The essential publication for BSAVA members

companion
MAY 2013
Case of a Collie
cross with pyrexia and
multiple joint effusions
Fundamentally
feline
Authors share
expertise P24
Congress in
pictures
A magnicent
meeting P4
How To
Approach Horners
syndrome
P16
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A web-based questonnaire to measure
dog health-related quality of life
This paper reports a companion animal HRQL
instrument, the contemporary approach
to animal welfare measurement, which
is presented in a web-based format with
automated producton of a HRQL prole.
The authors conclude that it oers major
advantages to dog owners, practtoners
and researchers.
Lef ventricular geometrical
dierences in dogs with myxomatous
mitral valve disease
This artcle nds that sphericity index and RWT
are simple methods for assessing LV geometry
using 2D echocardiography that may be useful
in MMVD dogs as part of risk stratcaton.
Investgatng the TATE canine elbow
arthroplasty on kinematcs of the elbow
The authors conclude that the rst
generaton TATE canine elbow arthroplasty
cartridge and its instrumentaton accurately
reconstructed the anatomic centre of rotaton
in eight of the 10 elbows assessed in this ex
vivo model.
Comparing xaton methods of femoral
diaphyseal fractures in cats
This study found no statstcally signicant
dierence in the tme to achieve bone
healing, but there was a signicant dierence
companion is published monthly by the British
Small Animal Veterinary Association, Woodrow
House, 1 Telford Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB. This magazine
is a member-only benet. Veterinary schools
interested in receiving
companion should
email companion@
bsava.com. We welcome
all comments and ideas
for future articles.
Tel: 01452 726700
Email: companion@
bsava.com
Web: www.bsava.com
ISSN: 2041-2487
Editorial Board
Editor Mark Goodfellow MA VetMB CertVR DSAM
DipECVIM-CA MRCVS
CPD Editor Simon Tappin MA VetMB CertSAM
DipECVIM-CA MRCVS
Past President Andrew Ash BVetMed CertSAM MBA
MRCVS
CPD Editorial Team
Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS
Tony Ryan MVB CertSAS DipECVS MRCVS
Lucy McMahon BVetMed (Hons) DipACVIM MRCVS
Dan Batchelor BVSc PhD DSAM DipECVIM-CA MRCVS
Eleanor Raffan BVM&S CertSAM DipECVIM-CA MRCVS
Features Editorial Team
Andrew Fullerton BVSc (Hons) MRCVS
Mathew Hennessey BVSc MRCVS
Design and Production
BSAVA Headquarters, Woodrow House
No part of this publication may be reproduced
in any form without written permission of the
publisher. Views expressed within this
publication do not necessarily represent those
of the Editor or the British Small Animal
Veterinary Association.
For future issues, unsolicited features,
particularly Clinical Conundrums, are
welcomed and guidelines for authors are
available on request; while the publishers will
take every care of material received no
responsibility can be accepted for any loss or
damage incurred.
BSAVA is committed to reducing the
environmental impact of its publications
wherever possible and companion is printed
on paper made from sustainable resources
and can be recycled. When you have finished
with this edition please recycle it in your
kerbside collection or local recycling point.
Members can access the online archive of
companion at www.bsava.com .
3 BSAVA News
Latest from your Association
45 Congress in pictures
A look at the 2013 event
67 At Congress
Key stories from Birmingham
810 International vets
The experience of foreign vets in
the UK
1215 Clinical Conundrum
A Collie with pyrexia and multiple
joint effusions abnormalities
1621 How To
Approach Horners syndrome
2223 Great lives
Woody Woodrow in profile
2425 Fundamentally feline
Editors of new manual share their
expertise
2627 PetSavers
Photography competition winners
2829 WSAVA News
The World Small Animal
Veterinary Association
3031 The companion Interview
Mark Hedberg
33 Postcards from the Regions
News from your local groups
3435 CPD Diary
Whats on in your area
Additional stock photography:
www.dreamstime.com
Alistair Scott; Gpgroup; Tatyana Chernyak;
Thomas Lammeyer; Zentilia
Whats in
JSAP
this month?
Here are just a few of the
topics that will feature in
your May issue:
in categorised complicaton rates between
the groups.
The vacuum phenomenon in
intervertebral disc disease of dogs based
on CT images
In dogs with intervertebral disc disease,
vacuum phenomenon is a frequent but
inconsistent nding. Although helpful to
identfy degenerated discs, the authors
conclude it is not suitable to identfy currently
herniated disc with su cient accuracy.
Correlaton of bronchoalveolar
eosinophilic percentage with airway
responsiveness in cats with chronic
bronchial disease
This study provides supportve evidence of
a correlaton between airway eosinophilic
inammaton and plethysmographic
measures of bronchoconstricton and
airway responsiveness.
Log on to www.bsava.com to access
the JSAP archive online.
SPECIAL ISSUE
OF EJCAP NOW
AVAILABLE
Dont forget that
as a BSAVA member
you are enttled to
free online access
to EJCAP register
at www.fecava.org/EJCAP to access the
latest issue.
Find FECAVA on Facebook!
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T
he government published the
draft Dangerous Dogs
(Amendment) Bill on April
9th. This will make it an
offence for a dog to be dangerously
out of control in any place, including
on private property, although there is
an explicit exemption in relation to
trespassers. Attacks on guide dogs
and other assistance dogs will also
be explicitly covered.
In regard to banned breeds, the
legislative changes will make clear
that the court must consider the
character of the person in charge of
the dog, as well the temperament
and past behaviour of the dog, in
deciding whether a dog needs to be
destroyed or can be placed on the
Index of exempted dogs. The
changes to attacks on private
property and to attacks on
assistance dogs apply to England
and Wales. The banned breed
amendment will apply to the whole of
Great Britain.
The BSAVA supports these
extensions and is particularly
pleased to see attacks on
assistance dogs included as
well as recognition that the danger
that a dog poses is dependent on
the owner. However, we are
concerned that these changes do
nothing to prevent attacks and we
recognise the need for coordinated
engagement, relevant education
programmes, and the introduction
of Dog Control Notices.
The BSAVA is currently
consulting with members to establish
your concerns and opinions on
compulsory microchipping. To have
your say contact the BSAVAs
Scientific Policy Officer Sally Everitt
via email s.everitt@bsava.com.
Dangerous
Dog Laws
National VN
awareness month
O
n Saturday 22 June at the World of James
Herriot Visitor Centre, Thirsk, the BSAVA
North East Region is holding a special Meet
the President event so members can get to
know Michael Day.
The event starts at 5pm with a welcome address
from Jim Wight, followed by a presidential address
from Michael. There will then be a buffet and drinks
and Jim will also be signing copies of his new book
The Real James Herriot. You will have the opportunity
to take a self-guided tour and step back in time to see
what has made James Herriot into a global
phenomenon. There will also be an educational
workshop for children. Places are free for the first
50members who register and the cost thereafter
will be 6 per head (children under five are free).
Tobook your place visit www.bsava.com or email
administration@bsava.com.
Meet new
President
Michael Day
O
ver the following pages you can see the
highlights from Congress 2013. Thank
you to the thousands of delegates and
exhibitors who contributed to this being
a superb year. Now its time to put the 2014 dates
in your diary: 36 April.
It was a very
good year
A
t BSAVA Congress in Birmingham, the newest
manual titles proved amongst the most popular.
Thetop five were: Feline Practice A Foundation
Manual; Neurology, 4th edition (includes a DVD);
Pocketbook for Veterinary Nurses; Pocketbook for Vets; and
Small Animal Practice Management and Development.
Congress also saw the launch of the first five e-Books:
Cardiorespiratory Medicine, Endoscopy and Endosurgery, Reproduction
and Neonatology, Rodents and Ferrets, and Wound Management and
Reconstruction. For those members who missed out on purchasing these
e-Books at Congress, they are now available in the BSAVA bookshop
visit www.bsava.com for more details.
and away
The BSAVA stand at the WSAVA Conference in Auckland, New Zealand,
held in March, was packed to the rafters with delegates eager to browse
the BSAVA Manuals and find out about overseas e-membership. Although
the meeting attracted only a small number compared with BSAVA
Congress (approximately 1700 delegates), over the 4-day event we
signed up over 100 new members and sold nearly 300 manuals. It goes
to show that BSAVA science is just as popular on the other side of the
world as it is here at home.
Success at home
M
ay is National VN Awareness
Month, which aims to highlight
the importance of the veterinary
nursing profession. Veterinary
Nurses, including many BSAVA VN members, will
be organising events to help promote the role of
the VNs to the general public, as well as raising
awareness of the professions contribution to the
welfare of animals. We wish all those getting
involved all the very best with their activities.
Formore information visit www.bvna.org.uk.
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Professor Richard Dawkins
gave an inspiring talk on
Thursday, in which he
demonstrated his vast
knowledge of evolutionary
biology and pondered a
future without pets.
Delegates got plenty of
opportunities to access the
industry expertise and new
launches in the impressive
exhibition.
The BSAVA Balcony
Publications and
Education stands were
kept busy, with
delegates keen to know
what the Association
had to offer.
The exhibition was
frequently packed with
delegates making the
most of the special
offers and free gifts.
Ian Battersby was
one of the winners
in the prestigious
BSAVA Awards
ceremony on
Thursday.
An esteemed
Question Time
panel chaired by
Chris Laurence
discussed Genetic
and Inherited
Diseases and
Alfie the King
Charlies Spaniel
came along with
his owner Nick.

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in pictures
Vets and VNs
were able to get
closer to the
experts in the
expanded
practical
programme at
this Congress.
BSAVA Banquet was a stylish
evening of great food and brilliant
entertainment from the band E2.
BSAVA was
delighted to
support Luke
Gambles World
Veterinary
Service and
their launch of
the ambitious
Mission Rabies
initiative.
Belly laughs and plenty of
dancing were features of Party
Night on Saturday thanks to
Alan Davies and the Noisettes.

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At
has lived in the UK for well over two
decades said; BSAVA has made huge
contributions to veterinary practice in the
UK, and already has a global reputation for
Congress and publications I believe we
have such a wealth of resources and so I
am convinced we have so much more to
offer the world.
Exhibition of excellence
Nearly 300 exhibitors, including new and
familiar names, filled the National Indoor
Arena, with many choosing to launch new
products, services or research findings.
The veterinary industry provides an
important contribution to Congress and it
was clear that many see the event as their
key opportunity to demonstrate their
products to the profession.
BSAVA Congress is produced by the profession for
the profession which means everything from the
science programme to the social events and
exhibition is planned by vets and VNs. This is why
it goes from strength to strength and has become
an important part of the professional landscape.
Here are just a few of the stories coming out of
Congress this year
A remarkable achievement
This years BSAVA Congress was
described as a remarkable achievement
by Mark Johnston, the Associations
outgoing President, as the event secured
its highest ever attendance. A total of
6199vets, vet nurses, practice managers
and students came to Birmingham, around
six per cent higher than in 2011 the last
time the BSAVA hosted its own Congress.
In 2012 it was jointly hosted with WSAVA
and FECAVA.
A significant number of international
delegates attended this year with almost
60countries represented notably
Scandinavia (186 delegates), Germany
(56), the Netherlands (40) and the USA (31).
Vets and vet nurses jointly acquired
more than 100,000 CPD hours in the
scientific programme, and were pleased to
see an increase in practical and hands-on
lectures, which allowed them to get even
closer to the expertise on offer.
The Management Stream was also
expandedacross three days and this was
well-received, offering a series of lectures
on practical business advice including
public relations, accountancy and
humanresources.
Newly inducted BSAVA President
Michael Day said he was looking forward
to extending the international aspect of
BSAVA. The Australian-born Professor who
06-07 Congress Report.indd 6 18/04/2013 10:20
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LISTEN UP
Members can now download the Congress
lecture MP3s online at www.bsava.com
so you can catch up on talks you missed or
reinforce your notes from those talks you
found partcularly helpful. You must be
registered with the website and logged in to
access this member-only content. For more
informaton email administraton@bsava.
com or call 01452 726700 in ofce hours.
No more pets
In a hundred years time, will the idea of
owning a pet be regarded as an
anachronism in much the same way that
slavery is viewed now? Evolutionary
biologist and best selling author Richard
Dawkins posed that question in an
interview before his opening day lecture of
the 2013 BSAVA Congress.
He said, If changes in public opinion
mean that our behaviour today will be seen
as backward then our treatment of
non-human animals will surely be high on
the list. I can see foresee a time that
keeping a pet will be viewed as wrong,
however well that animal is treated.
However, that isnt an attitude that the
emeritus Professor of the Public
Understanding of Science at the University
of Oxford would wish to encourage. Iam
a child of my time and I love my dog. His
choice of breed might surprise those who
know him for his Rottweiler-like tenacity in
defending Darwins legacy. He has a
Coton de Tulear, the fluffy white national
dog of Madagascar.
SAVSNET is go
BSAVA held a press conference at
Congress with their colleagues from the
University of Liverpool to talk about how
the surveillance project SAVSNET is all set
to improve understanding of small animal
disease.
A new website, www.savsnet.co.uk,
went live at Congress on 5 April, and after
three years of pilot projects, the impressive
SAVSNET team has ironed out any early
teething problems and are ready to launch
the project nationwide.
Mark Johnstons Sussex practice has
been involved in the development stages,
and he says that colleagues will find the
process of inputting data very
straightforward. It only adds about 30
seconds to the length of a consultation.
That is important if you want to guarantee
the quality of the data provided.
New Emergency PG Cert from
BSAVA & Vets Now
Congress saw incoming President Michael
Day and Vets Now Clinical Director
Amanda Boag sign the agreement
signalling the start of their partnership to
develop a new postgraduate certificate in
(ifyou didnt collect it you will be sent your
copy in May), finding out how they can
make the most of the new BSAVA CPD
offerings, and talking to the PetSavers
team about the vital work that the charity is
doing. Many were keen to sign up for the
London 10k on 14 July there are still a
few places available, so email info@
petsavers.org.uk for information. It was a
really great Congress for PetSavers who
were grateful for donations raised by
Petplan, the banquet raffle, Vetoquinol,
JCA and Willows totalling 7,471.74. n
emergency and critical care (ECC). The
programme, which will follow the same
broad structure as BSAVAs existing
Postgraduate Certificate, will take the first
group of students in May 2014.
Michael said: This is an exciting
development to develop a qualification
which will be relevant and accessible to
vets in practice. Amanda Boag added:
The combined expertise of both
organisations will result in an engaging and
high quality qualification in this field.
Getting involved with PetSavers
The BSAVA Balcony was packed with
members collecting their How To books
06-07 Congress Report.indd 7 18/04/2013 10:20
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More than 40 per cent of the vets that
register each year with the RCVS were
educated abroad. Britain is clearly an
attractive place for foreign-trained colleagues
to work but it isnt a land of milk and honey
and many of these will return home
disillusioned. John Bonner asked four
overseas vets what brought them to the UK
and what makes them want to stay
International vets
working in the UK
D
id we have a summer last year? asks Rocio
Chicon, a 2011 graduate of Madrid University
in sunny Spain, who arrived in the UK at the
beginning of 2012 and is now adjusting to the
cooler and wetter conditions commonly encountered
in South Wales.
Whatever draws foreign-trained vets to Britain, it
certainly isnt the climate. But there were few jobs
available for an inexperienced clinician back in Spain
and, as with the other three vets that companion
spoke to, she was keen to practice and develop her
professional skills. Some, like Essex-based practitioner
Nick Wojciechowski who graduated from Warsaw
University in 2003, have found the conditions to their
liking and put down permanent roots.

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It is very valuable seeing how veterinary medicine
is carried out in other countries and UK practice is
highly regarded in Europe. It also helped that I had
studied English as my second language and so the UK
was the obvious place to come to. I originally wanted
to stay for a year or two but I have now been here for
seven years, he says.
However, around 30 per cent of foreign graduates
decide against renewing their RCVS registration after
the first or second year and for many it is because
theyfind it difficult to adjust to living in the UK. Even
getting that first job can be a struggle: Rocio had
spent over six months in Britain looking for work and
was on the point of going home when she was offered
her job in Newport.
You have to be persistent because it can be
difficult to prove that you can be trusted; there have
been a few times in the past when European-trained
vets have made mistakes, Rocio notes. She was
referring to the numbers of EU-trained vets
becomingthe subject of a formal complaint to the
Royal College. The increasing proportion of EU
graduates having to appear before the RCVS
disciplinary committee is a cause for concern, said
itspresident Jacqui Molyneaux.
Mind your language
An analysis of those complaints shows that around
80per cent were due to some form of communication
failure. That doesnt surprise Stefano Susanna, a 1996
graduate from the Perugia veterinary school in Italy,
who now owns the practice in Cowbridge in the Vale
ofGlamorgan which he joined as an assistant in
1998.He says that developing excellent English is
absolutely fundamental to success for any
foreign-trained vet, along with an understanding of
the nuances of the language.
So if the animal is overweight, you should learn to
call it plump never call it fat. Also when you are new
to the UK you have to be aware of the cultural
differences. It is quite normal in Europe to give an
intracardiac injection when you are euthanasing an
animal. But that would horrify an owner if you did that
to their animal; it is something that is just not done here
except in very unusual circumstances.
Most EU vets that apply to register with the Royal
College will already have a good command of English,
and indeed many European veterinary schools do at
least some of their teaching in that language. But there
is a big difference between official and idiomatic
English. There are big variations in accent and the
slang terms used in Britain, even for places only 30 or
40 miles apart, notes Nick Wojciechowski.
My first job was in Coventry and it took a little
while to get used to the way that clients spoke. But that
was nothing compared with the difficulties I had at first
talking to my own colleagues. I am with Vets Now,
which is based in Scotland, and I found the Scottish
accent was a real challenge, he said.
Rocio found that the concentration needed to
alternate between communicating professionally with
colleagues and comprehensively but clearly with
clients was much more difficult than the actual clinical
it is very valuable
seeing how veterinary
medicine is carried out
in other countries
work. In the first few weeks I found it exhausting and I
had a headache most evenings when I finished work.
But I am finding it much easier now, she says.
Having a nurse nearby who I could call on was very
important. They can help you when you are trying to
deal with one of the more difficult clients.
The way that you say it
Those vets that receive their training outside the EU,
like Liron Hirsch, a 2007 graduate from the veterinary
school in Rehovet, Israel, cannot automatically apply
for RCVS registration on arrival in the UK. So he
worked for a year as a hotel receptionist in London
before taking his membership examination. That
experience fine-tuned his English language skills but
did not necessarily prepare him for every eventuality.
As a non-native speaker, one has to be very
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International vets working in the UK
careful with terms that may seem to be very similar.
Aclient who says Will you put him to sleep? could be
asking about a general anaesthetic or euthanasia.
Youhave to be really careful that you understand their
meaning if there is any doubt, always check with the
client or a colleague.
Land of learning
Surviving the first weeks in the job is a challenge for
any new graduate, but particularly so for one having to
cope while working in a second language. But there is
a bright future for those that do have the necessary
skills. The RCVS has counted the numbers of
members holding specialist qualifications and found
that 30 per cent had obtained their first degree at an
overseas university.
Nick Wojciechowski believes that the biggest
difference between small animal practice in the UK
the greater opportunities here to provide instruction for
clients on preventive medicine issues.
In Spain we love our pets just as much but the
attitude of clients is different. Often their dogs will be
working animals. The pet isnt seen as a member of
the owners family in the way that it is here.
Client-led learning
Nick agrees that UK pet owners are more likely to want
to discuss the treatment options with their vet but there
is a downside to this greater involvement in the case.
English people are more demanding and they do like
to complain. It is usually about the costs of treatment
and it can happen very quickly before you realise it,
they will bring out the big guns. That is, they will get
quite cross.
Like Nick, Liron Hirsch also works for Vets Now
and is currently the district vet responsible for the
companys four clinics in the Greater London area.
Surprisingly perhaps, he says he doesnt mind
receiving complaints from clients visiting their
practices. You can learn a lot about how the practice
is performing from what your clients say. I think it is
very useful information to show how you can improve
the service that you offer.
When he arrived here, Liron had planned to train as
an internal medicine specialist but has now decided
that he wants to stay in the emergency and critical care
field. Nearly every case that you see is clinically
challenging. The big difference between working in a
UK hospital and back home in Israel is that the pet
insurance industry has developed here much more in
Britain. That means that you can do some amazing
things to save an animals life or to improve its quality of
life and that is what is so satisfying about the job.
you can learn
a lot about how
the practice is
performing from
what your
clients say
and in his native Poland is that here he is working as
part of a team, whereas most continental practices
have only one or two veterinary surgeons and no
qualified support staff. There are some VNs or
technicians at the larger practices in his home country
but they dont have the quality of training available in
Britain. The diagnostic and surgical equipment
available in UK practices also tends to be of a much
higher standard, he suggests.
There are some key differences in the clients too.
Very few dog owners in Spain will agree to having their
pet neutered and so the only opportunities to practice
ovariohysterectomy procedures back home were in
bitches that were also being treated for mammary
tumours, notes Rocio. She says the greater numbers of
surgery cases at her practice have helped her build
confidence in her surgical skills and she appreciates
in Spain we love our
pets just as much but
the attitude of clients
is different
08-10 Overseas Vets Working in UK.indd 10 18/04/2013 10:41
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 are particularly aimed at vets or nurses
in first-opinion practice.
This is a valuable MEMBER BENEFIT
Coming soon
22 May MRI/CT Which one, when?
with Fraser McConnell
29 May Blood transfusion for nurses
with Jenny Watson
12 June Anaesthesia update for vets
with Liz Leece
Book online at
www.bsava.com
All prices are inclusive of VAT. Stock photography: Dreamstime.com. Isselee; Kristina Stasiuliene; Vriesela
Crusty canines and
festering felines
23 May
This practical and interactive course for GPs
will cover investigation and treatment of
common dermatological conditions in dogs
and cats and will also include a practical
cytology workshop.
SPEAKER
Natalie Barnard
VENUE
Crabwall Manor,
Chester CH1 6NE
FEES
BSAVA Member:
227.00
Non BSAVA
Member: 340.00
Imaging the
abdomen
20 June
This course is designed to include points of
interest for both general practitioners and
nurses with an interest in diagnostic imaging.
SPEAKERS
Andrew Parry and Lizza Baines
VENUE
Willows Veterinary Centre and Referral Service,
Solihull B90 4NH
FEES
BSAVA VN
Member: 167.00
Non BSAVA VN
Member: 250.00
BSAVA Member:
233.00
Non BSAVA
Member: 350
Managing birds in
practice for vets and
vet nurses
17 September
This course is designed for vets and
nurses who are interested in avian medicine
but who have limited experience (perhaps
dealing with less than five birds a week).
SPEAKERS
Neil Forbes and
Matthew Rendle
VENUE
Lismoyne Hotel, Fleet,
Hampshire GU51 4NE
FEES
BSAVA Member: 233.00
BSAVA VN Member: 167.00
Non BSAVA Member: 350.00
Non-Member Nurse: 250.00
11 CE Advert May.indd 11 18/04/2013 10:44
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Clinical conundrum
James Swann, a Junior Clinical Training Scholar at
the Royal Veterinary College, invites companion
readers to consider a Collie with pyrexia and
multiple joint effusions
Case presentation
A 6-year-old female neutered
Collie cross was presented for
investigation of pyrexia of unknown
origin. She had become acutely
lethargic 4 days previously and her
food intake had declined
progressively over this period. She
was lethargic a week previously and
had developed a low head carriage.
When examined 5 days ago she was
found to be pyrexic, but there had
been no response to administration
of a 5-day course of broad-
spectrum antibiotics.
On examination she was quiet
and lethargic, but her mentation
was appropriate. Rectal
temperature was 40.9C and she
had a low body condition score
(3/9). Her neck was ventroflexed,
and she showed signs of discomfort
when her head and neck were
manipulated dorsally. There were
marked effusions of both carpi
and tarsi, and she was reluctant to
walk. There was palpable
enlargement of the popliteal,
prescapular and submandibular
lymph nodes bilaterally.
n Chronic degenerative arthropathies,
including osteoarthritis. Such
conditions would not usually present
acutely or account for the other
problems observed in this dog.
n Infection of joints by pyogenic
bacteria (infective arthritis), which
may also cause pyrexia and
lameness. This disease rarely affects
multiple joints simultaneously in a
symmetrical pattern and it would be
expected to cause severe pain on
manipulation of affected joints.
Infective arthritis does cause local
reactive lymphadenomegaly but is
less likely to cause generalised
enlargement unless it leads to the
development of bacteraemia and
septicaemia.
n Immune-mediated arthropathies, which
may also cause severe pyrexia,
generalised lymphadenomegaly, pain,
and reluctance to ambulate.
Which investigations would you
perform, and why?
Prior to sedation, a complete blood count
and serum biochemical profile were
obtained to screen for major organ
abnormalities. The results are shown in
Tables 1 and 2.
Create a problem list for this
patient
n Symmetrical effusions of multiple joints
n Neck pain
n Peripheral lymphadenomegaly
n Pyrexia
n Lethargy, reluctance to ambulate, and
inappetence
Consideration of which problem
is most likely to lead to a
diagnosis? What are your
differential diagnoses for this
problem?
There are fewer differential diagnoses for
dogs presenting with effusion of multiple
joints and investigation of this problem is
likely to lead to a diagnosis with greater
expediency than consideration of non-
specific problems such as pyrexia and
inappetence. Differentials for effusions of
multiple joints include:
Parameter Result Reference interval
WBC 32.5 617.1 x 10
9
/l
Neutrophils 28.9 311.5 x 10
9
/l
Band neutrophils 1.95 00.3 x 10
9
/l
Lymphocytes 0.98 14.8 x 10
9
/l
Monocytes 0.65 0.151.5 x 10
9
/l
Eosinophils 0 01.3 x 10
9
/l
RBC 5.61 5.58.5 x 10
12
/l
HCT 0.38 0.370.55 l/l
Platelets 450 150900 x 10
9
/l
Table 1: Results of the complete blood count (abnormal results in bold)
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Parameter Result Reference interval
Total protein 53.7 4971 g/l
Albumin 24.4 2839 g/l
Globulin 29.3 2141 g/l
Urea 5.9 39.1 mmol/l
Creatnine 97 59138 mol/l
Cholesterol 9.5 3.38.9 mmol/l
Total bilirubin 6 02.4 mol/l
Amylase 777 1761245 IU/l
Lipase 49 72115 IU/l
ALT 27 1388 IU/l
CK 348 61394 IU/l
ALP 260 19285 IU/l
Table 2: Results of the serum biochemical profile (abnormal results in bold)
Parameter Result
Descripton Straw-coloured fuid with reduced viscosity
Total nucleated cell count 3.2 x10
9
/l
Culture Negatve
Cell types >80% neutrophils
Table 3: Results of synovial fluid analysis from a typical joint, in this case the left tarsus
Parameter Normal synovial fuid Degeneratve disease Infectous arthrits Immune-mediated arthrits
Colour Colourless or light yellow
Clear
Colourless or light yellow
Clear
Yellow, yellow/green, or
serosanguineous
Ofen turbid
Yellow, yellow/green, or
serosanguineous
Ofen turbid
Viscosity High High or slightly reduced Reduced Reduced
Total nucleated
cell count (x10
9
/l)
<3 <5 >3 (up to 250) >3 (up to 150)
Major cell types 10% neutrophils
90% mononuclear
10% neutrophils
90% mononuclear
>25% neutrophils (usually >90%)
<75% monocuclear
>20% neutrophils (usually >80%)
<80% mononuclear
Table 4: Typical results expected from synovial fluid analysis in different disease states
Neutrophilia and mild
hypoalbuminaemia are possible with all the
differential diagnoses so further
investigations are required. The dog was
then sedated, and samples of synovial fluid
were obtained by arthrocentesis from both
tarsi and carpi. These samples were
obtained to aid differentiation between the
joint diseases discussed above. The
results of cytological review and culture of
these samples are shown in Table 3 and a
representative specimen of the synovial
fluid is shown in Figure 1.
Fine-needle aspirates were taken from
Figure 1: Synovial fluid obtained by
arthrocentesis of the left tarsus. The cytological
report indicated that neutrophils constituted
more than 80% of the total cell count
several peripheral lymph nodes and
cytological review of these samples
revealed evidence of reactive hyperplasia.
Which parameters are usually
considered when analysing
synovial fluid? What results
would be expected with each of
the three causes of joint
effusions listed above?
A subjective description is usually made
of the appearance of synovial fluid and its
viscosity can also be assessed at the
time of sampling. In the laboratory, the
protein concentration and total and
differential cell counts can be measured.
The common patterns of results are
shown in Table 4.
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Clinical conundrum
Revise your problem list to
account for these findings
n Immune-mediated polyarthritis
n Reactive peripheral
lymphadenomegaly
n Presence of an inflammatory
leucogram
n Pyrexia, lethargy and inappetence
How are immune-mediated
arthritides classified? Why is
this important in this case?
Immune-mediated arthritides may be
associated with erosive or non-erosive
lesions. Rheumatoid arthritis is the only
form of erosive polyarthritis reported to
occur in dogs in the UK, though erosive
polyarthritis associated with Mycoplasma
spp. infection has been reported in dogs in
Australia and theUSA.
Non-erosive immune-mediated
polyarthritis (IMPA) may occur with
immune-mediated disease of other organ
systems, such as with systemic lupus
erythematosus (SLE) or steroid-responsive
meningitis/arteritis (SRMA). In most cases,
however, other organs are not apparently
involved and such cases of IMPA may be
further classified into four types:
n Type 1: Idiopathic IMPA with no
underlying cause detected.
n Type 2: Reactive IMPA associated with
remote infections, including pyometra,
pyoderma, pyelonephritis, and bacterial
endocarditis. Infection with Borrelia
burgdorferi sensu lato, Anaplasma
phagocytophilum, Ehrlichia canis or
Leishmania spp. has also been
associated with the development of
polyarthritides, and these are thought to
have an immune-mediated component.
n Type 3: Enteropathic IMPA associated
with severe forms of gastrointestinal
disease, including acute pancreatitis
and severe forms of inflammatory
bowel disease.
n Type 4: Paraneoplastic IMPA
associated with the presence of
neoplasia at remote sites.
This classification scheme identifies
those tests that are now required to
investigate for an underlying cause and to
establish a definitive diagnosis.
On the basis of this information,
how would you investigate the
arthritis further?
Diagnostic imaging was required to
differentiate erosive from non-erosive
arthritis. In this case, orthogonal
radiographs were made of the left tarsus,
and these images are shown in Figure 2.
The images confirm that the polyarthritis
was non-erosive.
Further investigations were required to
detect possible underlying disease or
inciting factors that could be associated
with the development of IMPA. In this case,
the following tests were performed.
n Computed tomographic (CT) scans
were made of the thorax and abdomen
to screen for the presence of
neoplastic masses and these
revealed no abnormality. Although
CTwas used in this case, thoracic
radiography and abdominal
ultrasonography could also be used
todetect macroscopic changes
consistent with neoplasia.
n A brief echocardiogram was
obtained and this did not detect any
changes suggestive of bacterial
endocarditis.
n Three blood cultures were collected
from different peripheral venepuncture
sites and no bacterial growth was
observed after these had been
incubated for 7 days.
n A urine sample was obtained by
cystocentesis and culture was
performed because bacterial urinary
tract infections may be an inciting
cause for type 2 IMPA. Culture of the
urine revealed no bacterial growth
and the results of urinalysis with a
semi-quantitative chromatographic
dipstick are shown in Table 5.
n Quantification of the serum anti-nuclear
antibody (ANA) titre yielded a negative
result at a dilution of 1:40. This result
indicated that the dog was unlikely to
have SLE.
n A sample of synovial fluid was
submitted for polymerase chain
reaction to detect genetic material
originating from Borrelia spp., the
causative agent of Lyme disease.
Nosuch material was detected.
n A blood sample was not submitted in
this case for measurement of the
serum titre of anti-Anaplasma
phagocytophilum antibodies, although
this is another organism endemic to
the UK that may cause polyarthritis.
A
B
Figure 2 A & B:
Mediolateral and
caudocranial
radiographs of the
left tarsus
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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.
ACKNOWLEDGEMENTS
The author is very grateful to Dr Oliver
Garden for clinical discussion of this case,
and to Patricia Crosse for kindly providing
the image shown in Figure 1 and for
interpretaton of clinical data.
Parameter Result
Colour Yellow, slightly cloudy
Specifc
gravity
1.045
pH 6.5
Protein 3+
Glucose Negatve
Ketones Negatve
Blood 3+
Sediment RBC: 110 per high power feld
WBC: 15 per high power feld
Culture No bacterial growth detected
afer incubaton for 48 hours
Table 5: Results of urinalysis
If this dog had a history of
foreign travel, would further
diagnostic tests be advisable?
Exotic tick-borne parasites such as
Ehrlichia canis and Leishmania spp. have
the potential to cause the signs described
in this dog and to act as stimuli for the
development of secondary IMPA. Tests to
rule out these infections would therefore
be advisable if the dog had a consistent
travel history. An immunochromatographic
SNAP test is available to test for exposure
to E.canis, B. burgdorferi and
A.phagocytophilum by providing
evidence of specific antibodies.
PCR-based tests are also available for
these organisms and Leishmania spp.
What is the final diagnosis in
this case?
Type 1 idiopathic IMPA, although
concurrent SRMA could not be ruled out
without CSF analysis.
What are the possible causes of
neck pain in this dog?
It is thought that many dogs with IMPA
suffer concurrent cervical or spinal pain
due to involvement of the intervertebral
articulations. A recent retrospective study
indicated that up to 48% of dogs with
IMPA and concurrent signs of cervical
pain had cerebrospinal fluid (CSF)
changes consistent with inflammatory
disease (Webb and others, 2002),
suggesting that polyarthritis may occur
commonly with SRMA. Collection and
analysis of CSF would have been required
in this case to rule out the possibility of
concurrent SRMA.
What are the possible
explanations for the proteinuria
and haematuria observed on the
urine sample?
The dog may have had an occult urinary
tract infection that was not cultured
because antibiotics had been
administered for several days before
the urine sample was obtained. IMPA has
also been associated with concurrent
glomerulonephritis and
immunohistochemical studies have
indicated that this may be related to
immune complex and complement
deposition in the glomeruli of some animals
(Bennett, 1987). Glomerulonephritis may
cause renal proteinuria and, in severe
cases, haematuria.
How would you treat this dog?
Which clinical, haematological,
and biochemical parameters
should be monitored?
Cases with idiopathic IMPA require
immunosuppressive treatment and the
agents used most commonly are
corticosteroids. In this case,
dexamethasone was administered
perenterally until the dog began to eat
reliably, when prednisolone was
administered orally at 3 mg/kg/day.
Treatment was also initiated with
azathioprine (at 2 mg/kg/day) so that the
dose of prednisolone could be reduced
in the future once the disease was in
remission. Once in remission
azathioprine was reduced to a
maintenance dose (0.52 mg/kg q48h)
and the dose of prednisolone in
increments every 3 weeks thereafter.
A course of antibiotics was also
prescribed in view of the possible occult
urinary tract infection. Proteinuria and
haematuria resolved within a week of
commencing immunosuppressive and
antibiotic therapy.
Azathioprine may cause bone
marrow suppression, hepatotoxicity,
and pancreatitis. Periodic blood samples
were therefore obtained to monitor blood
cell counts, liver enzyme activities, and
the serum concentrations of indicators
of liver function. With high doses of
corticosteroids, it may also be advisable
to submit periodic urine samples for
cytological review and, culture and
sensitivity testing, in case of occult urinary
tract infection. n
References and further reading are available at
www.bsava.com.
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How to approach
Horners syndrome
H
orners syndrome is a common
neurological disorder affecting the eyes,
which is present in both the canine and
felinepopulations.
Clinical manifestations
Horners syndrome occurs because of damage to
the sympathetic nervous supply to the eye. This
results in typical ocular changes (Figure 1) including
the following.
Miosis (pupil constriction)
In unilateral cases, the anisocoria will be more
pronounced in a darkened room, as the affected
pupil will be unable to dilate appropriately.
Enophthalmos
Is caused by sinking of the globe into the orbit
due to loss of tone in the orbital smooth muscle
Viewing the patient from above can make this
easier to appreciate.
Protrusion of the third eyelid (nictitating membrane)
In dogs, this occurs passively because of the
enophthalmos.
In cats, it is both an active process, as there is
a small amount of smooth muscle within the
third eyelid, innervated by the sympathetic
supply, as well as a passive process due to
enophthalmos.
Ptosis of the upper eyelid (drooping) and
decreased tone in the lower lid
Due to loss of tone to Mllers muscle
(smoothmuscle).
Other ocular changes can include ipsilateral
congestion of the scleral vessels and nasal mucosa,
and on a fundic exam the retinal blood vessels may
appear congested. Damage to the sympathetic supply
can also cause ipsilateral peripheral vasodilatation,
which will manifest as increased warmth and
hyperaemia of the pinna.
In cases with a partial Horners syndrome only
ipsilateral miosis will be present. This most commonly
occurs with acute severe lateralised cervical lesions in
dogs. A partial brachial plexus avulsion resulting in
damage to the T1 nerve root may also result in an
ipsilateral partial Horners syndrome.
Horners syndrome can be bilateral and this may
cause visual impairment if the protrusion of the
nictitating membrane causes obstruction of the pupils
(Figure 2). In general, however, Horners syndrome
does not cause visual impairment per se.
Victoria Doyle, European and RCVS
Specialist in Veterinary Neurology, helps us
approach this tricky problem
Figure 1: Right Horners syndrome in a dog showing miosis,
ptosis and protrusion of the third eyelid. Enophthalmos is
the fourth feature associated wth Horners syndrome but
cannot be appreciated in this image
Jacques Penderis. Reproduced from BSAVA Manual of Canine and Feline
Neurology, 4th edition.
Figure 2: Bilateral Horners syndrome in a Golden Retriever.
Third eyelid protrusion may interfere with vision in cases of
bilateral Horners syndrome, whereas in unilateral cases it
can be considered mainly cosmetic
Jacques Penderis. Reproduced from BSAVA Manual of Canine and Feline
Neurology, 4th edition.
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Anatomy
The pathway of the sympathetic supply is very long and
damage anywhere along its route can result in Horners
syndrome. The pathway remains ipsilateral along its
entire length. There are three orders of neuron in the
sympathetic pathway to the eye (Figure 3).
First-order neuron cell bodies are located in the
hypothalamus and rostral midbrain.
The axons of these neurons run caudally
through the brainstem into the lateral part of the
cervical spinal cord to reach the first three
thoracic spinal cord segments (T1T3) within
the tectotegmental spinal tract.
The first-order neurons synapse with the
cell bodies of the second-order neurons
(pre-ganglionic neurons) located in the
intermediolateral grey column of the
spinalcord.
The second-order neurons exit the vertebral canal
through the intervertebral foramina alongside the
ventral nerve root arising from the first three
thoracic spinal cord segments (T1T3).
The axons of the second-order neurons leave
the T13 nerve roots as the ramus
communicans and join the thoracic
sympathetic trunk.
The thoracic sympathetic trunk travels inside
the thorax ventrolateral to the vertebral bodies
before coursing cranially along the neck in
association with the vagus nerve.
The sympathetic supply and the vagus nerve
form the vagosympathetic trunk, which lies
within the carotid sheath.
The axons of the second-order neurons
course rostrally to the cranial cervical
ganglion located ventromedially to the
tympanic bulla. At this level the axons of the
second-order neurons synapse with the cell
bodies of the third-order neurons (post-
ganglionic neurons).
The third-order neurons pass through the ventral
part of the tympanic bulla and enter the cranial
cavity through the tympano-occipital fissure,
together with the carotid artery and
glossopharyngeal nerve (CN IX).
Within the cranial cavity the axons travel
rostrally, passing in close proximity to the
cavernous sinus before exiting the cranial
cavity through the orbital fissure with the
ophthalmic branch of the trigeminal nerve.
The sympathetic supply innervates the smooth
muscle of the eyelids (including third eyelid),
orbit and iris dilator muscle, as well as the
smooth muscles within the blood vessels to
thehead.
Clinical approach
Damage anywhere along the length of the pathway
from a vast array of conditions can result in clinical
signs of Horners syndrome. Therefore, Horners
syndrome should, in general, be viewed as a clinical
sign rather than a diagnosis, except in cases that are
ultimately diagnosed with idiopathic Horners
syndrome.
Animals presenting with clinical signs of Horners
syndrome should have a full history taken. Each
patient should also have a full clinical,
ophthalmological and neurological examination
performed. This information is amalgamated to
identify a location where the damage is likely to have
taken place.
Figure 3: The pathway of the sympathetic innervation to the eye and adjacent
structures of the head
Jacques Penderis. Reproduced from BSAVA Manual of Canine and Feline Neurology, 4th edition.
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How to approach Horners syndrome
Horners syndrome is classified as follows:
First order when the damage has occurred to the
first-order neurons
Which run between the hypothalamus and the
T1T3 spinal cord segments.
Secord order when the damage has occurred to
the second-order neurons
Which run from the intermediate grey column of
the spinal cord at the T1T3 spinal cord
segments to the cranial cervical ganglion
adjacent to the tympanic bulla.
This may also be referred to as a preganglionic
lesion in some texts as the lesion occurs before
the pathway reaches the cranial cervical
ganglion.
Third order when the damage occurs to the
third-order neurons
Which run from the tympanic bulla through the
cranial cavity to the eye.
This may also be referred to as a postganglionic
lesion in some texts as the lesion occurs after
the cranial cervical ganglion.
Possible neurological signs associated
with Horners syndrome
First-order Horners syndrome caused by a lesion
in the brain from the hypothalamus and rostral
midbrain to the brainstem:
Altered mentation (i.e. obtundation, stupor,
coma)
Change in behaviour (i.e. vocalisation, pacing,
circling towards or away from the lesion,
hemineglect/hemi-inattention if the lesion is
lateralised)
Seizures
Endocrine changes if the lesion is within the
hypothalamus (e.g. polyuria, polydipsia,
adipsia, abnormal eating habits, abnormal
temperature regulation, hyperglycaemia)
Altered cardiac function including bradycardia
Altered posture (e.g. head tilt towards/away
from the lesion, decerebrate/decerebellate
rigidity)
Altered gait (e.g. tetraparesis/plegia, or
hemiparesis, ataxia)
Postural reaction deficits of variable severity
Cranial nerve deficits (e.g. CN IIXII)
Spinal reflexes are likely to be normal but may
be increased in affected limbs
Cervical spinal hyperaesthesia is possible
depending upon the lesion
If the lesion involves the thalamus patients can
show non-specific pain which is referred to as
thalamic syndrome
First-order Horners syndrome caused by a
lesion within the cervical spinal cord C1C5
spinal cord segments.
Normal mentation
Recumbent if the lesion is severe enough
Tetraparesis/tetraplegia or hemiparesis/
hemiplegia, ataxia of the affected limbs
Generally the gait is more severely affected
in the pelvic limbs
Upper motor neuron (UMN) signs of the
affected limbs (normal to increased spinal
reflexes with good tone)
Postural reaction deficits in affected limbs
which are usually more marked in the affected
pelvic limb(s)
Respiratory compromise is possible if lesion
involves the C5C7 spinal cord segments as
they form the origin of the phrenic nerve
Spinal hyperaesthesia is possible depending
upon the lesion
First-order Horners syndrome caused by a lesion
within the spinal cord from C6T2 spinal cord
segments
Normal mentation
Recumbent if the lesion is severe enough
Tetraparesis/tetraplegia or hemiparesis/
hemiplegia, ataxia of the affected limbs
Lower motor neuron (LMN) signs of the
thoracic limbs (reduced/absent spinal
reflexes and reduced muscle tone) and
UMN signs of the pelvic limbs (normal to
increased spinal reflexes with good
muscle tone)
Postural reaction deficits in affected limbs
Respiratory compromise possible if lesion
involves the C5C7 spinal cord segments as
they form the phrenic nerve
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Reduced/absent cutaneous trunci (panniculus)
reflex if the lesion involves the C8T1 spinal
cord segments
Spinal hyperaesthesia is possible depending
upon the lesion
Second-order Horners syndrome caused by a
lesion involving the T1T3 nerve roots
Normal mentation
LMN monoparesis/plegia (reduced/absent
spinal reflexes and reduced muscle tone) and
to the affected thoracic limb
Postural deficits in the affected limb
Possibly reduced to absent sensation of the
affected limb depending upon the severity of
the lesion
Second-order Horners syndrome caused by
alesion involving the cranial thoracic
sympathetictrunk
May have no neurological deficits apart from
the Horners syndrome
Second-order Horners syndrome caused by a
lesion involving the cervical sympathetic trunk
May have no neurological deficits apart from
the Horners syndrome
If the lesion is bilateral there will be significant
involvement of the vagus nerve and so
laryngeal and oesophageal dysfunction may
be present
Third-order Horners syndrome caused by a lesion
affecting the tympanic bulla
Vestibular signs (i.e. ipsilateral head tilt,
nystagmus (horizontal/rotatory), ataxia)
Possible facial paresis/paralysis
Third-order Horners syndrome involving the
intracranial portion of the neuron (from the
tympano-occipital fissure to the orbital fissure)
Cavernous sinus syndrome, which can cause
dysfunction of cranial nerves III, IV, VI as well
as the ophthalmic and maxillary (possibly also
the mandibular) branches of CN V.
External ophthalmoplegia (inability to move
the eyeball) due to paralysis of the
extraocular muscles
Internal ophthalmoplegia (fixed pupil) due
to loss of function of the iris and ciliary
muscles
The pupil may be fixed either mydriatic
or mid-range as potentially the
parasympathic (via CN III) and the
sympathetic innervation to the pupil can
be affected
Absent pupillary light reflex if
parasympathetic component of CN III
involved
Both internal and external ophthalmoplegia
can occur (referred to as total
ophthalmoplegia or panopthalmoplegia)
Ipsilateral sensory deficits in the regions
innervated by the ophthalmic and maxillary
branches of CN V (Figure 4)
Reduced/absent palpebral reflex
Reduced/absent corneal reflex
Possible ipsilateral atrophy of the
masticatory muscles if the mandibular
branch of CN V is involved
The optic nerve is not affected. However,
due to the loss of accommodation by the
lens and reduction/loss of eyeball
movement this can impair the patients
vision
Third-order Horners syndrome involving the
retrobulbar region
Deficits involving CN II, III, IV, VI, ophthalmic
and maxillary branches of CN V
Possible pain on opening the mouth as it will
cause the ramus of the mandible to push
against a retrobulbar mass
Figure 4: (A) Sensory innervation fields of the three branches of the trigeminal nerve.
(B) Motor innervation of the mandibular branch of the trigeminal nerve to the muscles
of mastication
Jacques Penderis. Reproduced from BSAVA Manual of Canine and Feline Neurology, 4th edition.
A B
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Possible exophthalmos and resistance to
eyeball retropulsion if there is a retrobulbar
mass
Exposure keratitis due to inability to close the
eyelids over the exophthalmic globe
Mild increase in intraocular pressure
Differential diagnosis
First-order Horners syndrome
Localising to the brain cervical spinal cord
Encephalitis/encephalomyelitis
Infectious, e.g. Toxoplasma gondii,
Neospora caninum, fungal
(Cryptococcus), feline infectious
peritonitis (FIP)
Inflammatory, e.g. meningoencephalitis
of unknown aetiology (MUA)
Intracranial neoplasia
Localising to the cervical spinal cord
Ischaemic myelopathy/fibrocartilaginous
embolism (FCE)
Intervertebral disc extrusion
Infectious/Inflammatory myelitis
Neoplasia
Second-order Horners syndrome
Iatrogenic
Post dorsal laminectomy (T1T3 vertebrae)
Epidural ropivacaine
Venopuncture
Surgery in the ventral neck region
Idiopathic (more commonly third-order)
Infectious/inflammatory
Secondary to bite wound to ventral neck
Metabolic
Diabetes mellitus
Neoplasia arising from or infiltrating the nerves
of the brachial plexus
Thyroid tumours (e.g. adenocarcinoma)
Mediastinal tumours (e.g. lymphosarcoma
and malignant peripheral nerve sheath
tumours)
Traumatic
Brachial plexus avulsion
Bite wound to ventral neck
Intervertebral disc extrusion affecting T1T3
spinal cord segments
Ischaemic myelopathy/fibrocartilaginous
embolism (FCE) affecting T1T3 spinal cord
segments
Third-order Horners syndrome
Iatrogenic
Bulla osteotomy
Idiopathic (most commonly, but can be second
order)
Infectious/Inflammatory
Otitis media/interna
In association with trigeminal neuritis
Retrobular abscess
Metabolic
Diabetes mellitus
Neoplasia
Involving the trigeminal nerve and ganglion
Retrobular mass i.e. carcinoma, sarcoma,
lymphoma, meningioma, mast cell tumour
Pharmacological testing
Pharmacological testing can be used to support your
clinical suspicion of the location if the lesion has been
present for >2weeks. The test relies upon denervation
hypersensitivity, which occurs as the smooth muscles
within the eye increase their sensitivity to
neurotransmitters (i.e. noradrenaline) after denervation.
The test is not 100% sensitive or specific and so
must be interpreted in light of the clinical and
neurological findings. The degree of denervation
hypersensitivity is also related to the extent of the
denervation, which in some cases may not be
complete.
Topical 1% phenylephrine is applied to both eyes
simultaneously. The time taken for mydriasis (pupil
dilatation) to occur is recorded. The general principle
is: the closer the lesion is to the iris, the shorter the
time it will take for the pupil to dilate.
<20 minutes is suggestive of third-order Horners
syndrome
2045 minutes is suggestive of second-order
Horners syndrome
6090 minutes is suggestive of first-order Horners
syndrome. However, dilation over this time period
could also indicate there is no sympathetic
denervation to the eye
How to approach Horners syndrome
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Additional diagnostic tests
In general, haematology and comprehensive
biochemistry are recommended to assess for any
systemic component of the disease process, which
may be occurring (e.g. increased leucocyte count or
metabolic changes).
Patients with suspected first-order Horners
syndrome are likely to require advanced imaging of the
head and/or neck to the T3 vertebral body depending
upon the results of the neurological examination. MRI
will allow identification of structural lesions which may
be responsible for the Horners syndrome.
Routine cerebrospinal fluid (CSF) analysis can
assist in identifying the nature of any pathology seen
(e.g. inflammatory cells, rarely infectious organisms or
atypical cells indicative of certain types of neoplasia,
most commonly with lymphoma).
The CSF can also be submitted for PCR testing for
infections including Toxoplasma gondii and Neospora
caninum. If protozoal disease is suspected, paired
serology for T.gondii and N.caninum, taken 2weeks
apart to look for a rising titre, is recommended.
Patients with suspected second-order Horners
syndrome should have thoracic radiography performed,
as thoracic masses can damage the sympathetic
pathway as it passes through the thoracic cavity.
MRI of the cervicothoracic spine may also be
indicated to identify structural lesions which may be
responsible for the Horners syndrome. If the lesion
communicates with the subarachnoid space, then CSF
analysis may also be indicated to assist in further
identification of the pathological process. Surgical
biopsy of the lesion would be recommended if feasible.
Patients with suspected third-order Horners
syndrome should have an otoscopic examination
performed to assess for the possibility of middle ear
disease. Further imaging including radiography,
computed tomography (CT) or MRI of the bullae may
be indicated. Myringotomy to obtain samples for
cytology and culture may also be required if material is
found within the bullae. Part of the route of the
third-order neurons is intracranial and so MRI of the
brain may be indicated, depending on the presence of
additional neurological signs. If the lesion contacts the
subarachnoid space then CSF analysis can also yield
useful diagnostic information.
The specific diagnostic approach and diagnostic
tests that are indicated must be interpreted in light of
the details of each specific case. For example, a
trauma case with an avulsed brachial plexus
causingHorners syndrome may also have additional
injuries requiring more extensive stabilisation as
wellas investigation.
Treatment and prognosis
The treatment and prognosis is entirely dependent
upon the underlying cause and its severity. The exact
treatment and prognosis for all of the differential
diagnoses listed above is beyond the scope of this
article and the reader is referred to the BSAVA Manual
of Canine and Feline Neurology for further information.
For idiopathic Horners syndrome, the prognosis is
excellent, with recovery within weeks to months with
no treatment in most cases. Cases with bilateral
idiopathic Horners syndrome where the protrusion of
the third eyelids is affecting vision may benefit from
the topical application of 1% phenylephrine.
Conclusion
The sympathetic supply to the eye follows a very long
course and lesions anywhere along its length can
cause Horners syndrome. Interpreting the results of
the clinical, neurological and ophthalmological findings
in each patient will help to localise the lesion.
Once the lesion has been localised a differential
diagnosis list should be created to tailor specific tests
that are applicable to reach a final diagnosis.
Treatment and prognosis is dependent upon the
underlying cause but is excellent for cases of
idiopathic Horners syndrome.
NOW AVAILABLE
BSAVA Manual of Canine and Feline Neurology 4th edn
Comprehensively updated but retains practce nature
Neurological genetcs (refectng work on the canine genome)
DVD featuring over 100 video clips covering the neurological
examinaton and common manifestatons of
neurological disease.
Member price: 55
Non-member price: 89
16-21 HOW TO.indd 21 18/04/2013 11:18
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Great lives
C
ecil Erskine Woodrow MRCVS was born in Ormskirk,
Lancashire, the son of the local vicar, who was also the Canon
of Liverpool Cathedral. His mother died in his early childhood
and his father when he was a boy. Consequently he was
educated at St Edmunds School, Canterbury, a Church of England
School for orphans. He showed a particular aptitude for mathematics at
school and his first job in 1920 was at a bank.
This however was not to his liking and he took a post teaching
mathematics at a school in Cornwall before entering the Royal
Veterinary College in 1924. He qualified MRCVS in 1928, being the
Fitzwygram Scholar that year, and then worked as an assistant
before purchasing a declining equine practice in Chiswick, West
London. He developed this successfully as a small animal
practice up to the outbreak of the Second World War.
While in Chiswick, before the war, he had developed an
interest in both boats and navigation and owned a steam yacht,
the SY Vicuna, in which he regularly sailed on the Thames. On
the outbreak of war he joined the Thames Patrol piloting and
navigating cargo vessels along the Channel and the Thames to
get them to their destination. Later he wrote a book on
astronavigation, and was the first person to write a series of
articles, for a yachting magazine, on the use of the pocket
calculator as an aid to navigation.
Bruce Vivash Jones of the Veterinary
History Society and a founding member
of BSAVA has written a book about the
lives of 119 inspirational vets who have
had an impact on our profession. Here
he remembers his good friend Woody
Woodrow a small animal practitioner
who became first BSAVA President,
noted for his sound judgements and
leadership qualities
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After the war Woodrow resumed practice and
moved into a bomb-damaged building at 14 Pont
Street, SW1. From these rather cramped premises he
began to build a most successful West End practice.
In 1958 he negotiated a new lease and was able to
occupy the whole building, with an expansion of both
facilities and personnel. As one of the very first
practices to use an appointment system he was able
to exert a control over his work and also create an
environment which suited the society-oriented clientele
that he cultivated.
Living outside London, at Haxted Mill near
Edenbridge, Kent, he built quarantine and boarding
kennels which became a valuable adjunct to the
practice. Woodrow had foresight, he had the
personality that attracted his clients, was a good
diagnostician and spoke with conviction. His early Pont
Street practice days coincided with the, still only
partially explained, hard pad epidemic.
His advice was sought by Burroughs Wellcome,
then the only vaccine manufacturer, as he ran a
vaccination programme for a nearby department store.
As a result he wrote several clinical papers on the
topic. He was not a natural surgeon and passed this
work to Gordon Knight at the RVC.
After the enlargement of the premises he was
joined in partnership by W Brian Singleton in 1959.
Singleton also moved to Kent and built an additional
surgical facility; this enabled a significant
expansiongrowing to become the leading London
West End practice.
Apart from his work as a competent practitioner,
Woodrow made a major contribution to the profession
as the first President of the BSAVA: it was coincidental
that he was President of the Central Veterinary Society
when the meeting was called by Singleton, in 1956, to
discuss the formation of a small animal specialist
group. As almost all those present belonged to the
Central it naturally followed that he was elected
adhoc chairman of the meeting: it was a good choice
he had presence and commanded respect. Out of
that meeting grew the BSAVA, and Woodrow was
unanimously elected the first president and then
(uniquely for the Association) was elected for a
second term. It was a good decision: he not only gave
the infant a sense of direction and purpose but he
also controlled the hotheads who wanted a political
movement (and were anti-BVA inclined).
One obituarist wrote that he, gave the new
association prestige and standing due to his
commanding personality, his charm and tact. His
experience and wise advice was crucial in guiding the
council, which at times tended to be over-enthusiastic
and impatient, through its formative period.
For several years after his presidency he
continued to advise the Association on constitutional
matters. He also authored the first BSAVA Handbook,
The Export and Import of Dogs and Cats, published in
1962. Iremember working with him on this and was
amazed by his grasp of the multitude of regulations
that he had compiled into an easy-to-understand
reference book. He was presented with the Blaine
Award by BSAVA in 1963.
In his leisure time and in retirement he, with his
wife Mary and family, restored Haxted Mill, both the
house and the watermill to working order. Later he
established it as a fascinating museum and one of
hissons and wife also opened a teashop. Woodrow
was knowledgeable not just in veterinary medicine,
but in astronavigation, beekeeping, electronics
andwatermills.
Woody, as he was universally known (he did not
care for either of his given names), was always good
company, he was a stimulating conversationalist, was
considerate in his behaviour and modest in his manner.
He was a sound advisor; many times when I asked
him his opinion on an Association or other matter, he
would always return with a reasoned answer. His later
years were influenced by major abdominal surgery in
1963, with a slow recovery, but he suffered a terrible
blow with the loss of his eldest son in 1989. He had
had three sons. It is a fitting and lasting tribute that
BSAVA has named their headquarters building after
him, with his bronze bust in the lobby. n
TwenTieTh-CenTury VeTerinary LiVes
This book presents the history of the Britsh veterinary
profession from 19002000, told through the lives of
the people who both experienced it and helped to make
it happen. The life stories of 119 men and women are
presented, each of whom played a role, ofen signifcant
and sometmes pivotal, in the twenteth-century Britsh
veterinary world. Order forms for Twenteth-Century
Veterinary Lives (25.00) can be found on
www.veterinaryhistorysociety.org.uk.
Bruce Vivash Jones graduated from the Royal Veterinary
College in 1951. He had a varied veterinary career, both in
the UK and overseas, that brought him into contact with many leaders of the
profession. In fact he was either a friend of, or knew, 51 of the 119 people discussed
in his book. A long interest in the history of the profession has seen him take the
lead in cataloguing the RCVS Collecton of memorabilia as well as being Chairman of
the Veterinary History Society for some years.
22-23 Bruce Jones History.indd 23 18/04/2013 11:22
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The BSAVA Manual of Feline Practice:
AFoundation Manual was launched at
BSAVA Congress and became one of the
best-selling titles on the Publications stand.
The editors Andrea Harvey and Sverine
Tasker here explain the thinking behind the
book and how it will help both students and
vets in general practice
passionate that a holistic approach is vital to being
able to practise good feline medicine, and this is lost
in textbooks that cover both cats and dogs. What we
really mean by a holistic approach is that good
theoretical knowledge about diseases isnt enough.
The good feline vet also needs to have an
understanding of cat behaviour, of how to create an
environment that minimises stress for cats, of how to
handle cats appropriately for different procedures, of
what particular equipment to use in cats, and so on.
Who is this Foundation Manual aimed at?
It is really aimed at anyone that deals with cats in
veterinary practice. We envisage it being particularly
useful for new graduates and practitioners who maybe
arent as confident in performing certain diagnostic or
therapeutic techniques, or do not feel that they are as
comfortable as they could be dealing with feline
patients. It will also be very relevant to students, and
will help to give them an idea of what disorders are
common in general practice, as this can be difficult to
see from comprehensive student textbooks. The
Manual is not designed to be an exhaustive or in-depth
text but rather is predominantly aimed at general
practice, with the hope that it will provide any vet,
whether a new graduate or an experienced
practitioner, with the information that they need to
know to approach and manage common feline
problems to a high standard. Veterinary nurses will
also find useful information in the book, particularly
with regard to handling and positioning cats for
procedures, and to keeping wards cat-friendly.
How did you decide what to include
andwhat to leave out?
That was very difficult! But we tried really hard to focus
on problems that are most commonly encountered in
general practice. We started off with our own ideas,
based on our experience and on common queries that
we get asked by first-opinion vets, and then we also
got ideas from many groups of practitioners, including
some in different countries, and from vets with a
surgical bias (as we are both medics), to try and make
sure the topics were as internationally relevant as
possible and covered the whole spectrum of feline
practice. Finally, we gave the authors scope within
Why do we need a Manual solely for cats?
Cats are so different to dogs. In systems-based
textbooks the vast majority of a chapter is often on the
disease in dogs, with just a short section at the end
on cats. In problem-based books, the most common
problems in cats can sometimes be lost amongst the
canine ones; the most important differential diagnoses
are often different in cats and there may be important
differences in management. It is also vital to be able
to perform practical diagnostic and therapeutic
techniques and again there are many differences
between cats and dogs that arent usually evident in
textbooks covering both species.
Cats have overtaken dogs as the most common
pet in the UK and, as a consequence, both the
popularity of feline medicine and the need to do it well
have risen hugely. But probably our biggest reason
for wanting to do this Manual is that we are both so
Fundamentally feline
Sverine Tasker and
Andrea Harvey
at the launch of their
new manual at BSAVA
Congress in April
24-25 Publications.indd 24 18/04/2013 11:28
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their individual sections to suggest what they thought
was most important to include.
Quick Reference Guides what and why?
The QRGs were a key part of our vision for the
Manual from the beginning. There are so many
practical diagnostic and therapeutic
techniques that vets arent necessarily
confident in performing (and may be too
embarrassed to ask about); even with the
guidance of a textbook it can be very
daunting performing a procedure for the first
time, especially if you havent seen it being
done recently. Quite often textbooks dont
give quite enough detail for you to be able
to confidently perform the technique, just
refer to a technique without any guidance on how to
perform it, or the technique is described in dogs,
omitting subtleties such as restraint and positioning of
cats or special equipment required for them. What we
wanted to create was a set of practical illustrated
step-by-step guides for all the commonly performed
diagnostic and therapeutic techniques in feline
practice, with a level of detail that meant that anyone
could easily carry out the technique, without the need
to get information from other sources.
Additionally, when describing methods or
techniques, textbooks often give options to the reader,
such as different types of equipment or different
approaches, but this can sometimes lead to confusion,
especially when the book is being used cat-side, as we
envisage this Manual will be. Whilst we recognise that
there is always more than one way of doing things, we
wanted to present the reader, whenever possible, with
one clear set of straightforward instructions to reduce
confusion and allow them to perform the technique with
confidence, even if for the first time. This is particularly
important for emergency conditions.
Where appropriate we wanted to have as many
illustrated guides as possible, and we have used
detailed colour photographs throughout, rather than
diagrammatic representations, to make it as easy as
possible for the reader to see clearly what they need
to do. We put in a lot of effort to really try to get good
step-by-step photographs demonstrating techniques
and, importantly, all of the photo legends are full and
descriptive so that the reader doesnt have to guess
what they are showing.
What do you see as the main take-home
message?
That anyone seeing feline first-opinion cases has the
ability to practise excellent feline veterinary care for
many of the common feline problems encountered.
Wewant people to appreciate the specific needs of
the cat and to adopt a holistic approach to these
unique patients.
How can BSAVA members pass on their
comments and suggestions for future editions?
We would very much welcome feedback on any
aspect of the Manual: readers can email
publications@bsava.com with their comments. We
would particularly like them to suggest areas to
expand or omit in future editions, whether there are
any additional QRGs that would be useful to have, and
whether the level of information in the Manual has
been appropriate for their needs.
AVAILABLE FROM BSAVA
496 pages
Extensively illustrated
ISBN: 978 1 905319 39 8
Member: 55.00
Non-member: 85.00
24-25 Publications.indd 25 18/04/2013 11:28
Please take the opportunity to learn more
about PetSavers and the vital research that
is carried out year upon year. If you would
like to make a donaton to assist PetSavers
in their aim to improve the health of the
natons pets, please visit the Donatons
secton of the PetSavers website
www.petsavers.org.uk or call
01452 726 723.
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The PetSavers Photography Competition
awards were presented at Congress in April
T
he judges were overwhelmed with over
550entries for the PetSavers Photography
Competition this year, and the standard was
very high. The theme was to celebrate the pets
that we love and cherish as part of our family by
capturing Priceless Moments and sharing them with
the world. The competition was judged in two
categories Adult (Aged 16 and over) and Junior
(under 16).
We hope you enjoy the pictures as much as
wedid.
Winning pets and their
priceless moments
Debbie Ford
Pumpkin: Our Halloween Puppy
This is Pumpkin: the singleton puppy of our Sheltie
Poppys first litter. Pumpkin arrived several days
early and seeing as Poppy had shown no signs of
nesting or being ready to deliver, it was a miracle that
she survived at all. We had gone to bed and were fast
asleep, with Poppy asleep in the kitchen, when our
son happened to come home from the pub with his
mates. You can imagine his amazement when, as he
sat down to give the dogs a cuddle, he noticed one
very tiny puppy still attached to her placenta under
her mothers tail. She was very cold and tiny and for
several days we had to bottle feed her, but then she
began to grow in strength and to suckle from her
mother and since then, theres been no looking back.
This is a picture of her when she was a week old, in
Daniels (the midwifes) hands.
1
Adult Category
26-27 PetSavers May.indd 26 18/04/2013 11:36
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Roxi-Lola McCormick-Thompson
Talk to the hand
This is my bearded dragon Jasper. This
photo was taken when I first got him.
Imanaged to capture him waving which is a common
characteristic of young bearded dragons. This is a
Priceless Moment as he no longer arm waves and this
was our first time meeting each other.
Danielle Porter
Looking out
Shadow is looking out in the ocean.
Thisis a Priceless Moment as it captures
her personality.
Lucia Langan
Peek-a-boo!
My dog Lollie
wanted some fresh
air... eventually she
found a space for
her little face the
old cat flap!
Zoe Jervis
Lettuce Begin
Here is one of my
lovely guinea pigs
Bert, enjoying a juicy
piece of lettuce,
waiting for the sun
toarrive.
Ben Hickling
Hugs anyone?
My picture
represents the love
that I have with my
cats and the
happiness in our
household. Tinker
my cat is is posing
as she wants a hug.
1
2
3
2
3
Junior Category
26-27 PetSavers May.indd 27 18/04/2013 11:36
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2013 WSAVA
award winners
announced
The WSAVA has announced the winners of its
annual awards. Highly regarded in global
companion animal care, they recognise ground-
breaking achievement in clinical care. They were
presented to the winners at WSAVA/FASAVA World
Congress in Auckland, New Zealand
Wellness and Welfare Committee and is a
partner at the Wylie Veterinary Centre,
Upminster, UK.
Professor Peter Ihrke
Until his retirement in 2012,
Peter Ihrke was Professor of
Dermatology and Chief of
Dermatology Service at the
School of Veterinary
Medicine, University of
California, Davis. He was
also Clinical Associate Professor of
Dermatology at the School of Medicine,
Stanford University and an Executive
Board Member of the World Congress of
Veterinary Dermatology Association
(WCVDA). During his career, he combined
his practice with the teaching of students
and the continuing professional
development of veterinarians.
Professor Ihrke first became involved
with the WSAVA as assembly
representative for the American College of
Veterinary Dermatology (ACVD). He
became President in 2012 but had to step
down because of health problems. He was
awarded the WSAVA Hills Excellence in
Veterinary Healthcare Award in 2009.
WSAVA Hills
Excellence in
Veterinary
Healthcare Award
Professor
Thierry Olivry
This award recognises
outstanding work from veterinarians in
promoting companion animal healthcare
and the family pet/veterinary bond through
a sensitivity to clients and patients, using
leading edge clinical nutrition and
advanced medical and surgery techniques.
It has been awarded to Thierry Olivry,
Professor of Immunodermatology at the
North Carolina State University (NCSU)
College of Veterinary Medicine in Raleigh.
He has authored or co-authored more than
180 peer-reviewed articles and was
Clinician of the Year at NCSU in 2005. He
received the Pfizer Award for Research
Excellence at NCSU in 2010.
WSAVA Hills Pet
Mobility Award
Professor
James L. Cook
This award recognises the
outstanding work of a
clinical researcher in the
field of canine and feline orthopaedic
medicine and surgery. It has been made to
Professor James (Jimi) Cook, Director of
the Comparative Orthopaedic Laboratory
at the University of Missouri, USA, which
carries out research into osteoarthritis,
tissue engineering and articular cartilage
physiology. The author of many peer-
reviewed publications in the veterinary and
human medical sphere, Professor Cooks
interests lie in arthroscopy, minimally
invasive fracture repair, orthopaedic tissue
engineering and total joint replacement.
WSAVA Global One
Health Award
Professor
Lonnie King
This recognises an
outstanding contribution in
promoting One Health. It has
been awarded to Professor Lonnie King,
Dean of the Ohio State University College
WSAVA Presidents Award
Dr Ray Butcher and
Professor Peter Ihrke
This award is made periodically by the
President of the WSAVA to a member
judged to have made an outstanding
contribution to the Association. This year,
unusually, two members have been
recognised Dr Ray Butcher and
Professor Peter Ihrke.
Dr Ray Butcher
Through his work with the
World Society for the
Protection of Animals
(WSPA), Ray Butcher has
been instrumental in efforts
to control dog populations
humanely, particularly in Eastern Europe
and in Asia. He is a founding member of
the Blue Dog Trust, an international
programme to reduce the incidence of dog
bites in children. He is a founding director
of the Alliance for Rabies Control (ARC)
and is on the board of the International
Companion Animal Management Coalition
(ICAM), representing the ARC and WSAVA.
He is a past Chair of the WSAVA Animal
2829 WSAVA News May.indd 28 18/04/2013 11:39
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of Veterinary Medicine, USA.
During a long career, Professor King
has served many national and international
One Health organisations. Before joining
Ohio State University he was Director of
the Center for Disease Controls (CDCs)
new National Center for Zoonotic, Vector-
Borne and Enteric Diseases (NCZVED). He
is also past Chair of the One Medicine Task
force for the American Veterinary Medicine
Association (AVMA) and is Point of Contact
for One Health activities at the CDC.
WSAVA International
Award for Scientific
Achievement
Professor
David Twedt
This award recognises the
work of a veterinarian in
advancing the professions knowledge of
companion animal disorders. It has been
made to Professor David C Twedt. A
Diplomate of the American College of
Veterinary Internal Medicine (ACVIM);
David is Professor of Clinical Sciences at
Colorado State University and Director of
the Veterinary Endoscopy Teaching Center.
He is a past President of the ACVIM and
the Comparative Gastroenterology Society
and is an expert in gastroenterology and
hepatic diseases of small animals.
Iranian veterinarians benefit from first WSAVA CE
webinar programme
The first WSAVA CE webinar for the Iran Small Animal Veterinary
Association (ISAVA) took place last October with speaker Dr Kersti
Seksel. A specialist in animal behaviour, she provided an overview of
the diagnosis of behaviour problems in dogs and cats. The system
used to broadcast the webinar was provided by the Royal Veterinary
Colleges Continuing Professional Development team in London.
Dr Jill Maddison, Chair of the WSAVAs CE Committee, comments:
The webinar with ISAVA is just one of a number of new initiatives to
help us achieve our mission of bringing practical, relevant and inspiring
CE to companion animal veterinarians who have previously had little
access to training and development to international standards.
The webinar will be available shortly on the new WSAVA website.
CE in Cuba
Dr Zoe Belshaw from the School of Veterinary Medicine and Science at
the University of Nottingham, and WSAVA CE Co-ordinator for Eastern
Europe, ran two WSAVA CE meetings in Cuba on Fundamentals of
Small Animal Medicine. The topic was selected based on responses to
a questionnaire sent to Cuban veterinarians to ascertain their priorities
for CE. The sessions took place in Pinar del Rio and Havana and were
made possible by a donation from the Norwegian Small Animal
Veterinary Association. NSAVA, an organisation with 460 members,
has supported WSAVA CE work in Cuba since 2003.
Vaccination Group continues its work
The WSAVA Vaccination Guidelines Group has continued its work on
companion animal vaccination requirements in Asia, with a visit to
India. The team travelled to Delhi and Mumbai, meeting local
practitioners, government representatives, academic microbiologists
and vaccine suppliers. They also met Dr Nalinka Obeyesekere, a
private practitioner from Colombo and founder of the Blue Paw
Trust who updated them on infectious disease and vaccination
issues in Sri Lanka.
While in India, VGG members presented CE programmes on vaccinology which
were enthusiastically received. Chairman of the VGG, Professor Michael Day from the
University of Bristol, UK said: We gained a good understanding of the particular
problems faced by the subcontinent in particular the challenge of controlling canine
rabies infection. There are an estimated 20,000 human deaths annually from canine
rabies virus infection in India and it was encouraging to learn of a new governmental
control programme scheduled to start later this year. The VGG will next meet in China
and Thailand in July 2013. n
WSAVA global CE
Over recent months WSAVA has run
CEprogrammes in many parts of the world
here are a few highlights
Zoe Belshaw
Michael Day
Jill Maddison
Kersti Seksel
Commenting on the 2013 WSAVA Awards,
President Professor Jolle Kirpensteijn, said:
The achievements of this years winners
confirm the commitment of our profession
to constantly push boundaries to ensure
we enhance veterinary care for companion
animals. Iwould particularly like to
acknowledge the contributions made by
Ray Butcher and Peter Ihrke. Both are
living embodiments of what we stand for
but they are also great friends and
colleagues. We are proud of all our
winners. We congratulate them and hope
they will inspire others.
Nominations are now being considered
for the 2014 WSAVA Awards, which will be
presented at the 2014 WSAVA Congress in
Cape Town, South Africa, from 1619
September. For information on the
nomination process, please contact
wsavasecretariat@gmail.com. n
2829 WSAVA News May.indd 29 18/04/2013 11:39
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Mark was born in Portland, Oregon, though he
grew up in Saudi Arabia, and attended vet
school in Budapest. His parents are both
teachers his father teaches English for the
Saudi military. He decided on a veterinary
career after volunteering at Jeddah vet clinic in
his teens, and gained a DVM from Budapest in
2006. He returned to the clinic he had
volunteered for, as sole-charge, before moving
to the UK to spend two years in practice in
Dover. He is currently the Short Course
Manager at The College of Animal Welfare
where he runs their CPD programme. He has
been married to Vera for 7years and they have
two daughters, Suzanna (two years) and Klara
(five months). Mark is a much valued pastoral
mentor for the BSAVA Postgraduate Certificate
in Medicine.
the companion interview
Mark B.
Hedberg
Q
How did you decide to take the veterinary
career path you chose?
A
Every job I ever took (which isnt a terribly
long list) was because I was looking to
move forward in my career; whether that
was learning to be a better vet, looking for a new
challenge, or even hey, that looks like what I want
to do!.
What is your particular area of interest and
what is it about that subject/species that fascinates
you most?
I started as a small animal GP with an interest in cats
and exotics. I love consulting; its my favourite part of a
clinical day. I also enjoy practice management and
business matters.
Tell us about your involvement with the BSAVA
postgraduate programme.
I got involved with the BSAVA Postgrad Certificates
because it was something entirely new, and I saw
that mentoring was going to be an important part
of the programme. Im convinced that the
veterinary profession needs more emotional
support many vets feel they cant ask for it!
Ispecifically asked to be a pastoral mentor,
because while the technical and clinical support
is vital for success, sometimes you need a shoulder
to lean on.
30-31 Interview May.indd 30 18/04/2013 11:41
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your career is your choice;
and its up to you to decide
what working conditions youll
accept for yourself
What have been the most impressive developments
since you have qualified?
For an exciting development, I would have to say that it
would be the modern smartphone. At a stroke, its
allowed people to change the way they practice
medicine. Record your patients symptom with the
camera and email it to your friend the specialist. Check
the BSAVA Formulary app for that drug dose! Phone a
friend for help when your next house call is a crocodile!
(This last ones a true story, by the way.)
Do you think worklife balance and expectations for
quality of life have changed drastically in recent
years?
I think expectations have absolutely changed. Part of
the reason for that is changes in culture and economy.
Companies simply cant guarantee years of job
security, so employees no longer guarantee years of
loyalty. Its no longer a sin to want a life and a career.
Your career is your choice; and its up to you to decide
what working conditions youll accept for yourself.
Who has had an inspiration on you in your career
and why?
Dr. Ernie Ward is an inspirational speaker and
evangelically enthusiastic about vet medicine dont
miss his lectures! Dr. Andy Roark and Dr. Dave Nicol
are a wonderful mix of insane humour and passion for
all things veterinary. My parents Robert and Eva
taught me that nothing is impossible, and my wife
Vera has been my ironclad mentor and support.
If someone was thinking of being a mentor in the
certificate programme what would you advise?
Id advise you to get out there and do it! Contact
certificate@bsava.com and see if they need a hand;
the programme has new students every year and
those students may need mentoring.
What do these Certificates offer someone in
your opinion?
I believe the Certificates offer a happy medium of
structure and flexibility that vets are most comfortable
with. Many of the students have been in practice for a
few years and are looking to continue their professional
development. They are an interesting and varied bunch.
What are the common challenges facing someone
undertaking the Certificates and how do you help
them through that?
The biggest issue is probably the age-old problem of
only having 24 hours in a day. Im there for informal,
confidential advice, or when the stress gets too much
as a safety valve.
What would your advice be to someone considering
taking on the BSAVA Certificates?
Its a big commitment in time and effort. Dont
underestimate how much time youll need to do this
vet practice has a way of seeping into any spare time
you have earmarked for study or family!
What single thing would improve the quality of
your life?
Id have to vote for my newborn daughter sleeping
through the night!
What is the most important lesson life has
taught you?
You are never given a wish without being given the
power to make it come true. You may have to work for
it, however. Richard Bach, Illusions
If you had not been a vet, what other career might
you have chosen?
I probably would have ended up a TESOL teacher
its a career that can mix teaching and travelling. Plus,
you get some really interesting people ending up as
teachers too.
If you could go back and give some mentoring
advice to the younger you what would that be?
Youre studying vet medicine in a referral medicine
setting; youll be practicing in a first opinion world.
Dont forget that; youll feel like a fish out of water. No
advanced imaging, no advanced internal tests; and
money WILL be an object. Do a thorough clinical
exam theres no shame in treating the symptom.
Care about your patient, but be careful; sometimes
you will care more than the owner, and then youll
suffer emotionally.
30-31 Interview May.indd 31 18/04/2013 11:41
For more information or to order
www.bsava.com
BSAVA reserves the right to alter prices where necessary without prior notice.
New
BSAVA Manual of
Feline Practice
A Foundation Manual
This Manual is a source of practical and easy-to-follow
advice for veterinary surgeons in general practice who
encounter a wide variety of common feline problems. It is
designed as an essential tool for all new graduates and
first-opinion vets that see feline cases and will also be
valuable for undergraduate veterinary students and
veterinary nurses worldwide. See page 24.
New
How to
collected articles from companion
This new book brings together 40 of the best How to
articles published in companion over the past four years
into an easy reference book.
BSAVA LOYALTY BENEFIT
If you were a paying member in 2012 and renew your
BSAVA membership for 2013 you will qualify for a free copy
of this book. If you did not collect your copy at BSAVA
Congress it will be mailed shortly. Please note that
e-member categories are not eligible for a free printed copy.
All BSAVA members have access to the online How To
archive via www.bsava.com
BSAVA Publications
COMMUNICATING VETERINARY KNOWLEDGE
BSAVA Member Price: 55.00
Price to non-members: 85.00
BSAVA Member Price: 30.00
Price to non-members: 45.00
companion offerof the month
Exclusive offer for companion readers
call BSAVA on 01452 726700 and
quote companion offer Rehabilitation.
20% discount off member price
BSAVA Manual of Canine and Feline
Rehabilitation, Supportive
and Palliative Care
Case Studies in Patient Management
WHAT THEY SAY
...no progressive practce should be without this book...
JOURNAL OF FELINE MEDICINE AND SURGERY
Offer is available to BSAVA Members
only. Ends 31 May 2013. Free P&P on
telephone orders for UK and Eire
delivery, online rates of P&P apply for
overseas orders.
companion offer: 49.00 39.20
Price to non-members: 79.00
New exclusive
to members
BSAVA Pocketbook for
Veterinary Nurses
Veterinary nurses are an integral part of the practice team
and their responsibilities and knowledge have grown
rapidly in recent years. This pocketbook gives veterinary
nurses a concise source of key information on the
techniques that are part of their day-to-day work.
BSAVA VN MEMBER BENEFIT
BSAVA VN Members will receive a free copy of this
pocketbook. Visit www.bsava.com for informaton about
Veterinary Nurse Membership.
BSAVA Member Price: 20.00
(Exclusive to BSAVA Members)
32 Publications Advert May.indd 32 18/04/2013 11:43
companion
|
33
Letters from the regions
Welcome to Wales Croeso i Gymru
Wales is now a single BSAVA region,
combining parts of all the different
BSAVA regions previously involving
Wales (South Wales, Midlands & North
West). Unification is good for the
representation of Wales, yet the
expansion definitely increases the
challenge of providing accessible CPD
to all our members in accordance with
BSAVAs stated aim to promote
excellence in small animal practice
through education and science. Wales
is a beautiful country with many remote
areas and in many areas transport links
are limited. This both increases the
importance of providing locally
accessible CPD, and adds to the
challenge of widening accessibility.
BSAVA Wales needs you
Part of meeting this challenge has been to
recruit new committee members from
different areas of the country, and we are
especially delighted to have several new
members from North and West Wales.
However we still need more volunteers,
especially from mid- and North Wales. The
regional committee works together to
provide local day and evening CPD courses
aimed at the practitioner looking to update
their current knowledge and techniques. As
a committee member, you would have a key
role in shaping your regional CPD, planning
and organising local CPD meetings. In
return you can get complementary days at
BSAVA Congress and the knowledge that
you are helping to shape the future of your
profession. Its fun and the workload isnt
too demanding.
Come and meet us
May 2013 brings the first BSAVA Cymru/
Wales evening meeting to be held in
mid-Wales. The meeting will be held at
Welshpool Livestock Market on Wednesday
22 May. Join us at 7.30pm for a
complimentary drink and buffet, followed by
a presentation by Rosario Cerundolo on the
Management of Ear & Skin Disease in First
Opinion Practice.
As this is the inaugural mid-Wales
meeting for the new BSAVA Cymru/Wales
region, registration will be FREE for all, but
please register in advance. BSAVA Members
can register via the BSAVA website (visit
www.bsava.com and follow the Regions
tab). Non-members, please email us:
cymru.wales.region@bsava.com.
Meet your new committee
Our Regional Chair, Esther Barrett
(Chepstow) and Treasurer, Branwen Davis
(Cardiff) are delighted to welcome Roberta
Eley (Newport) as the new regional
Secretary. The Regional Officers are
supported by Craig Connolly (Ammanford),
Hamish Cormie (Blackwood), Marina
Crockford (Cardiff), Sian Howley (Caerleon)
and Emily Ward-Smith (Dinas Powys) and
are very pleased to be joined by Rhian
Williams (Lampeter), Sian Evans (Anglesey)
and Emma Owen (University of Liverpool/
North Wales).
Forthcoming Meetings
In Wales evening meetings are now free to
all BSAVA members as long as you book in
advance at www.bsava.com. A
complimentary buffet is provided at 7.30pm.
See the website or the diary pages in
companion for a list of events. Registration
fees are 45 for non-member vets and 25
for non-member nurses. If not booked in
advance, registration fees for member vets
are 20 and for member nurses 15.
Keeping up with the Joneses
Keeping up with CPD requirements is di cult for us all, but when I rst started
pract sing in Wales I didnt realise how di cult nding accessible CPD would be. The
closest day CPD courses can be two to three hours away, and I have driven a four hour
round trip for evening courses too!
My feeling has long been that my veterinary knowledge should not su er just
because I live in the back of beyond. Our clients deserve to have up-to-date vets as
much as clients elsewhere. That is where BSAVA Cymru/Wales has become invaluable
in providing good quality, a ordable CPD on my doorstep. So it is no longer as di cult
for me to keep up with the Joneses. Come along and see what its all about your
region needs you.
Mae cadw i fyny gydag anghenion CPD yn anodd i bawb, a pan ddechreuais
weithio yng Nghymru doeddwn heb sylweddoli faint o broblem byddai dod o hyd i CPD
yn lleol. Mae cyrsiau un diwrnod yn aml tua dwy neu dair awr i wrdd a dwi hyd yn
oed wedi gyrru am ddwy awr bob ordd a gyrfer cwrs yn yr hwyr!
Dwi wedi teimlo ers tro na ddylai fy natblygiad fel milfeddyg ddiodde oherwydd
mod in byw mewn ardal eitha anghysbell. Dylain cwsmeriaid ni gael yr un safon o
lfeddyg gydar wybodaeth ddiweddaraf a chwsmeriaid mewn unrhyw fan. Dyma pam
mae BSAVA Cymru/Wales mor werthfawr yn darparu CPD ordiadwy a safonol yn fy
millt r sgwar. Dyw Keeping up with the Joneses felly ddim rhy anodd. Dewch i weld
beth syn digwydd mae eich rhanbarth eich angen.
Rhian Williams BVetMed MRCVS
33 Regions May.indd 33 18/04/2013 11:45
34
|
companion
CPD diary
EVENING WEBINAR
Wednesday 22 May
20:0021:00
Simple, safe and effective
rehabilitation and physiotherapy
Speaker: Brian Sharp
Online
Details from administration@bsava.com
EVENING WEBINAR
Tuesday 25 June
20:0021:00
Current perspectives on FLUTD
Speaker: Jane Eastwood
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
June 2013 July 2013
EVENING MEETING
WEST MIDLANDS REGION
Thursday 6 June
Common corneal conditions and
the non-healing corneal ulcer
Speaker: Lorna Newman
Wolverhampton Medical Institute, New Cross
Hospital, Wolverhampton WV10 0QP
Details from westmidlands@bsava.com
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
EAST ANGLIA REGION
Saturday 18 May
A pot pourri of exotics:
ferrets, parrots and tortoises
Speakers: Kevin Eatwell and Molly Varga
Animal Health Trust, Lanwades Park, Kentford,
Newmarket, Suffolk CB8 7UU
Details from eastangliaregion@bsava.com
EVENING MEETING
SOUTH WEST REGION
Thursday 16 May
10 things you wish youd known
about medicine before you
started
Speaker: Mark Dunning
Venue TBC
Details from southwest.region@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Wednesday 15 May
Feline lower urinary tract disease
update: why are we still seeing
blocked cats?
Speaker: Tim Gruffydd-Jones
Yew Tree Lodge Best Western Hotel,
33Packington Hill, Kegworth,
Derby DE74 2DF
Details from eastmidlands@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Tuesday 11 June
Evaluation and management of a
patient with CNS trauma
Speaker: Mike Targett
Yew Tree Lodge Best Western Hotel,
33Packington Hill, Kegworth, Derby DE74 2DF
Details from eastmidlands@bsava.com
DAY MEETING
Thursday 20 June
Imaging the abdomen
Speaker: Andrew Parry and Lizza Baines
Willows Vet Centre & Referral Service, Solihull
Details from administration@bsava.com
EVENING MEETING
NORTH EAST REGION
Saturday 22 June, 17:00
Family friendly summer social
event: meet the President
Speakers: Jim Wight and Michael Day
The James Herriot Visitor Centre, Thirsk
First 50 places free to members who register
To book your place visit www.bsava.com
or email administration@bsava.com.
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 19 June
13:0014:00
Perioperative feeding
Speaker: Nicola Ackerman
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
AFTERNOON MEETING
SCOTTISH REGION
Thursday 30 May
Orthopaedic conditions of
young dogs
Speaker: Luke Arnott
Kingsmill Hotel, Inverness
Details from scottishregion@bsava.com
EVENING MEETING
WEST MIDLANDS REGION
Tuesday 2 July
Treating the pet chicken:
including live chicken handling
Speaker: Victoria Roberts
Animal Care Department, Solihull College,
Blossomfield Road, Solihull B91 1SB
Details from westmidlands@bsava.com
WEEKEND CONFERENCE
BSAVA NORTHERN IRELAND
Friday 31 May
Saturday 1 June
Armagh City Hotel
Further details available from
nirelandregion@bsava.com
34-35 CPD Diary May.indd 34 19/04/2013 12:29
companion
|
35
FECAVA EUROCONGRESS
25 October
Dublin, Ireland
Visit www.fecava2013.org or email
info@fecava2013.org for more details.
EVENING WEBINAR
Monday 5 August
20:0021:00
Management of lymphoma in
practice
Speaker: Mark Goodfellow
Online
Details from administration@bsava.com
August 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.
OTHER UPCOMING BSAVA CPD COURSES
See www.bsava.com for further details
BSAVA Educaton
Tuesday 24 September
Collapsed canids and oppy felids:
are uids always the answer?
Southern Region
Tuesday 24 September
Business/Management (TBC)
BSAVA Educaton
Thursday 26 September
How to work up an oncology case
in practce
FECAVA EuroCongress
25 October
Dublin, Ireland
Details from www.fecava2013.org
West Midlands Region
Thursday 3 October
Feline medicine: the evidence base
LUNCHTIME WEBINAR
Wednesday 14 August
13:0014:00
Investigating the itchy dog
Speaker: Janet Littlewood
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 21 August
13:0014:00
Medicines inspection
Speaker: Pam Mosedale
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 17 July
13:0014:00
Controlling ectoparasites
Speaker: Emma Cook
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 10 July
13:0014:00
Cushings disease
Speaker: Rory Bell
Online
Details from administration@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Wednesday 10 July
Patellar luxation: case
management options
Speaker: Damian Chase
Yew Tree Lodge Best Western Hotel,
33Packington Hill, Kegworth, Derby DE74 2DF
Details from eastmidlands@bsava.com
DAY MEETING
EAST ANGLIA REGION
Sunday 14 July
Ophthalmology
Speakers: David Gould and Christine Heinrich
Cambridge Belfry, Cambourne, Cambridge
Details from eastanglia.region@bsava.com
EVENING MEETING
NORTH WEST REGION
Thursday 19 September
Avian emergencies
Speaker: Molly Varga
Brockholes Nature Reserve, Preston
Details from northwest.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Thursday 19 September
Feline cardiology
Speaker: Virginia Luis-Fuentes and Joanna
Dukes-McEwan
Hilton, Bristol (Bradley Stoke)
Details from southwest.region@bsava.com
LUNCHTIME WEBINAR
Wednesday 18 September
13:0014:00
GDV
Speaker: Sam McMillan
Online
Details from administration@bsava.com
September 2013
LUNCHTIME WEBINAR
Wednesday 4 September
13:0014:00
Clinical pathology:
interpreting blood types
Speaker: Sverine Tasker
Online
Details from administration@bsava.com
EVENING MEETING
WEST MIDLANDS REGION
Tuesday 3 September
How to perform a neurological
examination
Speaker: Ulrike Michel
Wolverhampton Medical Institute, New Cross
Hospital, Wolverhampton WV10 0QP
Details from westmidlands@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Wednesday 11 September
Genetics and dog breeding
Speaker: Steve Dean
Yew Tree Lodge Best Western Hotel,
33Packington Hill, Kegworth, Derby DE74 2DF
Details from eastmidlands@bsava.com
DAY MEETING
Thursday 12 September
BSAVA Dispensing Course
Speakers: P.Sketchley, F.Nind, M.Stanford,
P.Mosedale, S.Dean, M.Jessop
Gipsy Hill Hotel, Exeter EX1 3RN
Details from administration@bsava.com
DAY MEETING
NORTH EAST REGION
Sunday 15

September
Neurology topics
Speaker: Gerad te Lintelo
Wetherby Bridge Hotel
Details from northeast.region@bsava.com
DAY MEETING EDUCATION
Wednesday 17 September
From well bird to Im trying to
die fast: managing them all
in practice
Speaker: Neil Forbes & Matthew Rendle
Lismoyne Hotel, Fleet
Details from administration@bsava.com
Friday 30 August
Sunday 1 September
Edinburgh Conference
Centre, Heriot-Watt,
Edinburgh
Details from
scottishregion@bsava.com
34-35 CPD Diary May.indd 35 19/04/2013 12:29
British Small Animal Veterinary Association
Woodrow House, 1 Telford Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB
Tel: 01452 726700 Fax: 01452 726701
Email: administration@bsava.com
Web: www.bsava.com
For more information or to
order visit www.bsava.com,
email administration@bsava.com
or call 01452 726700.
Order online to save on
Postage & Packing
NEW from
BSAVA Publications
After record-breaking sales at BSAVA Congress, the new BSAVA Manual of
Feline Practice is now available in our bookshop. This beautifully-illustrated
addition to the BSAVA Foundation Manual series serves to provide an easily
accessible source of practical advice on the management of common feline
problems encountered in rst-opinion practice. The Manual gives enough
information for any vet to deal very competently with such problems, also
providing guidance on where to go for further information if required. Where
appropriate, guidelines are also given for when referral should be considered,
and for situations where nancial limitations may exist.
Holistic approach to the cat as a patient
Handling techniques, principles of examination, and how to ensure
your practice is cat-friendly
Problem-oriented section, focusing on investigation and initial
management
Systems-based section with detail on the management of disorders
commonly seen in practice
Quick Reference Guides throughout, with practical techniques and
treatments in easy-to-follow step-by-step guides
The Manual is edited by two leading international feline clinicians and clinical
researchers, backed by an international panel of authors carefully chosen
for their practical expertise and passion in different areas of feline practice.
Thepractical and easy-to-follow advice provided in this Manual makes
it essential reading for all new graduates and rst-opinion vets who see feline
cases, as well as veterinary students and veterinary nurses worldwide.
BSAVA Manual of
Feline Practice
Edited by Andrea Harvey and Sverine Tasker
Available NOW
496 pages
Member
price

55
Price to
non-members
85
36 OBC May.indd 36 18/04/2013 11:57