Companion March2012

Dog Ends
Passive smoking
and pets
P4
Clinical Conundrum
A vomiting Yorkshire
Terrier
P8
How To
Approach the
hypertensive patient
P12
The essential publication for BSAVA members
companion
MARCH 2012
Cutting through
reconstructive
surgery at
Congress
01 OFC March.indd 1 20/02/2012 10:46
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companion
Your views
sought

on the VSA
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
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ISSN: 2041-2487
Editorial Board
Editor Mark Goodfellow MA VetMB CertVR DSAM
DipECVIM-CA MRCVS
Senior Vice-President Grant Petrie MA VetMB CertSAC
CertSAM MRCVS
CPD Editorial Team
Ian Battersby BVSc DSAM DipECVIM-CA MRCVS
Simon Tappin MA VetMB CertSAM DipECVIM-CA MRCVS
Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS
Features Editorial Team
Caroline Bower BVM&S MRCVS
Andrew Fullerton BVSc (Hons) MRCVS
Mathew Hennessey BVSc MRCVS
Design and Production
BSAVA Headquarters, Woodrow House
No part of this publication may be reproduced
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of the Editor or the British Small Animal
Veterinary Association.
For future issues, unsolicited features,
particularly Clinical Conundrums, are
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Members can access the online archive of
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3 BSAVA News
Latest from your Association
46 Dog-end Dangers
Passive smoking and pets
7 PetSavers at Congress
Ways to help and ways to win
811 Clinical Conundrum
Vomiting in an unvaccinated terrier
1219 How To
Approach the hypertensive patient
2021 Progress in Pathology
Sue Murphy at Congress
2223 Browsing on the Balcony
Publications at Congress
2426 Reconstructive Surgery
Mike Pavletic at Congress
27 Bulgaria to Benefit at BSAVA
Congress
Our special guests for 2012
2829 VN CPS
New Nurse Merit Awards from
BSAVA
3031 Join the Scottish Congress Clan
All about Edinburgh this summer
3233 WSAVA News
The World Small Animal Veterinary
Association
3435 The companion Interview
Cecilia Gorrel
37 Focus On
Kent region
3839 CPD Diary
Whats on in your area
The Defra consultation on changes to the
Veterinary Surgeons Act 1966 is currently
underway and BSAVA is encouraging
members to have a voice
A
s you are probably aware, Defra is currently undertaking a consultation into the
membership and size of the RCVS Disciplinary Committee and Preliminary
Investigation Committee. At this stage the intention is to enact these changes
through a Legislative Reform Order (LRO) to the current Veterinary Surgeons
Act (VSA) rather than through a new Act.
Under the current system, RCVS Council both sets the standards for the profession
and, through its Disciplinary and Preliminary Investigation Committees, deals with any
possible breache s of those standards. The proposed amendment to VSA will separate
this overlap of functions, bringing the veterinary profession in line with other professions
(such as doctors, through the General Medical Council and dentists through the General
Dental Council).
It is suggested that these changes will:
Increase impartiality and independence in dealing with complaints
Increase public confidence in the complaints system
Bring the veterinary profession in line with best practice in professional regulation
Enable the statutory committees to hear cases more quickly
Reduce the likelihood of challenge on human rights grounds to a decision made by
RCVS disciplinary committees
Enable the RCVS to balance its public and professional interests better.
BSAVA is currently seeking members views on these proposals; please visit the
Consultation Section of the website (under the Advice tab at www.bsava.com) to
access more details.
Additional stock photography Dreamstime.com
Dimitri Zimmer; Jeffrey Van Daele;
Jose Manuel Gelpi Diaz; Kodo34;
Lars Christensen; Silkyk; Vedran Vidovic
02 Page 02 March.indd 2 20/02/2012 11:56
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R
esearchers from the University of Bristol have
recently published evidence that the
prevalence of Borrelia in the UK tick population
is considerably higher than previously thought.
Ticks were collected from dogs selected at random
from veterinary practices throughout the UK. The study
found that of 3534
dogs examined, 810 (22.9%) were carrying at least
one tick, and Borrelia was detected in 2.3% of ticks
sampled. Although the paper draws on the results to
discuss the risk of Lyme disease in humans, and does
not provide any new information on clinical Lyme
disease in dogs, the research findings do have
implications for veterinary practice.
Ticks are common on dogs even when the owners
dont realise it, so protection against ticks
throughout the year is sensible.
Lyme disease is also widespread, and in this respect
the study simply shows that ticks in areas that dogs
(and their owners) walk may carry Borrelia.
The study also demonstrates the ability of data
collected from first opinion practice to contribute to
research and surveillance. BSAVA hopes to build on this
through its involvement with SAVSNET.
Further details of the research and information about
Lyme disease is available online in the Advice section at
www.bsava.com.
A record-breaking
year at NAVC
N
AVC (1518 January, Orlando) is
one of the largest conferences that
BSAVA attends, and this years
event was hugely successful. Weve
always had a big welcome from our American
colleagues, but this year was record
breaking, with the team signing up over 100
new overseas members and the highest ever
Manual sales. The most popular titles were
Ultrasonography, Behavioural Medicine,
Ophthalmology and Oncology, with stock
selling out before the end of the event.
Our lecture-share programme with the
NAVC saw Christine Heinrich and Sally Turner
presenting ophthalmology lectures. These
talks were so popular that there was standing
room only and delegates were overheard
singing their praises. An all-round success,
and proof that BSAVA science has great value
across the pond.
BSAVA President Andrew Ash
presenting Dory Stricker, the 100th
overseas member joining at NAVC,
with the latest edition of the BSAVA
Small Animal Formulary
Sue Paterson, Chair of Education
Committee, reveals highlights of latest plans
W
hen the Education
Committee
assembled for their
first meeting of 2012 it
was decided that centrally
organised courses should be
given a separate and unique
identity to differentiate them from
regional events.
With the loss of the modular
medicine courses to the
phenomenally successful PG
Certificates, and the popularity of
the mini-modules over the last few
years, it was decided to make the
latter a strong focal point in the
new programme. These courses
will run over a three-day period
(some consecutive and others as
separate days) with a single
theme, and will cover both
medicine and surgical topics.
Two other new initiatives are
also to be explored in the 2013
programme. The first will be more
extensive use of the very popular
Turning Point interactive
equipment in which BSAVA has
invested. These handsets allow
BSAVA speakers to ask the
audience during the lecture.
Courses will be themed, with a
variety of different subjects
covering a wide range of interests.
The other new concept will be
split-day courses, where the
audience will be divided into two
tiers and lecturers will alternate
between two rooms. Delegates
can choose between different
species, medicine or surgery,
basic or advanced, etc. This new
concept will also allow BSAVA to
run courses for their new nurse
members to provide them with
high-quality CPD given by
veterinary experts in their fields.
For more information about
how you can make the most of
your CPD budget and
membership discounts email
courses@bsava.com.
Making
BSAVA CPD
stand out
Ticks
& Lyme
disease
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Dog-end
dangers
Professor Clare Knottenbelt
of the University of Glasgow
describes how PetSavers
funding helped her to carry
out research into the impact
of passive smoking on pets
04-06 Passive Smoking.indd 4 20/02/2012 10:42
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T
obacco smoke has long been associated
with ill health in humans, increasing the risk
of cancer and cardiorespiratory disease in
both smokers and those exposed to
environmental tobacco smoke (ETS) through
passive smoking. Health professionals have
campaigned to reduce the exposure of working
adults to second-hand smoke (SHS) culminating in
the ban on smoking in public places. There are
ongoing campaigns to make smokers more aware of
the effects that SHS can have on both adults and
children in the home and during car travel and to
encourage outdoor smoking.
Smoking and pets
To veterinary professionals it seems obvious that pets
in the household are also exposed to SHS. However, in
pets the development of ETS-related diseases has
been difficult to prove. Studies have used owner
questionnaires to establish ETS exposure, but
inaccurate owner estimates and differing pet
behaviours make these estimations extremely difficult.
Despite these difficulties, studies have shown that
in cats, exposure to ETS is associated with increased
expression of oncogenic p53 in oral squamous cell
carcinoma and an increased relative risk of lymphoma.
In dogs there is an increase risk of nasal and
paranasal sinus neoplasia and lung cancer, and
significant changes on bronchioalvealoar lavage in
dogs exposed to ETS. In addition, air nicotine
concentrations have been found to be higher in
households in colder climates, suggesting that SHS
exposure may be higher in Britain than in other parts of
the world.
Where to find the evidence
In humans, hair nicotine concentrations (HNC) are a
useful biomarker of ETS exposure over the previous
23 months. Dogs and cats have a similar rate of hair
growth to humans (extrapolated from Muller et al.,
1989) suggesting that HNC would reflect a similar
time frame of ETS exposure in pets. Closeness of
interactions between children and smokers are
thought to explain the 35% higher HNC seen in
children and this effect is likely to be mirrored by
many petowner relationships.
Since nicotine adheres to the surface of hair it is
likely that pets internalise more nicotine through
self-grooming. Exposure to ETS may therefore be
even greater in pets than in children. The main aim of
my study was to establish if we could use the HNC to
measure the amounts of ETS that pets are inhaling
and compare these to the levels found in children due
to passive smoking.
Finding a sample group
In order to perform the study we needed to recruit at
least 20 pets from both smoking and non-smoking
households. PDSA facilitated collection of samples by
University of Glasgow vet Jenny Hammond. Samples
were taken with owner consent from dogs and cats
presented to the PDSA PetAid hospital, Glasgow
Shamrock Street. In addition, staff and students from
the University and pet owners referred to the
University Small Animal Hospital provided hair
samples from their pets.
The samples were analysed by the University of
Strathclyde. Unfortunately the cat hair was not able to
withstand the washing techniques previously
described. However the Strathclyde team have
developed a new technique which will allow us to
perform a larger study into the hair nicotine in cats
once further funding is secured.
The study has allowed us to confirm that dogs are
exposed to similar amounts of ETS as adults and
children in a smokers home. It also suggests that
smoking outdoors can significantly reduce ETS
exposure. Interestingly, some dogs in non-smoking
households had nicotine in their hair, which could
reflect environmental pollution or exposure to ETS of
which the pet owner is unaware.
Thanks to PetSavers
This project was funded by a Clinical Research grant
from PetSavers, who saw the potential in the project
and its importance to developing a policy for reducing
the amount of ETS exposure in pets. It has already
sparked interest from the media, anti-smoking
charities, health professionals committed to reducing
passive smoking in children and disabled adults, and
of course the pro-smoking lobbyists.
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Dog-end dangers
The way ahead
My next goals are to perform a complete study in
cats to establish if their differing behaviour affects
the amount of ETS they are exposed to. I have
established links with the University of Aberdeen
and hope to be able to measure the small
particulate matter (the carcinogenic part of tobacco
smoke) that dogs are exposed to. Finally I would like
to conduct a larger scale study into the variable
levels of hair nicotine found in dogs from non-
smoking households, as the increase in outdoor
smoking may be influencing air quality for pets
outdoors too. Of course this will all depend on
getting funding in increasingly difficult times.
Practice and owner engagement
Medical health professionals are adopting a policy
of questioning all patients about their lifestyle (diet,
exercise, alcohol, tobacco and drug usage) at every
consultation. This policy is one which veterinary
surgeons broadly adopt, but too few of us address
the issue of ETS exposure despite in many cases
being able to tell as soon as the patient enters the
room that it comes from a smokers household!
The PDSA has been been trying to reduce the
amount of ETS that pets are exposed to by
encouraging pet owners to give up smoking through
various means such as posters and media articles.
They have also worked with a number of local health
authorities to support this important issue.
The Roy Castle Lung Cancer Foundation
(www.roycastle.org) are developing material trying
to encourage pet owners to consider quitting for the
sake of their pets or to smoke outdoors to reduce
ETS exposure for both children and pets. The problem
for many of us is that once the pet has developed a
disease that could be associated with ETS exposure
it becomes very difficult to raise the issue without
distressing owners.
Impact on health
Many of us have experienced the terrible effects of
smoking amongst family and friends and I am
confident that owners might be more willing to give up
smoking for their pet partly because they are more
likely to see the negative effects during their own
lifetimes. As veterinary surgeons we champion the
prevention of illness and disease, and I believe that we
should do more to encourage our clients to avoid
exposing their pets to SHS.
In my role as a Clinical Professor at the University
of Glasgows Small Animal Hospital, I meet many
owners who are desperate to do the best for their
pets and yet have not even considered the possibility
that exposure to ETS could harm their pet. I hope
that by raising this issue the profession can start to
ask the difficult questions of owners and thereby
ensure that pets under their care get the smoke-free
air that they deserve.
This article with references is available online at
www.bsava.com/companion
SUPPORTING PETSAVERS
Donatng to PetSavers ensures contnued funding into
clinical research projects such as this. If you are interested
in making a one-o donaton, or want to nd out more
about commited giving and leaving a legacy, please
telephone 01452 726723, email info@petsavers.org.uk or
visit the PetSavers secton at www.bsava.com.
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I
f you are coming to Congress please pay us a visit
and meet some of our dedicated volunteers who will
be ready and waiting to answer any questions you
might have about PetSavers.
Win a Kindle
PetSavers will be running a
competition at Congress
again this year, which you
can enter at the PetSavers
stand. All you have to do is
fill in an entry form available
from our stand or in the
exhibition vouchers booklet,
and answer a few simple
questions. One lucky
person will be in for the
chance of winning a brand
new Kindle!
Banquet raffle
For those who are lucky
enough to be attending the
Banquet, PetSavers will be holding a raffle and one
lucky person will win an original, signed, limited
edition print by Alex Echo. The print entitled
Carnival Skies (pictured) is worth an astounding
1,450 and has been kindly donated by Castle
Fine Art (www.castlefineart.com).
There will be raffle envelopes on each table into
which you can put your donation. Alternatively, if you
are not able to attend this years Banquet but would
like to make a donation, please visit us on our stand
where we will be happy to let you know how you can
best support the charity.
PetSavers in your practice
On the stand you will be able to find out about the
range of products that PetSavers has available,
including heated pads and protective collars.
Of course, even if you cant come to Congress
this year, you can shop online anytime at
www.petsavers.org.uk.
Volunteering for PetSavers
Its going to be great fun on the stand this year and we
would love you to come along and meet the team of
volunteers who make the charity work. In addition, if
you are interested in volunteering for PetSavers, this is
a great chance to find out whats involved. And if you
dont get chance to talk to us at Congress contact us
anytime via email info@petsavers.org.uk or call us
on 01452 726723. n
PetSavers
pleased
to see you
You cant miss PetSavers at
BSAVA Congress. The stand
greets you as you enter the
BSAVA Balcony in the NIA
Visit our website www.petsavers.org.uk to fnd out more
about PetSavers and what we do.
Carnival Skies
by Alex Echo
07 Petsavers.indd 7 20/02/2012 10:42
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Clinical conundrum
What is your problem list?
Rationalise the likely differential
diagnoses
Problems identified were jaundice, cranial
abdominal pain, vomiting and delayed
gastric emptying (vomiting food 8 hours
after eating). Dehydration and lethargy
were thought be secondary problems, but
needed addressing nonetheless.
Causes of jaundice (icterus) can be
considered in three groups:
n Pre-hepatic causes (haemolysis from
drugs/toxins/immune-mediated
disease/massive haematoma) were
considered unlikely because no
haematomas or bruising were
identified, mucous membranes were
pink and pulses were not bounding
making anaemia unlikely.
n Hepatic causes of jaundice include:
infection (canine adenovirus (CAV),
leptospirosis); acute or chronic
hepatitis related to drugs/toxins, breed
or idiopathic; neoplasia; cirrhosis;
hepatopathy secondary to sepsis,
pancreatitis or metabolic disease; or
amyloidosis. Leptospirosis was a
particular concern given access to the
urban pond; CAV was also considered
given the dogs unvaccinated status.
Chronic disease and neoplasia were
thought less likely given acute history
and obesity.
n Post-hepatic jaundice follows biliary
rupture or extra-hepatic bile duct
obstruction (EHBDO). EHBDO can be
intraluminal (inspissated bile/
cholelithiasis), intramural (cholangitis/
Eleanor Raffan of the University of Cambridge
invites companion readers to consider a case of
vomiting in an unvaccinated Yorkshire Terrier
cholecystitis, neoplasia, stricture) or
extramural (pancreatitis, neoplasia,
duodenal mass/foreign body).
Acute vomiting can follow
gastrointestinal obstruction (foreign body
ingestion, intussusception, neoplasia or
functional/motility disorders);
gastrointestinal inflammation (infection,
toxins, diet, inflammatory bowel disease);
gastrointestinal ulceration; peritonitis;
systemic disease (hepatopathy,
pancreatitis, azotaemia, sepsis, metabolic/
endocrine disease); vestibular disease/
motion sickness; or toxicity.
Delayed gastric emptying can follow:
n Reduced motility (secondary to
gastrointestinal inflammation,
pancreatitis, peritonitis, uraemia,
sedation, metabolic/electrolyte
abnormalities or primary motility
disorders/neurological disease).
n Pyloric obstruction (foreign body,
mural or regional mass, pyloric
hypertrophy/fibrosis/scarring); or
pylorospasm (stress).
Few differential diagnoses can be ruled
in/out from this clinical sign.
Abdominal pain is caused by many
abdominal problems (organ/peritoneal
inflammation, visceral stretch/
displacement, trauma) or referred
musculoskeletal pain. Focal cranial
abdominal pain was considered most
consistent with pancreatic, gastric, small
intestinal or hepatobiliary disease.
Overall the combination of vomiting,
jaundice and cranial abdominal pain
implicated hepatobiliary disease,
pancreatitis, duodenal foreign body/mass
or sepsis as the most likely differential
diagnoses. Other important rule-outs were
haemolysis, other gastrointestinal diseases
and metabolic abnormalities.
Case presentation
A 7-year-old, FN unvaccinated
Yorkshire Terrier presented with an
8-day history of inappetence,
lethargy and vomiting (several
times a day), preceded by
restlessness and retching. Vomitus
was froth or partly digested food
and vomiting occurred up to
8 hours after feeding. Urination was
normal. The dog was restricted to
the house and urban garden
containing a pond. There was no
history of dietary indiscretion or
toxin exposure.
Physical examination
The dog was dull but responsive
and mildly obese. Skin and sclerae
were yellow. Mucous membranes
were tacky, pink and yellow tinged.
CRT was 1.5 seconds. Dehydration
was estimated as 5%. The heart
rate was 140 beats per minute and
the respiratory rate was 60 breaths
per minute. Otherwise, thoracic
auscultation was unremarkable.
Pulse quality and temperature were
normal. Cranial abdominal
palpation elicited signs of pain. The
rest of the examination was
unremarkable.
08-11 CLINICAL CONUNDRUM.indd 8 20/02/2012 10:41
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What management and initial
diagnostic procedures would
you perform in this case to
narrow your differential
diagnosis list?
The dog was admitted to isolation and
barrier nursed in case of infectious and
zoonotic disease (leptospirosis/CAV).
Sampling was performed prior to
administration of fluid therapy to prevent
this confusing interpretation of PCV and
renal parameters.
Haematology was performed to
evaluate for evidence of pre-hepatic
causes of jaundice and inflammation/
infection. Serum biochemistry was
performed to investigate metabolic or organ
dysfunction as a cause or consequence of
disease. Amylase, lipase and canine
pancreatic lipase immunoreactivity (cPLI)
were specifically requested to evaluate for
evidence of pancreatitis.
Urine was obtained by cystocentesis
and dark-field microscopy performed to
look for spirochaetes. Following acquisition
of diagnostic samples, intravenous fluid
therapy was commenced to correct
dehydration (Hartmanns solution at
6 ml/kg/h for 12 h). There was no
advantage to delaying analgesia and
methadone (0.2 mg/kg i.m.) was
administered pending results.
Do the results of diagnostic
testing (Figures 1,2 and 3) alter
the differential diagnoses?
Haematology ruled out anaemia from
haemolysis, confirming the clinical
assessment that jaundice was hepatic/
post-hepatic in origin.
Hyperbilirubinaemia confirmed severe
jaundice. Marked increases in liver
enzymes were consistent with a primary
hepatopathy or cholestasis. Secondary
hepatopathy (hypoxia, metabolic disease,
sepsis) would usually cause lesser
elevations. The greatest elevation
Haematology Day 1 Day 3 Reference interval
WBC 9.29 22.70 6.0017.00 x10
9
/l
Neutrophils 7.8 19.3 3.011.5 x10
9
/l
Lymphocytes 0.7 1.6 1.04.8 x10
9
/l
Monocytes 0.7 1.4 0.21.5 x10
9
/l
Eosinophils 0.1 0.5 0.11.3 x10
9
/l
Basophils 0.0 0.0 0.00.5 x10
9
/l
RBC 6.52 5.86 5.508.50 x10
12
/l
Hb 16.2 14.7 12.018.0 g/dl
HCT 0.448 0.404 0.3700.550 l/l
MCV 69 69 6077 f
MCH 24.5 24.3 19.524.5 pg
MCHC 36 35 3237 g/dl
RDW 13.6 14.5 13.217.8 %
Platelets 375 410 175500 x10
9
/l
Figure 1: Haematology results
Biochemistry Day 1 Day 2 Day 3 Day 8 Post discharge:
2weeks 6 weeks
Reference interval
Sodium 139.7 145.4 146.2 148.7 148.6 147.5 135.0155.0 mmol/l
Potassium 3.24 3.81 3.68 3.51 4.27 4.65 3.505.80 mmol/l
Chloride 99.2 112.9 105.3 109.4 112.1 110.8 105.0120.0 mmol/l
Urea 6.0 5.0 7.9 7.0 7.8 3.38.0 mmol/l
Creatnine 38 46 78 98 103 45150 mol/l
Glucose 6.5 5.7 5.3 5.2 5.6 3.45.3 mmol/l
Total protein 71.7 65.1 69.9 71.6 62.6 60.080.0 g/l
Albumin 30.4 28.4 34.6 36.2 31.9 25.040.0 g/l
Globulin 41.3 36.7 35.3 35.4 30.7 25.045.0 g/l
Calcium 2.70 2.59 2.62 2.69 2.55 2.302.80 mmol/l
Phosphate 1.39 1.37 1.35 1.58 1.25 0.781.41 mmol/l
ALT 2402 1682 781 74 57 2159 IU/l
AST 514 378 85 22 31 2032 IU/l
CK 284 997 339 193 224 76228 IU/l
ALP 12103 11809 7871 1220 221 3142 IU/l
GGT 152 113 67 112 9 010 IU/l
Total bilirubin 176.7 152.4 16.9 19.5 3.6 2.017.0 mol/l
Cholesterol 24.42 23.11 9.48 4.31 5.69 2.505.90 mmol/l
Amylase 1883 1238 785 1114 1154 1671126 IU/l
Lipase >400 400 130 160 114 0250 IU/l
Specimen
comment
Icteric Icteric Icteric Icteric Icteric *
Figure 2: Serum biochemistry results
* Sample lipaemic and haemolysed: will increase phosphate and bilirubin
Cystocentesis
sample
Reference value
WBC <5 05 /high power feld
RBC <5 05 /high power feld
Urine
sediment
Bilirubin staining ++, amorphous debris/cell fragments +, 23 epithelial cells/
high power feld. No leptospires seen.
Figure 3: Urinalysis and dark field microscopy results
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Clinical conundrum
was in ALP, suggestive of primary
cholestatic disease with secondary
hepatocellular damage.
Steroid induction of ALP was unlikely
because exogenous steroids had not been
given and the dog was not clinically
cushingoid. Bone remodelling,
gastrointestinal or placental release result
in only mild increases in ALP. Cholestasis
is further supported by the presence of
hypercholesterolaemia. Endocrine disease
(hypothyroidism, diabetes mellitus (DM),
hyperadrenocorticism), nephrotic
syndrome, primary hyperlipidaemia or
postprandial causes were considered
unlikely causes of hypercholesterolaemia
in view of the clinical and
clinicopathological findings.
Hypokalaemia and hypochloraemia
were considered to be a result of vomiting
as other causes were not supported by the
remaining biochemistry profile. Elevated
amylase and lipase were consistent with
pancreatitis but are non-specific findings.
Results confirmed hepatic or post-
hepatic causes of jaundice and ruled out
some metabolic causes of vomiting (DM,
typical Addisons). Leptospirosis is
commonly associated with azotaemia but
could not be ruled out as dark-field
microscopy is insensitive. The dog
continued to be barrier nursed pending
further assessment.
On the basis of these findings
what changes in management
should be undertaken? What is
your next diagnostic step to
distinguish between hepatic and
post-hepatic causes of jaundice?
Fluid therapy was adjusted to correct
hypokalaemia (potassium chloride (KCl)
was added to the Hartmanns solution to
produce a potassium concentration of
28 mmol/l). Administration continued at
6 ml/kg/h over 12 hours.
Abdominal radiography and
ultrasonography (Figures 4 and 5) were
performed to investigate abdominal
disease. A skilled ultrasonographer can
distinguish between hepatic and post-
hepatic causes of jaundice and evaluate
pancreatic pathology. For this procedure
the patient received sedation
(acepromazine (0.01 mg/kg i.m.) in addition
to the previously administered analgesia.
Imaging revealed bile duct distension
with normal hepatic parenchyma. There was
no visible intraluminal or mural abnormality
of the bile duct and distension was reduced
distal to the pancreas, which had the
typical appearance of pancreatitis on
ultrasonography (see legend to Figure 5).
On the basis of these findings
which remaining differential
diagnoses can be excluded?
Ultrasonographic findings of a normal
hepatic parenchyma with bile duct
dilatation are consistent with EHBDO.
Furthermore, pancreatic appearance
consistent with pancreatitis implicates
this as the cause of the EHBDO. Other
differential diagnoses including
leptospirosis/CAV were ruled out on
the basis that other clinical findings
were not supportive and that acute
pancreatitis causing EHBDO explained all
the presenting signs. Abscessation and
pancreatic neoplasia as causes or
complications of pancreatitis were
excluded on the basis of imaging findings.
Figure 4: Abdominal radiograph taken in right
lateral recumbency. Prominent splenic shadow.
C shaped moderately gas-filled loop of small
intestine. Faeces in colon
B
Figure 5: Abdominal ultrasound report.
Pancreas: Pancreatic body enlarged (1.14 cm)
and mottled hypoechoic appearance with
hyperechoic fat surrounding this. The left limb
is particularly hypoechoic. The right limb has a
more normal appearance. Liver: Within normal
limits. Gall bladder large. The main change is
severe dilatation of the common bile duct
which is tortuous and up to 1.25 cm wide in the
portion proximal to the pancreas. More distally
(at entry point into duodenal papilla) it
measures significantly less (0.46 cm) but is still
distended. (A) Note hypoechoic pancreas and
surrounding hyperechoic fat. (B) Note enlarged
common bile duct (CBD) next to part of the
gallbladder (GB). (C) Note narrower width of
CBD distal to pancreas.
A
C
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CORRECTION TO FEBRUARY CLINICAL CONUNDRUM
In the February issue, the Clinical Conundrum by Carl Bradbrook and Ambra Pant contained a
table with incorrect data. The table on page 11 should have appeared as below. Apologies for
any confusion caused. The online PDF has also been corrected to refect this change. Thank you
to all the readers who spoted the mistake and let us know.
Are antibiotics required?
Infection is uncommon in pancreatitis and
antibiotics are usually not warranted. If
infection is suspected then
cholecystocentesis/bile culture should be
performed but can result in bile leakage
peritonitis. There was no indication of
infection in this case and the risk from
cholecystocentesis was not justified.
How would you manage this
patient based on your
diagnosis?
Most cases of EHBDO will respond to
appropriate medical management. The
dog no longer required isolation or
barrier nursing. Analgesia and intravenous
fluid administration, supplemented with
potassium, were continued. Maropitant
(1 mg/kg s.c. q24h) was given as an
anti-emetic. Ranitidine (2 mg/kg s.c. q12h)
was chosen as a prokinetic and combined
with sucralfate (0.5 g orally q8h) for
gastroprotection as vomiting and
inappetence could be associated with
gastric ulceration. S-Adenosylmethionine
110 mg q24h was given to reduce the
hepatotoxicity of bile stasis.
On day 2 the dog was brighter, she
had stopped vomiting and her electrolyte
concentrations had returned to normal
(Figure 2). Clinically dehydration was not
apparent. The rate of fluid administration
was decreased to 2 ml/kg/hr and was
supplemented to give a potassium
concentration of 20 mmol/l. The dog ate
baby rice/chicken. Faeces seen on the
thermometer were acholic, suggesting
complete EHBDO.
Comment on the sensitivity and
specificity of the performed
tests for diagnosis of
pancreatitis
A number of the non-specific
clinicopathological findings (leucocytosis,
dehydration, raised liver enzymes and
hyperglycaemia) are commonly seen in
pancreatitis. Elevated amylase and lipase
are found as commonly in patients with
pancreatitis as in those without. As such
they are supportive rather than diagnostic
for the disease.
Abdominal ultrasonography by an
experienced operator is highly specific
for pancreatitis in dogs, but identification of
enlargement of the pancreas alone is not
sufficient for a diagnosis. Of the presently
available tests, canine specific pancreatic
lipase immunoreactivity (cPLI) is the most
sensitive and specific and identifies
pancreatitis in over 80% of affected dogs.
On day 3, we received the cPLI result
684 ng/ml. cPLI <200 ng/ml is
considered normal and >400 is consistent
with pancreatitis.
Outcome
Over the following days, analgesia was
continued. Haematology and biochemistry
showed marginal improvement in liver
enzyme activities (Figures 1 and 2).
Increased CK was explained by the
catabolic state and intramuscular
injections. Mature neutrophilia was an
appropriate response to pancreatitis.
On day 5 faeces were pigmented for
the first time, suggesting the bile duct was
no longer completely obstructed. On
biochemistry

bilirubin was reduced by two
thirds. Low-dose ursodeoxycholic acid
(UDA, 5 mg/kg orally q24h) was given,
having been withheld during complete
EHBDO, and the dog was monitored
closely for adverse affects.
Had there been no improvement in the
dogs clinical status then surgical
intervention and bile duct stent placement
would have been appropriate at this stage.
Both are associated with a high
complication rate.
By day 8, jaundice was reduced and
appetite/demeanour were much improved.
Ultrasonography showed reduced biliary
distension. The dog was discharged on
day 9 on UDA, S-adenosylmethionine and
a low-fat diet.
Follow-up
The dog was rechecked 2 and 6 weeks
later. She was generally well apart from
transient dullness/inappetance after she
had scavenged fatty foods. Haematology,
biochemistry and cPLI normalised
gradually. Ultrasound examination initially
showed gallbladder sludge, so UDA/S-
adenosylmethionine was continued until
the second visit when there was no sludge
and the pancreas was considered normal.
TLI was measured at the second visit
because exocrine pancreatic insufficiency
(EPI) can develop with chronic pancreatitis.
Slight elevation ruled out EPI but was not
diagnostic for pancreatitis (TLI = 20 ng/ml
(<2.5 EPI, >35 pancreatitis)). Sixteen
months afterwards the dog remains well
with no signs of EPI. n
Table 3: How to prepare a solution of dextrose at 2.5% and 5% using a 50% dextrose solution
Final soluton concentraton Bag size 50% Dextrose (ml)
2.5% (1:20 diluton) 500 ml 25
2.5% (1:20 diluton) 1000 ml 50
5% (1:10 diluton) 500 ml 50
5% (1:10 diluton) 1000 ml 100
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How to approach
the hypertensive
patient
S
ystemic hypertension can be
defined as persistently raised
blood pressure (BP) and is
increasingly recognised in both the
canine and feline populations, particularly
in older patients. The presence of systemic
hypertension can be damaging not only to
the cardiovascular system but also to other
target organs, such as the eye, kidney and
central nervous system. It is therefore
extremely important to monitor BP and,
when a diagnosis of systemic hypertension
is confirmed, to implement appropriate
long-term treatment and monitoring
strategies in order to prevent ongoing
target organ damage (TOD).
Categories of hypertension
Systemic hypertension is usually
categorized into one of three classes,
depending on underlying aetiology.
Secondary hypertension: This is
where systemic hypertension results
from an underlying disease process
(Table 1). Secondary hypertension
can also be attributable to the
administration of certain drugs that
can result in increased BP, e.g.
phenylpropanolamine, glucocorticoids,
mineralocorticoids or erythropoietin.
Idiopathic hypertension: This refers to
the presence of systemic hypertension
where no underlying disease state can
be identified. Idiopathic hypertension
has been reported to affect
approximately 20% of cats diagnosed
with systemic hypertension but is
considered rare in dogs.
White-coat hypertension: This is the
phenomenon whereby systemic BP is
transiently increased due to activation
of the sympathetic nervous system with
excitement or anxiety during a clinic
visit. Distinguishing white-coat
Rosanne E. Jepson
from the Royal
Veterinary College
helps us get to grips
with this high pressure
problem
hypertension from idiopathic
hypertension can be challenging.
How to recognise the
hypertensive patient
In human medicine, systemic hypertension
is often referred to as the silent killer
because there can be very few warning
signs and the same is true for many of
our veterinary patients. In some patients
suspicion for the presence of systemic
hypertension can be raised by evidence of
TOD (Box 1). These changes can be
dramatic, such as the cat that presents
with sudden-onset blindness as a
consequence of retinal detachment or
gross hyphaema, or the very rare patient
presenting with neurological signs
associated with hypertensive
encephalopathy (e.g. obtundation or
seizures). In most instances, however,
clinical signs associated with systemic
hypertension are minimal and vague. More
often the clinical signs reported will be
those related to an underlying disease
process. Systemic hypertension is
therefore most often diagnosed on the
basis of careful and repeated assessment
of blood pressure (Box 2).
In which patients should we be
monitoring blood pressure?
Regular monitoring should be
performed in any patient diagnosed
with an underlying condition that has
previously been associated with
systemic hypertension (Table 1), even
if initially normotensive. For example:
approximately 20% of cats that are
normotensive at diagnosis of
hyperthyroidism, will develop systemic
hypertension after instituting anti-
thyroid medication
Any patient with TOD (Box 1) but
especially those presenting with ocular
or neurological signs that could be
Table 1: Clinical conditions associated with the development of secondary
hypertension
disease conditon Reported prevalence of hypertension with underlying disease
conditon
Dogs Cats
Chronic kidney disease 1080% 2065%
Hyperthyroidism NA Pre-treatment 1025%
Post-treatment 20%
Hyperadrenocortcism Pre-treatment 6085%
Post-treatment 40%
NA
Diabetes mellitus 25-50% No associaton made
Primary
hyperaldosteronism
Unknown 50100% (Uncommon
conditon)
Phaeochromocytoma 4085% (Rare conditon) Unknown (Extremely rare
conditon)
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BOX 1: TargeT Organ damage (TOd)
Figure 1: Ocular lesions secondary to systemic hypertension. (A) Feline fundus with
evidence of multifocal intraretinal haemorrhages, large bullous retinal detachment and
oedema. Marked variation in vessel calibre, with marked apparent loss/attenuation of
retinal arterioles, is present (likely due to detachment/oedema). (B) Feline fundus with
central focal bullous retinal detachment; peripherally similar smaller circular lesions can
also be identified. There is also generalized oedema. Note how the blood vessel is raised
by the bullous detachment (arrowed). (C) Feline fundus with multifocal areas of
pigmentary disturbance. These represent old/inactive lesions likely to be secondary to
small bullous detachment in the past (for example, that indicated by arrow). This cat did
not have any detectable visual problem. (D) Feline eye demonstrating an area of total
bullous retinal detachment, with large folds of retina displaced anteriorly within the
vitreous and therefore now visible directly via the pupil with a focal light source (optic disc
more posterior and obscured by retinal folds in this image). Multifocal intraretinal
haemorrhages are present. Note also the marked mydriasis. This cat was clinically blind on
presentation with similar changes observed bilaterally. (E) Feline eye with evidence of
gross hyphaema (blood in anterior chamber). The blood has formed a solid clot. Also note
the mydriasis, which is suggestive of concurrent fundic damage. (F) Canine eye with
evidence of gross hyphaema. ((A)(E) courtesy of R. Elks.)
Reproduced from BSAVA Manual of Canine and Feline Cardiorespiratory Medicine, 2nd edition.
A C
E F
B
D
Systemic hypertension can cause damage to a
number of target organs, for example the eye, kidney,
cardiovascular system and central nervous system.
Eyes: Studies suggest that approximately 60100%
of cats with systemic hypertension will have
evidence of ocular damage, namely hypertensive
retnopathy/choroidopathy. Lesions can be
relatvely subtle but may include multfocal bullous
retnal detachments, retnal detachment, fresh
or resolving retnal haemorrhages, retnal vessel
tortuosity or perivascular oedema creatng the
impression of vessel narrowing and hyphaema
(Figure 1). Ocular manifestatons of systemic
hypertension are much less common in the dog,
with the prevalence reported to be only 520%.
Kidney: In order to maintain glomerular fltraton
rate and protect the kidney, glomerular capillary
pressure is tghtly controlled in the aferent
arteriole by autoregulaton. Systemic hypertension
can override this autoregulatory process so
that the glomeruli are exposed to elevated
pressures resultng in glomerular hypertension,
glomerulosclerosis and proteinuria.
Cardiovascular system: Cardiovascular changes that
have been associated with systemic hypertension
include lef ventricular hypertrophy and associated
murmurs, arrhythmias and gallop rhythms. Epistaxis
can also be a primary clinical sign of vascular
damage secondary to systemic hypertension.
Central nervous system: Neurological signs of
systemic hypertension have most ofen been
documented in experimental studies and include
obtundaton and seizures but are rare in clinical
patents. However, neurological complicatons of
systemic hypertension may be under-recognised
and many owners will report an improvement
in demeanour of their pet with successful
management of systemic hypertension.
associated with systemic hypertension
and which may require immediate
anti-hypertensive therapy
Any patient started on medication
that can cause increase in BP
particularly if there is any evidence
of underlying TOD
Part of a geriatric screening programme
for cats and dogs over ~9 years
Any patient receiving anti-hypertensive
medication
How do I diagnose systemic
hypertension?
One of the main difficulties when
approaching a patient that you suspect to
be hypertensive is deciding exactly when
to make the diagnosis and when to start
treatment. Recently the tendency has
been to move away from a single BP value
which defines systemic hypertension.
Instead guidelines have been formulated
as part of the American College of
Veterinary Internal Medicine (ACVIM)
Hypertension Consensus Statement, which
consider diastolic and systolic BP as
continuous variables and categorize them
according to the risk of developing TOD.
The risk categories for systolic
hypertension are listed in Table 2. In
general, unless there is evidence of
hypertensive retinopathy/choroidopathy or
hypertensive encephalopathy it is not
currently advocated to start anti-
hypertensive medication for those patients
that fall within the minimal or mild risk
categories (systolic BP <160 mmHg).
A flow diagram for a patient in which you
have performed a BP measurement and to
aid with diagnosis of systemic hypertension
is shown in Chart 1. If hypertensive
encephalopathy or hypertensive
retinopathy/choroidopathy is identified,
immediate anti-hypertensive therapy should
be started. In all other patients where an
underlying disease process has been
identified but there is no evidence of
hypertensive retinopathy/choroidopathy,
measuring BP on at least two occasions
714 days apart is appropriate in order to
confirm the diagnosis.
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How to approach
the hypertensive patient
BOX 2: HOW TO MEASURE BLOOD PRESSURE
Figure 2: Oscillometric blood pressure
measurement in the cat
Figure 3: Doppler blood pressure
measurement in the cat
Techniques available
The gold standard for measuring BP is via
direct arterial catheterisaton. This
technique provides contnuous assessment
of mean, systolic and diastolic BP.
However, it is an invasive procedure which
is not applicable to routne monitoring
requirements. Direct arterial BP monitoring
is therefore most ofen performed in those
emergency patents requiring parenteral ant-
hypertensive medicaton within an intensive
care environment or during
general anaesthesia.
Most ofen BP is assessed using an indirect
technique, e.g. using an oscillometric device
(Figure 2) or Doppler sphygmomanometry
(Figure 3). Oscillometric devices rely on the
detecton of pressure oscillatons of air
within the cuf when the artery is partally
occluded. When using an oscillometric
device the mean BP is measured and
systolic and diastolic pressures are calculated
using inbuilt algorithms.
The primary advantage of an oscillometric
device is that, afer cuf placement, the
process is automated. This means that the
technique requires litle training and may
make the machine easier to use in a
fractous patent. However, oscillometric
machines can be slow to take readings
and may fail to obtain a measurement in
patents with higher heart rates, arrhythmias
or if the patent does not remain stll
throughout measurement.
The Doppler technique utlises a
piezoelectric crystal to detect blood ow,
convertng this signal into an audible sound.
The Doppler technique requires some degree of
operator experience, but with a small amount
of practce is easily mastered. However, it
provides only reliable assessment of systolic
BP. It is important to realise that in human
medicine standards have been set for the
validaton of indirect BP measuring devices but
that no veterinary device currently meets these
criteria in conscious dogs and cats.
For the Doppler technique, it is usual to
perform an alcohol wipe and apply acoustc
jelly in order to obtain adequate contact. In
most instances clipping of fur adds additonal
stress for the patent and is not required.
In long-haired patents clipping may be
advantageous but the patent should be
allowed to reacclimatse aferwards.
It is widely advised that the frst
measurement obtained is discarded and
that subsequently a series of fve
consecutve and consistent measurements
should be recorded and the mean
calculated. For readings to be consistent,
ideally there should be <20% variability
between systolic measurements.
It is ofen helpful to produce a standard
form to allow documentaton of BP
recordings for each patent. This form
could also contain a record of the limb
circumference, cuf size, the limb/tail
used, the positon and temperament of
the patent during measurement and other
clinical data such as heart rate. A record
of this informaton allows operators to
compare BP measurements on consecutve
visits knowing that a similar approach and
technique has been used.
For both the Doppler and oscillometric
techniques, the BP cuf is most commonly
placed on the mid antebrachium, although
other sites can be used, e.g. hind-leg or tail
base. The limb circumference should be
measured with a sof tape measure and a
cuf width chosen that is 3040% of limb
circumference. Choosing a cuf which is
too narrow may lead to falsely elevated BP
measurements, whilst a cuf that is too large
may underestmate BP. Ideally the patent
should be positoned so that the cuf is
approximately at the level of the heart.
Tips for performing a BP measurement
Choose a quiet and relaxed environment
away from loud noise, disturbance and
other animals.
Every pet should have the opportunity
to explore and acclimatse to their
environment for approximately 510
minutes prior to BP measurement.
Allow the owner to be present in order
to relax their pet.
Careful and gentle restraint by the owner
or an experienced handler.
More reliable measurements are usually
obtained by allowing the patent to
adopt their preferred positon.
BP measurements should always be
performed prior to other procedures,
e.g. physical examinaton, blood
sampling or obtaining a temperature.
Avoid performing BP measurements if
the patent has received any sedaton or
undergone general anaesthesia.
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Risk category Systolic blood pressure
(mmHg)
recommendaton for startng treatment
Minimal <150 Minimal to mild risk of developing target organ damage (TOD)
Limited evidence that ant-hypertensive medicaton required
May represent cases of white-coat hypertension
Treatment should be considered if evidence of ocular or central nervous system TOD
Contnued monitoring recommended
Target categories for patents treated with ant-hypertensive therapies
Mild 150159
Moderate 160179 Moderate risk for the development of TOD
Ant-hypertensive therapy recommended in patents with evidence of TOD or where concurrent
clinical conditons associated with hypertension have been identfed
Confrmaton of hypertensive category status should be made on at least two occasions unless
there is evidence of ocular or CNS TOD, when therapy will be required immediately
Patents in this category which have no evidence of TOD or clinical conditons associated with
systemic hypertension should be monitored carefully to exclude white-coat hypertension before a
diagnosis of idiopathic hypertension is made and long-term treatment started
Severe >180 The risk of development and progression of TOD is high
White-coat hypertension is uncommon
Immediate ant-hypertensive therapy indicated if ocular or CNS TOD present otherwise confrmaton
of category status should be made on at least two occasions
Table 2: ACVIM risk categories for systolic hypertension
SBP measurement performed
No evidence of hypertensive retnopathy/choroidopathy or encephalopathy
Hypertensive retnopathy/choroidopathy or encephalopathy present
Instgate immediate anthypertensive medicaton
Go to Chart 2 (cats) or Chart 3 (dogs)
SBP <160 mmHg
No predisposing disease present
No requirement for further
assessment
Contnue to monitor
biannually/annually if geriatric
Predisposing disease present
No evidence that anthypertensive
medicaton necessary
Contnue to monitor BP every 23
months or with any change in
status or medicaton
SBP 160180 mmHg
Repeat measurement of SBP on 23 visits 714 days apart
If SBP persistently >170mmHg in geriatric cat, consider anthypertensive
medicaton for idiopathic hypertension. All other patents contnue to
monitor
Repeat measurement of SBP on at least 12 visits 714 days apart
If SBP persistently at higher end of category consider startng
anthypertensive medicaton
If consistently at lower end of category contnue to monitor every 23
months unless evidence of progressive TOD when anthypertensive
medicaton should be started
SBP >180 mmHg
Repeat measurement of SBP on 23
visits 714 days apart
Less likely to be white coat
hypertension if persistently >180 mmHg
Start anthypertensive medicaton
Repeat measurement of SBP on one
occasion
Instgate anthypertensive medicaton if
remains >180 mmHg
Chart 1. Reproduced from BSAVA Manual of Canine and Feline Cardiorespiratory Medicine, 2nd edition.
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How to approach
For all patients in which you suspect
systemic hypertension it is advisable to
obtain a minimum database:
Complete history
Full physical examination
Serum biochemical profile
Packed cell volume and total solids
Urinalysis (specific gravity, dipstick,
urine protein:creatinine ratio and
sediment examination)
Ophthalmological examination.
If there is clinical suspicion and
supportive evidence from your minimum
database you may wish to consider:
Total T4 (cats)
ACTH stimulation test / low dose
dexamethasone suppression test
Total T4/ TSH (dogs)
Ultrasound assessment of kidneys and
adrenal glands
Evaluation of urinary/plasma
metanephrines
Plasma aldosterone concentrations.
It is also important to consider other
clinical factors that could influence BP
measurements in your patient:
Age: Systemic hypertension is more
common in older patients (>9 years)
Breed: Sight hounds are reported to
have systemic BP 1020 mmHg
higher than other breeds. The
exception to this rule is Irish
Wolfhounds, that reportedly have
BP lower than other sight hounds.
So far no breed associations have
been made in the cat.
Medications being administered,
e.g. phenylpropanolamine,
corticosteroids, mineralocorticoids,
erythropoietin
Hydration status
Recent intravenous fluid therapy.
How to diagnose idiopathic
hypertension
A diagnosis of idiopathic hypertension
should only be made if persistent
hypertension is documented, perhaps with
evidence of hypertensive ocular changes in
combination with a full and unremarkable
diagnostic work-up. BP should be
assessed on at least two or three occasions
714 days apart. Theoretically the
diagnostic evaluation should include direct
assessment of glomerular filtration rate
(GFR) to exclude the possibility of non-
azotaemic kidney disease, although in
practice this is rarely performed.
Some patients with systemic
hypertension but no evidence of increased
creatinine concentration demonstrate an
inappropriate urine-concentrating ability
(urine specific gravity <1.030). In this
scenario the reduced urine concentrating
ability could reflect hypertensive pressure
diuresis and does not automatically imply
reduced renal function.
How to diagnose white-coat
hypertension
It can be difficult in some patients to
distinguish between idiopathic hypertension
and white-coat hypertension. A diagnosis of
white-coat hypertension should only be
made if: high BP readings have been
documented on multiple occasions in the
absence of other clinical signs; there is no
evidence of TOD or underlying disease
condition; the individual is at low risk for
systemic hypertension; and the clinician is
convinced that elevated BP measurements
can be attributed to the clinic situation.
How do I treat systemic
hypertension?
What are the goals of anti-
hypertensive therapy?
Gradual but persistent decline in BP
Avoidance of sudden fluctuations,
precipitous drops in BP and periods of
hypotension
Prevent severe TOD (e.g. ocular or
CNS damage)
Minimise ongoing chronic TOD
(e.g. vascular damage within the
kidney/ left ventricular hypertrophy).
Current evidence suggests that
reducing BP to the minimal or mild
ACVIM risk category (systolic blood
pressure of <160mmHg) is a suitable
target for most patients.
Preliminary considerations
Any underlying disease process that
may be contributing to the
development of systemic hypertension
or to target organ damage (e.g. chronic
kidney disease or cardiac disease)
should be identified and treated
For some conditions, e.g.
hyperadrenocorticism, this may lead to
the partial or complete resolution of
systemic hypertension. However, more
often adjunctive anti-hypertensive
therapy will be required and in some
instances, such as feline
hyperthyroidism, systemic hypertension
may only be detected after treatment
has been started
If possible, any medications that could
be contributing to increased BP should
be discontinued
Some disease conditions will need
specific anti-hypertensive therapy
For example, an aldosterone-secreting
tumour would require an aldosterone
antagonist (e.g. spironolactone)
combined with surgical adrenalectomy,
whilst treatment of a
pheochromocytoma would usually
include an alpha-blocker
(e.g. phenoxybenzamine), beta-blocker
(e.g. atenolol) and surgical
management.
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Suggested guidelines for instituting
and modifying anti-hypertensive treatment
are outlined in Chart 2 (cats) and Chart 3
(dogs). Currently there is no indication in
veterinary medicine to treat those patients
with white-coat hypertension.
When starting anti-hypertensive
therapy:
Always explain and discuss the
rationale for anti-hypertensive therapy
with owners so that they understand the
importance of long-term management
and BP monitoring for their pet
Introduce anti-hypertensive agents at
the lowest therapeutic dose
Monitor BP more frequently, e.g. after
approximately 2448 hours if there is
concern regarding TOD (e.g. ocular
Cat with systemic hypertension
Elevated SBP with hypertensive retnopathy Elevated SBP with hypertensive encephalopathy
Elevated SBP conrmed on 23 occasions
Perform diagnostc testng
SBP <160 mmHg, no evidence of development
or progression of hypertensive retnopathy
Maintain on amlodipine dose
Contnue to monitor BP every 23 months
SBP>160 mmHg or evidence of development or progression of TOD
Conrm owner/cat compliance as treatment with amlodipine is
usually eectve
Add ACE inhibitor to protocol
Re-examine 714 days
If SBP drops to <160 mmHg contnue to monitor every 23 months
If SBP remains >160 mmHg
Conrm owner/cat compliance as treatment is usually eectve
Check for underlying disease process
Consider diagnosis of white coat hypertension
Hyperthyroidism
If no evidence of TOD consider white coat hypertension. Treat hyperthyroidism but monitor SBP
carefully as may increase
If evidence of TOD treat as above
Hyperaldosteronism
Remove the source of elevated aldosterone (likely an adrenal tumour)
If no evidence of TOD consider spironolactone alone. If control inadequate add amlodipine as above
If evidence of TOD follow as above in additon to spironolactone prior to adrenalectomy
SBP >160 mmHg or evidence of development
or progression of hypertensive retnopathy
Increase dose of amlodipine to 1.25 mg
orally q24h
Re-examine at 714 days
Immediate anthypertensive medicaton
Perform diagnostc testng
Start amlodipine (0.625 mg orally q24h)
Start amlodipine
(0.625 mg orally q24h)
OR
then
OR
Hospitalizaton and contnuous BP
measurement for use of peripheral
vasodilators (e.g. hydralazine, nitroprusside)
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How to approach
changes). Monitoring after 714 days is
appropriate in most other situations
If a single anti-hypertensive agent fails
to adequately control BP consider
increasing the dose or adding a
second anti-hypertensive agent
Always confirm owner and patient
compliance prior to any dose
adjustment
Always reassess BP approximately
714 days after any dose adjustment or
sooner if there is TOD (e.g. ocular)
Aim to achieve BP in the minimal or
mild ACVIM risk category (systolic BP
<160 mmHg).
If chronic
Canine patent with CKD and suspected systemic hypertension
Start ACE inhibitor
SBP>160 mmHg, or evidence of development or progression of TOD
Start amlodipine at 0.1 mg/kg q24h
SBP<160 mmHg, no evidence of development or progression of TOD
Contnue on ACE inhibitor at same dose
Re-examine every 23 months
SBP <160 mmHg, no evidence of development or progression of TOD
Contnue on ACE inhibitor and amlodipine at same dose
Re-examine every 23 months
SBP >160 mmHg, or evidence of development or progression of TOD
Increase amlodipine to 0.2 mg/kg q24h
Re-examine at 714 days, if BP not controlled consider further
increase to 0.4 mg/kg
SBP >160 mmHg or evidence of development or progression of TOD
Consider additon of beta-blocker or substtuton of amlodipine with hydralazine
Elevated SBP with hypertensive encephalopathy
Elevated SBP with evidence of hypertensive
retnopathy
Hospitalizaton and contnuous BP measurement for use
of peripheral vasodilators (e.g. hydralazine, nitroprusside)
Elevated SBP on 23 occasions
If evidence of TOD re-examine afer ~48 hours otherwise 714 days
If evidence of TOD re-examine afer ~48 hours otherwise 714 days
If very
acute
Hyperadrenocortcism
If no evidence of TOD then treat hyperadrenocortcism and re-assess BP
If TOD present or hypertension persists with control of hyperadrenocortcism then follow CKD
anthypertensive protocol
Phaeochromocytoma
Treat with phenoxybenzamine and ttrate dose to eect
Surgical resecton of adrenal mass
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The first line anti-hypertensive agent in
cats is amlodipine besylate, a calcium
channel blocker. Cats appear to have a
unique sensitivity to this anti-hypertensive
agent and invariably a reduction in blood
pressure of 2030 mmHg can be
expected. Angiotensin-converting enzyme
inhibitors (ACEis) are the most common
second line antihypertensive agents but
have a relatively limited antihypertensive
action, reducing BP by approximately
510 mmHg.
Care should always be taken when
introducing an ACEi, particularly in cats
with moderate to severe chronic kidney
disease (CKD) or evidence of
dehydration, when use of an ACEi may
result in a rapid reduction in renal function
and worsening azotaemia. Monitoring of
renal function is advocated after
introduction of this medication.
Systemic hypertension in dogs is much
more challenging to manage than in cats.
In dogs with CKD and systemic
hypertension the first line anti-hypertensive
agent is an ACEi, although response to this
agent can be variable and disappointing.
However, there is evidence that ACEis may
have additional benefits in dogs with CKD
by reducing proteinuria. Once again care
must be taken if introducing this class of
medication to dogs with moderate to
severe kidney disease or dehydration due
to the concerns regarding decline in GFR.
If BP is inadequately controlled with an
ACEi alone, then amlodipine besylate is
often added to the regime. Hydralazine,
beta-blockers and aldosterone antagonists
can be considered if the combination of an
ACEi and amlodipine are ineffective, but
great care must be taken and frequent
monitoring performed to ensure against
episodes of hypotension (systolic BP
<120 mmHg).
Currently the evidence for a salt-
restricted diet in dogs and cats with
systemic hypertension is controversial and
use of a salt-restricted diet alone is unlikely
to modulate BP. High-salt diets should be
avoided but there is limited evidence that a
salt-restricted diet should be used and
instead a diet appropriate to any
underlying disease condition (e.g. CKD)
should be considered.
The emergency patient
Occasionally patients will present as an
emergency with evidence of hypertensive
encephalopathy and/or severe ocular TOD
(e.g. hypertensive retinopathy/
choroidopathy, retinal detachment, retinal
haemorrhage or hyphaema). Such patients
will require immediate hospitalisation and
more aggressive anti-hypertensive therapy.
A number of parenteral anti-
hypertensive medications are available,
e.g. sodium nitroprusside and hydralazine.
However, these agents should only be used
with continuous BP monitoring, ideally via
direct arterial catheterisation, or (at a
minimum) an intensive care environment
which allows frequent BP assessment.
The exception is those cats which
present with ocular TOD, where oral
amlodipine besylate therapy is successful
in rapidly reducing BP. In these patients
hospitalisation is not an absolute
requirement but more frequent follow-up,
for example within 2448 hours, would be
recommended in order to ensure reduction
in BP and prevent further TOD.
Management and monitoring of
the treated patient
Once BP has been stabilised, routine
monitoring approximately every 23
months is recommended
Aim to maintain BP in the mild or
minimal ACVIM risk category (systolic
BP <160 mmHg)
Continue routine monitoring to achieve
optimal management of any underlying
disease condition
Adjust anti-hypertensive medication
carefully to maintain BP control
Monitor BP more frequently if there is a
change in:
The patients clinical status
The underlying disease condition
The patients medication.
AVAILABLE FROM BSAVA
BSaVa manual of Canine and Feline Cardiorespiratory medicine, 2nd editon
Edited by: Virginia Luis Fuentes, Lynelle Johnson and Simon Dennis
This new editon reects the huge advances in the feld of cardiothoracic medicine that have
taken place over the past ten years. The approach of the Manual has been remodelled to
enhance the practtoners access to informaton, with fve sectons covering:
Clinical approach to the most common problems encountered in veterinary practce
Diagnostc methods available, including history, physical
examinaton, imaging and laboratory testng
Underlying pathophysiology of diseases associated with
respiratory disorders, heart failure and arrhythmias
Management of acute and chronic respiratory disorders, as well
as management of heart failure and arrhythmias
Up-to-date informaton on the diagnosis and management of
disorders commonly encountered in practce, including valvular
heart disease, cardiomyopathies, and canine and feline
tracheobronchial disease.
Member price: 55.00
Price to non-members: 85.00
Contact administraton@bsava.com to order your copy.
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Congress 1115 APRIL 2012
Progress in
pathology
W
hat does a veterinary practice expect from
the service that it gets from a commercial
pathology lab? It certainly hopes for a
speedy and accurate response when it
sends off a biopsy sample from an animal with a
possible tumour. The vet who took the sample would
like to know what sort of cell type is involved, so that
he or she is able to tell the client whether the mass is
benign or malignant.
But what if the report that comes back from the
lab can identify the specific gene mutation causing the
problem and give a reliable assessment of the likely
disease progression, based on the previous findings in
other animals with that particular abnormality?
Unfortunately, at present not even the most
advanced laboratory can offer that sort of deluxe
service but it wont be very long before they can,
Animal Health Trust oncologist Sue Murphy will tell
colleagues at the BSAVAs annual Congress in
Birmingham.
Seeing into the future
In her presentation on genetic testing in oncology on
Saturday 14 April Sue Murphy will outline the current
limitations and future potential of this powerful new
technology. Whether the initial cause is a spontaneous
mutation, caused by exposure to an environmental
mutagen, or by the actions of a viral oncogene, all
cancers are a result of damage to the patients DNA.
So it is possible for those changes to be passed on to
succeeding generations, and certain forms of cancers
are known to occur more commonly in particular dog
breeds brain tumours in Boxers, osteosarcomas in
Wolfhounds, etc.
The AHT is one of several veterinary research
centres around the world that is taking samples from
related dogs affected by the same form of cancer and
performing a genome wide analysis to find out how
their DNA differs from that of healthy individuals with
the same pedigree. There is a very good chance that in
such closely related animals any consistent differences
between the two groups will have had some role in the
development of the disease in the affected dogs.
Such information can identify those genes that are
key to the development of particular forms of cancer,
not just in that particular breed but in other types of
dog and even in humans. And by identifying the
particular problem gene it should be possible to test
dogs and bitches to be used for breeding and ensure
that their offspring will be healthy.
Delegates at BSAVA Congress will hear
about the potential of genetic testing in
oncology from Sue Murphy
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Results of a search to locate inherited gene mutations that predispose Labrador Retrievers to developing mast cell tumours
20-21 Congress Murphy.indd 20 20/02/2012 10:32
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Individual gain
However, the research that Sue Murphy and her
colleagues are doing will also have implications for
the health of individual cancer patients as well the
breed. They have been trying to identify the genetic
factors that determine whether, and to what extent, a
tumour is malignant. We have been comparing the
genetic profiles from two groups of dogs with mast
cell tumours that have spread and those whose
tumours didnt spread. The idea is that if we can
identify a genetic signature of badness we can
council owners accordingly and plan an appropriate
treatment, she explains.
Yet with the solitary exception of the very rare
condition RCND (renal cystadenocarcinoma and
nodular dermatofibrosis) in German Shepherd Dogs,
all the cancers that have been identified so far have
been multifactorial conditions, controlled by a
number of different genes. So it is unlikely that an
accurate diagnosis can be achieved on the basis of
a single, simple gene test. More likely, both the
diagnosis and prognosis will be based on a gene
profile that identifies a quantifiable risk in a particular
individual dog.
Benefitting from genome project
Still, rapid progress is being made in the science that
will enable the creation of this sort of technology.
Sue Murphy says these developments are being
helped by the completion in 2004 of the international
project to map the canine genome. The potential value
of dogs in comparative oncology studies is widely
accepted and so it is no longer such a struggle to
attract the funds needed to support this branch of
veterinary research.
That project has allowed the development of tools
that enable genetic investigations to be carried out
much more effectively funding bodies are aware that
investigators have access to these tools and therefore
are more likely to look favorably on investigations of
this type, she points out.
SUE MURPHY AT CONGRESS
Genetc testng in oncology: where are we? Saturday PM
See the full Science Programme online at
www.bsava.com/congress
Impact on practice
So what impact will this work have on first opinion
practices and what does the future hold? Ideally vets
will be taking a few cells of certain tumour types via
fine needle aspiration on to a special microscope slide
which the practice will send off to be processed. That
will confirm the tumour type and give an objective idea
of the prognosis for that individual tumour and also
whether it is likely to be sensitive to the treatment
options open to practitioners. I cant see that
happening in the next decade, it will be more like
20 years, Sue Murphy suggests.
However, i f practitioners want to get hold of these
valuable diagnostic tools any earlier than that, they will
have to play their part in supporting the necessary
research.
We can only do this research if we have
samples collected by vets and owners. We can
provide cheek swab kits for breed-based research and
a special fixative RNAlater for tumour samples.
Contact us for kits!
20-21 Congress Murphy.indd 21 20/02/2012 10:32
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Browsing on
the Balcony
Four important new
editions and the
inaugural BSAVA
Foundation Manual will
be launched at the
bookshop on the BSAVA
Balcony. Come and
browse and benefit from
some great special offers
BSAVA Manual of
Canine and Feline
Endocrinology,
4th edition
Edited by Carmel
Mooney and Mark
Peterson
Since publication of the third edition in
2004 there have been important advances
in the field of endocrinology. Several
endocrine disorders, such as feline
acromegaly and hyperaldosteronism, have
risen in importance. The use of diet and
novel insulins in diabetic cats, and new
drugs such as trilostane and methimazole,
which were mentioned briefly in previous
editions, are now considered routine. In
addition, the genetic risks associated with
many disorders have been elucidated.
There has been a change in the format
of the Manual to provide easier access to
relevant information. The first chapter deals
with the type of assays used for hormone
measurement and the collection and
storage of samples and how this may
influence the results obtained.
The second chapter represents a new
and exciting venture, outlining the
principles for interpreting endocrine test
results and introduces the reader to
assessment of test performance and how
to improve diagnostic confidence.
The following chapters describe
disorders associated with each major
endocrine gland. The final section of the
Manual provides information on solving
both clinical and clinicopathological
abnormalities for w hich endocrine
disorders are a major consideration.
Congress price: 49.00
BSAVA members: 44.00*
BSAVA Manual of
Canine and Feline
Haematology and
Transfusion
Medicine,
2nd edition
Edited by Michael Day
and Barbara Kohn
The first edition of the BSAVA Manual of
Canine and Feline Haematology and
Transfusion Medicine was a leader in its
field, and this new edition has been
eagerly awaited.
The basic principles of haematology,
which form the core of the Manual, have
been updated to include new diagnostic
procedures and new treatment strategies.
There are new chapters on anaemia of
inflammation and neoplasia, non-
regenerative anaemia, and vascular
thrombosis.
Arthropod-transmitted infectious
diseases in companion animals are
increasingly significant, reflected in
updated chapters on leishmaniosis,
babesiosis, monocytic ehrlichiosis
and anaplasmosis, where haematological
analysis is part of the first line of diagnosis.
Another area in which there have been
significant advances since the first edition
is feline haemoplasmosis, and a completely
revised chapter provides the latest
information on these infectious agents.
The section on transfusion medicine
has been reorganised and expanded, with
stand-alone chapters on canine and feline
blood groups and transfusion. A new
chapter considers the use of blood
substitutes. The information in the Manual
is presented in a way that is easily applied
to the clinical case the practitioner is
reading about. Substantial background
information is provided for those who want
to learn more about that particular topic.
BSAVA Manual
of Canine and Feline
Surgical Principles
A Foundation
Manual
Edited by Stephen
Baines, Vicky
Lipscomb and Tim Hutchinson
Meticulous attention to the basic principles
of surgery is critical if a good surgical
outcome is to be achieved. Good surgeons
are not simply those who are skilled at
surgery, but those who ensure that every
aspect of patient care is performed to the
highest standard. Complications that arise
following surgery are often attributable to a
lack of understanding or appreciation of
the importance of these basic principles.
The Manual is divided into three
main sections: surgical facilities and
equipment; perioperative considerations
for the surgical patient; and surgical
biology and techniques.
The Manual covers those key topics
required for surgical success that are often
overshadowed in larger textbooks of
veterinary surgery and which are relevant to
all members of the veterinary team.
The BSAVA Manual of Canine and
Feline Surgical Principles provides a solid
grounding in best practice for the basic
22-23 Congress Publications.indd 22 20/02/2012 10:31
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BSAVA Textbook
of Veterinary
Nursing,
5th edition
Edited by
Barbara Cooper,
Elizabeth Mullineaux
and Lynn Turner
Equine consulting editor: Tim Greet
The new edition of the classic core
textbook, updated to reflect changes
in the RCVS Veterinary Nursing
syllabus, covers the whole range of
veterinary nursing in small animal
practice, and core unit equine content,
with all chapters revised or rewritten.
New content:
Anatomy and physiology presented in
a single integrated chapter to allow
easy comparison
Stand-alone chapter on Nursing Models,
with clinical application examples
New chapter on Professional
responsibilities, Regulation and Ethics
Up-to-date content on MRSA and
PETS regulations
Addresses equine species as required
by VN core units including details on
anatomy, handling, stabling, feeding,
bandaging, radiography, reproduction
and anaesthesia.
*BSAVA MEMBERS EXCLUSIVE OFFER
BSAVA members get an additonal 5 OFF
all ttles at Congress on producton of a valid
membership card. Remember to show the
sales team your card to receive the discount.
ATTENDING A SATELLITE MEETING?
BSAVA is pleased to announce that this year
there will be two BSAVA Stands open on
Wednesday 11 April.
Registraton Area in the NIA
ICC (top of the escalators by the internet
caf)
Both stands are open from 10am to 6pm
For those atending A liated Group
meetngs who are not atending the main
BSAVA Congress, or those who want to beat
the rush during the main exhibiton, this will
provide an opportunity to nd out about
BSAVA membership, become a member, and
purchase copies of BSAVA Manuals.
RELATED LECTURES AT CONGRESS
A problem-oriented approach to focal
and multfocal alopecia in dogs and cats
Rosario Cerundolo
Thursday 12 April
Hall 5 08.3009.15
Blood smears (practcal) Roger Powell
Thursday 12 April
Hall 7 14.0017.30
Feline hyperaldosteronism
Hans Kooistra
Friday 13 April
Hall 3 15.1015.55
Managing a diabetc cat: what do you
need to know? (nursing lecture)
Jacqui Rand
Saturday 14 April
Hall 8 11.1512.00
Disorders of hypercalcaemia: how much
should I react? Dennis Chew
Saturday 14 April
Hall 4 14.1515.55
Principles of intestnal surgery
Bryden Stanley
Sunday 15 April
Hall 5 09.5510.40
principles of veterinary surgery, which will
be particularly helpful for veterinary
students, new graduates and veterinary
nurses as well as any veterinary surgeon
wishing to update their knowledge.
BSAVA Manual of
Canine and Feline
Dermatology,
3rd edition
Edited by
Hilary Jackson and
Rosanna Marsella
Dermatology constitutes a large
percentage of the daily caseload in small
animal practice and can represent a
challenge for the busy practitioner, as
many different diseases have similar
presenting signs. Thus, a solid
understanding of how to approach a
dermatological case logically and
sequentially is essential for a
successful outcome.
The BSAVA Manual of Canine and
Feline Dermatology begins by providing
the reader with a grounding in examination
and investigative techniques. The second
section provides a problem-oriented
approach to the common dermatological
conditions encountered in practice,
including erosions and ulcerations, focal
and multifocal alopecia, and pruritus.
The final part of the Manual covers
the major skin diseases of dogs and
cats caused by bacteria, yeasts, fungi
and parasites.
22-23 Congress Publications.indd 23 20/02/2012 10:31
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John Bonner meets Mike Pavletic, a man
driven to explore the boundaries of
reconstructive surgery and who will be
sharing his enthusiasm and expertise with
delegates at Congress next month
The possibilities of
reconstructive surgery
ago, before effective reconstructive surgery
techniques were developed for veterinary use. But
since then there has been remarkable progress in
methods to restore both function and cosmetic
appearance in a badly traumatised animal, and
no-one has made a greater contribution to that
work than one of the speakers at BSAVA Congress
in April.
American pioneer
Dr Mike Pavletic, director of surgical services at Angell
Animal Medical Center in Boston, Massachusetts, is
the author of the Atlas of Small Animal Wound
Management and Reconstructive Surgery, the
standard text on the subject, now in its third edition. He
has also developed more than 50 original surgical
techniques and was awarded the BSAVAs Bourgelat
T
reatment options used to be pretty limited for a
dog that arrived at a veterinary clinic with
extensive burns or any similar large scale
injuries. To spare the animal a lifetime of pain
and discomfort there would usually be little choice
except euthanasia. That was the situation 30 years
24-26 Congress_Pavletic.indd 24 20/02/2012 10:29
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international award in 1996 for contributions to small
animal practice. He will be delivering a series of three
presentations in the reconstructive surgery stream.
A 1974 graduate of the University of Illinois
veterinary school, Mike first became interested in
this particular branch of surgery during his first year
in veterinary practice. He was presented with a feline
case whilst working as an intern at the clinic where he
is currently based. (He returned to the Angell clinic in
1998 after spells as a professor of surgery at
Louisiana State University and head of surgery at
nearby Tufts University.)
A cat arrived with a tumour involving the left cheek
region, he recalls. Removal of the growth would have
resulted in a wound that could not be closed in any
conventional manner. Since this area of surgery was
never discussed in any depth at veterinary school,
I found an old human textbook in the library. In it, a
plastic surgical technique was described for use in a
human with a similar lesion. The technique, a
transposition skin flap, was what I replicated to close
the large facial defect in the cat. At that moment,
I became excited by the idea of moving and using
other regional tissues to reconstruct defects after
trauma or the removal of diseased tissues.
A growing passion
However, Mike found that there was little veterinary
literature to fuel his new found enthusiasm for
reconstructive surgery, and so to further his
knowledge he spent many hours in the university
library studying books and journal articles
produced by human surgeons. I also performed
numerous cadaver studies to understand the
anatomy and circulation to the skin and muscle.
Over the years, I have focused my research on
skin flaps, skin grafts, muscle flaps, footpad
reconstruction, facial and oral surgery. I have also
studied traumatic wounds and their management,
including gunshot wounds, burns and bite wounds.
Each of these forms of trauma can result in massive
tissue loss, he explains.
One of the problems he faced was that most of his
veterinary colleagues regarded this area as an
interesting niche of surgery but with little practical
application in their routine work, he says. What they
failed to understand was the fact that reconstructive
surgery used to close traumatic wounds opened the
door to more advanced cancer surgery in veterinary
medicine. Surgical oncology and reconstructive
surgery are closely linked: wide tumour resection
creates large, problematic defects where other tissues
are needed to close the hole. Plastic and
reconstructive surgery can oftentimes restore function
to a body region damaged by neoplasia.
The cosmetic appearance of the wound site after it
has healed may be important but it is not the main
surgical priority. Most owners simply want their pet to
(Main picture): Mike Pavletic examining a 25-year-old feline patient recovering from surgery. A tumour was resected from
the right side of the face and the area was reconstructed with a transposition flap elevated from the lateral cervical area.
(Above from LR): Views of the: tumour; surgical defect; closure with a transposition flap.
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AVAILABLE FROM BSAVA
BSAVA Manual of Canine and
Feline Wound Management and
Reconstructon, 2nd editon
Edited by: John Williams
and Alison Moores
This latest (2009) editon has been
completely updated under its new
editorial team. As before,
emphasis is placed on practcal
decision-making, underpinned by
an understanding of the biological wound healing process.
Chapters have been expanded to take account of recent
developments in wound care and in surgery.
Practcal decision-making
Advanced aps, grafs and microsurgery
Step-by-step Operatve Techniques
Case examples
Contents
The biology of wound healing; Wound aetology and
classicaton; Decision-making in wound closure;
Management of open wounds; Surgical drains in
wound management and reconstructve surgery;
Tension-relieving techniques and local skin aps;
Axial patern aps; Free skin grafing; Pedicled muscle
aps; Microsurgery; Special consideratons in wound
mangement; Complicatons of wound healing; Index.
Member price 49
Non-member price 75
The possibilities of
reconstructive surgery
return home as a functional member of the family. Of
the various body regions undergoing reconstructive
surgery, owners are most concerned about their pets
head, probably because we relate to our pets face to
face. They are always appreciative when we can
simultaneously restore function with the added bonus
of reasonably good cosmetic results.
Continuing to get a kick
Even after 30 years as a board certified surgeon,
Mike gets a real kick out of the challenges that he
faces when planning a complex reconstruction.
Personally, there is nothing more exciting than to
develop a procedure to resolve a problematic wound
or surgical problem, he says.
Most of the cases that come into his clinic are cats
and dogs but occasionally I have operated on exotic
pets, zoo animals, and even raptors at a local wildlife
rehabilitation facility. There is no shortage of
problematic wounds to close. Most of the techniques
translate well between species, although there are
greater limitations in birds due to the significant
anatomical differences from mammals, he says.
Expertise at Congress
Although many of the techniques that he will be
describing in his presentations in Birmingham are
technically complex, Mike insists that this is not always
the case. Many of the methods used in plastic and
reconstructive surgery are simple and practical for use
in routine surgical procedures. So he hopes that his
sessions will attract both experienced veterinary
surgeons with an established interest in reconstructive
surgery and their junior colleagues who are looking to
develop their skills in this area.
Mike is also keen for veterinary nurses to come
along to the sessions (BSAVA VN members can
upgrade to Vet Streams). He points out that VNs play
a pivotal role in helping clients to understand the
treatment that their pet will undergo and in
explaining the likely outcomes. Good nursing skills
are also vital in ensuring the success of any
surgical intervention.
Some surgical techniques are demanding and
require detailed postoperative care for an optimal
outcome. Infection is always a risk associated with
surgery and there are a variety of factors that can
contribute to its formation. Many factors can be
minimised or avoided to prevent infection. Like most
things in medicine, prevention is far more useful than
treating a problem, Mike explains.
So what are the most challenging cases that the
surgical team is likely to face? The challenge varies
according to the size of the wound or surgical defect
and its location. A while back I reattached the side of a
cats face that was sheared off by the fan on a car
engine. I was able to carefully reattach the face and
restore function to the left eye where the upper and
lower eyelids had been torn away from the skull. I was
impressed by the pets resilience and over time
function was restored.
MIKE PAVLETIC AT CONGRESS
How to manage trauma cases (Interactve Vet Stream)
Thursday AM
Management of bite wounds (Wound Management
Nursing Stream) Friday PM
Skin stretching techniques in reconstructve surgery
(Reconstructve Surgery Vet Stream) Saturday PM
See the full Science Programme online at
www.bsava.com/congress
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Each year a small group
of colleagues from an
emerging companion
animal veterinary
association is invited to
visit Congress as part of a
scheme run by BSAVAs
International Affairs
Committee (IAC)
International Affairs, Al Gibson, and will
pack in as many lectures as they can in
between social events like the Friday
Banquet and Saturdays Party Night.
Insuring pets is not common in
Bulgaria, so veterinary surgeons often find
themselves limited in their experience of
more involved procedures and treatments
and there is little incentive in practice
investment in expensive equipment that
wont be used. However, members of this
delegation represent two of the largest
veterinary clinics in the country.
Nobody in the party has been to a
BSAVA Congress previously and Maria
says that they are particularly excited
about the science: We are most looking
forward to hearing the world renowned
speakers in all those different fields;
obtaining new ideas, methods, and sharing
our experience with new colleagues.
Whos who
Maria graduated with honours from the
Faculty of Veterinary Medicine in Sofia in
2007 and has been working in a practice
since then, mostly with dogs and cats. Her
clinical interests include ophthalmology,
eye surgery, soft tissue surgery, oncology
and critical care.
Krasimira graduated from Sofia in
2008. She is working as a general
practitioner and her professional interests
include small animal reproduction, internal
medicine and exotics.
Anelia also graduated from Sofia in
2008. She is working at the Blue Cross
clinic and her special clinical interests
include cardiology, surgery and infectious
diseases of small animals.
Mihail is the most recent graduate in
the delegation, having left Sofia in 2010.
He also works as a general practitioner at
the Blue Cross clinic and his professional
interests are emergency medicine,
infectious diseases and orthopaedics.
Bulgaria
to benefit
from BSAVA
Choosing the nation
Wolfgang explains how the nation is
selected each year: At the moment the
Visiting Programme is only considering
members of companion animal veterinary
associations in European countries. The
scheme is advertised though the directors
of FECAVA, the Federation of European
Companion Animal Veterinary Associations.
Groups of up to four practising companion
animal veterinary surgeons are asked once
a year to submit an application of not more
than 500 words in which they detail the
composition of their group, their
professional backgrounds and in which
they explain how their daily work could
benefit from a visit to BSAVA Congress. IAC
reviews all submissions at the end of
October and, based on the majority vote of
its members, then decides who the visitors
to next years Congress will be.
Much to gain
Most participants in the scheme are
amazed by the sheer size of BSAVA
Congress, which in most cases is much
bigger than any veterinary conferences
they have visited before. Wolfgang says:
They are particularly impressed by the
variety of subjects that are covered in the
lectures and about the opportunities to
meet face to face with international leaders
in their field of expertise. Frequent
compliments are also made about the
excellent social programme, the evening
entertainment and the friendly atmosphere
at Congress. A number of these visitors
have used the Exhibition to set up business
contacts between UK-based companies
and businesses in their country.
In this World Congress year, overseas
delegates are expected in even greater
numbers than usual, and supporting our
colleagues from Bulgaria in this way
reinforces BSAVAs reputation as a
world-class event. n
I
n recent years the International Visiting
Programme has brought over guests
from the Ukraine and Latvia. In 2012 it is
the turn of Bulgaria to benefit from the
special invitation.
Aims of the scheme
Wolfgang Dohne, who usually plays host
on behalf of IAC, explains: The aim is to
enable a small group of practising
veterinary surgeons from a smaller sister
association to participate in the CPD
available at BSAVA Congress and to
transfer their knowledge back to their
national association and of course to use
their new information for the benefit of their
own patients. It also promotes BSAVA
Congress as the most important
companion animal CPD event in Europe
and should encourage more colleagues
outside the UK to consider the benefits of
BSAVAs overseas e-membership.
Bulgarian colleagues
The Bulgarian Association of Small Animal
Veterinarians will be sending four
veterinary surgeons to the WSAVA/
FECAVA/BSAVA World Congress in April
2012. Maria Savova, Krasimira
Kodzhanikolova, Anelia Stoilova and Mihail
Dimkov will be hosted by the Chairman of
27 Congress_Bulgarians.indd 27 20/02/2012 10:28
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As part of its commitment to expanding
provision of VN CPD, BSAVA is
introducing a new and
innovative offering to
challenge and inspire
vet nurses.
Dr Frances Barr,
Director of
Education,
explains
VN CPD and
new merit awards
B
SAVA has for many years encouraged
veterinary nurses, as valuable members of the
practice team who deserve the very best
science on offer, to attend Congress for their
CPD. Now veterinary nurses can be BSAVA members
in their own right, and membership brings with it
a range of benefits. This includes plans to
develop and extend the provision of CPD for
nurses outside Congress.
One fine day
Individual day courses designed specifically for
nurses in first opinion practice will of course
continue. These clinically relevant courses are
delivered by excellent teachers and, at a heavily
discounted rate for members, offer great value for
money. They are a fantastic opportunity to meet
other nurses, to concentrate away from the
distractions of the practice, and to pick up those
useful tips which can be applied day to day.
Webinars
In 2012 BSAVA will also be introducing monthly
Learn@Lunch webinars for veterinary nurses, which
will be free to BSAVA members. Webinars are a
wonderful way of keeping up to date without the
difficulties of taking time away from work and
travelling. We hope veterinary nurses will watch a
webinar with colleagues over a sandwich and
coffee at lunchtime or if lunchtime isnt a good time,
will view the recorded webinar later at a more
convenient time.
Something new
The most exciting development in 2012 for veterinary
nurses is the launch of the BSAVA Veterinary Nurse
Merit Awards. These awards will be for the motivated
nurse in primary care practice who would like to
expand his or her knowledge in a specific field.
There is an appetite amongst many veterinary
nurses for more focussed and structured CPD to
become available. BSAVA talked to many of the nurses
attending Congress in 2011 and this research
confirmed a demand for accessible CPD programmes
for individuals with a particular interest. Not all
individuals are in a position to be able to commit to
diploma level training but the passion which led
them into nursing in the first place continues.
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FURTHER INFORMATION
Further informaton regarding the BSAVA VN Merit Awards can be obtained by
emailing courses@bsava.com. Individuals may also nd more informaton and
enrol on either of the programmes in the CPD secton of the BSAVA website
www.bsava.com.
The opportunity to study a subject and develop
the corresponding skills, and then to apply those in
the practice, was an exciting prospect. The vets we
spoke to also saw the benefit to the practice of
having nurses with special interests and skills. To
meet this demand, BSAVA have developed the
Veterinary Nurse Merit Awards.
Nurse Merit Awards
The BSAVA Veterinary Nurse Merit Awards will provide
short structured CPD programmes. Each programme
consists of a two-day course, a follow-up one-day
course a couple of months later, two webinars, and an
online assessment. There will be a substantial
practical component.
All those who complete the programme and
assessment satisfactorily will receive a certificate and
badge. The programmes are not a formally accredited
qualification, but the awards provide recognition of
interest and expertise in a particular field. It is
expected that nurses would renew their award with a
short refresher course every 5 years.
In 2012 there will be two VN Merit Award
programmes running:
Rehabilitation and physiotherapy
The programme will be led by Lowri Davies, a veterinary
surgeon who has a particular interest in sports medicine
and rehabilitation therapy. Rehabilitation and
physiotherapy is an important and integral part of small
animal practice, encouraging the recovery of animals
from illness or injury. This is an area where the
veterinary nurse can play a vital role, working with the
vet and the owner to ensure the best patient care.
The holder of a BSAVA VN Merit Award in
Rehabilitation and Physiotherapy may be stimulated
to improve the routine care for hospitalised patients,
to introduce procedures which encourage recovery
after specific surgical interventions, and to run
special physiotherapy and rehabilitation clinics
within the practice to support ongoing recovery after
patients go home, or to manage patients with chronic
mobility problems.
Anaesthesia and Analgesia
This programme will be led by Derek Flaherty, who is a
veterinary anaesthetist at the Glasgow Veterinary
School. Veterinary nurses play a pivotal role in
monitoring anaesthesia in most small animal practices
and they are often best placed to evaluate the need
for pain relief in patients recovering from surgery or
hospitalised for illness or injury.
The holder of a BSAVA VN Merit Award in
Anaesthesia and Analgesia may be in a position to:
ensure that other nursing staff in the practice are
confident and competent when monitoring anaesthesia
and that the necessary equipment is available and
maintained; introduce routine evaluation of inpatients
for signs of pain; work with the veterinary surgeon to
ensure adequate pain relief; and run special pain
management clinics within the practice for patients
with chronic conditions.
A worthwhile investment
The BSAVA VN Merit Award programmes are very
competitively priced, at just 400 plus VAT for BSAVA
VN members. This includes registration for both the
initial two-day course and the follow-up one-day
course, and access to both webinars (live and
recorded) and the online assessment. Non-members
may enrol for the programme, but are not eligible for
the discounted price.
BSAVA encourages practices to view the BSAVA
VN Merit Awards as a worthwhile investment in the
skills of their staff. We expect holders of these awards
to be in a position to contribute to excellent patient
care, and to extend the services which a practice may
be able to offer.
The initial two-day course will take place on a
Friday/Saturday, thus sharing the time commitment
between the practice and the individual. The follow-up
course will take place on a Saturday. The remaining
study and assessment are online.
Launch offer at Congress
A special Launch offer for the BSAVA VN Merit
Awards will be running at BSAVA Congress 2012. Any
practice which pays to enrol one of their nurses on one
of the award programmes will receive one free place
for any nurse or receptionist within their practice on
one of the individual BSAVA day courses run in 2012
(subject to availability).
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Join the Scottish
Congress clan
O
nly 4.3 miles from Edinburgh Airport and
just off the M8/Edinburgh City Bypass/A71,
the excellent facilities (including ample free
parking) at The Edinburgh Conference
Centre is ideally placed to once again host the 2012
Scottish Congress.
Wherever you lay your hat
On-site conference accommodation is available to
delegates, set in the attractive grounds of the
Heriot-Watt University Campus. Alternatively, there is
the nearby four-star Novotel Edinburgh Park or, if
youd rather city centre living, The Hilton Edinburgh
Grosvenor has a great reputation.
Vet sessions
Our range of CPD topics is designed to provide
delegates with practical, up-to-date information
and tips that can be put to use in general practice.
Plus, there are some fascinating sessions that dig a
little deeper for the more adventurous and those
looking for a challenge. These cover events that you
are likely to come across at some point and so will
want to be more prepared for.
This year the veterinary surgeons Saturday
morning lectures will focus on ophthalmology, with
Neil Geddes of St Clair Veterinary Group. This will
include the ophthalmic exam and acute and
emergency presentations, as well as some time spent
discussing corneal/conjunctival surgery. Sunday
morning lectures will get to grips with orthopaedics in
practice; John Ferguson of East Neuk Veterinary
Clinic will talk about pelvic fractures in cats and
treatment options for hip problems in dogs; and there
will be a 10 top tips session.
BSAVAs Scottish Congress prides itself on
providing top quality CPD and outstanding
evening entertainment, all with a friendly
feeling and at an affordable price. Whether
you are travelling from afar or live just around
the corner, we would like to invite you to
become part of the clan
Scottish Congress 31 AUGUST 2 SEPTEMBER 2012
View of Heriot-Watt
Edinburgh
30-31 Scottish Congress.indd 30 20/02/2012 10:27
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VN sessions
The veterinary nurses Saturday morning lectures will
cover nutrition and nutraceuticals with Marge Chandler
of the R(D)SVS and will include topics such as
emergency cases, parenteral feeding and the uses of
nutraceuticals. Sunday morning lectures will look at
peri/postpartum conditions and neonatology with
Louise McLean of Croft Veterinary Hospital, discussing
when to be concerned and what to do, as well as
caesareans and neonatal care.
and so much more
Afternoon seminars will cover a variety of topics
including: ear disease; endocrinopathies; pancreatic
disease; the dyspnoeic cat; management of GDVs;
practical suturing; blood smears and urinalysis;
rabbit anaesthesia; and fluid therapy, plus interactive
sessions, helping to test your knowledge on CPR
and poisonings.
Tailor-made CPD bring your cases
Once again we will be encouraging vets, nurses and
students to provide us with an insight into the
interesting or challenging cases that they have been
dealing with over the past year. So if you want to share
your interesting cases contact Gerard McLaughlan at
gerard.mclauchlan@glasgow.ac.uk or Yvonne
McGrotty at yvonne.mcgrotty@vets-now.com for
more information or to submit your case abstract. If
selected to present your case you will receive free
Saturday Congress registration and could win a
BSAVA Manual of your choice.
Expertise on tap
The support and generous sponsorship provided by
our exhibitors enables this great event to continue. In
addition to the main exhibition, they will also be
present at the evening entertainment, giving everyone
plenty of time to discuss their needs and find out
whats new on the market.
Time to party
Scottish Congress is famous for its evening
entertainment. Last year the Big Pub Quiz was such
a hit that it will be making a return on the Friday
evening. Then, of course, the glamorous black tie
Gala Dinner event will take place at The Edinburgh
Corn Exchange with the fabulous Teannaich ceilidh
band, where we will be attempting to outdo last years
event (a tall task indeed).
Meet us in Birmingham
If you are attending BSAVA Congress, then come and
visit us on our stand next to registration in the NIA,
where you can take advantage of the one-off special
registration price available to delegates.
If you are not going to make it to Birmingham,
online registration is now open; visit www.bsava.com
and click on the Congress tab where youll find the
link to BSAVA Scottish Congress, or check us out
on our Facebook page www.facebook.com/
scottishbsava. n
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T
he World Small Animal Veterinary
Association (WSAVA) has
announced the winners of its
annual awards. Highly regarded in
global companion animal care, the WSAVA
Awards recognise ground-breaking
research and achievement in the clinical
care of companion animals. They will be
presented at the World Congress Opening
Ceremony in Birmingham on Wednesday
11 April. The winners are as follows.
WSAVA Presidents
Award
This award is made
periodically by the
President of the WSAVA to
a member judged to have
made an outstanding
of his work to educate the public in America
about pet welfare and health.
Dr Becker, a graduate of the
Washington State University College of
Veterinary Medicine, is a regular contributor
to national media across the USA. He has
also authored a range of best-selling
books. Dr Becker works at Lakewood
Animal Hospital in Coeur DAlene, Idaho
and North Idaho Animal Hospital in
Sandpoint. He is adjunct professor at the
Washington State University College of
Veterinary Medicine and at the Colleges of
Veterinary Medicine at both Colorado State
University and the University of Missouri.
He has also lectured at every veterinary
school in the United States.
Professor Kirpensteijn said: Dr Becker
has a long history of supporting the
humananimal bond. His continuous
efforts to improve the wellness of animals
and their owners have placed the
veterinarian at the heart of the bond
between animals and people. His title of
Americas Veterinarian is well deserved.
WSAVA Hills Pet
Mobility Award
This award recognises the
outstanding work of a
clinical researcher in the
field of canine and feline
orthopaedic medicine and
surgery. This year the award has been
made to Professor Daniel Lewis, Jerry
and Lola Collins Eminent Scholar in Canine
Sports Medicine and Comparative
Orthopaedics at the University of Florida.
Dr Lewis graduated from the University
of California, Davis in 1983. In 1993, he
was appointed Professor of Small Animal
Surgery and Eminent Scholar at the
University of Florida. His special interests
include traumatology, fracture
management and reconstructive surgery,
with a focus on the utilisation of circular
2012 WSAVA
award winners
announced
The WSAVA is pleased
to announce the
winners of its
prestigious awards
which will be presented
at the WSAVA/
FECAVA/BSAVA World
Congress on 11 April
contribution to the Association. This year it
has been made to Dr Anjop Venker-van
Haagen. Dr Venker-van Haagen graduated
from Utrecht University in 1967, working
there until 2004 as Associate Professor,
Ear, Nose and Throat Diseases. She is a
founder of the International Veterinary Ear,
Nose and Throat Association (IVENTA), one
of the first specialist groups to be affiliated
with the WSAVA. She is also Associate
Editor of Veterinary Sciences Tomorrow.
Commenting on the award, Professor
Jolle Kirpensteijn, President of the WSAVA,
said: Dr Venker-van Haagen has carried
the WSAVA name with pride, working for
years as the chair of our prestigious
Scientific Advisory Committee and as
President of IVENTA. She is an inspiration
to us all and a worthy winner of this award.
WSAVA Hills
Excellence in
Veterinary
Healthcare Award
outstanding work of
veterinary surgeons in
promoting companion animal healthcare
and the family pet/veterinary bond through
a special sensitivity to both clients and
patients using leading edge clinical
nutrition and advanced medical and
surgery techniques. This year, it has been
awarded to Dr Marty Becker in recognition
32-33 WSAVA NEWS.indd 32 20/02/2012 10:25
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and hybrid external skeletal fixation for
fracture management, deformity correction
and limb salvage procedures.
WSAVA Global One
Health Award
This award, launched in
2011, recognises an
outstanding contribution
made by an individual or
organisation in promoting
the One Health concept globally. This year,
it has been awarded to Professor Ab
Osterhaus, another graduate of the
University of Utrecht.
Since 1994 Dr Osterhaus has worked
at Erasmus MC in Rotterdam as Head of
the Department of Virology, building a
specialism in viruses that cross the species
barrier. His teams work has enabled health
authorities around the world to prepare for
potential disease outbreaks and, at an
individual level, he has campaigned
tirelessly for a global taskforce to prepare
for and combat viruses such as H5N1.
WSAVA
International Award
for Scientific
Achievement
work of a veterinary
surgeon in advancing the
WORLD CONGRESS OPENING CEREMONY
(with wSAVA & FECAVA AwArdS)
Date: Wednesday 1 April 2012
hall: Hall 1 18.30
Entry: Free to all with a Congress Badge
Kick-start your Congress at the free Welcome
ceremony at 6.30pm. Anyone registered
for Congress is invited to atend the World
Congress Opening Ceremony in Hall 1 on
Wednesday. Just show your badge. The
event will include the presentaton of the
prestgious WSAVA and FECAVA awards, and
Presidents of all partcipatng organisatons
(Andrew Ash, BSAVA, Jolle Kirpensteijn,
WSAVA, Simon Orr, FECAVA) will invite you
to join them in launching the largest ever
veterinary conference in Europe.
This event is also open to anyone atending
any of the pre-Congress Afliated Group
meetngs during the day on Wednesday.
professions knowledge of companion
animal disorders and has been made to
Professor Richard Halliwell. Professor
Halliwell graduated from the University of
Cambridge before spending 16 years
teaching in the USA at the University of
Pennsylvania and the University of Florida.
In 1988 he returned to the UK as William
Dick Professor of Veterinary Clinical
Studies at the University of Edinburgh,
serving six years as Dean of the Faculty.
Now a Professor Emeritus, he has
served as President of both the American
and the European Colleges of Veterinary
Dermatology and of the World Association
for Veterinary Dermatology. He teaches
dermatology at St Georges University,
Grenada, as well as giving presentations at
national and international meetings.
A year of great achievements
Commenting on the 2012 WSAVA Awards,
Professor Kirpensteijn said: 2011 was a
year of great achievements for the WSAVA,
including a partnership with OIE, a doubling
of our membership and pioneering
contributions from our committees. During
2012, we expect to continue this excellent
progress, ensuring that the WSAVA
develops its role as an essential partner in
global companion animal development. In
fact, WSAVA could also stand for Welfare,
Science, Advancement, Veterinary care
Raising standards of
pain management
The WSAVA Global Pain
Council involves three
prominent British
veterinary surgeons and
is working towards
global guidelines and a
CE programme
and Absolute dedication to the profession.
Id like to thank our major supporter Hills
Pet Nutrition for sponsoring two of the
awards and for being the prime sponsor of
our last three congresses. Hills also
contributes to the funding of our CE
programme, various disease
standardization groups and other initiatives.
Nominations are now being considered
for the 2013 WSAVA Awards, which will be
presented at the 2013 WSAVA Congress in
Auckland, New Zealand, from 69 March.
More information on the WSAVA is
available at www.wsava.org. n
GPC has been set up in response to challenges
faced by the profession in diagnosing and
managing pain in small animals and because of
the unavailability of various analgesic agents
around the world. The Britsh veterinary
surgeon members are:
n Dr Duncan Lascelles, Professor of Small
Animal Surgery at the University of North
Carolina, USA. Duncan, who qualifed at
the University of Bristol Veterinary
School, is a researcher and author on pain
management issues
n Dr Andrea Nolan, Professor of Veterinary
Pharmacology and Senior Vice-Principal
at the University of Glasgow. Andrea also
researches the area of pain assessment and
management
n Dr Sheilah Robertson, who qualifed at the
University of Bristol Veterinary School.
She is now Assistant Director of Animal
Welfare for the American Veterinary
Medical Associaton and a specialist in
feline pain management.
Commentng on the creaton of the GPC its
Chair, Dr Karol Mathews said: Assessing
and managing small animal pain is an issue
of global signifcance. Pain accompanies
many of the common ailments afectng
these animals but its treatment has not kept
pace with its incidence, leading to what we
believe to be a treatment gap. Dr Mathews
is Professor Emerita of Emergency and
Critcal Care Medicine at the Ontario
Veterinary College, Canada.
During 2012, the Council will conduct
research into existng pain assessment
and management procedures throughout
the world. Based on this it will produce a
Global Pain Treatse in 2013. The Treatse
will provide a comprehensive resource on
pain management and will be designed to
be of daily clinical relevance. Later in 2013,
pain management CE programmes will be
developed and rolled out globally.
WSAVA President Professor Jolle Kirpensteijn
added: The Global Pain Council will help us
to raise awareness of the importance of
pain management and to deliver on our
vision of an empowered, motvated and
unifed profession, which efectvely
recognises and minimises the prevalence
and impact of pain.n
A
s reported in previous issues, WSAVA
has launched a Global Pain Council
(GPC) to raise the standard of pain
management in small animals. The
Council, which includes three prominent
Britsh veterinary surgeons, aims to develop
easily accessible practcal guidelines on pain
management and medicaton for veterinary
staf and to create a CE programme which
can be rolled out around the world. The
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the companion interview
Cecilia
Gorrel
BSc MA VetMB DDS
HonFAVD DiplEVDC
MRCVS
Q
You have become well known within the
profession through your dentistry work,
how did you become involved in this area?
A
I am qualified as a human dentist and oral
pathologist as well as a veterinary surgeon.
When I decided to train as a veterinary surgeon
I had no idea of how common oral problems are in
animals I became a vet because I like animals and I
like medicine/surgery. It wasnt until I started working
as a vet in small animal practice that I realized how
common oral/dental diseases were and what an
impact they had on an affected animal. I also realized
that my previous training was useful. So, I joined the
Cecilia Gorrel was born in Gteborg to Swedish parents in 1956. She is the eldest
of three (a sister and brother, 2 and 6 years younger). Her mother was a
pharmacist and homemaker, and her father was a civil engineer and businessman
who worked in the Middle East from 1960 until he retired in the early 80s. So
Cecilia grew up in the Middle East Iraq then Lebanon. Her primary education was
in Baghdad and she undertook her O Levels and A Levels in the UK. Cecilia is
qualified as a Doctor of Dental Surgery, an oral pathologist and a veterinary
surgeon. She is a European and RCVS-recognised Specialist in Veterinary
Dentistry, and a partner in a veterinary dentistry and oral surgery referral service
(Petdent Ltd) in the UK. Cecilia is also an independent research consultant
investigating oral diseases in the dog and cat. She is a Diplomate of the European
Veterinary Dental College and was its inaugural president. She is also an Honorary
Fellow of the Academy of Veterinary Dentistry and an Honorary Lifetime Member of
the British Veterinary Dental Association.
British Veterinary Dental Association to find out what
was happening in animal dentistry. I quickly became
active within the BVDA as course organizer and then
the train left the station and hasnt stopped since.
What do you consider to be your most important
professional achievement?
Increasing the awareness within the veterinary
profession of the significance (importance and impact)
of dental/oral health problems in dogs and cats, and
improving the level of knowledge and skills through
teaching (articles, books, lectures, courses, etc.) thereby
allowing vets to treat these problems more effectively.
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most of it wouldnt have happened if I had not taken
opportunities. Change is at times frightening and many
people do miss out on things because they are too
settled in the predictable. I do actively seek new
opportunities and can and will make changes even if
they sometimes scare me!
What would help most to improve the standards of
dental care in the UK pet population?
I would love to see more dentistry taught at the vet
schools. It is the General Practitioner who will make the
real difference to dental care of pets.
What single thing would do most to improve your
quality of life?
Be less self-critical. While it drives me to succeed, it
perhaps also at times makes life more difficult than it
needs to be.
If you were given unlimited political power, what
would you do with it?
I am not a political animal but if I did have power
I would strive to improve education globally. It seems
to me that most conflicts are due to lack of knowledge
and thus lack of understanding and respect which
leads to fear and aggression.
Which literary or historical character do you most
identify with?
Female pioneers, like Amelia Earhart.
What is your most important possession?
Health, husband, family and friends are most
important, but they are not possessions. I do love my
Honda S2000 roof down, challenging driving and Im
a happy girl.
Is there any particular song that is guaranteed to get
you on to the dance floor at parties?
I love dancing so almost anything does get me on
the dance floor. Celebration by Kool and the Gang is a
particular favourite.
What has been your main interest outside work?
Fitness, sports, and physical challenges. For example,
I got to the top of Kilimanjaro in 2010. I use exercise as
a reward and a way of achieving emotional balance.
Who has been the most inspiring influence on your
professional career?
Professor ke Larsson (Dept of Oral Histology and
Pathology, Dental School, University of Lund, Sweden)
now retired. His lectures were incredible. Within five
minutes you were hanging on to his every word. He
made it all seem so clear and logical. You couldnt
wait to get home, write up your notes and find out more
information.
What I realized was that he didnt give you lots of
detail what he provided was a framework and
stimulation for you to go home and put the meat on
the bones. It really made me understand the
importance of giving people the tools. It is something
I have tried to do in my professional career. I also base
my lecture style on his, i.e. dont complicate give a
clear skeleton and hopefully encourage people to go
home and put in the details themselves.
What is the most significant lesson you have learned
so far in life?
How incredibly important it is to take opportunities and
move outside your comfort zone. I am, and have been,
extremely fortunate in life (I have lived in several
different countries and cultures, had several careers,
have a wonderful husband, great friends, etc.), but
take opportunities and
move outside your comfort
zone I do actively seek new
opportunities and can and will
make changes even if they
sometimes scare me!
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Linked
webinars
Many of our courses
now include the
opportunity for all
attending delegates to access
a free post-event webinar giving you
even more value for money and even
more practical knowledge to take back
to your practice.
The linked webinars are available where
you see this sign
For more information visit
www.bsava.com/webinars
For more information or to book your course
www.bsava.com
All prices are inclusive of VAT. Stock photography: Dreamstime.com. Isselee; Vriesela.
The acute abdomen:
making the right call
3 May
Discover a
measured
approach to this
clinical challenge
SPEAKERS
Elizabeth Welsh and
Yvonne McGrotty
VENUE
Ramside Hall, Durham
FEES
BSAVA Member: 227.00
Non BSAVA Member: 340.00
Rehabilitation and
physiotherapy
14 June
Dogs available for
hands-on sessions
SPEAKER
Brian Sharp
VENUE
Dogs Trust, Haresfield
FEES
BSAVA Member: 338.00
Non BSAVA Member: 507.00
The big picture:
imaging beyond the
radiograph
12 June
SPEAKER
Paul Mahoney
VENUE
Marston Farm Hotel,
Sutton Coldfield
FEES
BSAVA Member:
227.00
Non BSAVA Member:
340.00
36 CE Advert.indd 36 20/02/2012 10:24
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Focus on...
BSAVA Kent
Region
B
SAVA Kent Region are always keen to hear
what you want in your region so please let us
know. Email kentregion@bsava.com with
your suggestions on topics and speakers
and to find out about getting involved and helping to
design the delivery of CPD in your area.
The BSAVA Kent Region needs you. The Region
is looking for new volunteers to help organise the
exciting CPD meetings. Regional committees help to
provide local and regional day and evening CPD
courses aimed at the practitioner looking to update
their current knowledge and techniques. These local
meetings provide opportunities to meet neighbouring
colleagues and BSAVA is always looking for fresh
faces to work with our regions. Committee members
generate course and stream ideas, including deciding
how and where they are delivered so have a say in
what happens on your doorstep.
Getting involved really gives you the capability
to shape regional CPD and meet new people.
There are a range of benefits available to committee
members, including complimentary BSAVA
Congress passes, the opportunity to attend other
regions CPD throughout the country and the
knowledge that you are helping to influence the
future of your profession.
If you would like to volunteer to help, come along to
one of our meetings or contact Jane Pomeroy via email
kentregion@bsava.com.
WHOS WHO ON KENT COMMITTEE
Chair Jane Pomeroy
Secretary open post
Treasurer open post
PetSavers Rep Helen Groves
Commitee Members open post
MARCH Wednesday 14
Fundamentals of radiotherapy
and applications for treatment
of solid tumours in veterinary
medicine
Jerome Benoit
APRIL Thursday 26
Imaging the emergency patient
Audrey Pette
MAY Wednesday 16
The paralysed and weak cat
Laurent Garosi
JUNE Thursday 14
Avoiding complications in
orthopaedic surgery, with
particular emphasis on cruciate
disease
Andrew Willis
Courses in 2012
SEPTEMBER Wednesday 12
Ophthalmology
Karen Caswell
OCTOBER Thursday 18
Orthopaedic diseases of the
carpus
Christoph Stork
NOVEMBER Wednesday 7
Dentistry in rabbits and rodents
Cedric Tut
DECEMBER Thursday 6
Christmas referrals fair, talk
and quiz
Jane Coatesworth
Please visit www.bsava.com for
further informaton on prices and
course content.
WHAT DO PEOPLE GET OUT OF IT?
When I rst got involved in the regions it was a chance
for me to meet people, network, and inuence the kind
of CPD I could access in Scotland, says Richard Dixon,
BSAVA Past-President. Quickly I came to rely on the
camaraderie and support from the friendships I made.
Also, that sense of achievement and reward you get from
being truly engaged in the profession has grown through
my involvement with the various commitees Ive worked
with. Plus it can be a real laugh!
Speakers come
from both inside
and outside the
Kent Region many
offering referral
services. The
evening meetings
are a good
opportunity for
practicing
veterinary surgeons
in Kent Region to
meet those offering
referral services
either in Kent or
close by. For
example, our speaker for June is Andrew Wills, who offers referral orthopaedic
services at Toachim House Veterinary Surgery in Faversham. In his spare time
Andrew is a keen cyclist.
Currently, all the evening meetings are held at the Best Western Russell
Hotel (136 Boxley Road, Maidstone ME14 2AE). Here is what is planned for
the coming year
37 Focus On.indd 37 20/02/2012 10:23
38
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CPD diary
April 2012
DAY MEETING
Tuesday 6 March
Thinking and doing: animal
welfare in veterinary practice
Speaker: James Yeates
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
EVENING MEETING
NORTH WEST REGION
Tuesday 6 March
Chickens
Speaker: Victoria Roberts
Swallow Hotel, Preston
Details from northwestregion@bsava.com
EVENING MEETING
NORTHERN IRELAND REGION
Thursday 8 March
Feline behaviour
Speaker: Sarah Millsopp
VSSCo, Lisburn BT28 2SA
Details from nirelandregion@bsava.com
DAY MEETING
Tuesday 13 March
Introduction to practical cytology
Speaker: Michael Day
DAY MEETING
SOUTHERN REGION
Sunday 11 March
Backyard poultry: problems and
solutions
Speaker: Victoria Roberts
Botley Park Hotel, Winchester Road,
Boorley Green, Southampton SO32 2UA
Details from southernregion@bsava.com
EVENING MEETING
MIDLAND REGION
Wednesday 14 March
Rational management of heart
failure in practice
Speaker: Malcolm Cobb
Yew Lodge Hotel, 33 Packington Hill,
Kegworth, Derby DE74 2DF
Details from midlandregion@bsava.com
EVENING MEETING
SOUTH WALES REGION
Thursday 15 March
When it all goes wrong
Speaker: Carol Wright
The International Legacy Hotel,
Cardiff CF15 7LD
Details from southwalesregion@bsava.com
DAY MEETING
METROPOLITAN REGION
Sunday 18 March
Medical and surgical aspects of
the acute abdomen
Speakers: Ronan Doyle and Ian Battersby
Davies Veterinary Specialists,
Manor Farm Business Park, Higham Gobion,
Herts SG5 3HR
Details from metropolitanregion@bsava.com
EVENING MEETING
SURREY AND SUSSEX REGION
Wednesday 14 March
Update on rabbit medicine
and surgery
Speaker: Brigette Lord
Leatherhead Golf Club, Kingston Road,
Surrey KT22 0EE
Details from surreyandsussexregion@bsava.com
DAY MEETING
Tuesday 20 March
The ear, the nose, the throat...
tackling tricky problems and
providing practical solutions
Speaker: Davina Anderson
Chilworth Manor, Southampton
EVENING MEETING
SOUTH WEST REGION
Wednesday 14 March
Hot dogs: a practical approach
to PUO
Speaker: Sheena Warman
The Devon Hotel, Matford, Exeter EX2 8XU
Details from southwestregion@bsava.com
DAY MEETING
SCOTTISH REGION
Sunday 25 March
Dermatology: an update on
diagnostics and therapies
Speaker: Hilary Jackson
Glasgow Vet School
Details from scottishregion@bsava.com
EVENING MEETING
SOUTH WEST REGION
Thursday 22 March
Birds of the caged variety
Speaker: Steve Smith
Arundell Arms Hotel, Lifton,
Devon PL16 0AA
Practice Badge Deadline
Wednesday 14 March
The ICC/NIA, Birmingham, UK
Email: congress@bsava.com
WORLD CONGRESS
1115 April
WSAVA/FECAVA/BSAVA
EVENING MEETING KENT REGION
Wednesday 14 March
Fundamentals of radiotherapy and
applications for treatment of solid
tumours in veterinary medicine
Speaker: Jerome Benoit
Best Western Russell Hotel, 136 Boxley Road,
Maidstone ME14 2AE
Details from kentregion@bsava.com
DAY MEETING FOR NURSES
Thursday 8 March
Cardiology for nurses
Speakers: Simon Dennis and Charlotte Pace
DAY MEETING
NORTH EAST REGION
Sunday 11 March
Medical and surgical aspects of
the acute abdomen
Speakers: Ian Battersby and Ronan Doyle
Ron Cook Hub, University of York, Heslington,
York YO10 5DD
Details from northeastregion@bsava.com
EVENING WEBINAR
Monday 19 March
20:0021:00
Introduction to practical
cytology webinar
Speaker: Michael Day
Online
EVENING WEBINAR
Wednesday 28 March
20:0021:00
The ear, the nose, the throat
webinar
Speaker: Davina Anderson
Online
38-39 CPD Diary.indd 38 20/02/2012 10:22
companion
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39
DAY MEETING
SOUTHERN REGION
Thursday 10 May
Ferocious felines and
confrontational canines
Speaker: Sarah Heath
Venue TBC (Swindon)
Details from southernregion@bsava.com
EVENING MEETING
SOUTH WEST REGION
Thursday 10 May
Raised liver enzymes
Speaker: Jill Maddison
Exeter Hotel, Kennford, Exeter, Devon EX6 7UX
EVENING MEETING
SOUTH WALES REGION
Wednesday 16 May
Itchy cats and dogs
Speaker: Natalie Perrins
Shepherds Veterinary Hospital,
Bridgend CF31 2BF
Details from southwalesregion@bsava.com
Wednesday 16 May
The paralysed and weak cat
Speaker: Laurent Garosi
Maidstone ME14 2AE
EVENING MEETING
MIDLAND REGION
Wednesday 23 May
Managing chronic diarrhoea in
practice
Speaker: David Murdoch
Wolverhampton Medical Institute,
New Cross Hospital, Wolverhampton,
West Midlands WV10 0QP
Details from midlandregion@bsava.com
EVENING MEETING
SURREY AND SUSSEX REGION
Thursday 17 May
Practical dentistry
Speaker: Lisa Milella
Holiday Inn, Gatwick
Details from surreyandsussexregion@bsava.com
DAY MEETING
METROPOLITAN REGION
Tuesday 15 May
Soft tissue surgery for the general
practitioner: beyond the bitch spay
Speaker: Zoe Halfacree
Holiday Inn, Elstree
Details from metropolitanregion@bsava.com
DAY MEETING
NORTH WEST REGION
Wednesday 13 June
Simple repairs
Speaker: Turlough ONeil
Venue TBC (Warrington)
Details from northwestregion@bsava.com
Thursday 14 June
Avoiding complications in
orthopaedic surgery with
particular emphasis on
cruciate disease
Speaker: Andrew Wills
Maidstone ME14 2AE
EVENING MEETING
SOUTH WEST REGION
Monday 18 June
Spinal disease in dogs:
myths and misconceptions
Speaker: Noel Fitzpatrick
Charter Veterinary Hospital, North Devon
DAY MEETING
Tuesday 12 June
Imaging beyond the radiograph
Speaker: Paul Mahoney
Marston Farm Hotel, Sutton Coldfield
May 2012
DAY MEETING
Thursday 3 May
The acute abdomen case:
making the right call
Speakers: Elizabeth Welsh and Yvonne McGrotty
Ramside Hall, Durham DH1 1TD
DAY MEETING
EAST ANGLIA REGION
Sunday 13 May
Breeding for the future:
reproductive management
and genetics
Speakers: Angelika von Heimendahl,
Sarah Blott, Cathryn Mellersh, Eleanor Raffan
and Jeff Sampson
Animal Health Trust, Newmarket, Suffolk
Details from eastanglia.region@bsava.com
EVENING MEETING
SOUTH WEST REGION
Monday 14 May
Dealing with difficult dogs in the
practice environment
Speaker: Martin Pashley
Gipsy Hill Hotel, Pinhoe, Exeter, Devon EX1 3RN
EVENING WEBINAR
Thursday 24 May
20:0021:00
The acute abdomen case:
making the right call webinar
Speaker: Elizabeth Welsh
Online
Thursday 26 April
Imaging the emergency patient
Speaker: Audrey Petite
Maidstone ME14 2AE
AFTERNOON MEETING
SCOTTISH REGION
Thursday 7 June
Emergency and critical care:
my patient is bleeding, what do
I do next?
Speaker: Andy Brown
Kingsmill Hotel, Inverness
Details from scottishregion@bsava.com
June 2012
OTHER UPCOMING BSAVA CPD COURSES
See www.bsava.com for further details
Midland Region
Tuesday 19 June
Recent advances in cancer management
for frst opinion veterinarians
Metropolitan Region
Wednesday 20 June
Fracture fxaton: new concepts and
new techniques
BSAVA Educaton
Thursday 21 June
Pet loss support in veterinary practce
BSAVA Educaton
Monday 25 June
Imaging beyond the radiograph webinar
BSAVA Educaton
Thursday 28 June
Ophthalmology for nurses
WEEKEND MEETING
NORTHERN IRELAND REGION
Friday 25 and Saturday 26 May
BSAVA Northern Ireland
Conference 2012
Endocrinology
Speakers:
Mike Herrtage, Ian Ramsey,
Carmel Mooney
and Barbara
Gallagher
A practical programme designed to refresh
your knowledge of the basics of endocrinology
and to develop your understanding of a range
of complex conditions, allowing you to return to
your practice with new skills and techniques to
implement right away. We all see endocrinology
cases every single week, so there has seldom
been a more relevant topic for intensive study.
Radisson Roe Hotel, Limavady,
Northern Ireland
Details from nirelandregion@bsava.com
38-39 CPD Diary.indd 39 20/02/2012 10:22
WORLD CONGRESS 11 15 April
WSAVA / FECAVA / BSAVA
The ICC / NIA,
Birmingham UK
www.bsava.com
Not just any veterinary conference
this is a World Congress for the whole practice
Join us for the very best in veterinary science,
business knowledge, and networking.

More than 300 lectures by world class speakers

Inspiring management stream (Thurs and Fri)

Excellent exhibition featuring over 270 companies

Brilliant social events, with guest appearances
from Lord Robert Winston, Greg Davies,
Simon Evans and Olly Murs
40 Congress Ad.indd 40 20/02/2012 10:20

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