globally to achieve better access to pain
management medication.
2015: Phase III updating the GPC and
implementing the CE programme, extending its
reach into building pet owner education/
awareness. The regional lobbying programme
willcontinue.
The Global Nutrition
Committees
Nutrition Toolkit
Following the launch of the Global Nutrition
Guidelines in 2011, published in Journal of
SmallAnimal Practice, the GNC will launch a
suiteof tools to provide practical support when
working with owners on nutrition-related cases,
including educational materials to give them.
Seewww.wsava.org for further details.
WHO SITS ON THE GLOBAL PAIN COUNCIL?
Karol Mathews DVM DVSc DipACVECC (Canada)
Chair (contact: kmathews@uoguelph.ca)
Peter Kronen DVM DipECVA (Switzerland)
Duncan Lascelles BSc BVSc PhD DSAS DipECVS DipACVS (USA)
Sheilah Robertson BVM PhD DipACVA DipECVAA (USA)
Andrea Nolan MVB DVA PhD DipECVA DipECVPT (UK)
Paulo Steagall MV MS PhD DipACVA (Brazil)
Bonnie Wright DVM DipACVA (USA)
Kazuto Yamashita DVM MVM PhD DJCVS (Japan)
Walt Ingwersen DVM DVSc DipACVIM
(WSAVA Honorary Secretary, WSAVA Executve Board liaison)
2829 WSAVA News April.indd 29 15/03/2013 15:34
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companion
Paula Boyden was born in Essex and brought
up there until the age of 10. The rest of her
formative years were spent in Inverness and
Cambridgeshire, moves due to her fathers work
as a millwright and boat maintenance engineer.
Her mother was a bank clerk until she started a
family. Paula has one sister, 2years older, who
is a radiographer. Paula was state educated,
with A levels from a technical college in
Cambridge. She graduated from the Royal
Veterinary College in 1992 and then spent
11years in general practice before joining
Intervet/Schering-Plough Animal Health as a
veterinary adviser in 2003. She joined Dogs
Trust as Deputy Veterinary Director in June
2010 and became Veterinary Director in August
2011. She is married to Martin, a police officer,
and lives in Bedfordshire with their two dogs
and a cat called Norman.
Paula
Boyden
BVetMed MRCVS
the companion interview
Q
What made you decide to be a vet?
A
The whole way of life appealed to me. I knew
that I wanted to make a difference in some way
and being a vet was a way that I could do that
by helping both people and animals.
What did you do before joining Dogs Trust?
I was in practice for 11 years, first as a mixed
practitioner, and latterly in 100% small animal practice
in Oxfordshire with a particular interest in internal
medicine. I then joined Intervet, initially as a
companion animal veterinary adviser, then moving on
to practice development and project management.
During this time I developed a particular interest in the
link between violence to people and violence to
animals. The more I worked with the animal charities,
the more Irealised thats where I wanted to be. Roles
such as mine do not present that often, so I was
delighted to be offered the position.
This is a difficult time for the charity sector; has
financial stringency affected the work of your
department?
We are always mindful of what we are spending
charitable funds on. We look after around 16,000 dogs
per year, plus have over 5,000 Shared Adoption
Scheme dogs where we contribute towards veterinary
fees, so our spend is not insignificant. Over the past
couple of years we have rationalised our purchases
with regards to key pharmaceuticals such as
30-31 Interview April.indd 30 15/03/2013 15:36
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I have grave concerns not only about
rabies and Echinococcus, but also the
import of non-native diseases,
particularly leishmaniasis
antibiotics, antiparasitics and analgesics.
This is at a brand level, which gives us
economies of scale without impinging on
our centre vets clinical freedom (on the
whole we use local practices to provide
veterinary care within our rehoming
centres). We have also reviewed our
Shared Adoption Scheme, particularly with
regards to dispensing of long-term meds,
out-of-hours and referrals.
You are at the forefront of efforts to set
up an Association of Charity Vets what
is the latest on that?
The Association of Charity Vets has been
set up by the CVOs of the main charities in
conjunction with Rachel Dean and Jenny
Stavisky from the Centre for Evidence
Based Medicine at Nottingham. We had
our inaugural meeting on 2

February at
Nottingham Vet School, a day of CPD
looking at ethical/pragmatic decision
making, early neutering, behaviour, and
infectious disease at a herd level.
Why do you think it is necessary to have
another veterinary organisation?
Shelter medicine has been established as
a discipline in the US for some time and is
certainly relevant for the many welfare
organisations in the UK in terms of herd
health and the issues that come with
keeping a large number of animals in a
single environment. However, we see ACV
being broader than that, particularly in the
current climate. Many pet owners are
struggling to meet vets bills and often
referral may not be an option. Therefore
ethical/pragmatic decisions are becoming
more frequent. With the input from
Nottingham, we can ensure that there is
good science behind what we are saying.
What legislative changes would help you
in your work?
It is a legislative shopping list Im afraid:
Permanent identification and
registration, i.e. compulsory
microchipping. I am delighted that
Government has announced
microchipping of dogs is to become
compulsory in 2016; this is a huge step
forward in dog welfare. The regulations
are not written yet, and it is the detail
that is critical to make it effective.
Isincerely hope that factors such as a
central point of reunification that all
databases must subscribe to, a
mandatory requirement on dog
ownersto keep database records
updated, and for microchip insertion to
take place before first change of
ownership (i.e. whilst a puppy is still
with the breeder) will become essential
parts of this.
The Dangerous Dogs Act is a poorly
thought out piece of legislation that is
not fit for purpose. I welcome the
recent announcement that suspected
prohibited types will not automatically
be seized, as it will avoid unnecessary
solitary confinement for many dogs.
Whilst I would like to see a repeal of
section 1, at the very least I hope that
no further breeds will be added to the
list. Legislation should be based
around deed not breed. The extension
of the DDA to cover private property is
also welcome, but again we need to
await the detail. I sincerely hope there
will be exceptions in the case where a
person is not legitimately on private
property, such as intruders.
A revamp of the legislation
surrounding dog breeding and the
advertising/sale of dogs. This would
include more inclusive legislation
regarding breeders, bringing the
legislation in line with the Animal
Welfare Act, and better control
regarding advertising and sale, all to
encourage both responsible breeding
and responsible purchase.
A review of the Pet Travel Scheme.
Since the relaxation of the rules at the
start of 2012, there has been a
significant increase in the illegal
importof puppies to the UK, both from
Ireland and mainland Europe, which
hasa huge welfare impact on many
levels. In addition, now it is so much
easier to bring a dog into the UK,
Ihave grave concerns not only about
rabies and Echinococcus, but also the
import of other non-native diseases,
particularly leishmaniasis.
Who has been the most important
influence on your career?
Helen Munro. Helen paved the way in
terms of the research that gave us
diagnostic indicators for non-accidental
injury. She and Ranald (both veterinary
forensic pathologists) were at the forefront
of getting animal abuse on to the veterinary
agenda and played a critical part in those
all important early prosecutions. This all
took place in the later stages of her career
when many individuals are starting to slow
down. In terms of making a difference
Helen has absolutely nailed it.
What single thing would most improve
your quality of life?
Another (email free) day of the week!
What are the best/worst aspects of your
current job?
The best bits are working for an
organisation with such a positive approach.
No two days are ever the same and its all
for the benefit of dog welfare. This can
range from speaking with individual dog
owners to working with overseas
organisations to improving the welfare of
dogs in their own countries, and everything
in between. The most challenging bit is that
no matter what I am doing, the emails keep
coming. My office currently looks like a
deep litter system.
What are your main hobbies?
My husband and I own a narrowboat
whichis our great escape. Even just
spending a day or an evening on it is
hugely relaxing, as long as you dont mind
stepping over Retrievers.
My other hobbies are walking, wine
and intermittent dabbling with a
saxophone.
30-31 Interview April.indd 31 15/03/2013 15:36
For more information or to order
www.bsava.com
BSAVA reserves the right to alter prices where necessary without prior notice.
On offerfrom April:
BSAVA Manual of Small Animal
Ophthalmology
2nd edition
Missed this new
Manual?
BSAVA Manual of Canine and Feline
Neurology
4th edition
The latest edition of this best-selling Manual is fully updated
to cover all the latest advances in the field. Structured in the
same practical way as the previous edition to aid information
retrieval, the new edition includes new chapters on
neurological genetic disease testing and counselling,
adjunctive therapies, and the importance of providing
adequate nutritional support to neurological patients. An
accompanying DVD-ROM contains videos relating to clinical
presentation, examination and diagnosis.
Or this one?
BSAVA Manual of
Exotic Pet and
Wildlife Nursing
The number of exotic and wildlife cases presented at the
veterinary practice has increased significantly in the past
10 years, with increasing expectations regarding level of care.
This new Manual aims to provide veterinary nurses with a
greater understanding of the nursing requirements of these
species, enabling them to modify and apply their skills to
these cases.
WHAT THEY SAY
...a must-have text for any practce seeing rst-opinion
exotc cases, along with any nurses or students studying for
exotcs qualicatons... VETERINARY RECORD
BSAVA Publications
COMMUNICATING VETERINARY KNOWLEDGE
This Manual provides a practical, consulting room guide to
small animal ophthalmology.
WHAT THEY SAY
...an excellent book, clear and easy to read, and illustrated
throughout with photographs that aid clinical diagnosis. All
practtoners should own a copy... JOURNAL OF FELINE
MEDICINE AND SURGERY
Now on special offer!
BSAVA Member Price:
55.0030.00
Price to non-members:85.0050.00
A new edition of this Manual is due later in 2013
BSAVA Member Price: 55.00
Price to non-members: 89.00
Includes DVD with more than
100 video clips
BSAVA Member Price: 45.00
Price to non-members: 69.00
Got this in your
practice library?
BSAVA Guide to
Procedures in Small
Animal Practice
Provides practical, step-by-step guidance on how to perform
the diagnostic and therapeutic procedures commonly carried
out in small animal veterinary practice.
Indications and contraindications
Potential complications
Equipment
Hints and tips
WHAT THEY SAY
...a genuinely useful additon to any practce
library... JOURNAL OF SMALL ANIMAL
PRACTICE
BSAVA Member Price: 45.00
Price to non-members: 60.00
First Year Qualified member benefit.
All members have access to PDF and App
32 Publications Advert April.indd 32 15/03/2013 15:38
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33
Seeing is believing
Sometimes with CPD you want to be stretched to find out new techniques and be
encouraged to try something youve not done before. That was certainly the case with
the evening meeting about ocular emergencies in dogs and cats hosted by the
Southern region in January.
More than 50 delegates fought ice and snow to get to the meeting, and all found
themselves marvelling at the innovations in this area demonstrated by our speaker, Robert
Lowe from Optivet Referrals. Not only did we discover new techniques for managing ocular
emergencies, we also left feeling more confident and inspired by Robert Lowes encouraging
talk. Did you know for instance that you can easily take pictures of the retina with an iPhone?
We also learnt what useful tools we need as a basic emergency ophthalmic kit and how to
deal efficiently with ocular emergency problems.
Do you also think you can benefit from an update in ophthalmology, or feel you would like
to get some reassurance in what you are currently doing? There is an interactive
ophthalmology evening meeting coming up on 6 June in the West Midlands region
Common corneal conditions and the non-healing corneal ulcer with Lorna Newman.
Visit the BSAVA website or email westmidlands@bsava.com if you want
furtherinformation.
Krista Arnold
Letters from the regions
CPD with bite
BSAVA Surrey and Sussex joined forces with the British Veterinary Dental
Association to host a practical dentistry weekend last September. The meeting was
a huge success, attracting delegates from several regions, who found the lectures
and wetlabs on periodontics, simple and surgical extractions and dental
radiography hugely beneficial.
With small group numbers, individual specimens and a good supply of dental units we
were able to practice a variety of techniques including the taking and processing of dental
radiographs. It also meant that we could practice common dental scenarios but also tailor
our experiences by focusing on areas we normally find troublesome, whilst under the
guidance of expert tutors. Many thanks to Lisa Milella, Rachel Perry and John Robinson
for their enthusiasm, knowledge and help over the weekend.
It was our regions first collaboration with another specialist veterinary division and our
first provision of cadavre surgery. I personally found it very informative, useful and was
amazed how quickly it was over.
As the newly formed BSAVA South East we hope to provide further wet labs and
practical-based CPD. We are planning a cytology day later in the year and another
dentistry weekend. Thanks especially to our sponsors Veterinary Concepts for providing
dental and X-ray units, Pfizer Animal Health and also to the
BVDA who made the weekend possible.
Regional CPD is organised by local vets in your region,
so not only will you learn lots, youll meet new colleagues too.
Plus sometimes there is cake!
Olive oLeary
P.S Looking for a practical dentistry course? South West region have
one called PracticalDenistry Extraction Techniques on 17 June 2013
at Bicton College, EastBudleigh. Bookthrough www.bsava.com
33 Regions April.indd 33 18/03/2013 13:13
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companion
CPD diary
EVENING WEBINAR
Wednesday 22 May
20:0021:00
Simple, safe and effective
rehabilitation and
physiotherapy
Speaker: Brian Sharp
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 17 April
13:0014:00
Imaging of the muscloskeletal
system
Speaker: Nic Hayward
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 24 April
13:0014:00
Geriatric clinics for cats
Speaker: Martha Cannon
Online
Details from administration@bsava.com
EVENING WEBINAR
Wednesday 17 April
20:0021:00
Dealing with specific species:
case examples
Speaker: Liz Mullineaux
Online
Details from administration@bsava.com
EVENING WEBINAR
Wednesday 10 April
20:0021:00
Are blood transfusions possible in
small animal practice?
Speaker: Susana Silva
Online
Details from administration@bsava.com
EVENING WEBINAR
Wednesday 1 May
20:0021:00
Diagnosis and management
options for elbow dysplasia
Speaker: Andy Moores
Online
Details from administration@bsava.com
EVENING WEBINAR
Thursday 9 May
20:0021:00
Congenital vascular anomalies of
the liver: diagnosis and medical
management
Speaker: Penny Watson
Online
Details from administration@bsava.com
EVENING WEBINAR
Monday 13 May
20:0021:00
Tissue response to injury: how to
promote healing and why things
go wrong
Speaker: Liz Mullineaux
Online
Details from administration@bsava.com
April 2013 May 2013
EVENING MEETING
WEST MIDLANDS REGION
Thursday 2 May
The coughing dog
Speaker: Mike Martin
The Barn Beefeater and Premier Inn,
Stratford Road, Hockley Heath, Solihull,
West Midlands B94 6NX
Details from westmidlands@bsava.com
DAY MEETING
Thursday 2 May
This wont hurt a bit: simple, safe
and effective physiotherapy and
rehabilitation
Speaker: Brian Sharp
Dogs Trust, Harefield, Uxbridge UB9 6JW
Details from administration@bsava.com
EVENING MEETING
SOUTH WEST REGION
Wednesday 24 April
Practical transfusion medicine
in general practice for vets
and nurses
Speaker: TBA
Cullompton RFC, Stafford Park, Knowle Lane,
Cullompton, Devon EX15 1PZ
Details from southwest.region@bsava.com
DAY MEETING
METROPOLITAN REGION
Saturday 18 May
Canine endocrinology
Speakers: Mike Herrtage and Lucy Davison
Holiday Inn, Elstree
Details from metropolitanregion@bsava.com
DAY MEETING
SOUTHERN REGION
Thursday 2 May
A practical approach to skin
disease and otitis in cats and dogs
Speaker: Anke Hendricks
Apollo Hotel, Basingstoke
Details from southernregion@bsava.com
DAY MEETING
EAST ANGLIA REGION
Saturday 18 May
A pot pourri of exotics:
ferrets, parrots and tortoises
Speakers: Kevin Eatwell and Molly Varga
Animal Health Trust, Lanwades Park, Kentford,
Newmarket, Suffolk CB8 7UU
Details from eastangliaregion@bsava.com
EVENING MEETING
SOUTH WEST REGION
Thursday 16 May
10 things you wish youd known
about medicine before you
started
Speaker: Mark Dunning
Venue TBC
Details from southwest.region@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Wednesday 15 May
Feline lower urinary tract disease
update: why are we still seeing
blocked cats?
Speaker: Tim Gruffydd-Jones
Yew Tree Lodge Best Western Hotel,
33Packington Hill, Kegworth,
Derby DE74 2DF
Details from eastmidlands@bsava.com
The ICC/NIA, Birmingham, UK
Email: congress@bsava.com
47 April
LUNCHTIME WEBINAR
Wednesday 22 May
13:0014:00
MRI/CT: which one when
Speaker: Fraser McConnell
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 29 May
13:0014:00
Blood transfusions
Speaker: Jenny Walton
Online
Details from administration@bsava.com
34-35 CPD Diary April.indd 34 15/03/2013 16:52
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FECAVA EUROCONGRESS
25 October
Dublin, Ireland
Register Now:
Early Bird closes 30 April
Visit www.fecava2013.org or email
info@fecava2013.org for more details.
EVENING WEBINAR
Tuesday 25 June
20:0021:00
Current perspectives on FLUTD
Speaker: Jane Eastwood
Online
Details from administration@bsava.com
EVENING WEBINAR
Monday 5 August
20:0021:00
Management of lymphoma in
practice
Speaker: Mark Goodfellow
Online
Details from administration@bsava.com
June 2013
July 2013
August 2013
EVENING MEETING
WEST MIDLANDS REGION
Thursday 6 June
Common corneal conditions and
the non-healing corneal ulcer
Speaker: Lorna Newman
Wolverhampton Medical Institute, New Cross
Hospital, Wolverhampton WV10 0QP
Details from westmidlands@bsava.com
EXCLUSIVE FOR MEMBERS
Extra 10% discount on all BSAVA
publicatons for members atending any
BSAVA CPD event.
All dates were correct at tme of going to print; however, we
would suggest that you contact the organisers for conrmaton.
EVENING MEETING
EAST MIDLANDS REGION
Tuesday 11 June
Evaluation and management of a
patient with CNS trauma
Speaker: Mike Targett
Yew Tree Lodge Best Western Hotel,
33Packington Hill, Kegworth, Derby DE74 2DF
Details from eastmidlands@bsava.com
DAY MEETING
Thursday 20 June
Imaging the abdomen
Speaker: Andrew Parry and Lizza Baines
Willows Vet Centre & Referral Service, Solihull
Details from administration@bsava.com
OTHER UPCOMING BSAVA CPD COURSES
See www.bsava.com for further details
BSAVA Scot sh Congress
Friday 30 AugustSunday 1 September
Edinburgh Conference Centre, Heriot
Wat, Edinburgh
Details from scot shregion@bsava.com
West Midlands Region
Tuesday 3 September
How to perform a neurological
examinaton
BSAVA Educaton
Wednesday 4 September
Clinical pathology: interpretng
blood types
East Midlands Region
Wednesday 11 September
Genetcs and dog breeding
BSAVA Educaton
Thursday 12 September
BSAVA Dispensing Course
North East Region
Sunday 15

September
Neurology topics
BSAVA Educaton
Wednesday 17 September
From well bird to Im trying to die fast:
managing them all in practce
LUNCHTIME WEBINAR
Wednesday 12 June
13:0014:00
Anaesthesia update
Speaker: Liz Leece
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 14 August
13:0014:00
Investigating the itchy dog
Speaker: Janet Littlewood
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 21 August
13:0014:00
Medicines inspection
Speaker: Pam Mosedale
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 17 July
13:0014:00
Controlling ectoparasites
Speaker: Emma Cook
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 10 July
13:0014:00
Cushings disease
Speaker: Rory Bell
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 19 June
13:0014:00
Perioperative feeding
Speaker: Nicola Ackerman
Online
Details from administration@bsava.com
AFTERNOON MEETING
SCOTTISH REGION
Thursday 30 May
Orthopaedic conditions of
young dogs
Speaker: Luke Arnott
Kingsmill Hotel, Inverness
Details from scottishregion@bsava.com
EVENING MEETING
WEST MIDLANDS REGION
Tuesday 2 July
Treating the pet chicken:
including live chicken handling
Speaker: Victoria Roberts
Animal Care Department, Solihull College,
Blossomfield Road, Solihull B91 1SB
Details from westmidlands@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Wednesday 10 July
Patella luxation: case
management options
Speaker: Damian Chase
Yew Tree Lodge Best Western Hotel,
33Packington Hill, Kegworth, Derby DE74 2DF
Details from EastMidlands@bsava.com
DAY MEETING
EAST ANGLIA REGION
Sunday 14 July
Ophthalmology
Speakers: David Gould and Christine Heinrich
Cambridge Belfry, Cambourne, Cambridge
Details from eastanglia.region@bsava.com
WEEKEND CONFERENCE
BSAVA NORTHERN IRELAND
Friday 31 May
Saturday 1 June
Armagh City Hotel
Further details available from
nirelandregion@bsava.com
34-35 CPD Diary April.indd 35 18/03/2013 13:43
BSAVA Postgraduate Certificates in
Small Animal
Medicine and
Small Animal
Surgery
For a future that matters
Email: certicate@bsava.com
Tel: 01452 726715
Become more condent and skilled in dealing with the cases
you see in small animal practice
Experience exible study through a combination of taught
courses and online activities
Enjoy academic and pastoral support during your studies
Rely on quality assurance through UK University validation
Learn from internationally respected, expert teachers
For further information visit
www.bsava.com/postgradcert
Stock photography: Dreamstime.com Alvaro Pantoja; Scott Griessel; Steveheap
New subjects in development
Please register your interest in:
Ophthalmology
*
Anaesthesia and Analgesia
Emergency and Critical Care
*
by emailing certicate@bsava.com
*Subject to validation
36 OBC PostGrad.indd 36 15/03/2013 16:51