The essential publication for BSAVA members

companion
MARCH 2013
Imaging small mammals
at BSAVA Congress
How To
Read an ECG
P12
Get Endoscope
Savvy
Steve Divers at
Congress P4
Clinical Conundrum
Seizures in a
middle-aged cat
P8
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Ethical and evidental consideratons
on the use of novel therapies in
veterinary practce
This artcle reviews ethical and evidental
consideratons raised when novel therapies
are undertaken in veterinary practce,
based on a series of commitee meetngs
and intervening discussions held between
members of the Britsh Small Animal
Veterinary Associaton Scientc Commitee
and O cers (20102011). The aim of this
artcle is to encourage the advancement of
novel veterinary therapies while safeguarding
the welfare of animals.
Characterizaton of changes in the
haemostasis system in dogs with
thrombosis
This study concludes that in dogs
with thrombosis, both normo- and
hypercoagulable states are present and
actvated protein C resistance is common.
Canine breed predispositons for
hypocobalaminaemia or decreased
folate concentraton
The authors report that predispositon
diered between breeds the shar pei
had a markedly increased odds rato for
hypocobalaminaemia, but other at-risk
breeds were also idented.
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
47 Get Endoscope Savvy
Steve Divers to offer expertise
at Congress
811 Clinical Conundrum
Seizures in a middle-aged cat
1217 How To
Read an ECG
1819 Furry Friends in the Frame
Imaging small mammals
2022 Needle Stick Survey
Participate in BSAVAs consultation
23 BSAVA brings the Noisettes
Party Night music act revealed
2425 e-Books Launch
Latest news about BSAVA
publications
27 PetSavers
Looking for a patron
2829 WSAVA News
The World Small Animal
Veterinary Association
3031 The companion Interview
Mike Guilliard
33 Regional CPD
An invitation to BSAVA Northern
Irish Congress
3435 CPD Diary
Whats on in your area
Additional stock photography:
www.dreamstime.com
Davinci; Dml5050; Erik Lam; Isselee; Madartists;
Petr Jilek; Vilmos Varga
Whats in
JSAP
this month?
Here are just a few of the
topics that will feature in
your March issue:
STIR muscle hyperintensity in the
cervical muscles associated with
inammatory spinal cord disease
In this study the STIR changes idented on
MRI images were restricted to cases with
inammatory spinal cord disease. Sensitvity
and specicity suggested that STIR sequences
could be a useful additon to the
investgaton of suspected inammatory
spinal cord disease.
Foetal echoencephalography and
Doppler of the middle cerebral artery
in canine fetuses
This paper concludes that
echoencephalography and spectral Doppler
of the middle cerebral artery in canine
fetuses might be a useful technique for
prenatal care.
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 EJCAP on Facebook too!
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Pet Travel
In January BSAVAs Scientific Policy Officer, Sally Everitt, attended a
seminar organised by the Dogs Trust to explore the risks of increased pet
travel. There was general agreement that the changes to the Pet Travel
Scheme, which came into effect on 1January 2012, have resulted in a
significant increase in the number of pets, particularly dogs, entering the
UK. There has also been a significant increase in the number of illegal
imports, with the City of London Corporation admitting 80 puppies into
quarantine during 2012. Most of these were under eight weeks old and
were picked up when they were presented at a veterinary practice.
It was acknowledged that we do not have any real idea of how many
animals are entering the country illegally and that many of these may be
presented at veterinary practices for routine vaccination or other health
concerns. Veterinary surgeons are reminded that the responsibility for
illegal imports rests with the local authority, usually Trading Standards or
Environmental Health. It may be appropriate for veterinary practices to
contact their local authority to ensure that they know how to report before
the need arises.
In theory all animals entering the UK
under the Pet Travel Scheme should have
their documentation checked. Any
information about cases where this is not
taking place should be passed to Defra
on pettravel@ahvla.gsi.gov.uk.
AGM Notice
The AGM will take place in
Austin Court at BSAVA
Congress on Sunday at
10.45. Members are
welcome to attend.
For more information email
administration@bsava.com
or call 01452726700.
SAVSNET at Congress
Free
microchips?
T
he Small Animal Veterinary Surveillance
Network will be on stand 104 in the NIA
at BSAVA Congress. The aim of this
partnership between Liverpool
University and BSAVA is to create a national
data resource and dynamic disease
surveillance system, combining data from
veterinary consultations and laboratory results.
It is hoped that delegates at Congress will
come and see how they can take part,
discover how data is collected and presented,
and find out how this information might help
them in practice.
There will be interactive demo versions to
show how the SAVSNET questionnaire works
with practice software, as well as show how
this data can be collected ethically and with
little effort. There are also plans to launch the
new SAVSNET website atCongress.
A dedicated team has been recruited and
will be responsible for the running of SAVSNET
under the guidance of the academic team
made up of Dr Alan Radford, Dr PJ Noble, Dr
Philip Jones and Professors Susan Dawson and
Ros Gaskell. Visit the stand at Congress to talk
about the project and ask any questions you
might have. You can also make an appointment
for a private discussion at Congress email
savsnet@liverpool.ac.uk in advance to
arrangea mutually convenient time.
F
ollowing the governments announcement
that microchipping of dogs will be
compulsory from 6 April 2016, and that the
Dogs Trust will be making free microchips
available to all un- chipped dogs, BSAVA are
running a consultation to consider the implications
for all concerned.
Please go to the Advice tab on the BSAVA
website and take part in the consultation on
Compulsory Microchipping www.bsava.com/
consultations.
Image reproduced from the BSAVA Manual of Canine and Feline
Radiography and Radiology: A Foundation Manual
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Get endoscope savvy
P
arents of teenage boys who spend all their
time playing computer games should not
despair; their lads hobby may not be the
total waste of time that they fear it is. Instead, it
may be essential preparation for a career as a
veterinary surgeon.
Thats the opinion of Steve Divers of the University
of Georgia, a leading authority on the use of
endoscopy as an imaging tool in exotic animal practice.
He says that the hours spent operating a games
console can be useful in developing the skills needed
to operate this particular diagnostic technology.
I do a lot of training of small animal practitioners
and there is a definite generation gap in the way that
people develop competence in using an endoscope.
Those younger members of the profession who have
Delegates at BSAVA Congress will have
access to the impressive endoscopy expertise
of Steve Divers he tells companion how the
teenage trend towards digital devices is in fact
training for a future in our profession
Divers and Sam Rivera (vet at Zoo Atlanta, GA)
performing endoscope-assisted ovariectomy in
a hybrid giant tortoise in a field station in the
Galapagos. This was part of a conservation
programme to be able to release hybrid
animals back onto the island of Pinta
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grown up with Nintendos and PlayStations have
already developed the digitalhandeye coordination
that they will need. For older practitioners it will usually
take a little longer to become good at it.
Yet even those who have remained unacquainted
with Super Mario and friends will still get there
eventually a two day training course is all they
needto learn the basic skills needed to manipulate
anendoscope.
It is very much more difficult to develop the skills
needed to use, say, an ultrasound scanner than an
endoscope. That is probably because you dont have
to interpret the image that you are seeing to the same
extent. With endoscopy you get a colour image of the
animals interior organs so it is an extension of your
own eyesight. Clinicians are usually able to identify
what they are seeing, even if they have never
examined that particular species before.
Transatlantic expertise
At the BSAVA Congress in Birmingham in April,
Professor Divers will be explaining the various
applications of endoscopy in examining reptiles.
Running a university clinic for exotic animal species,
he has used this technology on a wide range of
animals and he reckons that maybe 95 to 98 per cent
of the species that I see are good candidates for this
technology and it will provide really useful information.
A 1994 graduate of the Royal Veterinary College in
London, Steve became an advocate for endoscopy
when he was newly qualified and working in practice
in Kent. He travelled to the US to learn from two of
thepioneers of veterinary endoscopy, Don Harris
andMichael Taylor. Energised by what he had seen,
he called his boss from across the Atlantic,
requestingthe practice credit card details so that he
could buy the kit. When, understandably, his boss
responded with a hollow laugh, Steve went ahead
andbought a basic $12,000 system with his own
personal credit card.
On returning home, he was allowed to use the
scope on all suitable cases and was paid by the
practice for each examination. His boss soon became
a convert, bought the kit off his assistant and has gone
on to become a leading light in the field. Take a bow,
Philip Lhermette of the Elands Veterinary Clinic in
Sevenoaks, and co-editor of the BSAVA Manual of
Canine and Feline Endoscopy and Endosurgery.
Worthy investment
The current cost of an endoscopy system varies from
around 10,000 for a basic unit up to about 15,000.
Steve insists that the buying a scope would be a
realistic investment for any first opinion practice keen
to develop its own endoscopy services.
The important change in recent times has been the
launch of a unit which provides the key components,
the camera and light source, in a way that can be used
both with a flexible endoscope for use in
gastrointestinal tract examinations and the rigid probes
need for examinations like arthroscopy. Instead of
having to make a choice between the two types of
endoscope you can have them both for about the
same price. That has really opened the door for
mainstream practices.
Pulmonary mycobacteriosis in a royal python
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Get endoscope savvy
Endoscopy has proved particularly useful in exotic
animal practice but is equally valuable in general small
animal practice. I think it is reaching the point where
endoscopy is just as critical a diagnostic tool as
radiography. It has been said that you cant function as
an exotic practice vet without it and I think the same
will soon be said about general practice.
Dont fear the technology
Steve feels that some practitioners treat the technology
with too much reverence. The most common mistake
that people make is to buy a scope and then neglect
to use it. It stays in its sterile packaging on the shelf
and gathers dust. After they have received the basic
training, what they need to is to use it regularly enough
to feel comfortable with it.
Initially he recommends using it for non-sterile
procedures, such as examining the carcasses of wild
animals brought in with injuries requiring euthanasia.
He also suggests offering minimally invasive post-
mortem examinations on pet animals. Often the
owners of a pet animal that has died do want to know
the reasons why, but they refuse to have the animal cut
up. With endoscopy you can examine the body and
take samples through a three or four millimetre
incision. It doesnt damage the body, you learn to
handle the equipment and you can create a small
revenue stream for the practice.
However, an endoscope will only earn its keep
when it is being used regularly for examinations in live
animals. The biggest hurdle to overcome is a cultural
one. Many vets are happy to make a diagnosis down
to an organ level but often they dont go on to find a
definitive diagnosis. For that you will usually need
biopsy and it is much better to do that endoscopically
if you want to avoid unnecessary morbidity and
mortality in opening up the animal.
Increasingly, clients are familiar with the
advantages of keyhole surgical techniques after
having an operation performed either on themselves or
on a family member. So it is easy to explain the
benefits of having their pets ovariectomy carried out in
the same way, even though it may cost considerably
more, he suggests.
Resident Dr Laila Proenca performing endoscopic gender ID
in a venomous beaded lizard
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it is reaching the point
where endoscopy is just
as critical a diagnostic
tool as radiography
Size doesnt matter, species might
Steve insists that there are virtually no limits to the size
of the animals in which these methods can be used.
Indeed, he jokes that he is in competition with his
friend Mark Stetter, former head vet at the Disney
Company, now Dean of Colorado State Veterinary
School. We are going in opposite directions he has
used endoscopy to castrate a two-ton elephant, I am
now using it to determine the gender of baby tortoises
weighing less than 30 grams.
Are there any animals that arent suitable? He says
that an exotic animal vet obviously has to be careful
when handling venomous snakes or reptiles. Penguins
are difficult because in order to swim they have lost the
airspaces in the body cavity used when examining
more conventional bird species. Similarly, koi carp are
also problematic because fibrous attachments in their
abdomen limit access.
What about the more conventional domestic
species? Steve says that examining chickens and
other galliforms like turkeys can be tricky but he faces
a more serious problem if any animal is very sick when
it arrives for an investigation. If anaesthesia is
contraindicated for that animal, then so is endoscopy
because it is a surgical procedure and it does need a
general anaesthetic.
Steve insists that the secret of making an
endoscopy service work for the practice is to make
sure that clinicians use it wherever possible and are
creative in finding new possibilities. Equipment
costing several thousand pounds is not going to pay
for itself if it is only being used on birds and reptiles.
You can use the same basic cameras and light source
on all patients from horses to budgies. The technology
is also modular. You can have the basic unit and add
further equipment such as larger or smaller diameter
scopes as the practice evolves and you develop new
services. That is one of the things that make this such
a powerful tool to use.
Endoscopic gender identification
in a 25 g Asian box turtle
Endoscopic view of the lung of a yellow-bellied terrapin
using a rigid endoscope via the prefemoral fossa
AVAILABLE FROM BSAVA
BSAVA Manual of Canine and Feline
Endoscopy and Endosurgery
Edited by: Philip Lhermete and David Sobel
Flexible and rigid endoscopy
Chapter dedicated to endosurgery
Detailed informaton on instrumentaton
Principles and basic techniques covered
Member: 49.00
Non-member: 75.00
Buy online at www.bsava.com
04-07 Divers Endoscope Savvy.indd 7 19/02/2013 10:07
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Clinical conundrum
Chiara Giannasi, an intern at Vets Now
Referrals, Glasgow, invites companion
readers to consider a case of seizures in a
middle-aged cat
Case presentation
A 5-year-old male Domestic Shorthair cat presented as an
emergency following a tonic clonic seizure. The cat had a previous
history of IMHA, which had been successfully treated with
prednisolone one year previously. Multiple discordant results for
FeLV (by ELISA and IFA) had been obtained over the years, the most
recent results being negative.
congestive heart failure
n Extramedullary haemopoiesis
n Inflammatory conditions: FIP, hypereosinophilic
syndrome, sepsis
Hyperaemic mucous membranes may be related
to a combination of changes, including alterations in
blood viscosity due to polycythaemia, or vasodilation
as a result of septic or inflammatory conditions.
Bradycardia in the cat is usually associated with
hypothermia, hypoxia, head trauma, hyperkalaemia or
the terminal stages of shock.
List the differential diagnoses for
seizures
The differentials for seizures can be divided into
intracranial and extracranial causes. Intracranial
causes may be further divided into structural (gross
lesion present) or functional causes (no gross
structural changes within the brain).
Intracranial causes:
n Structural:
Neoplasia
Inflammatory causes (FIP, toxoplasmosis)
Vascular (cerebral ischaemic necrosis,
haemorrhage)
n Functional:
Idiopathic epilepsy
Extracranial causes:
n Metabolic (hepatic encephalopathy,
hypoglycaemia, hyperosmolarity, uraemia,
polycythaemia, hypoxia, hypernatraemia,
hypocalcaemia)
n Toxic (lead, organophosphates, pyrethrins,
metaldehyde, metronidazole)
n Nutritional (thiamine deficiency)
Construct an initial diagnostic plan
A minimum database was obtained (PCV, total protein,
glucose and BUN) to investigate common extracranial
causes ofseizures.
Initial emergency blood work revealed marked
hypoglycaemia (glucose 1.9mmol/l, reference range:
3.897.94mmol/l) and a marked erythrocytosis with a
Physical examination
The cat was non-ambulatory, disorientated and
hypersalivating during examination. The mucous
membranes were hyperaemic and CRT was 1 second.
The heart rate was 120beats/min and respiratory rate
was 32beats/min. Thoracic auscultation was
unremarkable and no abdominal discomfort was
present on examination although there was evidence
of splenomegaly. Rectal temperature was 37.3C.
Create a problem list based on the cats
history and physical examination
1. Altered mentation
2. Splenomegaly
3. Hyperaemic mucous membranes and bradycardia
4. Seizures
Altered mentation was mostly attributed to the
post-ictal state of the cat. Seizures were considered
the main presenting complaint and investigations were
structured around this problem.
There are multiple possible causes for
splenomegaly; those considered are listed below:
n Splenic mass: haematoma, nodular hyperplasia,
neoplasia
n Congestion: splenic torsion, portal hypertension,
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Erythrocytosis
Primary Secondary
Endocrinopathy Inappropriate Appropriate
Polycythaemia
vera
Splenic
contracton
Absolute Relatve
Hypovolaemia
Absence of
hypoxia
Hypoxia
Figure 1: types and causes of erythrocytosis
PCV of 82% (reference range: 3755%). Complete
blood counts and serum biochemistry later confirmed
the hypoglycaemia and marked erythrocytosis with
normal cell morphology; all other values were within
normal parameters.
What are the differential diagnoses for
hypoglycaemia and erythrocytosis?
How would you further investigate
these findings?
Differentials for hypoglycaemia include delayed
separation of serum, excess insulin (insulinoma,
iatrogenic), neoplasia, liver failure, septicaemia,
polycythaemia, leukaemia and glycogen storage
diseases. Given the elevated PCV, the hypoglycaemia
was felt to be secondary to the erythrocytosis.
Erythrocytosis can be relative or absolute. Relative
erythrocytosis is an increase in haematocrit due to
splenic contraction or severe hypovolaemia. Relative
causes were excluded in this case on the basis of a
normal hydration status on clinical examination, normal
total protein and a PCV that remained above 70% after
aggressive intravenous fluid therapy.
Absolute erythrocytosis can be divided into
primary and secondary causes. Primary causes
include polycythaemia vera (a chronic
myeloproliferative disease, leading to excessive red
cell production) and secondary causes as a result of
increased erythropoietin (EPO) production. Secondary
responses are then divided into appropriate,
inappropriate and endocrinopathy-related
erythrocytosis (Figure 1).
Appropriate erythrocytosis defines an increase in
EPO due to hypoxia caused by cardiac, respiratory or
haemoglobin disorders. Inappropriate erythrocytosis is
an increase in EPO production in the absence of
hypoxia and is the result of an EPO-secreting tumour.
These are most commonly renal in origin but other
sites are occasionally reported. Endocrinopathy-
related erythrocytosis is due to elevations in hormones
that stimulate red blood cell production such as
cortisol, thyroxine and growth hormone.
An EPO assay was submitted to differentiate
between primary and secondary causes of
erythrocytosis. EPO levels were low, which in the
presence of erythrocytosis suggest a primary cause.
Abdominal radiography and ultrasonography did not
identify any renal changes although mild
splenomegaly was confirmed on ultrasound scan.
Fineneedle aspirates taken from the spleen revealed
marked extra-medullary haemopoiesis. Thoracic
radiography, echocardiography and blood gas
analysis were performed to exclude cardiorespiratory
causes of hypoxia-induced erythrocytosis; the
findingswere normal.
While awaiting results medical management was
initiated. Given the extent of the hypoglycaemia and
raised haematocrit, an initial intravenous bolus of
glucose and intravenous fluid therapy were
administered. It was assumed that the polycythaemia
was causing increased glucose consumption within
erythrocytes, resulting in hypoglycaemia.
Due to the previous conflicting results for
infectiouscauses, samples were submitted for
FIV/FeLV ELISA testing. On this occasion the results
were both negative.
How does interpretation of the results
help refine the differential diagnoses?
The seizures seen were thought to be due to a
combination of increased serum viscosity due to
erythrocytosis and the hypoglycaemia. Through
exclusion of relative and appropriate causes of
erythrocytosis and documentation of low EPO levels,
adiagnosis of polycythaemia vera can be made.
08-11 CLINICAL CONUNDRUM.indd 9 19/02/2013 10:18
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Clinical conundrum
How would you manage this patient
based on your diagnosis?
After initial glucose supplementation, phlebotomy
was performed. The desired post-phlebotomy
PCVwas <60%, which should be achieved by
removing 1020ml/kg aliquots of whole blood and
replacing them with a balanced crystalloid solution.
Removal of 20ml/kg of whole blood should reduce
thePCV by 15%.
In this case 45ml of blood were removed,
reducing the PCV to 67%. A few days after
phlebotomy the PCV had increased to 74%. At this
point the decision was made to explore other
options for treatment.
In view of the splenomegaly detected on physical
examination and confirmed on ultrasonography, a
splenectomy was performed to rule out splenic
neoplasia. This went well and allowed histopathology
of the spleen. Splenic histology revealed a
combination of reactive lymphoid tissue and
extramedullary haematopoiesis.
Post-surgery repeated phlebotomy was performed
as required, combined with oral hydroxycarbamide
treatment. Hydroxycarbamide is a myelosuppressive
drug, preventing the production of red blood cells by
the bone marrow.
The dose of hydroxycarbamide for cats is
10mg/kg q24h or 25mg/kg 3 times weekly but a
higher loading dose (30mg/kg) can be given. An
initial dose of 500mg was administered to this cat
until reformulation could be arranged.
Hydroxycarbamide is administered daily until the
PCVnormalises, at which time the frequency of
administration can be reduced.
Outcome
The cat developed marked cyanosis without
associated respiratory distress. PCV was 67% and
oxygen saturation was 84% on oxygen
supplementation (Figure 2). Methaemoglobinaemia
was suspected as the primary cause of the cyanosis
as a side effect of hydroxycarbamide therapy. This is a
recognised side-effect in cats treated with high doses
of hydroxycarbamide. A single dose of
N-acetylcysteine led to the resolution of the cyanosis
with immediate effect (Figures 3 and 4).
Figure 2: The patient in an oxygen tent after development
of cyanosis
Figure 3: Cyanotic foot pads
Figure 4: Foot pads after receiving N-acetylcysteine
08-11 CLINICAL CONUNDRUM.indd 10 19/02/2013 10:18
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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 5:
The leeches
attached to
the cat
Treatment with cimetidine commenced to inhibit
microsomal cytochrome P450, retarding hepatic
drug metabolism. S-Adenosylmethionine was also
added to the treatment plan as a glutathione donor.
Glutathione is a potent antioxidant which protects
hepatocytes from toxic damage and cell death.
Re-examination one week later revealed a PCV of
67%and no evidence of liver damage resulting from
the methaemoglobinaemia.
Three weeks after initial presentation, the PCV was
72% despite continued daily hydroxycarbamide
administration. Repeated phlebotomy was proving
impossible due to the viscosity of the blood and the
fractious nature of the patient.
The use of leech therapy was initiated as an
alternative to phlebotomy. Following sedation of the
cat, four medical grade leeches were applied to the
skin on both sides of the abdominal wall and one over
the saphenous vein (Figure 5).
The leeches remained attached for approximately
one hour until fully engorged. The sites of attachment
continued to bleed beyond this time and dressings
were applied to contain the blood. The PCV
immediately and 10 hours after leech removal was
64% and 62%, respectively. Facial irritation was
present following recovery and required the
administration of chlorphenamine; this may have been
a result of a hypersensitivity reaction to the leeches.
Leech therapy
Treatment of polycythaemia using leeches is a simple,
non-invasive and well tolerated method where
phlebotomy is not possible. The patients skin should
not be cleansed with odorous chemicals such as
chlorhexidine or saline as this may discourage feeding.
The leeches need to be attached to the skin surface, if
they are reluctant to latch on; drawing a small volume of
blood from the affected area encourages attachment.
Leeches usually stay attached for 3060 minutes
and detach themselves once sated. Once detached,
leeches must not be used on another patient and are
disposed of as clinical waste. The majority of the
therapeutic effect occurs after leech removal. Each
bite should be encouraged to bleed by gentle removal
of any locally forming blood clot. It is thought that each
leech feeds on 10ml of blood and a further 10ml is
lost in further bleeding after removal.
Follow up
Re-examination one week after leech therapy revealed
a static PCV at 62% and blood glucose within the
reference range. Currently the cat is doing well at
home maintained on hydroxycarbamide therapy
(40mg/cat q24h) and has had no further seizure
episodes. The long-term outlook is guarded; however
there are reports of individual cats having very good
quality of life over many years.
Acknowledgements
The author would like to thank Yvonne McGrotty,
Veterinary Specialist in Internal Medicine, and all the
staff at Vets Now Referrals, Glasgow for their
assistance with this case. n
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companion
How to
read an ECG
Introduction
In a previous How to (companion February 2011),
Nuala Summerfield described the indications for, and
practicalities of, recording an ECG. 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.
Do it yourself or send it away?
Whether an ECG is interpreted in-house or sent to
an individual with greater expertise in interpretation,
any assessment can only be as good as the quality
of the trace produced and the information that
accompanies it. In general, the best person to
interpret an ECG is the person who has examined
the patient, taken a thorough clinical history and can
make contemporaneous assessments of the
respiratory pattern during the recording and the
patients body conformation.
If sending an ECG to another veterinary surgeon
for interpretation, consider the following:
An original ECG trace or a high quality scanned
image sent electronically are preferred. Faxed,
photocopied or photographed traces are very
seldom of good diagnostic quality.
The patients physical examination findings and
history should accompany the trace.
Information on the patients position during ECG
recording, presence and type of any sedation or
other drug therapy, and laboratory abnormalities
should accompany the trace.
If it not automatically recorded on the trace, the
paper speed, deflection amplitude and leads
recorded should be clearly marked.
Particularly in very thin or obese animals, or in
animals which may have pericardial or pleural
effusions, alterations in electrical impedance by fat
or fluid may substantially alter complex amplitudes.
Unless such information or suspicions are
provided, misinterpretation can result.
It is also important to consider that remote
interpretation of ECGs can have some disadvantages,
and in particular one should be wary of treatment
advice based on ECGs interpreted in the absence of a
full clinical picture. Remember that many ECG
abnormalities may occur due to systemic disease
states affecting the cardiac conduction system as an
innocent bystander. Primary cardiac therapy may not
be indicated if an abnormality is merely a symptom of
a reversible underlying process.
Recording and storage
An ECG is a piece of clinical investigation in much
the same way as a radiograph. ECGs should be
recorded and stored in such a way that reflects the
care and cost involved in obtaining a diagnostic
trace and the time taken to interpret it.
It is a good idea to get into the habit of recording
ECG findings on a specifically created record
sheet and keeping this with the patients clinical
records to refer to should the need arise. An
example is shown in Figure 1. This will not only
encourage a systematic approach but will avoid
the tendency to view ECGs as low currency
diagnostic tests. A good ECG yields important
information and should be priced appropriately.
Encouraging staff members to take care in
production and storage of ECGs ensures a good
clinical standard and is a rewarding part of small
animal practice.
Using a ruler and a set of compasses helps to
record time intervals accurately.
A note about leads
The expression ECG lead is often confusing. It is
sensible to consider ECG lead systems as
analogous to radiographic projections. Each lead
views the electrical potentials of the heart from a
Jon Wray of Dick White Referrals helps us
adopt a logical approach to reading an ECG
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different direction and, accordingly, composite
information may be derived from interpreting them
together. A lead is effectively a galvanometer
examining the potential difference between two
points, an positive (+) electrode and a negative ()
electrode. The six standard leads are:
Bipolar standard leads (compare one site with
another)
Lead I: right forelimb () compared with left
forelimb (+)
Lead II: right forelimb () compared with left
hindlimb (+)
Lead III: left forelimb () compared with left
hindlimb (+)
Augmented unipolar limb leads (compare one site
the cathode with a combination of two others as
the anode)
Lead aVR: right forelimb (+) compared with
[left forelimb + left hindlimb]()
Lead aVL: left forelimb (+) compared with
[right forelimb + left hindlimb]()
Lead aVF: left hindlimb (+) compared with
[right forelimb + left forelimb]()
These six leads create the hexaxial lead system
which allows assessment of the electrical potential
vectors of the heart from six directions/projections
(see Figure 2).
An approach to reading the ECG
It is important to try and train oneself out of the habit
of simply eyeballing an ECG and forming a diagnostic
conclusion through pattern recognition. Just as with
many other areas of veterinary medicine, such an
approach may work with simple rhythm disturbances
but pattern-recognition approaches tend to fail where
more complex problems arise. Adopting a logical and
systematic approach to all ECG reading and
measuring, and recording findings, will avoid most
errors of omission.
Figure 1: Example of a canine ECG record form
Figure 2: Schematic diagram of a canine patient with frontal plane hexaxial lead system
(leads I, II, III, aVR, aVL, aVF) superimposed on it. This is sometimes referred to as a
Cabrera circle
90
150 30
+150 +30
120 60
+120 +60
+90
0
+0
180
+180
+aVF
+aVR +aVL
+I
+II +III
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How to read an ECG
1. Calculate the rate
It is usually easiest to calculate the rate from the
QRS complexes but remember that if the number
of QRS and P-waves differs, it is necessary to
calculate a rate for each of them
Heart rate may be measured over an interval of
time (which is most useful for animals with variation
in time interval between complexes), or by
measuring the instantaneous rate (which only
works if the rhythm is regular)
To measure a rate over an interval of time
(Figure3):
Review the paper speed and calculate how
many large boxes represents 1 second (at
25mm/s this will be 5 large boxes, at 50mm/s
this will be 10 large boxes)
Count the number of complexes occurring in a
6-second interval and multiply by 10
To measure an instantaneous rate (Figure 4):
Measure the number of small boxes between
Rwaves. At 25mm/s there will be 1500 such
boxes in a minute, at 50mm/s there will be
3000 such boxes in a minute
Divide 1500 by the number of small boxes
in the RR interval at 25mm/s to give the
heart rate
Divide 3000 by the number of small boxes
in the RR interval at 50mm/s to give the
heart rate
Calibrated rulers are available with which one
can measure an instantaneous rate (Figure 5).
Figure 3: An example of calculating the heart rate over an interval of time from the lead
II ECG. The paper speed is 50 mm/s and amplitude is 10 mm = 1 mV, so 10 large boxes
in width is equal to one second. The time in seconds has been marked along the
bottom of the trace with the QRS complexes numbered. Here the rhythm is regularly
irregular (sinus arrhythmia) and the rate is best calculated by counting the number of
QRS complexes occurring over a 6-second period and multiplying the result by 10,
in this case giving a heart rate of 110 beats/minute
Figure 4: An example of
calculating the
instantaneous heart
rate from the lead II
ECG. The paper speed is
25 mm/s and the
amplitude is 10 mm =
1 mV. The number of
small boxes between
the two R-wave peaks
is 13, each being 1/25
of a s (i.e. 0.04 s) in
duration. The
instantaneous heart
rate is calculated by
dividing 1500 (at
25 mm/s) by the
number of small boxes
= 1500/13, or 115 beats/
minute. At a paper
speed of 50 mm/s the
numerator would be
3000 rather than 1500
Figure 5: Using an ECG ruler to measure heart rate
Picture courtesy of Nuala Summerfield
2. Assess the rhythm
First perform a general inspection. Lead II is
probably the best lead to use for this initially
Is there a deviation from a regular rhythm? If so
is this arrhythmia (defined as a deviation from
normal in the origin or sequence of the rhythm)
regularly occurring, irregularly occurring,
occasional, frequent or repetitive?
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It is useful also to assess this at the time of
recording, whilst observing the patients
respiratory movements, in order to detect the
normal inspirational increase in frequency and
expirational decrease in frequency of a sinus
arrhythmia (Figure 6). It is important to note
that this will only be detected if a recording
is long enough and is interpreted with
respiratory movements
Identify P-waves
These may be more identifiable in some leads
than others and may be rendered difficult to
observe by excessive baseline artefact, tremor
and at very high heart rates in which they may
become hidden in the preceding complex
If P-waves vary in morphology it is a good
starting point to look for the P-waves that look
most normal first, before identifying variants
Identify QRS complexes
These will usually be narrow and upright in
Lead II
If QRS-waves vary in morphology it is a good
starting point to look for the QRS-waves that
look most normal first, before identifying
variants
It is important in differentiating supraventricular
from ventricular rhythm disturbances to
determine whether the QRS complexes are tall
and narrow or wide and bizarre (Figure 7)
Identify the relationship between the QRS
complex and the P-waves
Is there a P-wave for every QRS?
Is there a QRS for every P?
Is there a consistent relationship between the
P-waves and QRS complexes?
It can be useful to use the edge of a piece of
paper or a ruled line to mark off P-waves
and QRS complexes using different
annotations to evaluate their relationship to
oneanother and within a series, or to
usecallipers to evaluate the intervals between
the same complexes.
3. Measure complex size, duration and intervals
Use a calibrated rule or a set of compass callipers to
measure durations and amplitudes of waves and
complexes accurately. Lead II is conventionally used in
this assessment.
Measure duration in small boxes and convert to
seconds or use a calibrated ruler. Remember that
at a paper speed of 25mm/s, one small box
equals 0.04s and at 50mm/s, one small box is
equal to 0.02s
Measure amplitude in small boxes and calculate in
mV according to the deflection scale, i.e. at 1cm =
1mV, one small box (1mm deflection) will equal
0.1mV but at 2cm=1mV, one small box deflection
will equal 0.5mV
Figure 6: Example of a normal canine sinus arrhythmia. This
is a lead II trace at 25 mm/s with 10 mm = 1 mV. Note that
the complex frequency increases during inspiration and
decreases during expiration. Note also variation in the
P-wave amplitude (wandering sinus pacemaker) which
becomes decreased during and at the end of expiration,
increasing during inspiration
Figure 7: Examples of
tall-and-narrow (left) and
wide-and-bizarre (right)
morphologies of adjacent QRS
complexes. Lead II, paper
speed is 25 mm/s, amplitude is
10 mm = 1 mV
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How to read an ECG

Figure 8: Definition of amplitude and duration of waves, complexes and inter-complex
intervals using a canine lead II ECG
A B
Amplitudes and durations/intervals measured are
as follows (Figure 8):
P-wave amplitude (mV)
P-wave duration (s)
PR interval (s)
R-wave amplitude (mV)
QRS-duration (s)
QT interval (s)
T-wave amplitude (in relation to largest of Q or
R wave) and shape
Presence or absence of ST segment
depression or elevation >0.2mV from baseline
It is also worth noting the configuration of the QRS
complex. The Q-wave is defined as the first negative
deflection preceding the R-wave. The R-wave is the
first positive deflection of this complex. The S-wave is
the first negative deflection that follows the R-wave. If
more than one type of complex is present the second
is denoted by a as in R or S and large deflections
are denote d by capitalisation, with small deflections in
lower case. For example qRs, QS, etc. Notching and
slurring of the complex may be seen, but note that
these features do not cross the baseline.
4. Calculate Mean Electrical Axis (MEA)
The mean electrical axis may be thought of as the
average direction of the activation of many electrical
potentials in the manner of a composite vector. It is
very much affected by breed conformation, with
thinner chested breeds having more upright and
constant axes. There are three main ways of either
estimating or measuring MEA.
I. Isoelectric lead method. Inspect all six leads
of a I,II,III, aVR, aVL, aVF six-lead ECG to find
the lead where the algebraic sum of the QRS
deflections is zero (i.e. the sum of the deflection
above the baseline minus that below the
baseline is zero). This is the isoelectric lead.
Using the hexaxial lead diagram (see Figure 2)
the lead perpendicular to the isoelectric lead is
taken as the MEA. This method is simple but is
impractical if more than one lead is isoelectric
or no lead is isoelectric.
II. Major deflection method. The MEA can be
estimated to the nearest 30 degrees by
inspecting the six-lead ECG for the lead with
the largest net QRS deflection. If it is positive
then the MEA is directed along the positive arm
of that lead, if the net deflection is negative it is
along the negative limb.
III. Lead I and III vector plotting. This is the most
accurate but also most cumbersome method.
The net amplitude of leads I and III (Figure 9A)
are plotted to scale along the respective leads
of the vectorgram. A perpendicular line is then
drawn from both of these points and the MEA is
directed from the origin to where they cross
(Figure 9B). Some veterinary websites also now
contain calculators to produce an MEA from a
mathematical equation after inserting these
lead I and III measurements.
The normal MEA for the dog is between +40 and
+100 degrees and for the cat is between +0 and +180.
A deflection exceeding +100 degrees in the dog or
+180 degrees in the cat is a right axis deviation and
usually signifies right ventricular enlargement.
Adeviation below +40 degrees in the dog or 0 to 90
degrees in the cat is termed a left axis deviation.
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5. Put it all together
From the above steps the clinician should be able to:
Determine the heart rate
Determine whether the rhythm is regular or
irregular, and if the latter if it is regularly irregular
or irregularly irregular
Identify P-waves and their morphology
Identify QRS complexes and their
morphology
Identify what relationship exists between the
P-waves and QRS complexes
Where an arrhythmia exists, the type of
arrhythmia should then be classified and the
differential diagnosis considered before determining
afurther investigative and/or therapeutic plan. See
theApril follow-up feature - How to Recognise
Common ECG Abnormalities.
AVAILABLE FROM BSAVA
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Cardiorespiratory Medicine
2nd editon
Edited by: Virginia Luis Fuentes, Lynelle R. Johnson
and Simon Dennis
This fully updated editon refects the huge advances in
cardiothoracic medicine that have taken place in recent years
and covers:
Clinical approaches to common problems
Diagnostc methods
Underlying pathophysiology of diseases
Management of acute and chronic respiratory disorders, heart failure
and arrhythmias
Diagnosis and management of disorders commonly encountered in practce
Member: 55.00
Non-member: 85.00
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Figure 9: Calculating the Mean Electrical Axis (MEA) using leads I and III of the ECG. Paper speed is 50 mm/s and amplitude is
10 mm = 1 mV. (A) The net deflection of the QRS complex of both of Leads I and III are calculated. In this example the R-wave
amplitude in lead I is +2.0 mV and there is little or no negative Q-deflection below the baseline, giving a net amplitude of +2.0.
In lead III, the R-wave amplitude is +0.9 mV but there is a Q-wave of (negative) amplitude 0.5 mV, giving a net amplitude of
+0.9 0.5 or +0.4 mV. (B) Using the same scale for both (if multiplied) a line is measured along the lead I axis on the hexaxial
lead diagram in the direction of the positive lead I direction for a distance equivalent to +2 (for example using 2 cm on a ruler for
each 1.0 mV net amplitude, a line 4 cm long might be drawn). The same is performed on the lead III line but to a distance
equivalent to +0.4 (which using our similar scale would be a line 0.8 cm long). From the end of both lines a perpendicular line is
drawn at right angles and where these two lines cross a mark is made. A line is then drawn connecting the origin of the hexaxial
vectors to this point where the perpendicular lines cross and the MEA read from where this line crosses the outer circle.
A
+2.0
+0.4
Approx. 40
90
150 30
+150 +30
120 60
+120 +60
+90
0
+0
180
+180
+aVF
+aVR +aVL
+I
+II +III
B
III
II
I
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Congress 47 APRIL 2013
Furry friends
in the frame
A
dvanced imaging in rabbits and rodents
wouldnt be something you might have
expected to appear on the agenda at
BSAVA Congress a decade or two ago.
Atthat time, techniques such as computed
tomography and magnetic resonance imaging were
only just beginning to be used in veterinary practice;
the scanners were few and far between and the costs
of using them were considerable.
Moreover, while rabbits were becoming a
progressively more popular pet species, most owners
would have considered the idea of spending hundreds
of pounds on a diagnostic examination rather a
frivolous one. And a guinea pig or chinchilla isnt
there something else you can do?
A lecture about imaging small mammals will be
delivered at Congress 2013 by Dr Vittorio Capello, a
European diplomate in zoological medicine from Milan.
He can expect to face a large audience of veterinary
colleagues and VNs eager to hear about the role of
these relatively new methods in improving the quality
of care for an increasingly important group of patients.
Cost-cutting
So what has changed? Its a fortuitous combination
of the reduction in the costs of advanced imaging
examinations as the equipment has become more
widely available, alongside a growth in the number of
clients ready to spend good money on some
previously undervalued species.
Indeed, Dr Capello rejects the suggestion that a
CT scan on a rabbit should still be classed as an
expensive procedure. That is fair, in view of the efforts
that he has made to ensure that this is an affordable
option for his clients.
Normally the overall cost of a CT scan is a
combination of four elements the anaesthesia, scan,
the interpretation and the report. His patients are sent
to a specialist referral centre but he will accompany
them to take responsibility for the anaesthesia. It is also
important for the exotic vet to be present to assist the
radiologist by providing critical information on
positioning, the areas to highlight and what to look for if
the radiologist is unfamiliar with that particular species.
Also, I dont ask the radiologist for a report, I just
want the images, which I can read and show to the
owner. So basically, I pay just for the scan and as a
result, this investigation will only cost the owner about
250 euros.
Exotic expertise
A 1989 graduate of the Milan veterinary school,
DrCapello has been working exclusively in exotic
animal practice since 1996. He currently offers his
services to clients of two main clinics in the city. But he
has worked to build up the published data on using
advanced imaging techniques in rabbits and other
small furries. He is author of the Rabbit and rodent
dentistry handbook and Clinical radiology of exotic
companion mammals, and has both written and
served as guest editor for numerous publications,
including the US magazine Exotic DVM and the
Journal of Exotic Pet Medicine.
His presentation at Birmingham will assess the
potential value of three imaging modalities: endoscopy
and MRI, as well as CT scans. But it is the latter that
provides the most valuable source of information in
species where, due to their continuously growing teeth,
there is a high prevalence of skull and dental disorders.
Leading expert to share his experience
in the use of advanced imaging

3D reconstruction of a rabbit CT
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Congress 47 APRIL 2013
C
linical research abstracts
are perhaps the Cinderella
of BSAVA Congress;
tucked away in some of
the smaller and quieter rooms, they
provide researchers with the
opportunity to share their findings
and the audience with the chance to
ask questions. It is where some of
the scientific stars of tomorrow could
very well be inspiring the general
practitioners of today. And just like
the rest of the programme, BSAVA is
taking a fresh approach this year.
The short (15 minute)
presentations are grouped by
subject area. In the past these have
often concentrated on the
presentation of preliminary results,
which have been considered of
particular interest to other
researchers or those with a specific
interest in the subject. However, in
recent years they have also become
the place where practice-based
research has been presented.
When I presented a clinical
research abstract on the
characteristics of small animal
consultations in 2010, I was slotted
into the behaviour stream on the
grounds that it related to the
behaviour of vets and clients, if not
animals. This year for the first time
there are two streams specifically
dedicated to research about first
opinion practice, including such
diverse subjects as: Whats in a
name?, an assessment of the
misfortune of pets called Lucky; a
comparison of axillary, aural and
rectal temperature measurement in
dogs; and Shut up while I listen!
can we stop cats purring during the
consultation?
There are also many abstracts in
other streams which are relevant to
first opinion practice from Out of
hours consultations: are they really
so different? in the anaesthesia and
critical care stream, to Longevity of
dogs attending veterinary practices
in England in the oncology stream.
Those with a particular interest
will still find plenty of specific clinical
research, from ocular abnormalities
in European hedgehogs (exotics
stream) to stifle surgery
(orthopaedics stream); and from an
investigation of the relationship
between vitamin D status and
gastrointestinal disease in cats
(Gastroenterology and hepatology)
to a retrospective cohort study of
Vizsla polymyositis (Neurology).
As well as oral presentations
there is now also a poster session
on Saturday afternoon, held in the
Hall 4 foyer at 16.00, where you will
have the opportunity to discuss the
research presented on the posters
with the researchers themselves.
So take some time to study your
options and if you find something of
interest take a break from the hurly
burly of the main programme and
check out the Clinical Research
Abstracts.
For details of the programme
visit www.bsava.com/congress or
request more information via email
congress@bsava.com.
Improved tools
The quality of the equipment available to veterinary
practitioners has improved considerably in the past
decade and the images produced have excellent
resolution even for smaller rodents like guinea pigs,
rats and ground squirrels. Until a few years ago,
veterinary surgeons used second-hand machines
designed for use on human patients, and it was
difficult to scansomething smaller than a dog. Today
we can have good CT images even in a 500 gram
patient, he points out.
So for those clients who care deeply about
theirpet rabbit or rodent, the service that exotic
veterinary surgeons can offer represents extremely
goodvalue.
If the clinical examination shows a severe infection
of the facial bones in a rabbit, a detailed diagnosis and
possible treatment becomes a matter of life or death.
However, a traditional radiograph will not provide all
the information that we would need.
But there are other reasons why advanced imaging
should be considered. Yes, CT is mostly a diagnostic
procedure, but it is not only that. It also offers
prognostic information, and can be critical in planning
any surgical procedure. In other words, it
can generate a diagnostic and therapeutic process
which is more complex and more expensive than the
CT part alone.
VITTORIO AT CONGRESS
Friday 5 April
17.4018.30, Hyat Ballroom
Nursing the exotc patent:
how to get good radiographs
of your patents
08.3009.15, Hall 1 ICC
Small mammals: radiographic
interpretaton of rabbit and
rodent dental radiographs
09.2510.10, Hall 1 ICC
Small mammals: advanced imaging in rabbits and
rodents: X-ray, oral endoscopy, CT, MRI
11.0511.50, Hall 1 ICC
Small mammals: rabbit dental treatment: planning
and executon
15.0015.45, Hall 1 ICC
Small mammals: reproductve disease and a novel
approach to neutering female guinea pigs
Clinical Research
Abstracts for the
practitioner
When Sally Everitt was in general practice she
found the CRA stream at BSAVA Congress to
be an inspiration. As BSAVAs Scientific Policy
Officer she urges you to take a more abstract
approach to planning your lecture diary during
the four-day event this April
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Get stuck in to BSAVAs
needle-stick survey
I
f you tap the words veterinary and needle-stick
into the Google search engine, the first three results
offer legal rather than medical advice. That will not
be surprising for anyone who understands that
wherever theres an injury, theres a potential
opportunity for lawyers wanting to help the wounded
party claim for compensation.
Given the risks that a syringe may be contaminated
by blood from a human patient carrying a life-
threatening virus, governments are keen to minimise
the dangers from needles and other medical sharps.
So the Health and Safety Executive has published
proposals for the Health & Safety (Sharp Instruments in
Healthcare) Regulations 2013, which implement
European Directive 2012/32/EU and are due to come
into force in May.
These regulations require employers in the
healthcare industry to introduce arrangements for the
safe use and disposal of medical sharps, to provide
information and training to employees, and to record,
investigate and take action following a sharps injury.
They also place a duty on healthcare workers to report
any such injuries promptly to their employer.
They were introduced after a series of incidents
involving the transmission of blood-borne viruses to
healthcare staff, 17 of whom have contracted hepatitis
C while 5 have been infected with HIV through this
route. There have also been odd incidents of needle-
stick injuries being responsible for transmitting a range
of other human and zoonotic diseases, including
brucellosis, diphtheria, syphilis, toxoplasmosis and
tuberculosis.
Impact on vet practice
The draft regulations list the responsibilities of those in
charge of hospitals, GP practices, dental surgeries
and care homes but there is no mention of veterinary
practices in the text. With the possible exception of
veterinary practitioners dealing with non-human
primates, there is no risk of their patients carrying any
of the three viruses HIV, hepatitis C and hepatitis B
that are the main cause for concern. Yet it wouldnt
require much imagination to foresee these regulations
being used to support a compensation claim resulting
from an injury sustained in the course of a veterinary
treatment. In any case, it makes sound sense for a
practitioner to follow any steps necessary to avoid
injury to their colleagues, clients or themselves.
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However, veterinary surgeons should think
twice before they automatically adopt measures
introduced to direct the activities of their human
medical colleagues, cautions South Wales practitioner
and former BSAVA President Mike Jessop. Not only
are the disease risks from needle-stick injuries very
different when working with animal patients, there
isnt the evidence needed to make effective policies
for the veterinary field. While there is a huge amount
of data on the type of injuries affecting human
healthcare workers, there is little information anywhere
on what is happening in veterinary practice, and
nothing from the UK.
Looking at the evidence
One of very few attempts to analyse the frequency of
needle-stick injuries among veterinary staff was
published in the journal Occupational Medicine (vol
47(8), 451457) by Wilkins and Bowman of Ohio State
University in 1997. They surveyed 2532 female vets
across the US and found that 1620 (64%) had
sustained at least one injury. The majority of these
were inconsequential, with only 438 incidents causing
side-effects, most of which were mild or localised at
the injury site. Only 18 cases (0.7% of all injuries)
caused severe or systemic injuries.
The Ohio study shares the weakness of any
retrospective study, in that memories are imperfect
and the level of detail available can vary. Mike Jessop
identifies a further weakness in this and other
published studies. I have a problem with this and a lot
of other data on needle-stick injuries in that it doesnt
differentiate between an accidental jab with an empty
needle and an accidental self-injection. Usually, with
the first, you jab yourself, say ouch and just get on
with it but it really does matter if some of the contents
gets under your skin.
Colin Robertson, now retired as professor of
emergency medicine at the University of Edinburgh,
highlighted the risks of accidental injection of animal
vaccines at a meeting of the Veterinary Products
Committee (VPC) in November 2012. He showed the
severe injuries to the operators hand that can result
from mishandling the needle-less high-pressure
sprays commonly used to administer oil-based
vaccines in the fish, pig and poultry industries. But
there are also hazards from a range of products used
widely in small animal practice, including hormonal
preparations such as prostaglandin, which caused a
spontaneous abortion in a female vet who responded
to the Ohio study.
Ronnie Soutar, director of veterinary services at the
Edinburgh veterinary school, used to work in the
farmed fish industry and is well aware of the dangers
of oil-based vaccine products. So he tries to make
sure that all veterinary students entering their clinical
rotations at the school are fully aware of the steps
needed to avoid jabbing themselves or their
colleagues. This is something that we as a profession
have taken rather too lightly in the past, mainly
because we are not in the same position as our
medical colleagues in dealing with viruses like HIV. We
have tended to treat getting a scratch as part of the
job, and that really has to change.
Wilkins and Bowmans study noted a higher
incidence of stick injuries in less experienced vets but
there is no evidence that they are any more guilty than
their senior colleagues in committing the sort of
mistakes that can lead to accidental injuries. Soutar
notes that one the biggest risks is when recapping the
needle of a used syringe. This can be tricky with both
hands free but there is a significant risk if the clinician
only has one hand free and so holds the syringe in
their mouth. If it is necessary to recap a needle for safe
carriage using one hand then the cap should be
placed on a flat surface and the syringe held to slide
across and scoop it up, he says.
Another option to ensure that needles are safely
disposed of is to use one of the newer technologies
such as retractable needles or devices with a hinged
syringe cap. However, this is likely to increase the
costs of routine veterinary procedures significantly.
Safety strategies
Mike Jessop is also concerned about a strategy,
supported by the Environment Agency, to reduce risks
by insisting that the syringe and needle are disposed
of together as a single unit, rather than removing the
needle and putting it in the sharps container for
separate disposal as hazardous waste.
This is an idea that is being promoted by the
clinical waste industry. Practices pay them to dispose
of clinical waste on a volume basis and by putting the
whole syringe into the highest category waste that will
increase the volume and their turnover. Vets will have
to pay five to ten times as much for incinerating their
20-22 Needle Sticks.indd 21 19/02/2013 11:04
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Get stuck in to BSAVAs
needle-stick survey
hazardous waste, and I dont think it will have any
effect in reducing injuries because I would suggest
that very few incidents actually occur after the needle
has been used, he said.
However, as Professor Robertson pointed out at
the VPC meeting, there is a big hole in the place
where knowledge on the causes of needle-stick
injuries in veterinary practice should be. Mike Jessop
suggests that this could be filled through clinical audit
and the introduction of reliable system for recording all
incidents, no matter how trivial, and ensuring that it
clearly describes the circumstances that led up to it.
Ronnie Soutar said that private practice would
need to adopt the procedures that are already in place
within the veterinary schools for reporting all health
and safety incidents. We now have a very good online
system for reporting both accidents and near misses.
People are aware that it doesnt necessarily have
negative consequences; there wont be people
descending upon you to say that it is your fault and
wanting to make your life more difficult. Instead it is a
process that kicks in to say there is a problem and so
how do we address it in a sensible way?
Soutar warns that it is in practitioners best interests
to create more effective arrangements for monitoring
health and safety hazards. It would be very sad if a
court case is what it takes for people to take notice of
this problem. We, as a profession, should address this
and come up with solutions that suit us, as they are not
necessarily the same solutions as those needed by the
medical profession. We recognise that we are not
dealing with the same level of threat and often we are
talking about different issues in small animal, farm and
equine practice.
Get involved in BSAVA consultation
Representatives of both the RCVS and BVA were
present at the VPC meeting and recognised the
importance of dealing with the issue of needle-stick
injuries. A Royal College spokeswoman confirmed that
efforts to prevent future problems through staff
training, better record keeping, etc., are being
considered by inclusion as part of the RCVS Practice
Standards Scheme. The plan is to publicise the issue
in RCVS News and add it to the list of items to be
considered by the Practice Standards Group for
revision as they go through the current review of the
standards, she said.
In the mean time, the BSAVA intends to help the
gap in knowledge about the frequency and nature of
needle-stick injuries and help to ensure that any
policies that are introduced are both effective and
commensurate with the risks.
Sally Everitt, scientific policy officer at Woodrow
House, said the plan is to ask all small animal
practices around the country to record every incident
that happens within a specified period. This will
obviously have limitations as a scientific study
because it will be a self-selecting group. So it is a
scoping exercise that will tell us what happened in the
practice, what was in the syringe and what were the
consequences. My feeling is that these incidents will
probably be quite common and in most cases they will
have no significant impact. But because something
isnt serious doesnt mean that it isnt important we
need to get the information to give us some
perspective on this.
For more information about contributing to the
BSAVA consultation that will run until the end of April
visit www.bsava.com/consultations or email Sally
Everitt s.everitt@bsava.com. n
Basic measures for reducing needle-stck injuries:
n Educate all employees and volunteers about safe
sharps handling and needle-stck avoidance.
n Do not recap needles unless absolutely necessary. If
recapping is necessary, use a one-hand scoop method,
hold the cap with a mechanical device such as forceps
or use a needle recapping device.
n Ensure convenient access to sharps containers in all
areas where needles might be used.
n Promptly dispose of needles into approved sharps
containers.
n Never use temporary or unapproved containers for
sharps.
n Never try to remove anything from a sharps container.
n Do not fll sharps containers beyond the designated fll
limit.
n Consider the use of protectve devices such as
retractable needles or hinged syringe caps.
n Do not walk around with an uncapped needle.
n Ensure all personnel report all needle-stck injuries and
record informaton regarding the circumstances.
Taken from Scott Weese and Douglas Jack. (2008) Needle-stick injuries in
Veterinary Medicine. Canadian Veterinary Journal 49(8): 780784
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23
Congress 47 APRIL 2013
BSAVA brings the
NOISETTES
T
wo years on from a second album Wild Young Hearts, awash with
stomping electro-rock and galloping funk grooves, the London duo
that make up the Noisettes have returned with their third album
CONTACT, a set of sleek pop songs steeped in soul, dizzy on disco
and harking back to the days of blues and jazz greats.
Noisettes second album spawned five singles and took them on tour for
over a year, sharing arena stages with Muse and criss-crossing America
with Bloc Party, with instantly recognisable songs such as Dont Upset The
Rhythm (you might know it from the Mazda TV advert) and Never Forget
You (featuring extensively in adverts including DFS and a 2010 all-media
campaign by Vodafone).
Growing up with a wide mix of music from afro-beat to reggae and
funk to soul , jazz and rock n roll, singer Shingai Shoniwa and guitarist
Dan Smith see themselves as two divas with different record
collections who constantly introduce each other to new sounds,
whether its African music, jazz, Van Morrison or Black Sabbath.
Singer Shoniwa is famous for her faultless vocals whilst
engaging in almost acrobatic performances a nod to the circus
skills she learnt in her teens. She says that the idea of putting on a
proper show seems to be missing from a lot of young bands at the
moment. We always go that extra mile to give the crowd a night
theyll never forget.
So along with the Comedy Club
featuring Alan Davies and a late-night
disco, the Noisettes will help make this a
Party Night to remember. Book your social
tickets alongside your registration, or add
them now if you are already registered,
because in previous years this event has
sold out well in advance.
For more information visit www.bsava.
com/congress or email congress@
bsava.com if you have any questions.
To find out more about the Noisettes
visit www.noisettes.co.uk.
Congress Party Night has a great reputation
for top music acts that keep delegates dancing
all night long and 2013 promises to be no
exception with the tunes coming from the
immensely talented Noisettes
described by The Guardian as
the best live band in Britain
23 Congress Social.indd 23 19/02/2013 12:37
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BSAVA launches first
e-Books at Congress
B
SAVA members have been asking
to have the Associations highly-
respected series of Manuals as
e-Books; to read on PCs, tablet
computers and e-readers. The BSAVA is
pleased to announce it will launch its first
Manuals as e-Books this Spring.
Their complex design and generous
use of colour means the manuals have had
to wait for suitable technology to display
them properly in electronic form. Many
people are familiar with reading PDF files
on screen, but these are just electronic
facsimiles of printed pages. In contrast to
the clearly presented print versions,
on-screen PDFs can make for an
uncomfortable reading experience,
requiring you to scroll up and down each
page to read the columns of text, and
struggle to zoom in to see figures in
sufficient detail. Proper e-Book files (called
ePub files for most e-readers and MOBI
files for Amazons Kindles) re-design the
books to present them optimally on screen,
but the first e-readers (like the first TVs)
were black-and-white devices.
New e-Book devices
Most Kindles, for example, are great for
reading novels, in monochrome and with
simple layouts, but many of the benefits of
the highly detailed colour photographs and
illustrations in the manuals would be lost if
read on those devices. Now, however, with
the launch of the colour Kindle Fire, the
growing adoption of iPads, and greater
awareness that you can read in colour via
a free Kindle App or other e-reader
You asked for digital manuals and now we are
delivering. BSAVA will launch its first e-Books at
Congress with much more to come
they read our e-Books. So when they order
an e-Book from the BSAVA website, they
can select the e-Book file types that suit
their particular e-readers, and load them
onto as many devices as they own. We
want our members to be free to read a
BSAVA e-Book however they want. For
example, they may want to be able to
access it on their PC using the free Abode
Digital Editions e-reading program, or by
using the free Kindle App, AND read it on
their iPad sometimes too. By ordering from
the BSAVA website, they can.
Range of subjects
The initial group of BSAVA e-Books offers a
range of subjects across medicine and
surgery for dogs, cats and exotic pets. The
Association will welcome feedback from
members on these titles, so it can offer the
best possible service as it rolls out further
Manuals as e-Books later in the year. There
will be an easy way for members to leave
comments on the website. We are looking
forward to hearing how members use
these e-Books, what they like, and what we
might improve for them, says Greg Moxon.
If you want to comment or get more
involved then visit the website or email
publications@bsava.com.
BSAVA Manual of Rodents and Ferrets e-Book
viewed on an iPad
program on a PC,
Manuals can be read as
e-Books properly, to give
an excellent reading
experience.
In this fast-evolving
field, people are faced
with a wide choice of
different e-readers, says
Greg Moxon, BSAVAs
Head of Publishing. We
want to give our
members the widest
possible choice in how
See e-Books at Congress
Delegates at the BSAVA Congress at
Birmingham on 47 April will get the
first opportunity to browse and order
the e-Books on the Publications Stand
on the BSAVA Balcony in the NIA.
Youwill be able to try them out, and
see for yourself the flexibility and
convenience this new electronic
format offers.
24-25 Publications.indd 24 19/02/2013 11:07
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25
NAVC conference
a roaring success
N
AVC (1923 January, Orlando) is one the largest conferences
that BSAVA attends, and this years event cemented the success
of our record-breaking year in 2012. The team again signed up
over 100 overseas e-members during the 5-day event, and book
sales exceeded 190 copies with the Behaviour, Neurology,
Ultrasonography and Rabbit Manuals being amongst the most popular
titles. Visitors to the stand were also able to find out about the range of
e-Books that will be available later on this year (see opposite page).
Our lecture-share programme with NAVC saw Hattie Syme and Prue
Neath presenting lectures on a variety of topics including soft tissue
surgery, chronic kidney disease and how to take blood pressure
measurements. The lectures proved very popular with the delegates and
the sessions were busy throughout the day.
All in all a huge success and proof that BSAVA science has a well
earned place on the global stage.
And the winner is...
Anne Wilson was the very happy winner of the BSAVA
Publications Christmas Quiz, which featured in the
December issue of companion. She was the lucky
recipient of the five new titles published in 2012:
BSAVA Manual of Canine and Feline Dermatology,
3rd edition
BSAVA Manual of Canine and Feline
Endocrinology, 4th edition
BSAVA Manual of Canine and Feline Haematology
and Transfusion Medicine, 2nd edition
BSAVA Manual of Exotic Pet and Wildlife Nursing
BSAVA Manual of Small Animal Practice
Management and Development
Anne is an assistant in a busy mixed practice in
Carlisle and has been a member of the BSAVA for the
past four years. By day, Anne carries out small animal
work, but when on call or at the weekends still gets to
do the James Herriott thing and get out and about in
the countryside to do lambings and calvings.
Anne says Ive always found the BSAVA Manuals
very informative, relevant and user-friendly, written in
such a way that they are easy to navigate through and
understand, even if you are not familiar with the topic
and want to get up to speed. I have done locum work
in the past and found practice libraries can vary
hugely in terms of the number and type of books. The
BSAVA Manuals are great as they are easy to find on
the shelf when you need to look something up quickly,
and are a reliable point of reference.
Antipodean
adventure
BSAVA will have a stand at the
forthcoming WSAVA/FASAVA Conference being
held in Auckland, New Zealand. Come and visit us
on Level 5 (Stand 77) to find out about overseas
e-memberships, the new titles being released in
2013 and exciting developments in digital
publishing. We look forward to seeing you there!
BSAVA Senior Vice
President Andrew
Ash presenting
Natalie Morris from
North Carolina, the
100th overseas
member joining at
NAVC, with the latest
edition of the BSAVA
Small Animal
Formulary
24-25 Publications.indd 25 19/02/2013 11:07
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. Isselee; Milan Kopcok; 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
A practical and interactive course for GPs
will cover investigation & 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 for VNs
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 & Lizza Baines
VENUE
Willows Veterinary Centre and Referral Service,
Solihull B90 4NH
FEES
BSAVA Nurse
Member: 167.00
Non BSAVA Nurse
Member: 250.00
26 CE Advert February.indd 26 19/02/2013 11:08
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27
S
ince the launch of PetSavers new
image, it has become increasingly
important to raise awareness in the
most effective way possible. So we
are now seeking an influential figurehead
a Patron who has an avid interest in our
scientific and ethical values. This is where
you might be able to help.
You and your clients can assist
PetSavers in achieving its short and long
term goals. Sift through your client
contacts, and encourage others to
contribute to PetSavers you never know,
they could be the next major financial
donor which PetSavers values so
dearly! By sharing the value
of our work with pet
owners you will helpus
to help vets save pets.
Could your client
be our Patron?
Supporting PetSavers is a
fantastic way to inspire
your clients and
colleagues to be involved in
the charity. If you have a
client with a high public
profile they might be our
perfect Patron.
SEND PETSAVERS AN EMAIL, TWEET,
OR CALL TODAY
Email: info@petsavers.org.uk
Call: 01452 726723
Tweet: @PetSavers_UK
Alternatvely, you can visit us at BSAVA
Congress 47 April 2013. The PetSavers stand
will be situated on the BSAVA Balcony and we
welcome you to pop over and have a chat.
Come and say hello.
year. Show your support for the future of
pet health by assisting us in finding a
Patron who will give PetSavers the
awareness that it really deserves.
If you think that you can help, or if your
practice has a client that might be
interested in supporting PetSavers,
please get in touch. Email Gemma at
info@petsavers.org.uk or call 01452
726723 for more information.
Calling all clients
We can help you inspire any of your
clients to get involved in fundraising
events. Each year PetSavers has
guaranteed spaces in the London 10k,
so encourage them to sign up we can
reserve a number of spaces just for
you and your friends.
PetSavers patron
with public profile
If they have a love for animals, devoting
time to PetSavers can be extremely
rewarding confident in the knowledge
that their profile is helping to find cures for
many diseases and illnesses.
It is important that they know that
PetSavers work does not involve the use of
experimental animals; all research is
carried out to the highest ethical and
scientific standards.
Being a Patron for a charity is a great
opportunity to give something back. It
might be that PetSavers has funded
research into an illness or disease that a
beloved companion animal was
affected by, which is why many pet
owners value the work of PetSavers.
The support of a Patron
could make a real
difference to the ongoing
success of PetSavers.
Help us to bring the
charity to a wider
audience and
secure greater
support. It could go
a long way to
enhance the
research that is
carried out year on
In 2012, PetSavers launched a new brand identity at
BSAVA Congress. With a fresh approach to share with
the world, PetSavers gave delegates the opportunity to
see the charity in a new light. We also introduced new
funding for veterinary professionals to study a one year
Masters Degree. So, after an exciting year, what does
2013 have in store?
27 PetSavers March.indd 27 19/02/2013 11:26
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F
or 17 years, the government of Sri
Lanka adopted a policy of mass
slaughter (elimination) as a means
of controlling the stray dog
population, with the objective of curtailing
outbreaks of rabies in humans in Colombo.
The policy failed to achieve its objective
while severely compromising the welfare of
stray dogs in the city.
However, a project run by the Blue
Paw Trust (an NGO founded by Dr
Nalinika Obeyeskere, a former President
of the Sri Lanka Companion Animal
Practitioners) and focused around a no
slaughter policy has, in fewer than 6
years, achieved a significant reduction in
both the dog population and human
rabies outbreaks. This is a fantastic
example of the expertise veterinarians can
bring to solving One Health related
challenges in a way which takes into
account both human and animal welfare.
The Blue Paw Trust ran its project in
collaboration with the Colombo Municipal
Council (CMC) and World Society for the
Protection of Animals (WSPA). It aimed to
implement a sterilisation, rabies
vaccination and registration programme of
owned and roaming dogs in collaboration
with the CMC where owners taking their
dogs to the vet, rather than dog catching,
would be the basis on which a culture of
responsible pet ownership could be built. It
also aimed to support humane
improvements to the CMC dog pound
review the dog registration system.
Dr Ganga de Silva, President of SCAP,
explains We saw a real opportunity to
reduce dog bites and the incidence of
human rabies, and to improve local dog
welfare. We also wanted to move towards
achieving an environment of responsible
dog ownership, a sustainable dog
population and rabies control.
The project team used a variety of
approaches to meet its goal, including
vaccination of roaming and owned dogs,
sterilisation of female dogs, education of
school children on bite prevention, rabies
awareness and responsible dog
ownership [see photo below], the creation
of dog managed zones to minimise
conflict between the public and dogs in
high risk areas such as hospitals and
schools, and the training of CMC staff in
humane dog handling, catching and
veterinary techniques.
Now, as it reaches a conclusion, the
results are stunning:
n The annual average number of dog
rabies cases was 3 in 2012. It had
been 35 cases on average between
1992 and 2007
n The percentage of community pups was
1% in 2012. It had been 11% in 2007
n The percentage of community lactating
females reduced from 9% to 1% during
the 5 years
n The average body condition score
among roaming dogs increased from
75% to 95% during the 5 years
n The average skin condition score
among roaming dogs increased from
55% to 85% during the 5 years
n The dog population, which was
increasing at a rate of 18% in 2007, is
now decreasing at a rate of 9%.
Dr Ganga de Silva concludes Over the
past 5 years our project has produced
excellent results and we hope to make
Colombo free of rabies in 2014 possibly
even in 2013. We hope that other WSAVA
member associations will consider this
approach. We want to extend our work to
the whole of Sri Lanka but are in desperate
need of financial support. If you can help,
please contact me at gangadesilva@
hotmail.com.
BSAVA Vice-President Professor
Michael Day, Chairman of the WSAVAs One
Health Committee, adds The control of
canine rabies virus infection is an enormous
challenge in countries endemic with the
disease, and the elimination of this globally
significant pathogen is now a target of the
WSAVA One Health Committee. It is
scientifically proven that mass vaccination
campaigns are more effective than the
capture and destruction of stray dogs. The
Blue Paw Trust project is an excellent
example of a programme that has really
worked. A project such as this, which takes
into account animal welfare, demonstrates a
holistic attitude towards all forms of life,
creating a more compassionate society is
something the world needs. This really is
One Health in action! n
One Health in
action in Sri Lanka
Sri Lankan dog
population and rabies
management shows
One Health in action
Dr Ganga
de Silva,
President
of SCAP
2829 WSAVA News March.indd 28 19/02/2013 11:29
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I
t took me a while to adjust to being back in the presidential hot seat but
now that everythings on track its great to have the opportunity to reflect
on some of our achievements during 2012.
First things first Peter Ihrke is doing well. His therapy is taxing but
hes a fighter and, in the circumstances, things are looking good. We keep
closely in touch with him and send him positive vibes. Please keep him in
your thoughts and prayers.
Its great news that our new WSAVA Global Veterinary Community
website is now live. Explore it and participate in discussions with your
WSAVA colleagues. Your active involvement will help make the website the
hub of our global online community!
2012 has been another year of great progress. Our continuing education
work is spreading around the globe, following a refocusing of our efforts by
CE Chair Dr Jill Maddison and her enthusiastic team. As a result, this year we
have touched the lives of thousands of companion animal vets in most
continents of the world. This is a great achievement but Jill has even more
ambitious plans for 2013. If you would like to contribute to our work, or attend
a session, please contact her at jmaddison@rvc.ac.uk.
Our other Committees are also working hard to achieve their goals. The
Global Pain Council (GPC) has been working hard on the development of its
Global Pain Treatise. It will be launched at the World Congress and will be
one of our key focus areas for next year.
The major achievement of the One Health Committee was the publication
of an article in the highly regarded journal Emerging Infectious Diseases. The
article received acclaim around the world and Michael Day and his team
should be congratulated on this step forward in our One Health work.
We had some great moments in 2012 but also some sad times,
especially when we heard of Peters diagnosis. Whats great is that the
difficulties only brought us closer together. It seems to have strengthened the
feeling of community we have within the WSAVA a feeling that, wherever
you are, there are people looking out for you. Perhaps the most touching
example was the 10,000 paper cranes folded for Peter at the recent JPVP
Congress. A memorable moment for a fantastic guy! n
Update from
the President
Jolle reflects on a busy 2012 for the WSAVA
WSAVA has
unveiled a new
corporate identity
and launched a
new website at
www.wsava.org
Dr Siraya Chunekamrai,
Head of WSAVA
Communications
Jolle with Jan Gajentaan, a former WSAVA President
B
oth the website
and logo have
been designed
to help provide
an enhanced sense of
the global community of veterinarians the WSAVA
represents, by providing a strong external image and
enabling members to share information easily and
quickly with colleagues around the world.
Commenting on the WSAVAs new look,
DrSiraya Chunekamrai, Head of WSAVA
Communications and a Bangkok-based veterinarian,
comments WSAVA communications are
challenging as we are spread around the world,
coming from diverse cultures with differing levels of
access to technology. With the development of our
new website and corporate identity, were aiming to
help generate a sense of ownership, support and
mutual respect, while also making it easy for us to
share knowledge and experience. Now, more than
ever, the world needs a community of veterinarians
who are willing to work together to create a global
voice which can help change the world for the
better. Thats what the WSAVA aims to do and our
new communications initiatives will help us achieve
our goals. n
The new
WSAVA Global
Veterinary
Community
website is live!
2829 WSAVA News March.indd 29 19/02/2013 11:29
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Mike Guilliard was born in Leek in Staffordshire where his father was
the managing director of a textile mill and his mother a housewife.
Hewas an only child with the freedom to roam the countryside.
Hissecondary education was at Newcastle-under-Lyme High School
followed by the Cambridge University School of Veterinary Medicine.
His wife Kamila has been very supportive throughout his career and
currently works closely with him as the events organiser for the British
Veterinary Orthopaedic Association. In November he received the
rare honour, for a practitioner, of being granted fellowship of the
RCVS for his thesis on The nature, incidence and response to
treatment of injuries to the distal limbs in the racing greyhound.
the companion interview
Mike
Guilliard
MAVetMed CertSAO FRCVS
30-31 Interview March.indd 30 19/02/2013 11:29
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31
treat people with
respect and humour,
and then it is often
reciprocated
Q
What made you decide to be a
vet?
A
Becoming a vet was a natural
progression of my real interest in
natural history and animals in
particular.
What did you do before joining your
current practice?
I jokingly say that I have had nearly 40
years of hard toil at the Nantwich Veterinary
Group. Joining the practice shortly after
qualifying, I became a partner in 1980. It
was then primarily a dairy practice (and still
is one of the largest in the country) but
diversified into large equine and
companion animal components with the
opening of Nantwich Veterinary Hospital in
1998. Although joining as a cattle vet I
increasingly found my interest was in small
animals and this progressed to
orthopaedics.
What made you decide to specialise in
orthopaedics?
My interest in greyhounds and
orthopaedics stemmed from the influence
of Jimmy McWilliam, the Senior Partner of
the original Nantwich practice. At the time
of joining Jimmy had about 40 greyhounds
in training and a collection of coursing
dogs. Pups were reared on a couple of
local farms in lieu of veterinary fees, and
the local knacker man dropped off
carcasses to feed them. Injured
greyhounds were therefore a common
sight in the waiting room. I was soon to
realise that these dogs carried very
specific injures from the nature of their
athletic activities. There was little in the
literature on diagnosis and treatments and
what was available was generally
anecdotal and often very primitive.
What prompted you to begin original
research in this area?
I really got to grips with orthopaedics in the
early 1990s, gaining my CertSAO in 1995,
and it was then that I realised that I was
seeing a number of specific injures not
mentioned in the literature. My first
publication was in JSAP entitled Sprain of
the dorsal radiocarpal ligament in high
activity dogs and for this I was presented
with the BSAVA Dunkin Award. In 2005 I
began to work one night a week at a
licensed greyhound stadium, giving me the
cases and follow-up needed for the RCVS
thesis. Nearly two years ago I left the
practice to become a peripatetic
orthopaedic surgeon to in theory ease
myself into retirement!
Have the results of this research
influenced your clinical approach?
Interestingly, from this study my approach
to the management of many cases has
swung from surgical to conservative
management, often with equally good
results without the complications. My
proudest achievement is discovering the
use of temporary external fixation of the
digits for the successful management of
proximal interphalangeal joint and
metacarpo- and metatarso-phalangeal
joint instabilities.
What single thing would most improve
your quality of life?
That would be a good mobile phone signal
at home.
What do you enjoy most about your
work?
The best aspect of my job is the freedom
to pick and choose when and where I
work. Operating out of different practices
certainly has its challenges but I have got
to know many great nurses and veterinary
colleagues. The worst aspect of the job is
getting home to the paperwork, reordering,
and autoclaving for the next day.
What is the most important lesson that
you have learned in life?
I would say to treat people with respect
and humour, and then it is often
reciprocated.
What do you do in your off-duty hours?
My main hobbies throughout my life have
involved mountains, progressing from an
obsessed rock climber at university to
alpine climbing followed by fell running, the
highlight of which was successfully
completing the Bob Graham Round in the
Lakes. Now with the aches and pains of
age, it is fell walking with my wife and
lurcher Fly. This is often combined with
bird watching. The highlight of last year
was seeing four Lapland buntings on the
summit of Ben Nevis.
Who would be your ideal dinner
party guests?
Boris Johnson, George Galloway and John
Bishop together with Ian and Victoria
Hislop. If the comedy waned and the
politics became too heavy I would talk to
Victoria about her great knowledge of the
Greek Islands.
Which living person do you most admire?
Probably Margaret Thatcher for her stance
on breaking the power of the unions that
had the country on its knees at the time.
Some of the loads of money excesses of
the eighties were perhaps not so desirable.
Is there any particular song that will get
you up on the dance floor at parties?
To get me anywhere near a dance floor
requires sufficient alcohol and a good live
rock band; the song would be irrelevant
and probably incomprehensible by then!
30-31 Interview March.indd 31 19/02/2013 11:30
For more information or to order
www.bsava.com
BSAVA reserves the right to alter prices where necessary without prior notice.
companion offerof the month
Exclusive offer for companion readers
call BSAVA on 01452 726700 and
quote companion offer Psittacines
Missed this
new Manual?
BSAVA Manual of Small Animal
Practice Management
and Development
This Manual provides a daily reference for veterinary
surgeons, practice managers, VNs and students. Highly
illustrated and user-friendly, it offers a complete guide to
starting and developing a practice, with a focus on delivery
of clinical care and customer relationships.
Got this in your
practice library?
BSAVA Manual of
Practical Veterinary
Nursing
This popular Manual has been writen to cover the practcal
requirements of trainee veterinary nurses and to provide
additonal practcal support for qualied veterinary nurses.
WHAT THEY SAY
a must have for student veterinary nurses
and animal nursing assistants. Both practcal
and easy to follow, it is an incredibly useful
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WHAT THEY SAY
...I highly recommend it for veterinary students,
veterinary technicians or general practtoners...
JOURNAL OF THE AMERICAN VETERINARY
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Offer is available to BSAVA members
only. Ends 27 March 2013. Free P&P on
telephone orders for UK and Eire
delivery, online rates of P&P apply for
overseas orders.
companion offer: 49.0034.50
Price to non-members: 78.00
BSAVA Member Price: 55.00
Price to non-members: 85.00
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BSAVA Manual of Canine and Feline
Musculoskeletal
Disorders
Covers conditions of bone, tendon and muscle and provides a
ready reference for the practitioner faced with a dog or cat
showing lameness, stiffness or joint pain:
Arthritis in-depth
Chapters on individual joints
Common surgical procedures on joints
Step-by-step Operative Techniques
WHAT THEY SAY
...a great tool for anyone interested in the diagnosis and
treatment of musculoskeletal disorders...
VETERINARY AND COMPARATIVE
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BSAVA Member Price:
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32 Publications Advert March.indd 32 20/02/2013 10:24
companion
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33
Vets
Friday 31 May
The approach to veterinary
oncology
Principles of surgical oncology
Diagnostc imaging in the
oncology patent
Radiaton oncology: general
principles and expectatons
Chemotherapy drugs: general
principles and common
veterinary drugs
Palliatve care: maintaining quality
of life for our patents
Canine lymphoma: review and
update on current research
Feline lymphoma
Saturday 1 June
Practcal tps on giving
chemotherapy in practce
Management of oral tumours
Afershocks of chemotherapy:
managing adverse events
Nasal tumour or not?
investgaton of nasal disease
Canine sof tssue sarcomas:
from start to nish
Feline injecton-site sarcomas:
from start to nish
Molecular diagnostcs and
indicatons: focus on ow
cytometry and PCR
Comparatve oncology: the dog
as a model
Management of mast cell tumours
Canine osteosarcoma: amputaton
versus novel surgical approaches
Standards of care for
haemangiosarcoma in the dog
and cat
Tyrosine kinase inhibitors: can they
treat tumours?
Mammary tumours in dogs
and cats
Advances in radiaton therapy:
IGRT, IMRT and why we care
Transitonal cell carcinoma:
a sneaky expansion
Canine melanoma: does the
vaccine help?
Nurses
Friday 31 May
Obtaining a diagnosis: an overview of what
cancer is and how we obtain a diagnosis,
including the use of dierent biopsy
techniques
Staging the cancer patent: staging the
patent with cancer is an important process
for determining how advanced the disease is
and whether it has spread to other organs.
The stage of the patent can inuence both
treatment opton and prognosis
Cancer treatment optons: treatment
optons are increasing, with many therapies
becoming more widely available
Saturday 1 June
Common tumours in small animals:
the case management, treatment optons
and patent prognosis associated with many
tumours commonly seen in small animals,
including lymphoma, osteosarcoma and
mast cell tumours
The safe use of chemotherapy:
chemotherapy is being used more widely
by veterinary practces. These drugs have
the potental to cause harm to the people
handling them. This lecture will cover how
to safely prepare and administer cytotoxic
drugs, and how to manage patents that
have received these agents
Understanding the side-eects of treatment:
many of the treatment modalites we
use to treat cancer have the potental for
causing side-eects in our patents. These
side-eects will be discussed in greater
details, including methods for minimising or
managing them
The importance of nutriton in cancer:
patents with cancer can have altered
metabolism and have dierent nutritonal
requirements to normal animals
Palliatve care of the cancer patent: not all
patents with cancer can be treated, and not
all owners wish for their pet to be treated.
This lecture will discuss the methods we
can use to keep our patents comfortable
and how we can maintain and monitor their
quality of life
Principals of oncology for the veterinary
team
Popular with regular attendees, our NI Congress
has an impressive scientific programme and plenty
of social events to make it a memorable weekend.
Friday 31 May Saturday 1 June,
Armagh City Hotel, County Armagh
I
n 2012, over 100 vets and 40 nurses from
far and wide enjoyed an action packed
weekend in Limavady, Northern Ireland,
with four top quality speakers in an
incredible location. 2013 promises to build
on the increasing popularity of this event,
with an impressively high level of science, an
exhibition and a superb social programme.
A new venue was needed for this year,
and the Northern Ireland Committee
decided on the Armagh City Hotel, with its
excellent state-of-the-art conference
facilities and panoramic views over
Armagh, Irelands oldest city.
Social events include the Party Night
and Nursing Awards which consists of a
fantastic four-course meal followed by
dancing, entertainment and a late-night DJ.
Oncology +
Each year the event is built on a topic this
time it is oncology with expert speakers
Rachel Burrows, Samantha Fontaine,
Jessica Lawrence and Mary Millington,
providing top quality CPD for vets and
nurses. The talks will consider diagnosis,
surgery, chemotherapy, radiation therapy
and palliative care.
BSAVA & BVNA
Northern Ireland
Congress
Scientific Programme
Registration for the whole weekend
is from as little as 160 for nurses
and 260 for vets
For more information visit
www.bsava.com/congress
33 Focus On.indd 33 19/02/2013 11:32
34
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companion
CPD diary
EVENING WEBINAR
Monday 4 March
20:0021:00
Practical approach to diagnostic
and management issues in cats
with kidney disease
Speaker: Jonathan Elliott
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 13 March
13:0014:00
Surgical management of aural
disease
Speaker: Alison Moores
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 20 March
13:0014:00
Chemotherapy
Speaker: Linda Roberts
Online
Details from administration@bsava.com
EVENING WEBINAR
Wednesday 6 March
20:0021:00
Basic principles of wildlife rescue
and first aid
Speaker: Liz Mullineaux
Online
Details from administration@bsava.com
EVENING WEBINAR
Monday 18 March
20:0021:00
Case based clinical approach to
stifle lameness
Speaker: Toby Gemmill
Online
Details from administration@bsava.com
EVENING WEBINAR
Monday 25 March
20:0021:00
Therapeutic exercises: a practical
approach to what can be achieved
in practice
Speaker: Lowri Davies
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
March 2013
April 2013
EVENING MEETING
WEST MIDLANDS REGION
Tuesday 5 March
Acute pain management/
peri-operative analgesia
Speaker: Matthew Gurney
Wolverhampton Medical Institute, New Cross
Hospital, Wolverhampton WV10 0QP
Details from westmidlands@bsava.com
DAY MEETING
Tuesday 5 March
A clinical dissection of brain
disease in dogs and cats
Speaker: Pete Smith
Wildpark Farm, Ashbourne, Derbyshire DE6 3BN
Details from administration@bsava.com
DAY MEETING
METROPOLITAN REGION
Tuesday 19 March
Wound management
Speakers: Davina Anderson and Kate White
Holiday Inn, Crest Road, Handy Cross, High
Wycombe HP11 1TL
Details from metropolitanregion@bsava.com
DAY MEETING
Thursday 21 March
BSAVA Dispensing Course
Speakers: P. Sketchley, F. Nind, J. Hird,
P.Mosedale, S. Dean, M.Jessop
Hawkwell House, Oxford OX4 4DZ
Details from administration@bsava.com
DAY MEETING
SOUTH WEST REGION
Thursday 21 March
Medical and surgical
aspects of gastrointestinal
disease
Speakers: Ed Hall and Ed Friend
Canalside, Marsh Lane, North Petherton,
Bridgwater, Somerset TA6 6LQ
Details from southwestregion@bsava.com
DAY MEETING
SOUTH WEST REGION
Friday 22 March
Medical and surgical aspects of
gastrointestinal disease
Speakers: Ed Hall and Ed Friend
Lostwithiel Hotel and Country Club, Lower
Polscoe, Lostwithiel, Cornwall PL22 OHQ
Details from southwestregion@bsava.com
DAY MEETING SCOTTISH REGION
Sunday 24 March
Oncology: top 6 cancers
seen in small animal practice,
medical and surgical
management
Speakers: Kathryn M. Pratschke and
JennyR.Helm
Glasgow University Vet School
Details from scottishregion@bsava.com
DAY MEETING
NORTH EAST REGION
Sunday 10 March
Smelly ears
Speaker: Sue Patterson
Wetherby Racecourse
Details from northeastregion@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Wednesday 13 March
Diagnosis and management of
liver disease in cats and dogs
Speaker: Nick Bexfield
Yew Tree Lodge Best Western Hotel,
33Packington Hill, Kegworth, Derby DE74 2DF
Details from eastmidlands@bsava.com
Practice Badge Deadline
Wednesday 6 March
The ICC/NIA, Birmingham, UK
Email: congress@bsava.com
47 April
34-35 CPD Diary.indd 34 19/02/2013 12:10
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35
FECAVA EUROCONGRESS
25 October
Dublin, Ireland
Call for Abstracts:
Closing 28 March
Register Now:
Early Bird closes 30 April
Visit www.fecava2013.org or email
info@fecava2013.org for more details.
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
Speaker: Liz Mullineaux
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
May 2013
June 2013
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
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
EVENING MEETING
WEST MIDLANDS REGION
Thursday 6 June
Common corneal conditions and
the non-healing corneal ulcer
(Interactive)
Speaker: Lorna Newman
Wolverhampton Medical Institute, New Cross
Hospital, Wolverhampton, WV10 0QP
Details from westmidlands@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
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
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
OTHER UPCOMING BSAVA CPD COURSES
See www.bsava.com for further details
BSAVA Educaton
Wednesday 19 June
Perioperatve feeding
BSAVA Educaton
Thursday 20 June
Imaging the abdomen
BSAVA Educaton
Tuesday 25 June
Current perspectves on FLUTD
West Midlands Region
Tuesday 2 July
Treatng the pet chicken: including
live chicken handling
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 12 June
13:0014:00
Anaesthesia update
Speaker: Liz Leece
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
DAY MEETING
SCOTTISH REGION
Thursday 30 May
Orthopaedic conditions of
young dogs
Speaker: Luke Arnott
Kingsmill Hotel, Inverness
Details from scottishregion@bsava.com
WEEKEND CONFERENCE
BSAVA NORTHERN IRELAND
Friday 31 May
Saturday 1 June
Armagh City Hotel
Details from
nirelandregion@bsava.com
34-35 CPD Diary.indd 35 19/02/2013 12:10
47 April 2013
The ICC / NIA Birmingham UK
www.bsava.com/congress
Register online now
More than 300 lectures catering to all
career and experience levels
Extended management stream
Panel discussions
State of the art lectures looking at
current concepts and ongoing research
in the field
Great flexibility by being held over
4 days with great rates for individual
day passes available
Extensive commercial exhibition with
over 250 companies
Great networking opportunities
Unrivalled social events
Not yet
registered?
Visit www.bsava.com/congress
to register today and download the
complete scientific programme
Can you afford to miss out on:
Already
registered?
Enhance your learning experience
at Congress by getting closer to the
experts with Small Group and
Practical Sessions
Small Group Sessions include advanced,
intermediate and general levels. Topics covered
include Thoracic surgery, Ophthalmic imaging,
Complications of ear surgery, Video case-based
neurology problems, Snotty noses, Chronic
enteropathies, Interpreting biochemistry, Client
communication workshops, Case-based canine renal
disease, Case-based basic fracture planning and ECGs.
Practical Sessions consist of 5 work stations and
groups of a maximum of 8 delegates will work their
way round, spending 30 minutes at each station. The
main topics are Practical investigation of abdominal
disease (Veterinary) and The practical
management of the recumbent patient (Nursing)
Please visit www.bsava.com/congress
for further information on prices,
speakers and timings
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36 OBC March - Congress Ad.indd 36 19/02/2013 11:36