The essential publication for BSAVA members

companion
JUNE 2013
How To
Approach the dog
with neck pain
P16
Nick Stace
Interview with CEO
of RCVS
P8
Clinical
Conundrum
A recurrent UTI
P12
Are we producing
too many vets?
01 OFC June.indd 1 16/05/2013 16:46
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companion
CT assessment of the inuence of
dynamic loading on physiological
incongruency of the canine elbow
In this study, signicant changes in humero-
radio-ulnar congruency occurred, suggestng
pronaton of the radius with respect to
the ulna was induced during loading. The
authors conclude that this movement may
inuence the load experienced by the medial
coronoid process and could play a role in
the aetopathogenesis of medial coronoid
process disease.
Transverse sectoning for histological
assessment of sebaceous glands in
healthy dogs and canine sebaceous
adenits
The authors conclude that transverse
sectoning of canine skin specimens to allow
visualizaton of the follicular isthmus or
deep porton of the common infundibulum
enhances the histological assessment of
sebaceous glands in both health and disease.
Prevalence, outcome and risk factors
for post-operatve pyothorax in 232
dogs undergoing thoracic surgery
This study shows that idiopathic chylothorax,
intrathoracic biopsy and prior thoracocentesis
are independent risk factors for postoperatve
pyothorax.
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 Mark Johnston BVetMed 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
46 Are We Producing
Too Many Vets?
Undergraduate veterinary training
consultation results
810 A Year at the Top
Nick Stace CEO of the RCVS
11 Medicines Guide Update
Details about recent revisions
1215 Clinical Conundrum
A Golden Retriever with recurrent
urinary tract infection and suspected
urinary incontinence
1623 How To
Approach the dog with neck pain
2425 All Go for SAVSNET
Surveillance scheme set up
and ready
26 Cost of Illness can Make You Sick
Keep your practice safe from the
cost of long-term sickness absence
27 PetSavers
Passive smoking and pets
2829 WSAVA News
The World Small Animal
Veterinary Association
3031 The companion Interview
Freda Scott-Park
33 Letters from the Regions
News from your local groups
3435 CPD Diary
Whats on in your area
Additional stock photography:
www.dreamstime.com
Andres Rodriguez; Angel Luis Simon Martin;
Anton Starikov; Antonio Guillem; Cammeraydave;
Christos Georghiou; Edyta Pawlowska; Ewa Walicka;
Hong Chan; Isselee; Kirill Zdorov; Vladischern
Whats in
JSAP
this month?
Here are just a few of the
topics that will feature in
your June issue:
E cacy and safety of cimicoxib in the
control of perioperatve pain in dogs
In this study, cimicoxib demonstrated
statstcal non-inferiority compared to
carprofen. Both drugs were well tolerated.
Relatonships between heart rate and
age, body weight and breed in dogs
Body weight, age, breed and disease status
all inuence heart rate in dogs, although
these factors account for a relatvely small
proporton of the overall variability in
heart rate.
Statstcs: using regression models
The latest in our series of artcles helping
practtoners with statstcs asks How are we
related?, and will demonstrate the statstcal
techniques required to reach a conclusion.
Log on to www.bsava.com to access
the JSAP archive online.
EJCAP ONLINE
Dont forget that
as a BSAVA member
you are enttled to
free online access
to EJCAP register
at www.fecava.org/EJCAP to access the
latest issue.
Find FECAVA on Facebook!
02 Page 02 June.indd 2 16/05/2013 16:45
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3
D
ont miss a thing. If you are not
already following the BSAVA
on Twitter and Facebook, but
would like to receive up to the
minute updates on all things BSAVA,
such as association news, membership
benefits, CPD, publications, Congress
and events, then sign up to Follow us
on Twitter and Like us on Facebook.
T
he annual report from the
RSPCA Prosecutions
Department was issued on
30 April and its contents are
shocking, even to those familiar with
seeing cases of abuse.
The latest report from the
RSPCA makes grim reading indeed,
particularly for members of the
veterinary profession, said Professor
Michael Day, BSAVA President. It
demonstrates all too clearly that our
nation of animal lovers sadly also
includes those who carry out acts of
wilful cruelty, or are at least negligent
in their duty of care.
BSAVA did find one positive
aspect of this report however in the
78,090 welfare improvement notices
that have been dispensed. As
Professor Day commented, These
are seen as being extremely effective
in changing poor conditions for pets
if steps are taken early enough,
before welfare has been seriously
compromised avoiding suffering for
the animal and at the same time
offering advice and education to a
pet owner who might otherwise
become neglectful.
As some of the cases in the
report illustrate, where animals are
abused there may also be people at
risk of violence in that household, this
correlation is not uncommon and
requires multi-agency involvement,
which The Links Group has promoted
for over 12 years.
Dr Freda Scott-Park of The Links
Group said: Although many of the
cases described were not presented
to veterinary practices, veterinary
colleagues should be aware that if
they are presented with a case of
animal abuse, then there may also be
violence against vulnerable humans
in the same household.
Dr Scott-Park was joined by
Detective Inspector Linda Borland
and vet Paul Roger to give a talk on
dealing with cases of animal abuse
at BSAVA Congress. Members of the
Association can download the talk as
a Congress podcast from www.
bsava.com. See the interview with
Dr Scott-Park on pages 3031.
RSPCA
prosecutions
report
Be social with BSAVA
T
he Frank Beattie scholarship was established
in 1988 in memory of Frank, a well respected
veterinary surgeon and a long-standing
member of the BSAVA. It is awarded annually
from a generous gift given by Franks widow, Annie.
The scholarship, worth 2000, is to help a BSAVA
member undertake a trip abroad to study a particular
aspect of veterinary practice. To apply for this
scholarship email h.field@bsava.com. The deadline
for application is 26 September.
Apply for
travel scholarship
T
he prestigious BSAVA Awards give
you the chance to acknowledge
the inspiring work of colleagues
who have made their own
exceptional contributions to our profession people
we work alongside every day or those whom we
admire from afar.
All members of BSAVA are eligible to vote
you can choose to select just one, or nominate in
multiple categories. It takes just a few minutes to
encourage and honour a colleague visit
www.bsava.com/awards for details. The Awards
Ceremony will take place at BSAVA Congress
36 April 2014.
Nominate now
please
03 Page 03 June.indd 3 16/05/2013 16:44
Are we producing
too many
vets?
S
ince the announcement that the University of
Surrey would be opening a new veterinary
school in 2014, and rumours of other
universities considering to do so, there has
been a great deal of discussion about the potential
consequences for the veterinary profession.
The recent consultation with BSAVA members
revealed that the majority of respondents considered
that another veterinary school is not a good idea, with
concerns about the overproduction of new graduates,
the problems of maintaining teaching standards and
accessing sufficient good quality extramural studies
(EMS). However, there were also some positive
comments, with increased opportunities for
prospective students and more opportunities for
academics being mentioned as possible benefits.
Concerns
Concerns about the number of veterinary
graduates being produced are not new. Similar
concerns were expressed when the new veterinary
school at Nottingham was announced and until
recently the veterinary profession was classed as a
shortage occupation. Although Nottingham is now
producing graduates this is not the only reason for
the recent increase in graduate numbers, as one
respondent noted:
Overproduction of students is mostly attributable
to the huge increase in numbers of vet students in the
current schools e.g. Edinburgh almost doubling from
100 to 160170 in 10 years. If the new vet school
poses such a threat to the profession, why has no one
made such a fuss about the ever increasing number of
students in the current systems? Its ridiculous as far as
I can see its a free market, let them compete on a
level playing field.
BSAVA recently ran a
consultation with members
about undergraduate
veterinary training. Scientific
Policy Officer Sally Everitt
reviews the results
04-06 University Consultation.indd 4 16/05/2013 16:44
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A recent analysis of the veterinary
profession produced by the RCVS for the
Migration Advisory Committee shows that
RCVS membership continues to increase
year on year with no drop off so far
recorded. These figures show that the
RCVS is registering around 600 veterinary
surgeons from overseas (EUand non EU)
on top of the 800 UK veterinary registrants
every year. The RCVS figures suggest that
there is still a shortfall of 422 vets per year,
with the forecasts indicating a requirement
for 1222 vets per year to replace those
retiring and the apparent increased
demand for veterinary surgeons.
Although the RCVS has not yet noticed
any change in registrations, responses to
our member consultation suggest a rather
different picture with reports of an
increasingly difficult job market.
We cannot get jobs! I have friends
who are working at bars as they cannot
get jobs. A practice near me has recently
employed x2 new grads as VNs!
Ridiculous those places should be taken
by qualified VNs not new grads how is
that fair to VNs who have worked hard for
their qualification to now have to fight with
Vets for the same position, totally
unsuitable for all concerned.
Yes it took myself and several friends
from my graduating year (2009) several
months to find a job, with several
interviewers telling me they were getting
around 30 applicants for one position,
Itherefore had to sign on for jobseekers
allowance and move in with my parents
which I found very demoralising after
6years of study and obtaining a
professional degree.
Support from practices
The increasing number of students is
producing another problem for the
profession in providing suitable
opportunities for EMS. Problems
reported in our survey related both to the
practices and the students. Several
practices reported being inundated with
requests for EMS and work experience
and having waiting lists to 2015. The
problems seemed to be most acute in,
though not confined to, mixed, farm and
equine practices. However there are also
reports of practices that would be willing
to take students if contacted.
The practices feel that more is expected
of them, with one respondent saying the
vet schools have recently had to start
practice-specific alliances with vet practices
in order to ensure provision of EMS as local
practices are tired of giving their skills,
services, time and patience for nothing
especially when they have to pay
250600 per day themselves for CPD at
the same universities. Also, with competition
increasing between practices, vet students
are effectively commercial espionage.
There were also comments about the
variability of EMS and the increasing
demands of students who are paying for
their degree, frequently paying for
accommodation when seeing practice,
as this cannot always be arranged close
to home, and in a few cases even paying
for EMS itself, with one respondent saying
that practices are starting to charge up to
200 per week. There was also mention
that there are an increasing number of
qualified but as yet unemployed vets
seeing practice.
Specifically Surrey
In response to a specific question about
the suitability of the location of Surrey as
the site for a new veterinary school, only
17 out of 118 respondents considered the
location appropriate. Those that did cited
as reasons that this is an area of high
population density and has proximity to
the Veterinary Laboratories Agency at
Weybridge. In contrast, those that gave
specific reasons against the location (as
opposed to general comments that there
shouldnt be a vet school anywhere) cited
that it was too close to other vet schools,
especially the RVC, and that the location
did not provide easy access to livestock.
Asked whether they thought the
stated emphasis on One Health is
appropriate, the most frequent comment
was that this is not a unique selling point
for Surrey and is already being promoted
in other schools. This was seen to be a
trendy term which wouldnt translate into
anything different in reality since all
schools have to fulfil the curriculum
requirements of RCVS and EAEVE, and
students are predominantly looking for
training forpractice.
Too many graduates
Although one, or more, new veterinary
schools will increase choice and access
for the many prospective students, it will
also inevitably increase the number of
graduates. With changes to the
mechanisms of funding higher education,
limits on student recruitment except for
those with high grades and a high demand
for places, veterinary courses would still
appear to be an attractive proposition for a
university. Australia has increased the
number of veterinary schools from four to
seven in recent years and there are plans
for a further four veterinary schools to open
in the USA, showing that this problem is
not confined to the UK.
However, as one respondent put it:
I am a recent graduate and quite
simply there arent enough opportunities
for those leaving University. Given the debt
students are taking on, it is morally
unacceptable to throw them into a market
where we already know there is over
supply of labour and due to the number of
young vets and limited career
development opportunities.
04-06 University Consultation.indd 5 16/05/2013 16:44
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Are we producing too many vets?
A lthough the UK job market for
veterinary graduates appears to be
becoming more difficult, the prospects still
look reasonable compared to both
graduates in other subjects and to
veterinary graduates in some other
countries. It is yet to be seen how long this
will continue and whether the profession is
able to adapt by expanding into other
areas of work, or whether the
overproduction of vets will drive down pay
and conditions and ultimately the numbers
and calibre of applicants for veterinary
courses.
The RCVS are likely to be conducting
another survey of the professions
(veterinary and veterinary nursing) in 2014;
it will be interesting to see what changes it
shows, and what effect the economic
climate and increasing number of
veterinary surgeons registered are having
on those within the professions.
Consultation
results
MORE ABOUT THIS SUBJECT
We plan to follow up on this consultaton
with a feature in a future editon of
companion that explores the experience
of vets in practce and how they view the
potental impact of more vet schools on
the profession.
If you would like to contribute email Kay
Colquhoun k.colquhoun@bsava.com
or call 01452 726718.
Q1
Do you think that the opening of a new veterinary
school at the University of Surrey isa good idea?
No 111
Yes 6
Blank 1
Q3
What do you see as the disadvantages of having
another veterinary school?
A range of responses were given to thisquestion but the
main issues raisedwere:
Overproduction of new graduates (97responses)
Reduced resources for research and teaching leading
to falling teaching standards (17responses)
Pressure on EMS (14 responses)
Debt burden (6 responses)
Q5
Are you aware of any problems relating to the provision of
EMS (seeing practice) in the UK?
Yes 78
No 22
Variable 1
Q7
Do you think that the emphasis on One Health is
appropriate?
Yes 41
No 22
Other 39 (no comment, not sure, and mixed responses)
Blank 17
Q6
Do you consider the location of the new veterinary school
appropriate?
Yes/OK 17
No 55
26 provided ambivalent responses/dont know these were
mostly negative opinions or doesnt matter where its placed;
again many of these were negative about the prospect of a new
vet school
20 people didnt answer this question (all bar one of these did
not think the opening of the new vet school was a good idea)
Q4
Are you aware of any problems relating to over- or
underproduction of veterinary surgeons in the UK?
77 replied yes, although 5 of these stated that their evidence
was onlyanecdotal
10 replied no
5 others thought that there would be problems in the future
6 raised concerns about the effect of foreign graduates entering
the UKmarket
4 respondents mentioned that there are still problems recruiting
for farmpractice and public health
Q2
What do you see as the benefits of having another
veterinary school?
60 said they did not see any benefits and one went
so far as to say Genuinely NONE! = a terrible idea
42 positive responses divided into the following
broad themes
20 made reference to an increase in choice or
access for prospective students
9 respondents made reference to increasing the
number of UK graduates
10 noted that it would increase jobs for academics
and opportunities for research
1 hopeful respondent suggested it could result in
smaller class sizes
04-06 University Consultation.indd 6 16/05/2013 16:44
For more information or to book your course
www.bsava.com
All prices are inclusive of VAT. Stock photography: Dreamstime.com. Andersastphoto
Imaging the
abdomen
20 June
This course is designed to cover imaging of the
abdomen, with particular emphasis on radiological
and ultrasound findings, and includes 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: 350.00
S
p
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C
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s
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f
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v
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a
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V
N
s
VN Merit Award
Surgical Nursing
FEES
BSAVA VN Member 494.00
Non BSAVA VN Member: 741.00
Day I: 27 September 2013
SPEAKERS
Laura Owen and Hayley Carne
The first day will look at preoperative assessment of
surgical patients, including triage and stabilisation of the
emergency patient, principles of fluid therapy,
assessment of anaesthetic risk, analgesic options and
principles of antibiotic prophylaxis.
Day II: 28 September 2013
SPEAKERS
Laura Owen and Hayley Carne
The second day will look at the nurses role during
surgery, including optimising the role of a surgical
assistant, use of advanced surgical equipment,
indications for and placement of drains and monitoring
blood loss.
Webinar I: 15 October 2013
SPEAKER
Laura Owen
Wound healing: understand the biological processes
and how to optimise your management of traumatic
wounds (includes case examples).
Day III: 9 November 2013
SPEAKERS
Laura Owen and Hayley Carne
The final day will look at monitoring and care of the
postoperative patient, including assessment and
treatment of pain, nutritional requirements and tubes/
catheters/drains
Webinar II: 3 December 2013
SPEAKER
Laura Owen
Blood products: when and how should we use them in
surgical patients?
An online assessment will follow these attendance and
online activities and at the end of the award you will
receive a certificate and a badge. Holders of the award
will be expected to complete a refresher course in
5 years.
N
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From well birds to
I am trying to die fast
17 September
This mixed session will include anaesthesia, diagnostic
work-up and clinical pathology. We will also cover
some of the welfare and behavioural needs of well
psittacine birds. In the afternoon, vets will cover
topics such as therapeutics, orthopaedics and soft
tissue surgery, whilst nurses will take on catching and
handling, nutrition and fluid support.
SPEAKERS
Neil Forbes and Matthew Rendle
VENUE
Lismoyne Hotel, Fleet, Hampshire GU51 4NE
FEES
BSAVA VN Member: 167.00
Non BSAVA VN Member: 250.00
BSAVA Member: 233.00
Non BSAVA Member: 350.00
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New courses for Autumn 2013
Look out for your copy of the new BSAVA CPD Brochure
coming soon? Cant wait? Why not take a sneak peak here:
www.bsava.com/CPD/ChooseaCourse/tabid/
1383/Default.aspx
07 CE Advert June.indd 7 16/05/2013 16:43
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T
aboo words exist for the members of most
professions. For actors, it is any quotation from
that part of Shakespeares canon which they
like to call the Scottish play. For veterinary
surgeons, it is in using the term customers to describe
the people on whom their living depends.
Nick Stace, the Chief Executive of the Royal
College of Veterinary Surgeons, has either never
heard of this convention or (as seems more likely) he
chooses to ignore it. As far as he is concerned, the
Royal College is an organisation providing services
to two separate groups veterinary staff and the
general public and they are both his customers.
Mr Stace was appointed in June 2011, and quickly
acquired a reputation for honesty, plain-speaking and
a willingness to push the RCVS in new directions in the
way that it engages with the outside world. That was
clear from his first public appearance in the role at the
November meeting of the Royal College Council,
where he rebuked unnamed members for discourtesy
in their dealings with both college staff and each other.
Fact finding
Previous occupants of the chief administrators post at
the RCVS have come from either a legal or military
background. Nick is neither, having served as a
A year at the top
Many have come to think of the
RCVS as an aloof and rather
stuffy institution; it has certainly
received its fair share of criticism
in the last few years. That
shouldnt be the case anymore,
according to the Chief Executive
Nick Stace, who has been seen
by some to be a breath of fresh
air at the 169-year-old regulatory
body. John Bonner went to
meet him a year on from his
initial appointment
08-10 Nick Stace.indd 8 16/05/2013 16:42
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9
communications specialist in government service, and
more recently as the head of the Australian consumer
protection agency CHOICE. So it is not surprising that
with this background in working for the antipodean
equivalent of Which?, his first priority was to carry out
some market research.
You come into a job like this with some ideas and
the thing you need to do is to find out if it is likely that
they will work. So my initial task was to reach out to the
profession and the public to hear what they have to
say about the ways that we operate, what we do well
and what we dont do quite so well.
He wrote to the veterinary press, giving his email
address, and asked for comments which he promised
would receive a reply within 24 hours. In the first week
he had around 60 messages and he is still getting an
average of 6 per week, with a mixture of regular and
new correspondents. Meanwhile, he estimates that
around one-fifth of the UK veterinary profession has
responded to an online questionnaire.
Nick also wanted to know the views of other
organisations which have regular dealings with the
Royal College, including BSAVA and he has carried a
series of interviews with senior officials. In addition,
he took an in-depth look at the way that other bodies
with similar functions both at home and abroad carry
out their work.
All this research feeds into what Nick is calling the
First Rate Regulator initiative, a project designed to
improve the structure and function of the RCVS and
ensure that both sets of customers are happy with the
service that they get.
Complaints process
Of course, one of the main responsibilities of the
RCVS is to listen to and investigate complaints from
one set of customers about the behaviour of the other.
Nick asked his staff to follow up every complaint
made against an MRCVS over the past three years to
find out how the complainant felt that the issue had
been dealt with.
What he found was that there is little correlation
between the outcome of the process and the feelings
of the complainant. Many would be dissatisfied that
the RCVS was unable to deal with their grievance,
often because it was a case for the civil court system
and didnt involve professional misconduct. However,
even some of those whose complaints were upheld in
the disciplinary committee process were unhappy with
the process. Often that was because of time taken to
reach a decision, and no doubt the respondent in the
case would have similar concerns.
On average it takes just under two years for a
case to go through the whole process from initial
complaint to a final decision. Compared with other
regulators that isnt too bad but I do think that we can
do a lot better, he says.
Part of the solution is already in hand, with
parliamentary approval in April for the legislative
reform order that modernises the RCVSs disciplinary
structures and will create preliminary investigation and
disciplinary committees that are independent of
Council and contain roughly equal numbers of
veterinary surgeons and lay people.
The College has appointed an independent
recruitment firm and selection panels to sift through
the 170 or so applicants. Previously, when having to
draw solely on RCVS Council members, meetings of
the full disciplinary committee have sometimes
struggled to remain quorate. Nick hopes that with a
larger pool of potential members, the committee will
be able to meet more frequently and process cases
much faster.
Yet it isnt just the time that cases take which
creates dissatisfaction; many complainants felt that
they werent kept informed and when they were, the
reports were delivered in legal language that they
often couldnt understand. So part of the reform
process that Nick has introduced will be the allocation
of a case officer for each complaint to keep both sides
informed on what is happening.
As an extension of this concept, the College has
appointed a new senior staff member Nicola South to
be Customer Experience Manager, with responsibility
for ensuring that all those contacting Horseferry Road
feel that their enquiry has been dealt with properly.
A philosophical approach
As well as these relatively simple practical changes,
Nick also wants the First Rate Regulator project to look
at some broader philosophical issues. One task is to
examine the RCVSs joint role as a statutory body and
as a Royal College required by its charter to try to
progress the art and science of veterinary medicine.
Few if any of the other statutory bodies have this dual
function, he points out.
Between 90 and 95 per cent of the money we
spend is on regulation, only a tiny percentage goes
into being a Royal College. I think there is a real
appetite to have a fully functioning Royal College as
well as a regulator. So we will be exploring what
people mean by and want from a Royal College. We
want to look at the different models of college to see
which one we should adopt. In this process we will
want to involve the BVA, BSAVA and other
stakeholders. They have nothing to fear from this; our
role will be complementary to what they are already
doing in professional education, etc.
08-10 Nick Stace.indd 9 16/05/2013 16:42
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A year at the top
One logical conclusion to this line of thought is that
changes may be needed in the Colleges council
system to separate the two functions, particularly as no
other organisation with purely statutory duties would
be run by an unwieldy 42 member committee like the
existing Council. A report on options for the next steps
in the reform process will be discussed at the June
Council meeting and Nick insists that the debate and
any subsequent decision-making will be conducted
entirely under public view.
A team effort
Changes on this scale in any organisation would
normally be expected to make the permanent staff
rather anxious. While three posts have been made
redundant, those beavering away at Horseferry Road
appear to be fully supportive of Nicks programme.
That is probably because he has taken every
opportunity to communicate with his team and tried
to assess their morale through a staff engagement
study. That scored 59 on a scale of 1 to 100 really
happy and effective organisations generally score in
the 80s and those with serious management issues
as low as 40, he explains.
The middling satisfaction rating for RCVS staff is a
little disappointing but not that surprising for a first-time
study as people will naturally remember issues that
have cropped up at any time that they have worked
there. What matters, Nick says, is to carry out regular
reviews to make sure that the necessary steps have
been taken to ensure that the trajectory of staff morale
is heading in the right direction.
Staff engagement is not some fluffy peripheral
issue. I think it is central to being a good or possibly
even a great organisation. If we want to give our
customers the best service and to constantly improve
what we do, then we need highly engaged staff to do
that. It will also help us in the long run by ensuring that
we can recruit and retain the best staff.
Not just vets and pets
Unlike most of his predecessors at the Royal College,
Nick also has responsibility for regulating a group of
people who are not themselves veterinary surgeons
but for whom the College has become an essential
part of their working lives. Nick says there needs to be
further debate about whether veterinary nurses should
be integrated more closely within the RCVS structure,
or whether they should achieve greater autonomy in
setting their own professional goals.
One key step is to ensure that the meaning of the
term veterinary nurse is clearly defined and he says
the RCVS has persuaded Defra to agree to a proposal
for a Bill to make this a protected title. The next stage
is to persuade an MP to take this on as a Private
Members Bill, and as the legislation is likely to be
uncontroversial there is every chance that it will
succeed, he says.
Transparency on every level
One immediate and tangible change at Horseferry
Road has been the building work to convert what was
formerly a rabbit warren of corridors and small offices
into an airy open-plan workspace. At the centre of
each floor there is a pod a small glass cubicle in
which staff, members and visitors can hold impromptu
meetings. The concept was borrowed from one of the
buildings used by the Home Office and, while the idea
is to reduce the amount of time spent in unnecessary
meetings, the see-through glass walls may be viewed
as a reflection of the new management style.
We are trying to repair some of the damage
caused by the McKelvey report, he says (referring
to the investigation into the cost overrun from a
previous building project which ultimately led to the
resignation of his predecessor and Staces
appointment as Chief Executive).
It was a mistake to redact parts of the report
before it was made public. That looked as though we
were trying to conceal something. We have got nothing
to hide but if we are entirely open about what we are
doing then that does involve some risks. I want the
profession to get used to the idea that we will tell them
all there is to be told, whether that news is good, bad
or indifferent. All I ask is that they take that in the right
spirit and to help us get on with the job. n
08-10 Nick Stace.indd 10 16/05/2013 16:42
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11
T
he BSAVA Guide to the Use of
Veterinary Medicines provides a
comprehensive and authoritative
guide to the safe and legal use of
veterinary medicines in companion animals
in the UK, for all members of the veterinary
team. Everyone who uses veterinary
medicines has a legal, ethical and moral
responsibility to use them appropriately.
Many infringements of the law relating to
the possession, use and disposal of
veterinary medicines are criminal offences
and this Guide helps practitioners stay on
the correct side of the law in an area where
this can sometimes be problematic.
The Medicines Guide is updated
on a regular basis, whenever the
Veterinary Medicines Regulations are
reviewed and at other times if legislation
or recommendations for good practice
change. In April of this year, a
comprehensive review and update was
completed; a couple of the revised
sections are detailed here.
Suitably Qualified Person
Suitably Qualified Person (SQP) is a
phrase used in the veterinary medicines
legislation in relation to the prescription and
supply of medicines. In practical terms this
means a person registered with the Animal
Medicines Training Regulatory Authority
who is permitted by the regulations to
prescribe and/or supply medicines
classified as POM-VPS or NFA-VPS.
An SQP can orally or in writing
prescribe a POM-VPS medicine for a
client. They do not need to see the animal.
They may not diagnose disease but can
identify infestation (e.g. lice). They may not
treat disease but can advise on prevention
and control of disease. Most of the
medicines in the VPS categories do have
preventive uses, e.g. antiparasitic
medicines, farm animal vaccines,
nutritional supplements, antiseptic
medicines and some local anaesthetics.
When prescribing and supplying a
product within the POM-VPS category or
supplying a product within the NFA-VPS
category, the SQP must always:
Be satisfied that the person who will
use the product is competent to use
itsafely
Advise on any warnings or
contraindications on the label or
product leaflet
Provide advice on the safe
administration of the product
Supply the product specified in that
prescription
Take all reasonable steps to ensure that
the product is supplied to the person
named in the prescription.
Pharmacovigilance
Pharmacovigilance is the monitoring of
unwanted or adverse events in response to
medicines and vaccines. For veterinary
surgeons, veterinary nurses and animal
owners, this monitoring is done through the
Suspected Adverse Events Surveillance
Scheme. The reporting of suspected
adverse events is a key part of the process
of ensuring the safety of medicines, and
also plays a part in keeping existing
medicines on the market and available.
Adverse events are harmful and
unintended reactions to a medicine when
administered to an animal at its
recommended dose and route of
administration. Adverse events in animals
that should be reported to the Veterinary
Medicines Directorate (and also to the
manufacturer or distributor of the medicine
where known) include:
Lack of efficacy, including resistance to
antimicrobial or antiparasitic agents
Events not mentioned in the datasheet
Events mentioned in the datasheet but
occurring more frequently or more
severely
Events arising during clinical use of a
new medicine under development
Any reaction to a medicine which has
been authorized for less than a year
Events arising during off-licence use
(i.e. under the prescribing cascade)
Environmental problems.
Reports are collated by the
manufacturer and used as part of the
ongoing safety monitoring of all
medicines. Information on serious
adverse events and events in humans in
response to veterinary medicines must be
reported to the VMD within 15 days.
Reports from all European Union
countries are collated by the European
Commission. Quarterly summaries of the
reports received are published in
Veterinary Record and MAVIS.
Under the expert guidance of Fred Nind and
PamMosedale, the BSAVA Medicines Guide has
provided a ready source of information on veterinary
drugs since it was first published four years ago
Visit the Advice section
of the BSAVA website
(www.bsava.com) to
view the completely
revised Guide to the
Use of Veterinary
Medicines.
Medicines
Guide
updates
11 Publications Medicines Guide.indd 11 16/05/2013 16:42
Case presentation
An 18-month-old female neutered Golden Retriever presented with a
history of recurrent urinary tract infection (UTI) and suspected
urinary incontinence. Over a 14-month period she had demonstrated
intermittent episodes of stranguria and haematuria, responding on
each occasion to symptomatic therapy with amoxicillin/clavulanate
and meloxicam. Prior culture and sensitivity of the urine
documented an E. coli and Proteus infection. She had also been
noted to suffer from episodes of suspected urinary incontinence,
most commonly coinciding with excitement, where she passed large
volumes of urine without apparent awareness. During the 2 weeks
prior to presentation the patient was reported to have a slightly
reduced appetite although she had remained bright in other regards
and there had been no change in water intake.
On presentation she was overweight, with a body condition
score of 7/9. Her vulva was recessed within a perineal fold and she
had matted, urine-stained hair surrounding it, with erythema of the
underlying skin. The remainder of the physical examination was
unremarkable.
12
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Clinical conundrum
Fran Taylor-Brown, a previous
intern at the Royal Veterinary
College, invites companion
readers to consider a Golden
Retriever with recurrent urinary
tract infection and suspected
urinary incontinence
Create a problem list based on the
patients history and physical
examination
n Inappropriate urination
n Recurrent UTI
n Recessed vulva
n Urine scald and staining
n Overweight
What differential diagnoses should be
considered based on the problem list?
For the first two problems the possible differential
diagnoses can be organised into three main categories.
n Inappropriate urination
Structural abnormalities
Lower urinary tract inflammation or infection
Neurogenic disorders
n Recurrent UTI
Structural abnormalities
Lower urinary tract inflammation e.g. urolithiasis
Systemic disease
Given the patient was young, structural
abnormalities were high on the list of differential
diagnoses. A prioritised list of differential diagnoses for
this case would be:
1. Congenital structural abnormality, e.g.ectopic
ureter, vulval hypoplasia
2. Urethral sphincter mechanism incompetence
(USMI)
3. Urolithiasis
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What diagnostic procedures would you
perform in this case?
Routine haematology and biochemistry were
performed to investigate systemic causes which could
be responsible for recurrent UTI; these results were
unremarkable. Urinalysis and culture were performed
on a sample obtained by cystocentesis with particular
interest in the urine sediment, pH and specific gravity.
The urinalysis revealed only mild haematuria, and urine
culture was negative.
In order to investigate structural abnormalities of
the urinary tract, abdominal ultrasonography was
performed. This revealed that both kidneys were small
with an irregular contour; this was more severe on the
left side. These changes were thought to be
consistent with a chronic nephropathy. The patient
was non-azotaemic (creatinine 102 mol/l; reference
interval 50110 mol/l) with adequate urine
concentrating ability documented repeatedly (specific
gravity 1.036). However, changes identified on
ultrasound examination supported International Renal
Interest Society (IRIS) stage one, non-azotaemic,
chronic kidney disease (CKD).
Systolic blood pressure was assessed using the
Doppler technique (124 mmHg), a result considered
low risk in accordance with the American College of
Veterinary Internal Medicine Hypertension Guidelines.
The patient was protein-negative on urine dipstick with
well concentrated urine and therefore urine
protein:creatinine ratio assessment was not performed
at this stage. Further assessment of proteinuria was
postponed due to the presence of haematuria.
The patient was anaesthetised and plain
radiographs were obtained to assess general
anatomy and positioning of organs within the
abdomen. The images were unremarkable and
showed a normally positioned bladder. Following this,
an intravenous urogram was obtained to assess
kidney and ureteric structure and positioning; a left
ectopic ureter was documented (Figure 1).
Subsequently, retrograde vaginourethrocystography
was performed in order to assess for the presence of
caudal structural abnormalities in the urogenital tract.
It demonstrated normal filling of the vestibule, vagina
and urethra, and confirmed a normally positioned
bladder within the abdomen.
What techniques are available for the
diagnosis of ectopic ureters?
n Urethrocystoscopy
n Computed tomography (CT)
n Excretory urography
n Ultrasonography
n Retrograde vaginourethrocystography
Urethrocystoscopy is considered the gold standard
for diagnosis of ectopic ureters in female dogs and is
the only technique which allows accurate detection of
the point of termination of the ectopic ureter or
identification of multiple openings. CT ( contrast) is
considered the gold standard for diagnosing ectopic
ureters in male dogs. It is a superior diagnostic
technique to excretory urography as it allows three-
dimensional reconstruction, which can aid in following
the course of ureters and their distal insertion. The
diagnostic success of using conventional radiographic
Figure 1:
Slightly oblique
ventrodorsal view of an
excretory urogram with
negative contrast in the
bladder. It demonstrates
a left ectopic ureter.
(Black arrows highlight
the course of the left
ectopic ureter and white
arrows show the course
of the right ureter)
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Clinical conundrum
excretory urography can be enhanced by combining it
with negative contrast within the bladder and also
performing oblique views.
Ultrasonography can be used to diagnose
ectopic ureters, especially in cases where the
affected ureter is dilated. However it can be
challenging even for highly skilled ultrasonographers
to detect ectopic ureters in the absence of ureteral
dilation, and the detection of an appropriately
positioned ectopic opening does not preclude the
presence of multiple openings.
Obtaining a retrograde vaginourethrogram can be
very useful to diagnose ectopic ureters, as the ectopic
ureter often readily fills during contrast injection. The
technique is also useful for identifying the bladder
neck and assessing bladder positioning, which is
important for the diagnosis of common concurrent
conditions such as USMI or short-urethra syndrome.
What are the options available for
treating ectopic ureters?
n Surgical correction
In order to correct intramural ectopic ureters a new
ureteral opening is created from the bladder lumen
after performing a ventral cystotomy. Success rates
of 2259% have been reported, as defined by
resolution of urinary incontinence.
n Cystoscopic laser ablation
CLA is a more recent technique appropriate for the
treatment of intramural ectopic ureters and involves
ablation of the tissue separating the ureter from the
bladder lumen at the point where a typical ureter
would terminate into the bladder. Success rates,
with respect to resolution of urinary continence, are
reported to be comparable to that of more
traditional surgical correction techniques. However,
due to the minimally invasive nature of the
procedure there is less postoperative pain and the
need for hospitalisation is reduced.
In this patient it was elected to perform CLA.
Theright ureteral orifice was visualised in the bladder
trigone region (Figure 2) and the left ureter was
observed to enter into the proximal urethra (Figure 3);
urine jets were observed coming from both ureters.
Acatheter was placed via a guidewire into the left
Figure 2: Cystoscopic image of the bladder trigonal region,
showing the right ureteric orifice in a normal position
(asterisk marking the bladder lumen and the arrow
identifying the ureterovesicular junction)
ureter in order to outline the ureter clearly and a
Holmium:YAG laser was then used to carefully cut the
abnormal ureteral wall in a continuous manner from a
caudal to cranial direction. The laser treatment was
completed level with the right ureteral orifice (Figure 4).
Outcome
The patient had an uneventful recovery from the CLA
and was discharged from the hospital.
The presence of chronic bilateral nephropathy was
thought to be either a developmental abnormality or to
reflect chronic pyelonephritis. Despite the negative
urinary culture and the absence of pyelectasia, the
history of ectopic ureter and recurrent UTI raised the
suspicion for pyelonephritis, prompting treatment with
a prolonged course of antibiotics.
Weight loss was recommended, to help with
perivulval conformation and improve all-round health.
It was discussed with the owner that if weight loss
alone failed to improve perivulval conformation,
surgical resection of excess perineal skin could be
pursued if recurrent UTI remained a persistent feature.
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15
CONTRIBUTE A CLINICAL CONUNDRUM
If you have an unusual or interestng case that you would like to share with your
colleagues, please submit photographs and brief history, with relevant questons
and a short but comprehensive explanaton, in no more than 1500 words to
companion@bsava.com
All submissions will be peer-reviewed.
Figure 3: Urethroscopic image showing the left ectopic
ureter opening abnormally within the urethra (asterisk
marking the urethral lumen and the arrow identifying the
ectopic ureter)
Figure 4: Cystoscopic image of the ectopic ureter following
CLA. The ureteric catheter is still in place
What possible complications should you
make the owner aware of?
Following any treatment for ectopic ureters there
remains a risk of persistence or deterioration of urinary
incontinence. In this case, concurrent signs
compatible with USMI were not present, although this
would not preclude a future diagnosis of this condition.
Furthermore, an underlying pyelonephritis can result in
or exacerbate renal damage, which would be
detrimental to the outcome of the patient.
Follow-up
One month following CLA the patient developed a UTI
which was resistant to amoxicillin/clavulanate and she
was treated with a 6-week course of enrofloxacin. Two
months after discharge the patient was continuing with
her weight loss and had a body condition score of 6/9.
There had been no further episodes of inappropriate
urination and there was minimal urine staining of the
perivulval hair.
Four months after discharge the patient was
diagnosed with a further UTI and after treating the UTI
it was elected to commence therapy with
phenlypropanolamine to optimise control of a possible
low-grade persistent urinary incontinence and to
perform vulvuloplasty to improve the patients
conformation. Since surgery the patient has had no
further episodes of inappropriate urination or UTI,
although some degree of perivulval hair staining has
persisted. Following the diagnosis of CKD it is
necessary to initiate regular monitoring of the patient
with the frequency dependent on IRIS stage.
Biochemistry, urinalysis, urine protein:creatinine ratio
assessment and blood pressure measurement are
performed at 6-month intervals in this patient. n
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How to approach the
dog with neck pain
N
eck pain or cervical
hyperaesthesia is a common
presenting sign in canine patients
and can be associated with many
different conditions. As with all other
neurological conditions, a systemic
approach to the patient with cervical
hyperaesthesia is essential, with a general
physical examination giving important
information for example about pyrexia,
enlarged lymph nodes or swollen and
painful joints.
Cervical hyperaesthesia is an important
factor when considering the most likely
differential diagnoses in cases that are
showing neurological deficits. It is
important to remember that the severity of
the hyperaesthesia is not predictive for the
disease nor its potential severity.
Causes
Anatomical structures that can be
responsible for cervical hyperaesthesia
are vertebrae, meninges and nerve roots.
Spinal cord parenchyma does not contain
nociceptors and therefore purely
intramedullary lesions do not cause signs
of cervical hyperaesthesia. Other
potential sources of the cervical
hyperaesthesia are the vertebral
articulations and surrounding soft tissue
in the neck area. Any condition affecting
one of these structures can produce any
degree of cervical hyperaesthesia.
An important cause of cervical
hyperaesthesia is intracranial disease.
Space-occupying intracranial lesions can
stretch the meninges and therefore
produce pain. Lesions in the thalamus can
produce the signs of pain, so-called
thalamic pain. With intracranial lesions
other neurological signs are usually
present and can either be observed by the
owners or are detected on neurological
examination. It should be mentioned that
cervical hyperaesthesia is very commonly
persistent, however intermittent the
clinical signs may appear. Occasionally
these cases are misdiagnosed as having
epileptic seizures especially when the
clinical signs are very paroxysmal.
Clinical signs
The clinical signs of cervical
hyperaesthesia are often very obvious
(Figure 1), although in many cases only
thorough neurological assessment, neck
palpation and assessment of neck
movement can pick up signs of
hyperaesthesia. Patients with nerve root
involvement can also show signs of
lameness of the thoracic limb or may hold
the limb up (nerve root signature;
Figure2) as well as neurogenic muscle
wastage on the affected limb.
Affected patients are reluctant to bend
their neck and will turn their body instead.
They are reluctant to flex the neck ventrally
to eat or drink from their bowl. It is not
uncommon that the owner described
inappetence. If neurological deficits are
present, the most common clinical signs
are gait abnormalities or tetraparesis. Very
specific signs are usually seen with the
Chiari-like malformation and associated
syringomyelia. These clinical signs are
attributed to the neuropathic pain
syndrome: phantom scratching and
spontaneous yelping are the most
commonly encountered.
Occasionally patients with
thoracolumbar pain appear to have low
neck carriage as they shift their weight to
the thoracic limbs. This changes posture
and it can often be mistaken for a sign of
cervical hyperaesthesia. Very rarely,
painful orthopaedic diseases of scapula,
shoulder and proximal humerus can mimic
cervical hyperaesthesia without obvious
lameness. If the patient shows signs of
lameness, orthopaedic conditions should
be excluded before evaluating for causes
of nerve root signatures.
Viktor Palus,
of Dick White
Referrals,
talks us through
this painful
presentation
Figure 1: A Miniature Schnauzer with C3C4
intervertebral disc extrusion, showing the
typical posture associated with cervical
hyperaesthesia
Figure 2: A Lurcher with C6 vertebral body
tumour showing a nerve root signature
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Diagnosis
Definitive diagnosis in these cases is
usually very difficult to achieve without
further specialised investigation. However
a few hints can be found from careful
history taking and on physical examination;
as a result the diagnosis can be very
straightforward in some cases. Anexample
of such a case would be a subcutaneous
or subfascial abscess in the cervical area
due to previous subcutaneous injection,
migrating foreign material or previous dog
or cat bite wounds.
Thorough palpation of the cervical
area should be performed to rule out soft
tissue masses; also palpation of the
temporomandibular joint and periaural
area needs to be performed. Thoracic
lesions, for example pleuritic pain, can
also present in a similar way to cervical
hyperaesthesia.
The differential diagnosis list should
be formed before further investigation is
undertaken. Table 1 lists the most
common differential diagnoses associated
with cervical hyperaesthesia. A logical
approach to investigation is important in
these cases as some of them require
costly and specialised evaluation. For
example, if there is a suspicion of a
vertebral tumour spinal radiographs can
be useful but this is not true for cases with
suspected meningitis.
Haematology can be helpful in
narrowing down possible inflammatory or
infectious diseases. For example, cases
with steroid-responsive meningitisarteritis
(SRMA) can have very marked
neutrophilia, although caution is needed
as other inflammatory diseases cannot be
excluded on this basis. Biochemistry can
be helpful to confirm an inflammatory
process or raise the suspicion of bone
tumours or multiple myeloma that can
invade the vertebrae. However, results of
blood tests can be completely normal in
cases of a severe inflammatory process in
the central nervous system. Survey
radiographs can reveal marked osteolysis,
caused by bone tumours and the changes
associated with discospondylitis.
Radiography should be strongly
considered in cases of suspected spinal
fractures and atlanto-axial instability
(Figure 3), but should be performed with
extreme care. Myelography is an invasive
diagnostic procedure and should be
contemplated only in cases when the
surgical management can be pursued
under the same general anaesthesia.
Myelograms can reveal an extradural
compression (Figure 4), intradural
extramedullary compression of the spinal
cord or an intramedullary lesion in the
spinal cord.
Advanced imaging is preferable in
most cases of cervical hyperaesthesia
and magnetic resonance imaging (MRI)
is usually superior to computed
tomography (CT) as regards soft tissue
resolution. MRI and CT are non-invasive
diagnostic procedures and MRI can also
assess the soft tissue surrounding the
spinal cord.
Cerebrospinal fluid (CSF) analysis is
an important part of the diagnostic
work-up, especially if inflammatory central
nervous system causes are suspected.
Additional tests such as arthrocentesis
need to be considered, as dogs with
Neurological conditons
Meningomyelits (SRMA,
granulomatous meningoencephalits,
meningoencephalits of unknown
aetology, etc.)
Intervertebral disc disease
Chiari-like malformaton and syringomyelia
Cervical spondylomyelopathy
Atlanto-axial instability
Pathological vertebral fractures and
vertebral tumours
Discospondylits
Facet joint pain (DJD)
Polymyosits
Mid-thoracic spinal lesions
Intracranial lesion
Spinal cord haematoma or haemorrhage
Synovial cyst
Non-neurological conditons
Abscess in the sof tssue in the cervical
area
Otts media
Sof tssue tumour in the neck
Bicipital bursits
Polyarthrits
Temporomandibular joint or
oropharyngeal pain
Thoracic lesion, e.g. pleuritc pain
Proximal humerus or scapula lesions
Table 1: Differential diagnoses for cervical
hyperaesthesia
Figure 3: Lateral radiograph with mild flexion of
a 1-year-old Yorkshire Terrier. There is an
increased gap between the dorsal lamina of C1
and dorsal spinous process of C2. This is a
typical finding in atlanto-axial instability
Figure 4: Lateral myelogram of the cervical area
of 6-year-old English Springer Spaniel with
cervical hyperaesthesia and ambulatory
tetraparesis, showing the presence of an
extradural compressing lesion at the level of
C4C5. This was confirmed at surgery to be
extruded intervertebral disc material
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How to approach the dog with neck pain
immune-mediated polyarthritis can have
concurrent cervical hyperaesthesia and
an inflammatory picture on CSF analysis.
Urinalysis, urine culture or blood cultures
can be potentially useful in cases of
discospondylitis.
Common neurological causes of
cervical hyperaesthesia
Steroid responsive meningitis-
arteritis (SRMA)
This condition is also known under different
names such as juvenile polyarteritis
syndrome, necrotising vasculitis, aseptic
suppurative meningitis, Beagle pain
syndrome and several others. It can affect
any breed but medium to large breeds,
particularly Beagles, Bernese Mountain
Dogs, German Pointers, Weimaraners and
Nova Scotia Duck Tolling Retrievers, seem
to be predisposed to this condition.
The age of onset is usually between
6and 18 months but cases have been
reported in dogs as old as 7 years. The
major clinical signs are cervical
hyperaesthesia, stiffness, depression and
pyrexia. Two forms of this disease are
commonly observed. The acute form is
characterised by stiffness and pyrexia,
whereas the chronic form is commonly
associated with neurological deficits that
can be very severe, mainly in cases of
spontaneous subarachnoid bleeding.
The chronic form can rarely cause
obstruction of the normal cerebrospinal
flow and can produce obstructive
hydrocephalus. Extension of SRMA to the
brain has also been reported, though is
rare, and intracranial neurological signs
(various cranial nerve deficits, seizures or
vestibular signs) might also occur.
The pathogenesis of SRMA is
unknown, but it is likely due to
dysregulation of the immune system. This
hypothesis is supported by elevated IgA in
CSF and serum, increased CSF and blood
B cell:T cell ratio and increased levels of
interleukin8 in CSF. A neutrophilic
infiltration commonly targets the
subarachnoid space, arteries, spinal cord
and, uncommonly, the brain.
Peripheral neutrophilia with left shift is
commonly seen. Final diagnosis is made
on the basis of CSF findings and by
excluding other causes of cervical
hyperaesthesia. The CSF analysis usually
reveals severe neutrophilic pleocytosis
(Figure 5) and elevated protein content.
The neutrophils are usually not degenerate
and culture of the CSF is negative.
In the chronic form mononuclear
pleocytosis can be found. Measurement of
IgA from CSF and serum, as well as
measurement of C-reactive protein in the
serum, can be helpful in confirming the
diagnosis, but care must be taken with
interpretation as these parameters can be
elevated in other systemic inflammatory or
infectious processes. MRI is useful to rule
out other causes of cervical hyperaesthesia
and this is important from the therapeutic
point of view, especially if an infective
process such as discospondylitis is
suspected. Meningeal enhancement of the
spinal cord is commonly found on MRI in
cases with SRMA.
New MRI features (Figure 6) have
recently been identified in dogs with
suspected SRMA and most likely
represent secondary changes in the
adjacent paraspinal musculature due to
the inflammatory process in the meninges
and nerve roots.
Figure 5: CSF with marked neutrophilic
pleocytosis from a 13-month-old Bernese
Mountain Dog with SRMA. Note that the
neutrophils are not degenerate and there are
no signs of microorganisms
A
B
Figure 6: (A) Sagittal and (B) transverse STIR
images from a 1-year-old Border Collie with
severe cervical hyperaesthesia and pyrexia due
to SRMA. The images highlight increased fluid
content of the paraspinal cervical muscles,
findings very commonly associated with SRMA
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The prognosis is good, with long-term
remission seen in up to 80% of cases.
Treatment is long term and consists of
immunosuppressive corticosteroids. Other
immunomodulatory drugs such as
azathioprine can be used in refractory
cases or those that show severe side
effects from corticosteroid use.
Intervertebral disc disease
Cervical intervertebral disc disease is a
common disorder, especially of
chondrodystrophic dogs. It is very
common in small breeds, although any
breed can be affected. In large dogs, the
condition is very commonly a part of
cervical spondylomyelopathy, discussed
later. The mean age of small dogs with
cervical intervertebral disc problems is
about 6 years.
The clinical signs range from severe
acute or chronic cervical hyperaesthesia
and low head carriage to nerve root
signature or differing degrees of
tetraparesis. Extrusion of intervertebral
disc material is more common in small
breeds and protrusion is more common in
large breeds. C2C3 is the most common
site of the extrusion, especially in small
breeds, whereas large breeds commonly
have more caudal sites affected.
In the cranial cervical area extrusion
can be very prominent and the dogs
exhibit only cervical hyperaesthesia,
whereas with more caudal sites the
extrusion might not be that prominent and
dogs can have severe neurological
deficits. This is due to the larger vertebral
canal to spinal cord ratio in the cranial
cervical area. For this reason the spinal
cord does not need to be that severely
compressed in the cranial cervical area.
Cervical hyperaesthesia is usually very
severe with characteristic low head
carriage and spontaneous screaming
when only small movements of the head
are attempted. Interestingly, dogs with
neurological deficits do not show as severe
pain as the dogs without.
Survey radiographs very commonly
show no abnormalities with this condition.
However, narrowing of the intervertebral
space and presence of mineralised
radiopaque material in the vertebral canal
can be suggestive of intervertebral disc
disease (Figure 7). Myelography should be
performed, as a minimum, to confirm the
compression of the spinal cord or presence
of extradural lesion (see Figure4).
In some cases, especially when the
extruded material is located in the
intervertebral foramen, this can be difficult
to interpret correctly. Therefore CT, CT
myelography or MRI are superior in
localising the extruded site and the
extension of the affected area. MRI
(Figure8) especially is very sensitive and
a non-invasive method to diagnose
intervertebral disc disorder in dogs,
especially if the intervertebral disc
material is not mineralised.
Ultimately, treatment for intervertebral
disc extrusion is surgical decompression.
The method of achieving this is chosen
according to the position of the affecting
intervertebral disc material to the spinal
cord either ventral or dorsal
decompression. A ventral slot procedure is
very challenging to perform because many
peri- and postoperative complications can
occur. However, it allows removal of the
intervertebral disc material and provides
rapid resolution of the clinical signs. It is
therefore the preferred surgical option.
Dorsal laminectomy or cervical
hemilaminectomy are less commonly
performed unless indicated by a dorsal or
foraminal location of the extruded
intervertebral disc material.
Prognosis for surgically treated dogs is
excellent. If surgical treatment is not an
Figure 7: A survey radiograph of the dog in Figure 4. This radiograph
reveals narrowing of the C4C5 intervertebral space with radiopaque
material within the vertebral canal
Figure 8: A sagittal T2-weighted MR image of the cervical area of a
middle-aged Miniature Schnauzer with cervical hyperaesthesia. This
image shows an extrusion of the C2C3 intervertebral disc with a
deviation of the spinal cord dorsally
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How to approach the dog with neck pain
option then conservative management can
be tried, especially in cases with cervical
hyperaesthesia without neurological
deficits. Although successful in many
cases, the recurrence rate of the clinical
signs in dogs with conservative
management can be more than 30%. If
conservative management is undertaken,
then controlled exercise should be pursued
for at least 6 weeks. In addition, either
non-steroidal anti-inflammatory drugs or
low-dose corticosteroids with narcotics can
be used. If, however, there is a lack of
improvement or a progression of the clinical
signs in 12 weeks, surgical treatment
should be strongly recommended.
Cervical spondylomyelopathy
(Wobbler syndrome)
This condition is predominantly seen in
large and giant breed dogs. Dobermann
and Great Dane are classic examples of
breeds predisposed to this condition.
However, a very similar condition has been
recognised in Bassett Hounds and was
described in small breed dogs such as
Chihuahua and Yorkshire Terrier.
The most common presentation is
abnormalities in gait, though cervical
hyperaesthesia and low head carriage
can also be present. Care must be taken
to assess the gait correctly in these
cases because the pelvic limbs are
usually more severely affected than the
thoracic limbs, especially in cases with
caudal cervical lesions. This can lead to
a mistaken consideration that the
problem is either in the lower portions of
the spine or even in the hips.
Lameness of the thoracic limbs and
atrophy of the supraspinatus and
infraspinatus muscles is common when
there is a nerve root compression of the
one of the nerves of the cervicothoracic
plexus. Another common sign of nerve root
compression and neuropathic pain is
excessive licking and chewing of the
thoracic limb paws (Figure 9). Dogs that
have a lesion in the C1C5 spinal segment
usually have a floating gait in addition to
tetraparesis. In comparison, dogs with
C6T2 lesions show so-called two-engine
gait, with a short stride and stilted gait in
the thoracic limbs and a long-stride gait in
the pelvic limbs.
Pathogenesis is complex but stenosis
of the vertebral canal and compression of
the spinal cord or the nerve roots by the
intervertebral disc protrusion, ligamentum
flavum hypertrophy, enlarged articular
facets, vertebral anomalies and vertebral
instability are the main reasons for
development of neurological signs.
As with other neurological conditions
advanced imaging is superior in identifying
the exact structure that is responsible for
neurological signs. Survey radiographs
can reveal the degenerative changes but
these changes cannot be used to
determine the site and degree of the spinal
cord compression. Myelography or CT
myelography are more useful, although
linear traction views should be used to
identify the compression (Figure 10).
Stressed view studies should not be
performed as these can worsen the
neurological signs significantly. MRI can
assess not only the lesion but also the
effect on the spinal cord, and is less
invasive (Figure 11).
Figure 9: A 4-year-old Dobermann which was
diagnosed with cervical spondylomyelopathy.
The owners reported that the dog had been
chewing and licking his thoracic limbs
excessively since they had acquired him. This
sign can be due to the nerve root compression
often seen with this condition.
(Courtesy of Giunio Bruto Cherubini DECVN)
A
B
Figure 10: Lateral myelograms of a middle-aged
dog with progressive tetraparesis and cervical
hyperaesthesia. (A) Multiple sites of ventral
attenuation of the contrast column, more
apparent in the caudal cervical area, which
responded well to linear traction (B)
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Cervical spondylomyelopathy is a
chronic and progressive disease; surgical
treatment is therefore preferred. However
medical management can be tried in some
circumstances. Controlled exercise and
anti-inflammatory drugs can be used, but it
is important to monitor these patients very
closely, because in case of further
deterioration surgery should be strongly
recommended. Around 3050% of
affected dogs can be managed with
conservative treatment.
If surgical treatment is chosen, multiple
techniques have been described. Dorsal
decompression is preferred in cases with
dorsal or dorsolateral compression, and
ventral approaches with stabilisation are
recommended in cases with instability and
ventral compression (Figure 12). The
prognosis is worse for dogs with severe
neurological deficits but it appears that
about 80% of surgically treated dogs have
a good prognosis. There is a recurrence
rate of about 20% and it is therefore wise to
monitor the dogs after surgery for the rest
of their lives.
Chiari-like malformation and
syringomyelia
Chiari-like malformation is also known as
caudal occipital malformation syndrome.
Chiari-like malformation occurs due to
malformation of part of the occipital bone
decreasing caudal fossa volume. This
results in the herniation of the cerebellum
through or into the foramen magnum or
indentation of the cerebellum. This is more
complicated because there are other
potential structures that can alter the
normal caudal flow of the CSF through the
foramen magnum. Syringomyelia is a
presence of the fluid-filled cavity in the
parenchyma of the spinal cord; it is
commonly associated with Chiari-like
malformation but can be present alone.
Chiari-like malformation is very
common in toy and small breeds. The
most common breeds affected are
Cavalier King Charles Spaniels and
Griffon Bruxellois. The most common
clinical sign is pain or signs of neuropathic
pain syndrome. The affected dogs may
rub their face, chew their paws, or show
spontaneous screaming and so-called
phantom scratching. Less common signs
are scoliosis of the cervical spine,
tetraparesis and ataxia.
Facial paresis or other intracranial
signs can be present in severely affected
cases. Dogs of 6 months up to 10 years of
age have been reported to have this
condition, but the most common age on
presentation is around 3 years. Dogs can
be completely asymptomatic and this is
noted in a significant number of Cavalier
King Charles Spaniels.
Chiari-like malformation and
syringomyelia is known to be a hereditary
condition. It is also known that Cavalier
King Charles Spaniels have simply too
much brain parenchyma in the cranial
vault for their relatively small skull, which
causes overcrowding of the caudal fossa.
This affects the normal and smooth
caudal CSF flow, which becomes
turbulent. The altered CSF flow is
believed to be the main reason for the
development of syringomyelia in the
cervical spinal cord but also in more
caudal areas of the spinal cord and in the
syringomyelia, size and location of the
Figure 12: Postoperative
radiograph of the
cervical area of the dog
from Figure 11. Pins and
polymethylmethacrylate
were used to stabilise
the area
A
B
Figure 11: Sagittal T2-weighted MR images
of the cervical area of a middle-aged
Dobermann with progressive tetraparesis.
(A) Compression at the level of C6C7. The
compression is more severe from the
protruded and degenerated intervertebral
disc. From the ventral aspect, however, there
is also a mild compression dorsally, suspected
to be hypertrophied ligamentum flavum.
Note the hyperintensity in the spinal cord at
the level of the compression that can be due
to the chronic compression of the spinal cord.
(B) There is significant improvement of the
compression during the linear traction,
confirming instability in that area
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How to approach the dog with neck pain
Figure 14: Intraoperative picture of foramen
magnum decompression and partial C1 dorsal
laminectomy. The vermis of the cerebellum,
cisterna magna and medulla oblongata are
visible in the bone defect
syrinx are significantly associated with
the discomfort and pain.
Diagnosis is unfortunately difficult to
reach without MRI. However, it is
important to rule out other diseases that
can mimic the clinical signs, especially
otitis externa or media in cases of
scratching. It is crucial to rule out these
conditions by thorough otoscopic
examination. All the diseases discussed in
this review should be considered as
potential differentials and the work-up
should be tailored to rule them out.
Caudal fossa height to length ratios on
skull radiographs have been used to
predict Chiari-like malformation in Griffon
Bruxellois, with promising results. However,
MRI is the gold standard for assessing the
cerebellum and the size and extent of the
syrinx. MRI features are very characteristic,
with caudal fossa overcrowding or
herniation of the cerebellum through the
foramen magnum, kinking of the
brainstem and a syringomyelia in the
spinalcord (Figure13).
Treatment is still controversial and no
consensus has been reached amongst
neurologists, especially for cases with
severe neurological signs and pain. Either
medical or surgical treatment can be tried.
The aim of the medical treatment is to
decrease the production of the CSF and
establish a good analgesia protocol.
Furosemide or prednisolone are commonly
used, but other drugs such as omeprazole
and acetazolamide can also be employed.
Neuropathic pain is more complicated to
treat but gabapentin or pregabalin are
common drugs which are trialled.
Anticonvulsants, tricyclic antidepressants,
amantadine and non-steroidal anti-
inflammatory drugs are usually a part of the
analgesia protocol. The response to this
treatment is good but rarely complete and
as this is a chronic progressive disease the
treatment does not stop progression.
If medical treatment is not successful,
surgical treatment should be considered.
Foramen magnum decompression (FMD)
(Figure 14) is the most common procedure
to be performed. Other techniques have
been described with variable results. FMD
success rate is about 80% but recurrence
is not uncommon.
The prognosis depends largely on the
severity of the clinical signs on
presentation and response to treatment.
Itis important to mention that the BVA has
developed a screening and breeding
scheme for breeders of Cavalier King
Charles Spaniels. This is a logical
approach to breeding that will hopefully
decrease or eliminate the incidence of
inherited Chiari-malformation and
syringomyelia and should be strongly
encouraged amongst breeders.
Atlanto-axial instability
The anatomy of the atlanto-axial area is
very complex but, put simply, the dens of
the axis along with its ligament are
important to maintain cervical stability. This
joint does not have an intervertebral disc,
and ligaments largely maintain the position
of the vertebrae. If the dens of the axis
vertebra and/or the ligament are absent,
underdeveloped or malformed, instability
of the area occurs. This is most commonly
a congenital abnormality, although
traumatic fracture or damage to the
ligament can cause the neurological signs.
Clinical signs are most commonly seen
in immature animals but traumatic
instability can occur at any age. Toy and
small breeds with a predisposition are
Yorkshire Terriers, Chihuahuas and
Miniature Poodles; however cases have
also been reported in large breeds.
Figure 13: Sagittal T2-
weighted image of the cervical
area and the caudal fossa of a
4-year-old Cavalier King
Charles Spaniel with severe
cervical hyperaesthesia. There
is a cerebellar herniation
(vermis) through the foramen
magnum and syringomyelia of
the cervical spinal cord within
more dorsal localisation, this
is consistent with the
Chiari-like malformation
and syringomyelia
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Cervical hyperaesthesia is very common,
especially in dogs following trauma. The
neurological dysfunction can range from
mild proprioceptive deficits to tetraplegia
with respiratory compromise.
Occasionallyseizure-like episodes are
described, but these can be a
presentation of intermittent spinal cord
compression with a sudden cervical
hyperaesthesia and neurological deficits.
If this condition is suspected, the
examination of the cervical area should
exclude extension, flexion and lateral
movement of the neck, as this can
exacerbate the condition. In fact any young
dog with cervical hyperaesthesia should
be initially treated as having suspected
atlanto-axial instability.
The diagnosis can be confirmed on
survey radiographs (see Figure3) but
extreme care must be taken when
performing this on the anaesthetised animal
and intubation needs to be done very
carefully. Lateral views are the most useful,
as they can reveal a misalignment on mild
flexion. This must again be performed with
care. The ventrodorsal view is useful to
assess the dens and it is generally safe to
position the dog for this view. CT and MRI
can assess the area better.
The preferred treatment is surgical
stabilisation of the joint. Ventral and dorsal
approaches have been described,
however the ventral approach is the
treatment of choice. Ventral fusion with
pins, screws, plates and bone cement has
been described (Figure 15) and the choice
of technique is mainly dependent on the
surgeons preferences. The prognosis is
good if the animal survives 48 hours
postoperatively. The predictors of a
successful outcome are: age of onset, with
dogs younger than 2 years having better
prognosis; and severity and duration of the
neurological signs. Dogs with less severe
and shorter duration of neurological signs
usually have a better prognosis. Cervical
hyperaesthesia and ataxia can be still
present in some cases after successful
surgical treatment.
Medical treatment should only be
attempted in cases of acquired atlanto-
axial instability. Neck braces, appropriate
analgesia and a resting regime are
recommended. The prognosis can be
good, but concerns arise for long-term
prognosis and the possible complications
of braces, as well as sudden deterioration
with more dramatic consequences.
Conclusion
Canine cervical hyperaesthesia is a
common clinical presentation in veterinary
practice. A logical approach to these
patients can be very rewarding in
determining the underlying cause.
Thorough clinical and neurological
examinations are essential and to have the
list of differential diagnoses to hand can
make it easier for the clinician to make
correct decisions for further investigation
or the necessity of referral. Rapidly
progressing disease with severe
neurological deficits should be considered
an emergency, but with appropriate
diagnosis and treatment these cases can
have very successful outcomes.
Figure 15: Lateral
postoperative radiograph of
a young Cavalier King Charles
Spaniel with atlanto-axial
instability. Four pins and
polymethylmethacrylate
have been used to stabilise
the area
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T
he Small Animal Veterinary Surveillance
Network was at BSAVA Congress for the first
time this year. Visitors were able to experience
the demo version of the SAVSNET system and
to talk to members of the team about how their
practice can be involved.
Delegates were able to get details about all
aspects of the project from the people at the heart of
SAVSNET Professor Susan Dawson, Dr Phil Jones,
Dr P-J Noble and Dr Alan Radford were joined by
Suzanna Reynolds, Tarek Menacere and Fernando
Snchez-Vizcano Buendia.
What will it mean in practice?
There is a growing awareness of SAVSNET amongst
the profession and now that the project is really taking
off, visitors to the stand at Congress were keen to
know more about how the data collection will work and
about the aims and objectives for the coming year.
Sothe demonstration version of the SAVSNET
questionnaire was a real success, showing people that
taking part in SAVSNET would generally add just a few
seconds to consultation time, and that in only about
1in 15 consultations would a full survey be launched
which in itself is also not an onerous task.
The demo showed that even when a full survey is
launched, it takes only 1025 seconds from start to
finish. This is of course very important for busy vets in
practice the SAVSNET philosophy has always been
to make participation in the scheme as easy as
possible and to combine it with feedback to practices
in the form of benchmarking data. Being involved in
the scheme will not be difficult, but it will be valuable
to your practice, and to the profession.
Team talk
A new team of staff has been employed to provide a
strong infrastructure to SAVSNET, and it was the first
time some of them had attended BSAVA Congress.
Tarek Menacere is the new Database Developer; he
was struck by the number of people there and the range
of exhibitors. Fernando Snchez-Vizcano Buendia is
SAVSNETs new epidemiologist, just back from his part
in organizing the Society for Veterinary Epidemiology
and Preventive Medicine (SVEPM) conference in
Madrid. He was impressed by the organization and
thegood mix of business and academia.
Project Co-ordinator Suzanna Reynolds is a
qualified vet and so has attended BSAVA Congress
many times as a delegate when working in small
animal practice. However she found the experience
very different as an exhibitor: The atmosphere
amongst the exhibitors was fantastic. When we arrived
everything we needed had been delivered and once
we collected our lead retrieval device, we set up the
stand and were ready to go. I thought that there might
be quiet times outside of the breaks, but the reality is
that there is a constant swirl of delegates its a
brilliant networking occasion.
At Congress, delegates got to meet the team
from the Small Animal Veterinary Surveillance
Network and found out just how important
this project could be to the profession. The
event also saw the launch of the new website
which will help you find out how to get
involved and keep informed
From left: Susan Dawson, Fernando Snchez-Vizcano Buendia, Andrew Ash, Philip
Jones, Suzanna Reynolds, Alan Radford, Sally Everitt
All go for SAVSNET
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Working towards welfare
Fernando Snchez-Vizcano Buendia Epidemiologist
Born in Murcia, Spain, Fernando graduated in Veterinary Science
from the University of Murcia in 2005. The following year he spent
seven months training in Epidemiology and Preventve Veterinary
Medicine at the Complutense University of Madrid (UCM).
Fernando spent the next four years in the Animal Research and
Technology Center of Valencia (CITA-IVIA) working on his PhD developing
epidemiological models to analyse the risk of entry of highly pathogenic avian
inuenza virus and Newcastle disease virus into Spain. During his PhD, Fernando
spent three months in the Veterinary Clinical Sciences Department of the Royal
Veterinary College (RVC). Since obtaining his PhD he has worked as a post-
doctorate researcher in the VISAVET group at UCM. Looking for new challenges
brought him to his new role. SAVSNET will allow the monitoring of spatal and
temporal trends of animal and zoonotc diseases and syndromes in UK, which
provide valuable informaton in terms of early detecton and more cost-eectve
control of expected and unexpected health-related events.
Susan Bolan Administrator
Susan has joined SAVSNET afer spending a signicant period
working for the NHS. She was initally involved with processing and
reportng of waitng list statstcs for the Regional Health Authority.
Following a career break she returned to Wirral Hospital Trust,
taking on secretarial and administratve roles to support managers
and consultants in a variety of disciplines. She looks forward to using her
experience to drive the SAVSNET project forward and to engaging with the
veterinary profession. Susan hopes that joining the SAVSNET team will allow her
to diversify somewhat; having dealt solely with the human populaton previously,
it will be interestng and challenging to build up knowledge about domestc small
animals. Shes denitely a cat person, being owned by two at present.
Tarek Menacere Database developer
Tarek graduated from the University of Liverpool in 2006 with a
rst-class degree in Computer Science. He worked at Lancaster
University within the Security Lancaster research group, and for
the last ve years he has been developing sofware for the use of
security groups in the areas of decepton, insider threat and
linguistc analysis. He has been in charge of successfully delivering sofware for
projects totalling over 700,000 worth of investment and is now keen to take up
the challenges of making data accessible and useful with SAVSNET: This current
project is an ambitous one that has a number of challenges. It has taken, and will
contnue to take. Im condent we can do it, Im really motvated by the
opportunites the SAVSNET project will create to revolutonise the industry for
the benet of all.
Shared enthusiasm
The enthusiasm and dedication of the SAVSNET team
was easily caught by delegates, many of whom went
straight to their practice management software
providers requesting that their software be made
SAVSNET-compliant. The attending press were also
keen to pick up the SAVSNET story; a media briefing
allowed journalists to talk to the team, and Alan
Radford gave a talk about SAVSNET in the Exhibitors
stream.
IT links
It is important to have the involvement of practice
management software providers, and during Congress
SAVSNET entered into an agreement with VetSolutions,
the makers of RoboVet software, to develop and test
their standard software tools. Importantly, these tools
will subsequently be made freely available to all PMS
providers to make their own software SAVSNET-
compliant.
More online
With a new website launched at Congress,
www.savsnet.co.uk is a great place to start if you
want to know more about the project or the people.
As more and more data are produced, the website
will no doubt become a favourite on veterinary
browsers across the UK. So for more information
about SAVSNET and to contact the team visit the
website or call 0151 795 6005.
All go for SAVSNET
As well as the academic team led by Dr Alan Radford, the Small Animal
Veterinary Surveillance Network will have a core team based at the
University of Liverpool who will handle requests for informaton and
manage the day-to-day running of the project. Suzanna Reynolds has been
in post as Project Co-ordinator since July 2012, and she has recently been
joined by the rest of the new team.
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Cost of illness can
make you sick
I
n the current economic climate most businesses
have to save money and cut costs wherever
possible, and of course veterinary practices are not
immune from this. However it seems that one huge
cost to business is often largely ignored by UK
employers that of long-term sick leave.
According to research by the Centre for Economics
and Business Research*, the bill for long-term
sickness leave costs businesses in the private sector
3.1bn per year. The bulk of the cost mainly comes
from companies own sick pay policies, in cases where
employers are providing full pay to the absentee for a
set number of weeks, followed by a period of half pay.
Add to this the cost of replacement staff salaries,
recruitment and training for replacement workers and
the overall loss of productivity, and long-term sickness
leave becomes an expensive business.
In many cases businesses are either unsure of
their responsibilities in terms of sick pay obligations, or
just continue to pay those who are off sick long-term
despite their contributing nothing to the profitability of
the business. In other cases, businesses treat
employees circumstances on a case-by-case basis;
meaning that some may benefit more than others,
depending on the situation. In either case, the cost to
the business can be extensive.
Planning
Sickness policy planning should be a key part of
managing your business risks. By taking out an
income insurance plan, an employer turns a potential
unbudgeted loss into a fixed monthly cost this means
for a set amount per month, the possibility of a
business paying out unscheduled sick pay for an
unknown period of time is eliminated.
PG Mutual offers BSAVA members and their staff
tailored income protection cover to suit their needs
and budget. This means that for a monthly amount, a
business takes away the risk of spending thousands of
pounds on staff sick leave, as well as gaining the
reassurance that they have a fair and appropriate staff
sickness policy in place.
Self-employed
If you are self-employed, and provided your N.I.
contributions are up to date, then you do not qualify for
statutory sick pay but instead would have to apply for
Employment Support Allowance, ESA. Providing that
you qualify the level of ESA is currently set at 71.70
per week resulting in a significant drop in income. With
EAP comes a degree of qualification that the state can
use to ascertain whether an individual really isnt fit
enough to work. This would potentially require a
claimant being checked out by an independent doctor.
With little or no help from the state and so many
people now in a position of little assistance from their
employer, Income Protection can be utilised to provide
security to protect their own and their familys lifestyle.
The BSAVA has negotiated a 20%discount for its
members and their staff for the first three years cover

.
Visit www.pgmutual.co.uk/Quotation and enter
BSAVA12 or call 0800 146 307. n
Benefit more
Your benefit package continues to grow with the
launch of the new legal helpline in 2013. BSAVA
has also negotiated a range of discounts and
benefits for its members with other providers. For
more information visit the Benefits section under
Membership at www.bsava.com
50 Marks & Spencer
voucher
New PG Mutual members are being offered
50Marks & Spencer vouchers if they join by
30June 2013. It is easy to apply online at
www.pgmutual.co.uk and remember that PG
Mutual will not take any premiums until you are
ready to start your policy.
*Telegraph.co.uk June 2012

Please note this ofer is subject to PG Mutuals terms and conditons,

applies to new PG Mutual members only and excludes uplifs. It cannot be
used in conjuncton with any other ofer, and expires 31 December 2013.
Mike Perry, CEO of PG Mutual, who offer
a discount to BSAVA members, explains
how to keep your practice safe from the
cost of long-term sickness absence
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This talk was just one of the
many PetSavers actvites at BSAVA
Congress. As well as talking to
delegates at their stand on the
Balcony in the NIA, they also raised
nearly 8,000 thanks to the cyclists
on the Vtoquinol stand and the
generosity of revellers at the
Petplan awards and at the
BSAVA Banquet.
For more informaton about
PetSavers and the studies
it funds please visit
www.petsavers.org.uk
or email
info@petsavers.org.uk.
Passive smoking
and pets
Questioning clients about their cigarette
consumption should become a normal part of a
routine veterinary consultation because of the
potential impact of secondary smoking on the pets
health, according to leading oncologist Clare
Knottenbelt during a PetSavers presentation to the
press at BSAVA Congress
P
rofessor Knottenbelt from Glasgow
University has recently published a
study demonstrating a correlation
between the levels of nicotine in a
dogs fur and its exposure to cigarette
smoke in the home.
The project, funded by PetSavers,
was prompted by evidence that tobacco
smoke increases the risks of lung and
nasal cancers in dogs and of lymphoma
in cats. However, proving the link is
difficult because smokers consistently
underestimate the numbers of cigarettes
that they consume. So the research was
necessary to provide objective data on
the extent of the pets exposure to their
owners smoke.
Not surprisingly, the study
demonstrated that dogs in non-smoking
households had very low levels of nicotine
incorporated into their fur compared with
doctor. I hope that we can encourage them
to say that this is the year I am going to
give up cigarettes for the sake of Fluffy.
Making it work in practice
Philip Lhermette, former PetSavers
Chairman, noted, As a vet in first opinion
clinical practice I often come across
diseases in dogs and cats that I feel sure
are exacerbated by their owners smoking.
It is difficult to discuss an owners
personal habits in a consultation,
especially as Icould never prove any link
between second-hand smoke and animal
disease. Clares work has opened the
door to many more studies in this area
and will certainly help me be more open in
discussing the possible effects of
second-hand smoke on pet cats and
dogs from a scientific standpoint. With
better client awareness of this problem
animal welfare will be improved and
hopefully owners may be more inclined to
give up smoking themselves which can
only be good for their own welfare.
Petsavers is proud to be
associated with such a
worthwhile project.
animals owned by regular smokers. A third
group of pets owned by smokers who only
smoke outside the house had intermediate
levels of nicotine in their coat.
Many owners have never thought about
the possible effects of their habit on their
pets. So it is extremely distressing for them
to be told that a pets cancer may be a
result of secondary smoking, Professor
Knottenbelt explained. It was important
then to try to persuade the owners to give
up smoking at a much earlier stage.
More work to do
In the next phase of the study, the
researchers will be sending
questionnaires to veterinary
surgeons and nurses, asking
them how frequently the effects
of smoking are discussed
during consultations with pet
owners. Clare says she wants
to encourage veterinary staff
to tell clients about the
damage they may be causing
to their pets health.
In her experience, Professor
Knottenbelt said owners may be
more willing to take health advice
from their veterinary practice staff
than from their own GP. Many of our
clients have a much closer bond to
ourselves than they have with their Clare Knottenbelt and Philip Lhermette
27 PetSavers June.indd 27 16/05/2013 16:38
28
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companion
New standards for
global pain
management
and nutrition
launched by WSAVA
at BSAVA Congress
During this years BSAVA Congress, the
WSAVA announced global initiatives aimed at
improving the standard of pain management
provided to companion animals globally and
at enhancing understanding of the importance
of nutrition in health and welfare
Global Pain Treatise
The Global Pain Treatise is a downloadable, practical
resource providing pain management protocols for a
wide range of conditions and drug availability,
designed to assist practitioners around the world. The
Treatise has been researched by the WSAVAs Global
Pain Committee (GPC), chaired by Karol Mathews of
the University of Guelph, Canada, and is expected to
be of value to all veterinarians around the world. It will
be available to download from the WSAVA website and
has been submitted for publication in the Journal of
Small Animal Practice.
The Global Pain Treatise is the product of a vast
body of global research and expertise and is an
effective tool for all veterinary practitioners. The WSAVA
believes it to be a great step forward in the effective
management of pain and urges all veterinarians to read
it and share it with their colleagues.
Commenting on its work, Dr Mathews said:
Weknow that pain occurs more commonly than it is
treated, which makes it even more important that we
engage veterinarians globally to recognise, anticipate,
alleviate and terminate pain.
Following the launch of the Global Pain Treatise,
the GPC will focus on the development of a global CE
programme, as well as lobbying at a regional level to
help veterinarians gain access to pain management
medication in countries where there is a limited
selection. It will, for instance, seek approval for
veterinary analgesics available in many other countries
to be adopted without further local trials, and to work
with local veterinary associations and regulatory
agencies to obtain government-controlled drugs.
Global Nutrition Toolkit
This is a suite of nutrition tools developed by the
WSAVAs Global Nutrition Council following the launch
of its global nutrition guidelines in 2011 (published in
Journal of Small Animal Practice). They include
practical aids for the veterinary healthcare team and a
range of educational materials for pet owners. The
non-branded toolkit contains the following materials:
n A document outlining the calorie requirements for
healthy dogs
n A document outlining the calorie requirements for
healthy cats
n Nutritional assessment checklists (both quick and
extended versions) which can be completed by the
veterinary healthcare team and pet owner
n An advice sheet for owners searching for nutritional
information on dogs and cats online
n An advice sheet for owners on selecting the right
food for their dog or cat
n A hospitalised patient feeding guide
n A nutrition monitoring chart for hospitalised dogs
and cats
n A body condition score chart. Karol Mathews
2829 WSAVA News June.indd 28 16/05/2013 16:38
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29
Fun(d) Run, which proved such a success
that it will be a regular feature at future
Congresses! Finally, it was also the
occasion to welcome our first veterinary
nursing association member the New
Zealand Veterinary Nursing Association.
Engaging with veterinary nurses will only
strengthen our global community.
On a personal note, for a country which
is still recovering from the devastating
effects of the 2011 Christchurch
earthquake which I witnessed at first hand,
New Zealand did us proud. I extend our
warmest thanks to Pieter and his team.
WSAVA Honorary Secretary Siraya
Chunekamrai adds: Each World
Congress is different and what struck me
about Auckland was that the laid back,
happy character of the New Zealand
people really shone through. The
The toolkit is available to download at
www.wsava.org/nutrition-toolkit. Commenting,
GNC co-Chair Lisa M Freeman said: Research
shows that more than 90% of pet owners would like
nutritional advice but fewer than 15% feel they receive
it. In some parts of the world, pet malnutrition remains
a major challenge, while in many other countries, pet
obesity is an increasing problem. In addition, there is
confusion about optimal nutrition because there is now
so much conflicting and inaccurate information
available online. Our Nutrition Toolkit is designed to
help the veterinary healthcare team address nutrition
at every patient visit and to advance the central role of
the veterinary healthcare team as the expert source of
nutrition information. n
Denmark to host World Congress 2017
The Danish Small Animal Veterinary Associaton (DSAVA)
has won the bid to stage the 2017 WSAVA World
Congress. The Congress will take place at the futuristc
Bella Sky Conventon Center, just outside Copenhagen.
President of the DSAVA and WSAVA Assembly
Representatve Dr Karina Ryborg says: World Congress is
where veterinarians from around the world come together
to infuence the future of our profession. We want to help
lead it in a positve directon so were very excited to hear
that wed won.
We will focus on key issues such as One Health and
antbiotc resistance. We are looking forward to welcoming
veterinarians from all over the world and will strive to
create a Congress which they wont want to miss!
A World Congress of firsts
F
rom the heart-warming Maori
welcome through to the closing
ceremony, it was a World Congress
of firsts. Our first visit to New
Zealand and we all fell in love with this
wonderful country! Our first fundraising
WSAVA President Jolle Kirpensteijn and others share
their reflections on a memorable World Congress
organisation of the whole event, from
the pre-Congress day right through to the
end, was also flawless right down to the
smallest detail. This was no mean feat with
1,350 vets and exhibitors from all around
the world to satisfy! Thank you to our
local hosts, NZVA-CAS for a truly
wonderful World Congress!
Peter Verhoek, Chairman of the Local
Organising Committee, comments: It was
four years in the planning and, in just four
days, we hosted WSAVA Congress. But
what a Congress it was! The CE was
exceptional and the speakers were
magnificent. The exhibitors added an
important dimension, showcasing many
exciting technologies and products. We
made sure that the learning and fun didnt
finish at 6.00 pm because thats when
delegates started to experience New
Zealands culture. We hope everyone left
thinking Wow what a fantastic country,
no wonder its the centre of the world!
Most importantly, though, we hope they left
with many fond memories! n
2829 WSAVA News June.indd 29 16/05/2013 16:38
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companion
Dr Freda Scott-Park qualified from the Royal Dick,
Edinburgh in 1979. She lives on a family farm on the
banks of Loch Lomond with her husband David and
their two children. Freda has been President of both
BSAVA and BVA and now combines her commitment
to the farm and family life with being Chairman of
TheLinks Group, a multi-agency interest organisation
that promotes the welfare and safety of vulnerable
children, animals and adults so that they are free from
violence and abuse. In April she gave a talk at
BSAVA Congress about the Domestic Abuse
Veterinary Initiative alongside her colleagues
Detective Inspector Linda Borland of the Violence
Reduction Unit and fellow vet Paul Roger.
the companion interview
Freda Scott-Park
Q
Tell us about your involvement
with The Links Group.
A
As BSAVA Public Relations Officer
Iwas sent off to a conference in
November 2001 called Forging
the Link. I was profoundly affected by
what Iheard that day, which built on the
work contained in the papers published by
Helen Munro and Mike Thrusfield in the
JSAP (MayAugust 2001), which coined
the phrase the battered pet and, further
described the link between animal cruelty
and abuse of vulnerable humans. The
main problem for me was that Id seen
these papers in JSAP and chosen not to
read them; firstly, because they made
uncomfortable reading; secondly, because
the injuries described in them were outside
my knowledge. It was only after attending
the conference that it began to dawn on
me that I had seen several kittens who had
fallen off the bed and broken their leg. It
took Helen Munro to point out that kittens
can fall out of tenement windows from a
great height, possibly fracturing their
mandible but they wont break their legs.
Food for thought; and I realised that I had
missed other incidents of non-accidental
injury and, beyond that, seen a couple of
cases of human injury consistent with
violence. It was after that conference
that The Links Group was started with
the support of Intervet (now MSD
Animal Health). The Links Group aims to
raise awareness of the well-researched
links between the abuse of children,
vulnerable adults and animals to all
professionals in the hope that agencies
will work together to help prevent related
cases from going undetected.
In the case of the Links Group it is
human and animal welfare that you are
seeking to champion there must be some
key challenges there for vets.
Members of the veterinary team may
occasionally be presented with animals
that have suffered non-accidental injury;
vets may also suspect that the owner is a
victim of abuse. Our responsibility lies
quite firmly with the animal but since vets
are often trusted individuals, they may find
themselves receiving information about
violence in the clients household
(disclosure) and find themselves in a
position to grasp the golden moment
that opportunity to extend some
compassion towards a victim of violence.
This single empathic gesture may be the
key to encouraging the victim to seek
help. Vets are often ill-prepared to cope
with this situation and often do not
understand the implications of the
disclosure. Members of the practice may
be faced with a victim (animal) and a
perpetrator the person responsible for
the abuse or the victim may have been
brought in by a third person, either acting
out of concern for the animal or under
30-31 Interview June.indd 30 16/05/2013 16:37
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31
duress from the perpetrator; they may be
a victim themselves.
What tools or guidance exist for vets
in practice?
As interest grew in The Links Groups work,
it became apparent that there was a gap in
practical reference materials to guide
veterinary staff on what to do when faced
with a potential case of non-accidental
injury. Often these cases appear in the
surgery late at night or over the weekend,
which means that sources of advice, like
the Royal College of Veterinary Surgeons
(RCVS), are firmly closed and unavailable.
The concept of a veterinary guidance
document was born and it was launched in
April 2012 as a consultation text, available
on The Links Group website. However,
absent from this document was an
effective practice protocol: a what to do
when faced with a disclosure about a
violent incident. It was at this moment that
a fortuitous meeting between The Links
Group and Medics against Violence took
place. Medics against Violence (MAV)
works from its Glasgow base and among a
host of initiatives that aim to combat violent
behaviours, it provides training to dentists
about domestic abuse. MAV uses a
protocol called AVDR (ask, validate,
document and report/refer) that guides
healthcare professionals through the
process of supporting a victim of domestic
abuse. This was the missing link from the
veterinary guidance and the two
complementary documents are now
available from either The Links Group or
MAV websites.
What are the challenges that face those
working within this area?
In the early days, the biggest challenge
The Links Group faced was being taken
seriously; many vets did not believe there
was a problem. Over the years, we have
learned to categorise vets into 3 groups:
those who dont see and dont hear;
those who see and hear but dont want to
know; and, finally, those who see and hear
and want to help. The last group is
increasing in number and it is this
momentum, along with encouragement
from the Veterinary Defence Society,
whose members contact them regularly to
ask for help, that has driven the work of
the Links Group forward.
How can vets in practice contribute in
situations where abuse is suspected?
No one should doubt the complexities of
deciding whether a situation (when faced
with an incident or a person giving rise to
concerns of non-accidental injury, violence
or abuse) warrants being reported. It will
be particularly challenging for young
veterinary surgeons to decide on the
correct course of action, particularly if
other members of staff, for example the
senior partner, do not believe there is
non-accidental injury or abuse. I would
urge practices to read and understand the
veterinary guidance document
Recognising abuse in animals and
humans. Every practice should have a
copy of Animal Abuse and Unlawful
Killing (Munro & Munro, 2008). Practices
should ensure that all their staff have
attended the Medics against Violence
training in AVDR, which will be held in
venues across the country with input from
members of The Links Group and others.
After the training, practices should choose
one member of staff (this may be a senior
veterinary nurse) to be responsible for
advising others in the practice when there
is a potential case of non-accidental injury.
The practice should also follow the
advice in the guidance for establishing
local connections to womens aid
agencies, the police and, of course, the
RSPCA or SSPCA.
Tell us about the work being done
with students.
I can take no credit for the excellent work
that is being done with our young vets of
the future. One of the continuing areas of
support from MSD Animal Health has been
to ensure that final-year students in 6 (out of
7) vet schools have the opportunity to learn
about non-accidental injury before they
graduate. The talks are provided as part of
ethics and welfare or within the professional
studies module and are now a regular
feature on the undergraduate timetable.
Although the talks were initially delivered to
final years, we now speak to 3rd and 4th
years so that they have an understanding of
non-accidental injury before they embark
on the main bulk of their EMS. To date, The
Links Group has not yet been welcomed to
Cambridge. Paula Boyden of the Dogs
Trust and Treasurer of The Links Group has
done sterling work introducing the difficult
concepts of non-accidental injury to
animals or vulnerable humans to our future
veterinary surgeons.
What single change would contribute
to a better understanding and approach
to the care of animals and people in
abusive situations?
Going back to our three types of vets, if
every member of the practice attended the
veterinary training day, then we could
become a profession that collectively
endorsed the mantra: We see, we hear
and we want to grasp the golden moment,
which could change the life of a victim
animal or human forever.
For more informaton about the
work of The Links Group visit
www.thelinksgroup.org.uk
I realised that I had
missed incidents of
non-accidental injury
and seen cases of
human injury consistent
with violence
30-31 Interview June.indd 31 16/05/2013 16:37
For more information or to order
www.bsava.com
BSAVA reserves the right to alter prices where necessary without prior notice.
Missed this new
Manual?
BSAVA Manual of
Exotic Pet and Wildlife
Nursing
The number of exotic and wildlife cases presented at the
veterinary practice has increased significantly in the past 10
years, with increasing expectations regarding level of care.
This Manual provides veterinary nurses with a greater
understanding of the nursing requirements of these species,
enabling them to modify and apply their skills to these cases.
WHAT THEY SAY
...a must-have text for any practce seeing
rst-opinion exotc cases, along with any
nurses or students studying for exotcs
qualicatons... VETERINARY RECORD
Got this in your
practice library?
BSAVA Manual of
Canine and Feline
Thoracic Imaging
Covers:
Radiographic anatomy and variations
Interpretive principles
Diseases and imaging findings
Introduction to radiography and radiology
WHAT THEY SAY
an invaluable resource for students, general practtoners,
residents and radiologists alike...a valuable additon to the
library of any practce where thoracic imaging is
undertaken... VETERINARY RECORD
BSAVA Publications
COMMUNICATING VETERINARY KNOWLEDGE
BSAVA Member Price: 45.00
Price to non-members: 69.00
BSAVA Member Price: 52.00
Price to non-members: 89.00
companion offerof the month
Exclusive offer for companion readers
call BSAVA on 01452 726700 and
quote companion offer HNT.
20% discount off member price
BSAVA Manual of Canine and Feline
Head, Neck and Thoracic
Surgery
Demystifies common surgical techniques
Focus on common conditions encountered in practice
Organ- and systems-based approach
Step-by-step Operative Techniques
Offer is available to BSAVA Members
only. Ends 30 June 2013. Free P&P on
telephone orders for UK and Eire
delivery; online rates of P&P apply for
overseas orders.
companion offer: 44.0035.20
Price to non-members: 69.00
On special offer
BSAVA Manual of
Ornamental Fish
2nd edition
An indispensable resource covering:
Husbandry and filter systems
Diseases by system and cause
Diagnosis and treatment
Anaesthetic systems and surgery
WHAT THEY SAY
a superb manuala must for all
veterinary practtoners who have, or
might have occasion to deal with sh
FISH VETERINARY JOURNAL
BSAVA Member Price:
57.00 30.00
Price to non-members: 85.00 50.00
32 Publications Advert June.indd 32 16/05/2013 16:36
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33
Letters from the Regions
Treating the pet
chicken
Always a popular speaker in the regions,
Victoria Roberts will deliver a practical course
at the West Midlands meeting on Tuesday
2July at 7.30pm and there will be a hands-on
demonstration of correct handling of hens.
Many more people are keeping chickens
now and obviously want them to have the same
comprehensive veterinary treatment as their
other pets. Certain prophylactic tasks are
important for all poultry, and good husbandry
is, of course, a vital element in maintaining the
health and welfare of chickens, whether small
commercial free-range units, pet hens in the
back garden or pedigree exhibition breeds.
Relevant husbandry and anatomy will be
clearly explained, and diseases and problems
in chickens will be covered. Topics include:
history taking, positive signs of health,
diagnostic tests, drug administration,
reproductive problems, common medical
conditions including external and internal
parasites, Notifiable Diseases, nutritional
disorders, poisons and toxins, anaesthesia
andsurgery, vaccination, emergency and
critical care.
For more information visit www.bsava.com
or email administration@bsava.com.
Calling all VNs in the South East
On Thursday 18 July 2013 the South East Region will welcome Emma Archer RVN from
the Animal Health Trust to come and speak about Anaesthetic emergencies. This topic
should be relevant to everyone, vet and nurse alike, as however experienced you are a
true anaesthetic emergency is always a heart-sinking moment.
Emma is an experienced speaker, who is passionate about training vets and nurses
to stay calm whilst identifying and tackling complications logically before they become
life-threatening. She will also go through the most up-to-date cardiopulmonary
resuscitation guidelines.
Surrey & Sussex and Kent Regions have merged together and as the new South
East Region we would like to encourage more vet nurses to become involved with
BSAVA. We would also love to see more students at our meetings. If you have any ideas
or requests for nurse CPD that you would like us to organise in future, then please get in
touch, or even join our committee and have a say in what we do.
Our evening events are currently held at Leatherhead Golf Club, Surrey, which is just
off Junction 9 of the M25. They start at 8pm with food provided from 7.30pm. Costs are
reduced for nurses: you can have 2 hours of CPD for 22 or just 10 if you are a BSAVA
member. See the website www.bsava.com for details, or to find out about the region
contact us at southeast.region@bsava.com.
Louise Smith
Made in the Midlands
The first ever meeting of BSAVAs new West
Midlands Region was held 3 January at the
Wolverhampton Medical Centre. We enjoyed
a full hot meal and then an excellent
presentation by Dr Eithne Comerford of
Liverpool University speaking about surgical
interventions for canine cranial cruciate
ligament rupture. I cannot say that this
controversial subject was made simple, but
the complexities of the variety of possible
surgeries was discussed in a useful and
entertaining fashion and the audience was
well satisfied.
David Godfrey
REGIONAL ORTHOPAEDICS
MEETINGS TO WATCH FOR
East Midlands have a course Patella luxaton-case
management optons on 10 July with Damian
Chase, and The evidence for/against surgical
and medical optons for the management of hip
dysplasia on 13 November with Mark Morton.
North West Region will oer Simple Orthopaedics
for Practtoners 19 June, and a Spinal Surgery
meetng on 12 November, both with Turlough
ONeill and aimed at general practtoners.
33 Regions June.indd 33 16/05/2013 16:36
34
|
companion
CPD diary
EVENING WEBINAR
Tuesday 25 June
20:0021:00
Current perspectives on FLUTD
Speaker: Jane Eastwood
Online
Details from administration@bsava.com
EVENING WEBINAR
Monday 5 August
20:0021:00
Management of lymphoma in
practice
Speaker: Mark Goodfellow
Online
Details from administration@bsava.com
July 2013
August 2013
EVENING MEETING
WEST MIDLANDS REGION
Thursday 6 June
Common corneal conditions and
the non-healing corneal ulcer
Speaker: Lorna Newman
Wolverhampton Medical Institute, New Cross
Hospital, Wolverhampton WV10 0QP
Details from westmidlands@bsava.com
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
SOUTH WEST REGION
Monday 17 June
Practical dentistry: extraction
techniques
Speaker: Peter Southerden
Bicton College, Devon
Details from southwest.region@bsava.com
EVENING MEETING
CYMRU/WALES REGION
Wednesday 5 June
Thoracic imaging: radiography
and beyond
Speaker: Paul Mahoney
The Unicorn Inn, Llanedeyrn Cardiff
Details from cymru.wales.region@bsava.com
DAY MEETING METROPOLITAN
Friday 7 June
Feline ophthalmology: a day to
remember
Speaker: Rick F Sanchez
The Kennel Club, 15 Clarges Street,
Piccadilly, London
Details from metropolitan.region@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
DAY MEETING NORTH WEST
Wednesday 19 June
Simple orthopaedics for
practitioners
Speaker: Turlough ONeill
Haydock Holiday Inn
Details from northwest.region@bsava.com
SOCIAL VISIT FROM BSAVA
PRESIDENT MICHAEL DAY
NORTH EAST REGION
Saturday 22 June
The James Herriot Visitor Centre
in Thirsk
Details from northeast.region@bsava.com
LUNCHTIME WEBINAR
Wednesday 12 June
13:0014:00
Anaesthesia update
Speaker: Liz Leece
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 17 July
13:0014:00
Controlling ectoparasites
Speaker: Emma Cook
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 10 July
13:0014:00
Cushings disease
Speaker: Rory Bell
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 19 June
13:0014:00
Perioperative feeding
Speaker: Nicola Ackerman
Online
Details from administration@bsava.com
EVENING MEETING
WEST MIDLANDS REGION
Tuesday 2 July
Treating the pet chicken:
including live chicken handling
Speaker: Victoria Roberts
Animal Care Department, Solihull College,
Blossomfield Road, Solihull B91 1SB
Details from westmidlands@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Wednesday 10 July
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
SOUTH EAST REGION
Thursday 18 July
Anaesthetic emergencies
Speaker: Emma Archer
Leatherhead Gold Club
Details from southeast.region@bsava.com
EVENING MEETING
SOUTH WEST REGION
Thursday 25 July
Oncology: practicalities
in practice
Speaker: Suzanne Murphy
Bridgwater Canalside Centre, Bridgewater
Details from southwest.region@bsava.com
34-35 CPD Diary June.indd 34 16/05/2013 16:35
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35
FECAVA EUROCONGRESS
25 October
Dublin, Ireland
Visit www.fecava2013.org or email
info@fecava2013.org for more details.
DAY MEETING
Tuesday 24 September
Collapsed canids and
floppy felids: are fluids always
the answer?
Speaker: Sophie Adamantos
BSAVA Headquarters
Details from administration@bsava.com
EXCLUSIVE FOR MEMBERS
Extra 10% discount on all BSAVA
publicatons for members atending any
BSAVA CPD event.
All dates were correct at tme of going to print; however, we
would suggest that you contact the organisers for conrmaton.
OTHER UPCOMING BSAVA CPD COURSES
See www.bsava.com for further details
BSAVA Educaton
Thursday 10 October
Ascitc alsatons, bradycardic boxers,
coughing cavaliers and pantng pugs:
everything you need to know about
canine cardiology
BSAVA Educaton
Friday 11 October
Haematological disorders in dogs from
pallor to pred
BSAVA Educaton
Saturday 12 October
Canine case-based liver and
pancreatc disease
South West Region
Tuesday 15 October
Feline geriatric medicine
East Midlands Region
Tuesday 15 October
Diagnosing and managing sh/reptle
diseases in practce
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
EVENING MEETING
NORTH WEST REGION
Thursday 19 September
Avian emergencies
Speaker: Molly Varga
Brockholes Nature Reserve, Preston
Details from northwest.region@bsava.com
EVENING MEETING
WEST MIDLANDS REGION
Thursday 3 October
Feline medicine: the evidence base
Speaker: Rachel Dean
The Barn Beefeater and Premier Inn,
Stratford Road, Hockley Heath, Solihull,
West Midlands B94 6NX
Details from westmidlands.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Thursday 19 September
Feline cardiology
Speaker: Virginia Luis-Fuentes and
JoannaDukes-McEwan
Hilton, Bristol (Bradley Stoke)
Details from southwest.region@bsava.com
DAY MEETING SOUTHERN REGION
Tuesday 24 September
Business/management (TBC)
Speaker: Alan Robinson
The Potters Heron Hotel, Ampfield, Romsey,
Hampshire SO51 9ZF
Details from: southern.region@bsava.com
DAY MEETING
Thursday 26 September
How to work up an oncology case
in practice
Speaker: Tom Cave
Yew Lodge, Kegworth
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 18 September
13:0014:00
GDV
Speaker: Sam McMillan
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 9 October
13:0014:00
Dealing with nasal tumours
Speaker: Jackie Demetriou
Online
Details from administration@bsava.com
September 2013
October 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 and 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 June.indd 35 16/05/2013 16:35
Did you know that pro-rata per day a full BSAVA member pays just 59p,
representing fantastic value for money, and other member categories
payconsiderably less.
Your BSAVA membership gives you access to a wide range of member-only
benets, many available 24/7 and accessible at the touch of a button.
What can you get today
for 59 pence?
So what can you get today for 59 pence?
With BSAVA membership
the answer is quite a lot!
If you have any queries about
your membership or would like to
know more about a membership
service please contact
administration@bsava.com
or call 01452 726700.
Exclusive member-only area on the
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Journal of Small Animal Practice,
companion archives and much more
Four fabulous focused days of learning
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Catch up with any missed lectures with
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Keep your practice library up to date
with BSAVA publications
Free copy of the BSAVA Small Animal
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Topical articles and How to features
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Annual subscription to the
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