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The essential publication for BSAVA members

Feline Dementia
Cognitive dysfunction
in cats
Clinical Conundrum
Diagnosis and
management of diarrhoea
in a middle-aged GSD P4
APRIL 2009
How To
Treat hyperthyroid cats
with radioactive iodine
Ferrets: habits,
handling and
health care
2 | companion
Ferrets and
Thursday 4 June 2009
Speaker: Emma Keeble
Mottram Hall, Wilmslow Road,
Mottram St Andrew, Cheshire
Registration: 10:00; Lectures:
10:30; End: 18:00
Course Fees:

Member: 170.22 +VAT

(195.75 inc VAT)

Non Member: 255.32 +VAT

(293.62 inc VAT)
3 Round Up
RCVS Elections
46 Clinical Conundrum
Diagnosis and management of
diarrhoea in a middle-aged GSD
79 Cognitive dysfunction
in cats
John Bonner on feline
1013 How To
Treat hyperthyroid cats with
radioactive iodine
1415 GrapeVINe
From the Veterinary Information
1618 Euthanasia
Coping with the responsibility
and supporting clients
19 Petsavers
Canine quality-of-life project
2021 Ferrets
Habits, handling and health care
22 Petsavers
Latest fundraising news
2325 WSAVA News
World Small Animal Veterinary
26 The companion Interview
Vic Simpson
27 CPD Diary
Whats on in your area
companion is produced by BSAVA exclusively for its members.
BSAVA, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB.
Telephone 01452 726700 or email to contribute and comment.
Additional stock photography
Eric Issele |
James Steidl |
Lane Erickson |
Linqong |
Stephen Coburn |
n the last few years the number of pet
ferrets and rodents has grown
considerably and along with this a
consequent growth in demand for
appropriate veterinary care. Many pet
owners develop a strong emotional
attachment to their ferret or rodent and
expect high-quality medical care. The small
size, susceptibility to stress-related
problems and short natural life expectancy
of these species present challenges
compared with traditional companion
Veterinary undergraduate training may
not cover pet ferrets and rodents in any
great detail and often vets have to rely on
extrapolation from other species. These
animals however have significant differences
in anatomy and physiology.
BSAVA has developed a new one-day
course that will cover the diagnosis and
treatment of common diseases of ferrets
and rodents, with practical tips and an
emphasis on clinical approach. There will be
opportunities for case discussion and
interaction with the speaker. It is designed
to equip vets in practice with the
knowledge required to deal confidently and
effectively with these delightful animals.
See page 20 for information about treating
ferrets and details about the new BSAVA
Manual of Rodents and Ferrets.




companion | 3
ast year just 17% of the profession
exercised their right to vote in the
RCVS elections.
The College recognises that this
disappointing lack of enthusiasm may have
been a result of members not being aware
of the candidates or their views, so they
are trying to change that for the elections
now underway.
Theres a special edition of RCVS News
Extra, containing candidate biographies and
Voter apathy has resulted
in a consistently low
turn-out in RCVS elections
for several years, which is
why this year they are
finding more ways to
introduce the candidates
and generate debate
their manifesto statements, together with
the all-important contact details so you can
put any questions to them directly.
Members should have received this along
with their ballot paper in the Colleges
March mailing.
The College has also teamed up with
the online veterinary community website in order to generate
discussions between voters and the
candidates. You can go online to read more
about them and their work, ask your own
questions, and see what others have to say.
The RCVS hopes that by joining in, or even
just following the discussions, you will be
able to make more informed choices and
engage in the debates.
This year, there are nine people standing
for six places on the Council, including five
veterinary surgeons who currently sit on
Council, one former Council member and
three previously unelected candidates.
They are:
lthough at the time of writing it
looked like delegate figures would
be up on last year, we know that
not all our members can attend Congress
every single year and even if you do, you
cant attend every lecture. This is why from
the middle of April you will be able to
download any lecture you want from the
2009 programme online. This adds to the
Whether you were
there in person or not
all BSAVA members
have exclusive access to
all the science online
archive which allows you to download
and listen to any MP3 from the nursing
and veterinary programme from the last
three years.
If you did miss out on Congress
this year look out for the full update
in the May edition of companion
and we hope you can make it next year
(811 April 2010). n
1. Dr Jerry Davies BSAVA Member
2. Mr Chris Gray BSAVA Member
3. Mr Peter Jinman BSAVA Member
4. Mr Thomas Lonsdale
5. Mr David McDowell
6. Mrs Jill Nute BSAVA Member
7. Mr Nigel Swayne BSAVA Member
8. Mr Chris Tufnell BSAVA Member
9. Dr Bradley Viner BSAVA Member
Voting opened on 13 March 2009, and
you can vote by post, over the phone
(freephone 0800 197 4622), or online
right up to the deadline of 5 pm on Friday
1 May. Voting instructions can be found on
the back of your ballot paper or on RCVS
online at
Newly elected Council members will
take their seats at RCVS Day, the Colleges
AGM and awards ceremony, on Friday
3 July 2009. n
4 | companion
Patricia Ibarrola, of Davies
Veterinary Specialists,
discusses the diagnosis and
management of diarrhoea in
a middle-aged GSD
insipidus) or any disease that interferes
with the renal ability to concentrate
urine (e.g. renal disease, hypoadreno-
corticism, hyperadrenocorticism, liver
disease, hypercalcaemia)
3) Severe dehydration and
(The latter was manifested by the
tachycardia, weak pulses, pale mucous
membranes with prolonged CRT and low
rectal temperature). The dehydration and
hypovolaemia was thought to be secondary
to the diarrhoea and excessive fluid loss.
4) Anorexia
A vague sign of many different disorders.
How would you investigate and
manage this case?
Given the patients significant hypovolaemia,
urgent fluid therapy is a priority. Given the
severe dehydration, hypovolaemia and
hypotension (mean arterial pressure (MAP)
was 60 mmHg), the patient required both
expansion of circulating volume and
replacement of fluid deficits, so 20 ml/kg/h
of 0.9% NaCl and 5 ml/kg/h of Hetastarch
was initiated.
A complete blood count (Figure 1),
biochemistry profile (Figure 2) and
urinalysis (Figure 3) were performed in
order to assess the dog systemically.
What is your interpretation of
the test results and do they aid
in refining the differential
diagnosis list?
A poorly regenerative, microcytic n
anaemia. Microcytosis was most likely
due to iron deficiency secondary to
gastrointestinal haemorrhage
Case Presentation
A 6-year-old female neutered
German Shepherd Dog was
presented with a one-week history
of anorexia, polydipsia and
diarrhoea. On examination the
bitch was quiet but responsive.
Rectal temperature was 37.8C.
Cardiac auscultation revealed
tachycardia (160 bpm) but no
murmur or muffled heart sounds.
Respiratory rate was 26 breaths/
min. Mucous membranes were
pale and tacky, with a capillary
refill time of 3 seconds. Femoral
pulses were weak but regular, with
no pulse deficits. There was a loss
of skin turgor (estimated 1012%
dehydrated). Body condition score
was 4/9. The remainder of the
physical examination including
abdominal palpation was
Based on the information you
have so far, create a problem list
and consider the differential
1) Diarrhoea
Primary intestinal disease n (e.g. infectious
process, inflammatory disease, dietary
intolerance, neoplasia or partial
intestinal obstruction)
Secondary to systemic disease (e.g. n
hepatic disease, hypoadrenocorticism,
exocrine pancreatic insufficiency)
At this stage, it was not clear whether
the diarrhoea was due to primary
gastrointestinal disease or secondary to
systemic disease.
2) Polydipsia
An appropriate response to n
More commonly, polydipsia is secondary n
to polyuria. Causes of polyuria include
lack of ADH secretion (central diabetes
companion | 5
A marked neutrophilia (left shift), n
moderate lymphocytosis and absence of
eosinopenia. Neutrophilia with a
moderate left shift is commonly seen
with inflammatory (infectious or
non-infectious) processes. The
documented lymphocytosis was
considered a striking finding in such a
sick dog; possible causes include
hypoadrenocorticism, certain infectious
diseases, lymphoma or leukaemia. The
absence of an eosinopenia in a
metabolically stressed dog, together
with lymphocytosis, made Addisons
disease (hypoadrenocorticism) a
possible differential.
Biochemistry and urinalysis
Marked hyponatraemia and n
hypochloraemia (Na:K ratio 27:1).
Both biochemical abnormalities can
occur with severe vomiting and
diarrhoea, hypoadrenocorticism and
renal insufficiency.
Marked azotaemia. Prerenal causes n
include severe dehydration and
hypovolaemia. Renal azotaemia occurs
as a result of primary renal disease or
systemic disease with renal
manifestation, e.g. pancreatitis or
infection. Postrenal azotaemia caused
by obstruction or rupture of the
urinary tract was unlikely in this case.
Urine specific gravity (1.043) was
supportive of adequate renal
concentration ability, making prerenal
azotaemia most likely.
Parameter Day 1 Day 9 Reference range
RBC (x 10
/l) 4.59 3.62 5.48.0
Hb (g/dl) 10.7 9.9 1218
HCT (l/l) 0.27 0.25 0.350.55
MCV (fl) 59.3 69.8 6575
MCH (pg) 23.3 27.3 19.524.5
MCHC (g/dl) 39.1 39.1 3237
Platelets (x 10
/l ) 319 196.0 150400
Reticulocytes (x 10
/l) 170 1013
WBC (x 10
/l) 41.1 17.1 618
Segmented neutrophils
(x 10
31.0 14.3 312
Band neutrophils (x 10
/l) 2.87 1.05 00.3
Lymphocytes (x 10
/l) 5.08 1.47 1.23.8
Monocytes (x 10
/l) 0.65 <0.01 01.2
Eosinophils (x 10
/l) 1.30 0.21 0.11.3
Basophils (x 10
/l) <0.01 <0.01 00.1
Normoblasts (x 10
/l) 0.13 35.5
Figure 1: Haematology results
Parameter Day 1 Day 3 Reference range
Sodium (mmol/l) 131 147 140153
Potassium (mmol/l) 4.9 3.6 3.85.3
Chloride (mmol/l) 105.0 112.0 99115
Calcium (mmol/l) 2.36 2.18 2.22.7
Phosphorus (mmol/l) 2.05 1.05 0.82.0
Glucose (mmol/l) 5.4 7.0 3.55.5
Urea (mmol/l) 22.9 3.8 3.56.0
Creatinine (mol/l) 104.0 47.0 20110
Cholesterol (mmol/l) 3.7 3.4 3.26.5
Protein (g/l) 54.0 51.0 5778
Albumin (g/l) 26.0 21.0 2331
Globulin (g/l) 28.0 30.0 2740
Alkaline phosphatase
42.0 27.0 0100
Alaninine aminotransferase
64.0 41.0 750
Figure 2: Biochemistry results
Parameter Day 1
Source Cystocentesis
Colour Yellow
Specific gravity 1.043
pH 6.0
Protein 1.8 g/l
Creatinine 13.9 mmol/l
Glucose Negative
Bilirubin Negative
Blood Trace
Leucocytes/HPF <5
Epithelial cells/HPF Negative
Erythrocytes/HPF 5
Crystals Negative
Bacteria Negative
Figure 3: Urinalysis results
Parameter Result Units Reference
<20 nmol/l Normal: up
to 250
1 hour
<20 nmol/l Normal: up
to 400
Figure 4: Results of ACTH stimulation
Mild hypoproteinaemia may be the n
result of reduced protein synthesis (e.g.
starvation, malabsorption, liver disease
or acute injury) or increased protein
loss (e.g. protein-losing nephropathy or
enteropathy, haemorrhage, formation of
exudates). Urine protein:creatinine ratio
was 1 making a protein-losing
nephropathy unlikely. Given the
suspicion of gastrointestinal ulceration,
enteric loss was considered most likely.
As the dog was hypovolaemic and
dehydrated, the hypoproteinaemia and
anaemia were likely to be more severe and
clinically significant. Given the clinical
presentation, unexpected lymphocytosis
and electrolyte changes, hypoadreno-
corticism and intestinal disease were
considered the main differentials.
What further diagnostic tests
would aid in diagnosis?
An ACTH stimulation test was performed
(Figure 4).
As the MAP had normalised, fluid rates
were adjusted to provide the remaining
volume replacement and maintenance fluid
requirement over the following 24 hours.
Gastroprotectants were prescribed
(sucralfate/ranitidine) in case of
gastrointestinal ulceration. The electrolytes
were monitored closely to ensure gradual
correction of the hyponatraemia to prevent
sudden changes in osmolality which can lead
to severe neurological signs.
What is your diagnosis and how
does it affect your management
of the case?
ACTH stimulation results confirmed
hypoadrenocorticism, and an intravenous
infusion of hydrocortisone (0.5 mg/kg/h)
6 | companion
Figure 5: VD and
lateral abdominal
commenced in addition to the gut
protectants and fluid therapy. Intravenous
hydrocortisone was chosen because of
concerns over poor intestinal absorption of
any oral medication. Hydrocortisone only
provides glucocorticoid supplementation;
mineralocorticoids are required in the
long-term management of such cases.
All clinical parameters remained stable;
the dog started eating and passed solid
faeces. Repeat blood tests showed a
persistence of the poorly regenerative
microcytic anaemia and moderate
hypoalbuminaemia, but a complete
resolution of the azotaemia. Hypokalaemia
was addressed by changing the fluid therapy
to Hartmanns solution supplemented with
potassium chloride.
On Day 5 the dog started
vomiting and abdominal
discomfort was evident on
palpation. What would be your
plan of action now?
Vomiting and, rarely, abdominal pain can be
seen in Addisonian patients. However, given
the dogs therapy and improvement in the
biochemical parameters, another disease
process was considered likely. Biochemistry
and a manual PCV were performed to
reassess the patients metabolic status.
Abdominal imaging was also carried out.
Biochemistry and PCV were relatively
unchanged with a mild anaemia and
What changes are evident
on the radiographs and what
is the most likely cause of
the changes?
There is gas and faecal material in the
descending and transverse colon, and some
small intestinal loops are gas-filled (Figure 5).
There is an air-distended loop of small
intestine in the mid-abdomen; at the ventral
aspect of this is a region with expanded
serosal-to-serosal width and mottled gas
and soft tissue opacity contents, consistent
with a gravel sign. These findings are highly
suggestive of a partial obstruction.
What would you do next and
what are your differentials?
Differentials for intestinal obstruction
include a foreign body or neoplasia. An
ultrasound examination is therefore
indicated but the presence of gas in the
intestine prevented examination of the area
of interest.
In view of the radiographic findings and
the clinical deterioration, an exploratory
laparotomy was performed. This confirmed
the presence of a foreign body (piece of
rubber) in the mid jejunum.
How would you manage this
dog postoperatively and in the
long term?
Addisonian dogs require glucocorticoid
supplementation at times of stress. Given
the vomiting, an intravenous infusion of
hydrocortisone was used. Oral gut
protectants were continued and fluid
therapy adjusted based on serial monitoring.
The dog recovered well from surgery,
electrolytes remained stable and the protein
levels gradually improved. Treatment with
oral prednisolone (0.2 mg/kg every
24 hours) and fludrocortisone (0.01 mg/kg
every 24 hours) was initiated and
intravenous therapy slowly withdrawn.
Four days after surgery the dog had a
markedly regenerative anaemia, which was
considered appropriate for the previous
chronic gastrointestinal blood loss.
The dog was maintained long term on
fludrocortisone alone, as it has both
glucocorticoid and mineralocorticoid
activity. However, in times of stress (e.g. if
she has surgery, goes into kennels, etc.) the
glucocorticoid requirements may increase,
and additional supplementation with
prednisolone was suggested. n
companion | 7
Contrary to popular belief, cats only
have one life, but that life is
becoming longer and longer lasting.
With better diets and veterinary
care, more of Britains cats and dogs
are living to a ripe old age. With this,
they are also becoming increasingly
prone to the same dementia-type
diseases as their owners, conditions
which are putting massive strains on
the National Health Service. John
Bonner asks veterinary experts how
the profession is dealing with its
own demographic time bomb
oughly 40 per cent of Britains pets
have reached that stage of their lives
when their veterinary surgeon will
mentally reclassify them as seniors rather
than mature adults. That boundary,
reached at around 7 years of age in dogs
and 10 years in cats, marks the point where
the pet will become increasingly vulnerable
to cognitive dysfunction diseases.
Clinical signs
Clinical signs often appear relatively soon
after the transition to seniority in cats
aged 1114 years, it is estimated that 28
companion | 7
8 | companion
percent have the sort of behaviour problems
that occur in human geriatrics, rising to more
than 50 per cent in cats aged 15 years and
older. Similarly, in dogs aged 7 and above, about
one in three shows signs of confusion,
restlessness and a reduced appetite for life,
while up to 20 per cent start to cause more
serious problems by urinating or defecating
inside the house.
Those problems in an ageing population
present both a challenge and an opportunity for
first-opinion practitioners. It can be extremely
difficult to tease out the relative contribution
played by mental senility when there are other
pathological processes involved, points out
Danille Gunn-Moore, Professor of Feline
Medicine at the University of Edinburgh
veterinary school. Is the cat failing to use its
litter tray because it is senile? Or is it arthritic
and finding it difficult to step over the side of
the litter box? There are so many factors that
may interact in these cases.
Jon Bowen, a veterinary behaviourist at the
Royal Veterinary College, agrees that is often
difficult to say whether behaviour problems are
entirely due to this type of cognitive change. It
can certainly be a factor in a lot of his cases,
with many dogs referred because of separation
anxiety or increased fearfulness that are at least
partly caused by dementia.
Role of the owner
If veterinary surgeons have difficulty in reaching
a definitive diagnosis, what chance is there for
the owner? Gwyn Eggington is an Essex-based
practitioner with a particular interest in pet
behaviour problems. I dont see many cases
involving dementia in my behaviour referrals
but I do see them in my general practice. The
biggest problem is in getting clients to recognise
that the changes in their pet are due to
dementia. They assume that it is just one of
8 | companion
companion | 9
those things they have to put up with, but it
is often a condition that we can do
something about.
Indeed owners have expectations of the
changes that might occur in their pets
behaviour as a normal consequence of
ageing which may make it difficult for them
to recognise any specific problems caused
by dementia.
Increasingly, owners are surrendering
pets with other chronic degenerative
conditions for which they claim they can no
longer afford veterinary treatment but it is
extremely rare for them to be brought in
specifically because of dementia, notes Chris
Laurence, veterinary director for the welfare
charity. Indeed, it is much more common for
dogs to be abandoned because the owners
themselves have Alzheimers disease or some
other neurological condition that prevents
them looking after themselves or their pets.
More than 15,000 dogs were looked after by
the Dogs Trust last year, some percentage of
which must have had some signs of
dementia. Yet, as dogs taken in for rehoming
suffer high levels of stress, changes from
their normal behaviour will be extremely
common, as such even experienced
observers may be limited in their ability to
identify real cognitive dysfunction in animals
in unusual environments.
The vast majority of dogs cared for by
the welfare charities only stay for a short
while before they are reunited with their
family or rehomed. So it would be unusual
for kennel staff to see the gradual
deterioration in a pet that will eventually
become apparent to its normal carers.
Treatment and expectations
Fortunately, effective treatment is
available for such cases, particularly as
the expectations for its success are lower
than they might be for the families of
human patients with degenerative brain
disease. Ultimately, the goal in human
medicine will be to restore all aspects of
complex personality in a pet animal it is
often enough for them to regain their
appetite for life.
As with most disease conditions, the
success of treatment in slowing down the
effects of cognitive dysfunction depends
upon the stage that this process has
reached. Nutraceutical diet supplements
and formulations specifically designed for
the older pet have been shown to help dogs
with mild to moderate disease. These
contain essential fatty acids, antioxidants
and free-radical scavengers that can reduce
the rate of degenerative changes in the
brain. Significant positive changes occurred
in both the objective behaviour of dogs
suffering from canine cognitive dysfunction
as well as in the perception of the dogs
condition by people in regular contact with
them, noted veterinary behaviourist Sarah
Heath in a report of a placebo-controlled
trial of one type of nutritional supplement
published in 2007. There are few equivalent
studies on the role of nutritional factors in
feline disease but anecdotal evidence
suggests that they do provide similar
benefits, adds Danille Gunn-Moore.
In more advanced cases it is better for
the veterinary practitioner to start
immediately on medical treatment such as
a monoamine oxidase inhibitor and/or a
xanthine derivative. Improvement may
take several weeks and so it is important
to minimise any further deterioration,
says Jon Bowen.
It is of prime importance that the
practitioner investigates, identifies and
treats any accompanying diseases, such as
osteoarthritis or cardiovascular conditions.
Improving the animals general health will
improve its tolerance of exercise and
produce further improvements in its quality
of life. The importance of physical activity
in reducing the impact of dementia should
not be underestimated getting blood
flowing faster around the brain will make a
big difference, Danille points out.
The end of the road
However, there are limits to what can be
achieved, even by the highest quality care.
At some stage the owners of a senile dog or
cat and their veterinary advisor will have to
discuss the topic of euthanasia. In some
cases, that decision may be unavoidable
when the relationship between the animal
and its owner is broken under the stress
caused by unwanted behaviour such as
soiling inside the house or constant wailing
at night. Even in these situations, it needs to
be explained to the owners that the
behaviour is not wilfulness on the part of
their animal and is the result of a genuine
disease. Pointing out that the condition is
likely to affect the animals enjoyment of life
also helps assuage any guilt felt by members
of its human family, says Danille.
In other cases, though, it is much more
difficult to decide when it is better to put
the animal to sleep. Danille suggests to
owners of any pet with irreversible
degenerative disease that they keep a diary
of their pets behaviour. This should note
roughly how much the animal ate that day
and how much time it spent in playing or in
other favourite activities. Even just a rough
visual analogue scale of 15 will give the
owners some form of objective evidence on
which to base their assessment of the pets
quality of life, she says. n
10 | companion
lthough a wealth of data are
available on the consequences and
outcome of feline hyperthyroidism,
the exact cause remains unclear. Prevention
is therefore not possible but because of the
benign nature of the lesions in most affected
cats, the disease carries a favourable
prognosis with effective therapy.
Treatment of hyperthyroidism is
achieved by removing or destroying the
abnormally functioning thyroid tissue or
Carmel T Mooney
is an RCVS Specialist in
Small Animal Medicine
(Endocrinology) working at
the University College Dublin.
Here she discusses one of the
most common conditions
affecting the older cat
Each treatment method carries its own
specific advantages and disadvantages that
must be taken into consideration for each
individual case. Few studies exist that
directly compare the outcome of each of
the different treatment methods in
hyperthyroid cats. However, radioactive
iodine therapy, if available, is considered by
most to be the optimal treatment in terms
of safety, simplicity and efficacy.
How does radioactive iodine
Radioactive iodine as
I, like stable iodine, is
actively concentrated by the thyroid gland. It
has a half-life of eight days and emits both
-particles and -radiation. The -particles
cause over 80 per cent of tissue damage, and
are locally destructive, travelling a maximum
of 2 mm with an average penetration of
400 m. The radiation therefore destroys
abnormally functioning thyroid tissue, but
carries minimal risk of significant damage to
adjacent parathyroid tissue, atrophic thyroid
tissue or other cervical structures.
How is the dose of radioactive
iodine calculated?
The overall aim of radioactive iodine
therapy is to restore euthyroidism with a
single dose whilst minimising the risk of
hypothyroidism. The smallest dose
possible should be used radiation
exposure should be kept as low as
reasonably achievable (ALARA principle)
to decrease potential risk for humans.
Various methods have been used to
calculate the optimum dose for individual
cats. In initial reports, tracer kinetic studies
were performed with low doses of
intravenous radioactive iodine.
Data were collected on percentage
inhibiting thyroid hormone synthesis and
release. Surgical thyroidectomy and thyroid
ablation using radioactive iodine are the
only curative methods. Medical
management controls thyroid hormone
production but has no effect on the
underlying disorder. Although an option
long-term, medical management is also
often used to stabilise patients prior to
surgical thyroidectomy or to control clinical
signs until radioactive iodine administration.
companion | 11
iodine uptake, effective half-life and
estimation of thyroid gland weight (all
factors known to influence therapeutic
dose) and the therapeutic dose subsequently
calculated. However this method requires
access to sophisticated computerised
nuclear medicine equipment, is time-
consuming, expensive, involves repeated
sedation of the patient and it has been
shown to be a poor predictor of actual
therapeutic dose kinetics. It is therefore
rarely used today. Another method is to use
a relatively high fixed dose of between 150
and 250 MBq in all cats regardless of their
clinical presentation. Although this method
is successful and simple, it potentially results
in the under- or overtreatment of a
significant proportion of cats.
Markedly elevated pretreatment serum
thyroid hormone concentration, the size of
goitre and the severity of the clinical
thyrotoxicosis all have potentially adverse
effects on the eventual response to
radioactive iodine therapy. These factors
can be used in a scoring system to calculate
the therapeutic dose an example is
presented in the table on page 13. When
such a scoring system is used, doses range
from approximately 50 to 250 MBq allowing
titration to each individual cat, avoiding
unnecessary under- or overtreatment. It is
a simple method that does not require
access to sophisticated nuclear medicine
equipment. Success is comparable to dose
estimation by tracer kinetic studies.
Although some variations are applied, it is
the principle method used by most centres
offering radioactive iodine today.
How is radioactive iodine
I was administered
intravenously. Oral administration has been
attempted but higher doses are generally
required, the risks of radiation spillage are
greater, and vomiting may occur.
Subcutaneous administration is equally
effective, simpler to administer, safer for
personnel and less stressful to cats, and is
currently preferred. Although not strictly
required, patients are usually lightly sedated
prior to injection to avoid any risks to those
handling the cat.
How successful is radioactive
iodine therapy?
Whatever method of dose calculation or
route of administration, attainment of
euthyroidism is expected in approximately
95 per cent of cases with a single dose. A
small percentage of cats remain persistently
hyperthyroid. In some of these cases,
serum total T4 concentrations continue
to decline after treatment and
euthyroidism is eventually attained up to
3 months later. Those that remain
persistently hyperthyroid are usually the
most severely affected but will respond
to a second treatment. Recurrent
hyperthyroidism can develop but appears
Radioactive iodine offers a
non surgical, curative
therapy for hyperthyroidism
12 | companion
to be rare and other side effects are
minimal. Serum total T4 concentrations
may become subnormal after treatment but
the development of clinical signs of
hypothyroidism is rare, and there is
eventual reactivation of normal or ectopic
thyroid tissue with time.
Renal failure may develop or worsen as
glomerular filtration rate declines when cats
become euthyroid. This may occur in up to
25 per cent of treated cats. Generally the
decline in renal function becomes evident
within one month of therapy and then
remains relatively stable for up to 6 months.
It is an unavoidable consequence of any
treatment modality but should not preclude
treatment of the hyperthyroidism. To date,
there is no simple biochemical test capable
of predicting cats at risk. However, it is
prudent to assess renal function one month
after treatment and institute renal support
as necessary.
How do I prepare cats and their
owners for radioactive iodine
Currently within the UK there are six
centres offering radioactive iodine therapy:
Animal Health Trust, Newmarket,
Suffolk (
Barton Veterinary Hospital, Canterbury,
Kent (
Bishopton Veterinary Group,
Ripon, North Yorkshire
Glasgow University Veterinary School,
Glasgow, Scotland (
Langford Veterinary Services,
Langford, North Somerset
Queen Mother Hospital,
Royal Veterinary College, London
Capacity at each centre is limited to 1
to 2 cases per week and isolation times vary
from a minimum of 2 weeks to a maximum
of approximately 4 weeks. Shorter isolation
periods necessitate greater restrictions in
the home environment (limited close
contact, no children, etc.) Waiting lists
vary but can be up to 6 weeks. Only
Langford Veterinary Services can use the
extremely high doses required for the
treatment of thyroid carcinoma.
Most hyperthyroid cats can be treated
with radioactive iodine. However, given the
prolonged period of boarding and
restrictions on handling, the presence of
any concurrent illness that adversely affects
appetite or necessitates frequent
medications usually precludes radioactive
iodine therapy. Most centres require full
haematological and biochemical screening,
often with cardiac ultrasound, before
accepting patients for treatment.
The effect of prior antithyroid
medication on efficacy of radioactive iodine
therapy is controversial. Prior methimazole
(and therefore carbimazole) therapy has
been variably suggested to enhance, worsen
or have no effect on radioiodine treatment
outcome. Overall prior therapy probably
has a minimal effect if at all. However,
revealing asymmetric,
bilateral disease
companion | 13
Estimating the dose of radioactive iodine from clinical signs, total thyroxine (T4)
and size of goitre as estimated by palpation. Adapted from Mooney CT.
Radioactive iodine therapy for feline hyperthyroidism: efficacy and
administration routes. J Small Anim Pract 1994;35:289.
Score Severity of
clinical signs
Total T4
Size of goitre Total
1 Mild < 80 Barely palpable
2 Mild moderate < 100 1.0 x 0.5 cm 39 < 120
3 Moderate 100150 1.5 x 0.5 cm 912 120150
4 Moderatesevere 150400 >1.5 x 0.5 cm > 12 160 or more
5 Severe > 400 Visible to naked
Further reading
Boag AK, Neiger R, Slater L, et al. Changes in the glomerular filtration rate of 27 cats
with hyperthyroidism after treatment with radioactive iodine. Vet Rec 2007;161:711.
Milner RJ, Channell CD, Levy JK, et al. Survival times for cats with hyperthyroidism
treated with iodine 131, methimazole, or both: 167 cases (19962003). J Am Vet
Med Assoc 2006;228:559.
Mooney CT. Radioactive iodine therapy for feline hyperthyroidism: efficacy and
administration routes. J Small Anim Pract 1994;35:289.
Peterson ME, Becker DV. Radioiodine treatment of 524 cats with hyperthyroidism.
J Am Vet Med Assoc 1995;207:1422.
Slater MR, Geller S, Rogers K. Long-term health and predictors of survival for
hyperthyroid cats treated with iodine 131. J Vet Intern Med 2001;15:4751.
Slater MR, Komkov A, Robinson LE, et al. Long-term follow-up of hyperthyroid cats
treated with iodine-131. Vet Radiol Ultrasound 1994;35:204.
Van Hoek I, Lefebvre K, Peremans K, et al. Short and long term follow up of
glomerular and tubular markers of kidney function in hyperthyroid acts after
treatment with radioiodine. Dom Anim Endocrin 2009; 36:45.
concurrent administration adversely affects
effective half-life of radioactive iodine and is
not recommended. Therefore, such drugs
are withdrawn for at least 5 days and up to
2 weeks prior to administration of
radioactive iodine. While some centres
accept untreated hyperthyroid cats, others
require assessment while euthyroid on
antithyroid medication in order to assess
renal function accurately.
How can I establish a radioactive
iodine unit at my practice?
The main drawback to widespread
establishment of radioactive iodine units is
the requirement for special licensing,
specific personnel training and suitable
premises for receipt, administration and
disposal of radioactive iodine. A dedicated
isolation unit and a means of storing
radioactive waste (for up to 3 months) are
required. In addition, an attainable source
of radioactive iodine is required. Many
centres are supplied by local hospitals
but not all hospitals use radioactive
iodine. Obtaining radioactive iodine direct
from manufacturers can be difficult and
erratic. Advice should first be sought from
your local radiation protection adviser
Most of the requirements will be
dictated by national and local ionising
radiation protection legislation. However,
consideration must also be given to
minimising the adverse effects of prolonged
hospitalisation through appropriate
environmental management. This may
include, but is not confined to, using larger
cages with separate areas for feeding and
sleeping and of a size that allows some
movement, in a room with some form of
stimulation. It may be worth checking out
the USA website for
an example of one of the most successful
large scale dedicated radioactive iodine
units together with its webcam system for
owners to look in on their pet.
Patient quarters following iodine 131
treatment at Langford Veterinary
Photo courtesy of University of Bristol Veterinary
14 | companion
The Veterinary Information Network brings together veterinary professionals from across
the globe to share their experience and expertise. At users get instant access to
vast amounts of up-to-date veterinary information from colleagues, many of whom have
specialised knowledge and skills. In this regular feature, VIN shares with companion
readers a small animal discussion that has recently taken place in their forums
heard on the
Adam Honeckman, DVM
Diplomate ACVIM (Small Animal
Internal Medicine)
Mobile Veterinary Diagnostics,
Casselberry, FL
The radiograph is difficult to evaluate.
I would do Chest x-rays and send out
blasto antigen testing (urine) if there is a concern for Blasto.
Any big lymph nodes you can do FNA cytology on?
Carolyn Eichkorn
Blastomycosis Negative. Kaiser was
in today with his owner...seems to be
doing fabulously...Not lame, bright and
alert, but still has a swelling (Grapefruit
size) on the inside of his thigh...Seems a
bit more localized than before but not
appreciably changed in size. I repeated the x-rays today...
essentially the same, maybe a wee bit more lysis on the
proximal tibia. I have started him on a course of clindamycin
pending your reply here. I am thinking more all the time that
this is some sort of osteomyelitis with perhaps an organizing
abscess (did not feel any soft spots)...I didnt feel really
comfortable poking around in the lump for a fine needle
aspirate but if you think that might yield some useful data, I
could try. His lymph nodes are all normal, his chest x-ray was
clear....His case is still quite a mystery...but at least the dog is
doing well!?! Anyway....any further thoughts you might have
at this point would sure be appreciated.
Carolyn Eichkorn DVM, Winrose
Animal Hospital, Winnipeg MB,
My patient is a 2 year old M/N Rottie who
presented with marked swelling of the
left hind leg extending from the inguinal
area to just distal of the stifle joint. The
dog walks quite well on the leg. Palpation reveals no pain;
however, the dog does tense up when I try to elicit a cranial
drawer. No sign of punctures or wounds.
X-rayed and really dont like what I found. There is an area of
translucency (I think some refer to it as moth-eaten or cotton
ball appearance?) mid to distal femur and the cortical bone is
fluffy/ periosteal reaction. The right femur appears normal.
There also appears to be lysis on the distal femur near the
stifle joint and on the proximal tibia. Dog has a history of
going to a blastomycosis endemic area several times over
summer and history of human blastomycosis in the family
acquired on the same property.
Tried to get some bone aspirates and a bone biopsy but the
bone is very hard and I am unable to penetrate the cortex well
with either a 16 gauge biopsy needle or a core biopsy punch
(with as much force as I could exert!!). I am hoping that being
unable to penetrate the cortex is good prognosis-wise.
My rule outs are bacterial osteomyelitis, blastomycosis and
osteosarcoma. I have started the dog on Cephalexin for now
but am wondering where to go from here if I cant get my
tools to penetrate the bone for a biopsy. Would you try again?
Look elsewhere for lesions? Other??
Thanks so much in advance.
companion | 15
All content published courtesy of
For more details about the Veterinary Information Network visit As VIN is a global veterinary discussion forum not all diets,
drugs or equipment referred to in this feature will be available in the UK, nor do all drug choices necessarily conform to the
prescribing rules of the Cascade. Discussions may appear in an edited form.
Carolyn Eichkorn
Just a quick update,...Kaiser is
undergoing an amputation tomorrow by
disarticulation at the hip. Pathology
report came back with a suspect Grade 1
soft tissue sarcoma though they did not
specify a cell of origin.
Pathology report:
The histologic findings suggest a soft tissue sarcoma the
lesion has high cellularity. For prudence, recommend
aspiration of regional lymph nodes and survey abdominal and
thoracic imaging (done) to rule out metastatic disease
(nothing on the histo strongly suggest metastatic potential at
this point, however it would be worth performing for
Histopathology: Section of the joint capsule/synovium are
available for evaluation. Extending from the joint capsule into
portions of the synovial lining is a large, unencapsulated,
moderately-well demarcated mass comprising dense,
multilayered, highly cellular and occasionally intersecting
streams of mildly pleomorphic, neoplastic spindle cells with
minimal surrounding connective tissue matrix.
Re: bone core sections: Along the endosteal surface of one
biopsy, and along the periosteal surface of another are small,
yet moderately thickened sheets of mildly plump spindle cells
(several layers thick)..There is mild anisocytosis/anisokaryosis
in this population and a single mitotic figure is noted.
Sooooooooooo....I dont see that we have much choice with
this dog but to amputate the leg but we will make sure that
the owner understands that there is always potential that the
mass has already metastasized.
Do you have any other thoughts?
Carolyn Eichkorn
We had Kaisers leg amputated at the hip
and sent it for pathology (we covered the
cost as the owner didnt want to send it
but I thought there was much to be
Came back grade II Sarcoma, suspect fibrosarcoma though
rhabdomyosarcoma cannot be completely ruled out...
Recommended monitoring regional lymph nodes, rule out
metastasis, which is not highly anticipated, though possible.
Margin clean by 23 cm on proximal end.
Mass was approx. 28 cm long by 16 cm wide!!!
Hes a great dog so hopefully this is his bad luck for the next
long while!!
Thanks again for all the help.
Cathy Wilkie, DVM
Associate Editor, Diagnostic Imaging
Animal Medical Hospital, West
Vancouver, BC Canada
A 2 year old Rottie with a lytic bone
mass needs a biopsy. There is a spike of
osteosarcoma in this age group (12
years), in addition to the old dogs. I would sample from the
center of the lytic area in the femur, hoping to get tumor (if
its there, it will be central, not peripheral). Use a Jamshidi if
you can.
Mike Harter, DVM
VIN Associate Editor, Parasitology,
Diagnostic Imaging, Animal Medical
Clinics, Rockford, IL
It may not be OSA, with multiple sites
metastatic histiocytic sarcoma or any
hematogenous pathology could be
involved, but theyd all need biopsies.
ps. The patella is elevated, too. Could you biopsy the soft
tissue component?
Cathy Wilkie, DVM
So if its a soft tissue sarc, are the bone
lesions all mets? (Im thinking of the
diaphyseal femur lesion ) If its a
synovial sarcoma, the stifle may be the
primary but if its some other kind of
sarcoma, dont we still have a primary
out there somewhere?
It sounds to me like we have local invasion of the tumour into
the bone at the site of the identified mass...
Adam Honeckman
Hi Bill,
I just wanted to say hi. Its been a long
time (Purdue Vet School class of 1992,
internship 92-93), but I saw your ad in
JVIM and decided to join as a VIN
I think you let me do my first ultrasound guided liver biopsy
when I was an intern. Who knew then that I would do mobile
ultrasounds/biopsies for a living?
Bill Blevins, DVM, MS, DACVR
School of Veterinary Medicine,
Purdue University, West Lafayette,
A synovial sarcoma in the stifle could
cause radiographic changes like this;
however, there is a lesion in the diaphysis of the femur. This is
a location where we commonly see metastasis to bone.
In any event, a neoplastic process is likely and a biopsy is
needed for a definitive diagnosis. I would also make
radiographs of the thorax. It may also be filled up with
Oh yes, fibrosarcoma of the joint capsule can also cause
lesions like this.
Bill Blevins
Hi Adam;
Welcome to VIN.
Who knows what path we will follow. It
seems to eventually work out. My work
with VIN is the most rewarding thing that
I do.....and it is on a worldwide stage.
16 | companion
Providing a kind, gentle end
to a pets life may be viewed
as a privilege part of the
vets everyday work to
preserve animal welfare.
However, as it often
provokes strong emotions,
euthanasia can be a significant
cause of stress. Jenna
Maryniak talked with a vet
and a psychologist about
coping with the responsibility
of euthanasia and supporting
grieving clients
any vets, particularly young
graduates, find themselves quite
unprepared to cope with the
ethical dilemmas surrounding certain
euthanasia cases, and their bereaved clients.
Elizabeth Ormerod is a practising vet in
Lancashire and chairman of the Society for
Companion Animal Studies (SCAS). She
believes that the importance of
undergraduate training in this area should
not be underestimated: When I was a
student in the 1970s, there was little
understanding of how to support bereaved
clients. During my training, I was greatly
influenced by two veterinary surgeons, Dr
Mary Stewart and the late Dorothy
Campbell, both of whom demonstrated the
importance of compassionate care.
However, as a young graduate, although I
children should be told the truth about n
pet loss
terminology should be used carefully, n
especially when working with children
youngsters of different ages require n
different approaches in support.
Colleagues advised that clients who
were well supported would cope better
with pet loss, would be more likely to adopt
another animal and would have strong
loyalty to the veterinary practice. I realised
that there were wide implications for the
mental health of clients, for animal welfare
and for the success of the veterinary
practice, she says.
As she developed a deeper
understanding of the issues surrounding
terminal illness and euthanasia, Elizabeth
could empathise with the clients, I was
unsure how to support them after those
dreaded euthanasia consultations.
The road to support
While travelling throughout the USA,
meeting researchers and practitioners who
were assessing the potential of the human
animal bond and its applications, Elizabeth
learned that the keys to supporting clients
advising all bereaved clients of available n
pet loss support
understanding that pet loss could n
generate strong emotions in clients
which could be negative and directed
at the veterinary surgeon and not to
respond with anger
companion | 17
became more comfortable with helping
grieving clients. The level of support she
provided in her UK practice increased
greatly following her travels. Detailed
written handouts for grieving clients and
the offer of one-to-one support were
introduced, in line with the best practice
witnessed in the USA.
I admit I was apprehensive about
offering to support clients after their loss
I was concerned that I could end up
spending hours in client support, rather
than treating patients but was encouraged
by American colleagues. Very few clients
actually feel the need to come and talk, and
even fewer since the excellent befriending
service introduced by Pet Bereavement
Support Service in 1994, notes Elizabeth.
However, my clients tell me the fact
that we provide literature and offer a
listening ear gives them tremendous
support and the feeling of having a safety
net if everything gets too much for them. I
believe all clients who have lost a pet should
be informed about the support available
from the PBSS. It is a very simple act, but it
is much appreciated and may help to prevent
mental health problems in some clients.
Communicating with children
For young children, the euthanasia of a pet
may be their first experience of death. Dr
June McNicholas, a human psychologist,
explains that children under the age of
seven often have limited understanding of
the finality of death and may also have a
less-developed sense of cause and effect.
This can cause a feeling that something
they have done may have caused an animals
death; for example, If I had not been
naughty, my dog would not have died.
Illness and death need to be explained
simply and honestly to children.
A common mistake (although
understandable) is for adults to sanitise a
pets death by saying that the dog/cat has
gone to live on a farm. In fact, this can
cause great distress and resentment on the
part of the child as he/she was not allowed
to say goodbye.
In other cases well-meaning
euphemisms, such as put to sleep, can
result in lasting psychological trauma. I have
dealt with a number of cases of night phobia
where the reason for a childs inability to
sleep or be settled at night can be traced to
a pet being put to sleep.
Children of all ages can be helped to
accept death. A simple funeral, laying of
flowers, etc., can help enormously, as can
encouraging children to think about the
good things they remember about owning a
pet. It all helps children come to terms with
the death of a pet and it can also lay the
foundation for coping with other losses.
Early psychiatric research has linked
unresolved death of a pet with greater
difficulty in coping with other losses,
particularly deaths of close family.
Staff emotion and stress
Elizabeth advises students that showing
some emotion during euthanasia consults is
not unprofessional. I myself was advised by
health care colleagues that clients would, in
fact, appreciate it if veterinary staff
appeared moved and this has been my
experience. She also has no hesitation in
advising her clients on when the right time
has come. How can we expect people with
no knowledge of terminal disease to know
when the time is right? I dont believe it is
wrong to guide them.
The request to euthanase a healthy pet,
however, presents a whole different set of
problems for the veterinary surgeon and can
be particularly stressful. In some countries,
such as Italy, legislation has been enacted to
prevent euthanasia of healthy companion
animals. As a young graduate, I was
unprepared for clients who wanted healthy
animals euthanased, said Elizabeth. There
are many reasons given for unwarranted
euthanasia requests the dog grew too big;
having the kitten is inconvenient now we
have a caravan; the dogs hair shows up
against the new carpet; were emigrating;
were getting divorced; we cant find homes
for the kittens/rabbits/pups and myriad
minor behaviour problems.
Over the years, Elizabeth learned that
theres no point in getting angry with such
clients. To do so can result in the animal
losing its life. She explained: Its all about
suspending your own judgements, actively
18 | companion
listening to the client and never losing your
temper or criticising. I aim to appear
understanding, empathetic, non-
judgemental and accepting. During this, I sit
next to them, rather than face them across
a table. When I judge that we have
developed a rapport, I lean toward them,
smile kindly, touch their arm and advise that
the practice has a solution for such
circumstances. We offer to care for the
animal until we can select a suitable home.
The practice charges the same fee for
rehoming as for euthanasia and cremation;
this covers any necessary veterinary care
and treatment until the animal is rehomed.
The owner also signs a consent form
transferring ownership to the practice.
Elizabeth has also learned not to query
the clients reason for an apparently
unwarranted euthanasia request over the
telephone. We should also be aware that
there may be more sinister motives behind
euthanasia of healthy animals, she said.
For example, people may arrange such
euthanasia to get revenge against former
partners. I have experience of fathers
getting rid of their teenage sons dogs.
Companion animal euthanasia can also be a
precursor to someone committing suicide.
Elderly owners
Dr McNicholas recently carried out an
in-depth analysis of the situation for older
pet owners moving into sheltered
accommodation or care. The SCAS study
looked at 234 care homes and sheltered
housing units in six UK cities: only 29 per
cent of which routinely allowed pets.
Despite the growing body of evidence of
the health and social benefits of pets to
older people, the importance of pet
ownership seemed to be largely ignored.
Indeed, only 24 per cent of facilities actually
asked potential residents whether they had
a pet. Being forced to have a much-loved
pet euthanased or rehomed can be a major
cause of distress.
Elizabeth Ormerod has found that in
many cases where pets are initially refused,
an approach from the veterinary surgeon
to the housing provider or care home
manager can result in a reversal of that
decision and the older person being
allowed to keep their pet. Details of how
to prepare a case for an older pet owner
can be found at the SCAS website
(; follow the link to Pets
for Life). Where this fails, alternative
accommodation might be found that
permits pets the Cinnamon Trust
( keeps a register
of pet-friendly accommodation, as does
the Elderly Accommodation Counsel
Practice protocol
Elizabeth and her husband Edward, a
veterinary pathologist, introduced a
written protocol on euthanasia for their
practice. This defines the circumstances
under which they will perform euthanasia.
We feel that the protocol has resulted in
fewer healthy animals being presented for
euthanasia and has helped to develop a
greater reverence for the lives of animals in
our district. It also reduces staff stress and
raises the perception of the practice within
the community.
Elizabeth believes that through
reflection and analysis it is possible to
identify and categorise the reasons for the
breakdown in the humananimal bond and
to implement supportive strategies. Many
problems could be avoided with pet
selection counselling by veterinary practices
and animal welfare centres. Weve all
experienced that sinking feeling when we
see a client mismatched with a new pet
and just know that relationship is doomed.
Its so sad, when another animal would have
suited them very well.
Veterinary practices can support the
bond in many ways and early intervention in
pet behaviour problems is very important.
Behaviour problems are a leading cause of
relinquishment of animals, but by the time
many owners realise there is a behaviour
problem, they are at the point of
surrendering the animal. I encourage all staff
to be alert for potential behaviour problems
and then tactfully draw the clients attention
to these.
Professional support
For vets feeling the responsibility and
stresses surrounding euthanasia, Elizabeth
recommends training available through the
PBSS. She believes that the more you know
about the subject of bereavement, the more
confident you will become in helping clients
in distress, coping with your own feelings
and making decisions. The Pet Bereavement
Support Service (0800 096 6606; email or go to www. operates 12 hours a day,
seven days a week and there is no charge to
the client or to the referring veterinary
practice. PBSS also offers one-day
workshops, or a one-year accredited
distance-learning programme for those who
wish to develop a deeper understanding.
For those who need support
themselves, the Veterinary Benevolent
Fund ( supports
veterinary professionals who are
struggling to cope with work-related stress
and other problems.
Many people believe that losing a pet is
like losing a family member and the acute
sense of loss and stages of grief, can indeed
be seen with pet bereavement. Dr
McNicholas says, however, Personally, I
have never fully subscribed to the loss of a
pet equating the loss of a human
relationship, except in exceptional
circumstances. It is true that some feel pet
loss acutely, and the more stresses in life a
person has, the more they may feel the
added effect of losing a gentle companion.
However, the majority of pet owners
quickly go about looking for another pet,
sometimes within a matter of weeks, even
days. This does not devalue the relationship
that an owner has had with a previous
individual animal, rather it points to a desire
to maintain a lifestyle. Controversial, but
worth researching n
companion | 19
In collaboration with the
Bristol RSPCA clinic,
Petsavers has funded a
Clinical Training Scholar at
the University of Bristol in
Animal Welfare, Ethics and
Law. James Yeates, who
qualified in 2004 from the
University of Bristol, has
been recruited to the
position. Here James
describes a research project
which will evaluate a quality-
of-life screening programme
for use with dogs
to use their common sense, and it can allow
for a more holistic style of practice.
The art of veterinary practice
More technical matters, such as those
based on pathology and physiology, have
well established and reported protocols.
But other aspects are still very much part of
the art of veterinary practice. Dealing with
these involves skill and wisdom that vets
have gained through practical experience.
Every vet has gained an appreciation of the
levels and severities of these conditions and
every vet has valuable ideas that they give
their clients to improve their animals lives.
Expensive academic studies can try to
quantify the levels of problems but such
descriptions rarely determine how the
problems can be remedied. They cannot look
at what changes owners could make, what
stops them making those changes, and how
vets can help. Studies that do not take vets
views into account can provide information
that is useless for veterinary surgeons,
because they do not address the nature of
real life in practice situations. Even when the
information is appropriate for use in
practice, some studies erroneously treat vets
as passive recipients of information, able only
to receive the teachings of academics and
robotically repeat them to clients.
This fails to make use of the valuable
acumen of vets, who are involved daily in a
complex balancing of the thousands of
different issues and factors. This gives vets
an intuitive and deep understanding of the
problems, which further allows them to
suggest changes to improve those problems
because this is what they do in their job
every day.
Petsavers project
This Petsavers project has created an easy
method for bringing together vets ideas on
what are the important issues for canine
quality of life. It will tap vets knowledge by
asking questions and will collate the
responses. This will then allow vets to share
their experiences on what they think would
improve these issues and what steps are
needed to bring about this about.
Members will be contacted by email
that will lead them to a two-page
questionnaire that takes about four minutes
to complete. Vets will be asked to share
their opinions on issues concerning
particular species and in each region.
Thank you very much to those who help.
Contact Petsavers on 01452 726723 or
Written enquiries should be sent
c/o BSAVA, Woodrow House, 1 Telford
Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB.
dvising owners on how to improve
their animals lives is a fundamental
desire of veterinary practice. Every
day a large proportion of each vets time is
given to advising on quality-of-life matters
that impact on the animals in more ways
than just affecting their health. In fact,
advising on these more personal matters
can be one of the main enjoyments of
practice. It can strengthen the bond
between vet and client, it can allow the vet
20 | companion
Related to weasels, otters,
badgers and skunks, the
Latin name for the domestic
ferret, Mustela putorius furo,
literally means mouse-like
stinking thief . Despite this
obvious drawback, ferrets
are increasingly popular as
pets. Gidona Goodman
(BSAVA Publications
Committee) and Anna
Meredith (co-editor of the
new BSAVA Manual of
Rodents and Ferrets) discuss
some important aspects of
their veterinary care
omesticated from the European
polecat, probably around 1800BC,
ferrets were introduced to Britain
by the Romans. In addition to the common
polecat or fitch variety and the albino,
many other varieties are now bred,
including sable, silver, chocolate, siamese,
panda and black-eyed white. Ferrets are still
used for hunting rabbits in many countries,
though not in the USA or Japan, where they
are kept almost exclusively as pets. The UK
ferret population is estimated at 250,000 to
400,000, with pet ferrets on the increase.
Ferrets have an elongated body that can
turn on itself an adaptation to hunting in
tunnels or burrows. They have relatively
poor eyesight compared to their senses of
smell, taste, and hearing; their eyes are
correspondingly small. Ferrets typically
show short energetic bouts of activity,
followed by deep sleep, and it is common
for them to sleep for up to 18 hours a day,
which may make lethargy difficult to assess.
That scent
Ferret skin is extremely tough and seasonal
alopecia is common during the summer,
with a thicker coat developing over winter.
Sebaceous glands in the skin produce the
characteristic ferret odour and may excrete
a brownish yellow substance that discolours
the fur. Neutering reduces these glandular
secretions and thus may decrease smell.
Most pet ferrets are easy to handle using
gentle restraint around the neck and
shoulders, with support of the
hindquarters. It may be necessary to scruff
a fractious animal, but it is often better to
encircle the neck with one hand (acting as a
neck brace). The bodyweight and hindlimbs
are supported with the other hand, or can
be tucked under the elbow to free up that
hand for clinical examination.
Take care not to bring a fractious animal
close to your face: ferrets have poor
eyesight and reflex reactions may result in a
bite to your face or nose. Ferret bites may
be deep and, once attached, the animal may
be difficult to dislodge. If this occurs, place
the ferret on a table and attempt to pry
open its mouth. Cold water applied to its
head may encourage it to let go.
Very fractious individuals may need
sedation prior to clinical examination.
These animals may appear frightened and
hiss or scream, indicating that they are likely
to be difficult to handle.
Clinical examination
Observe the animal at a distance initially. It
may be placed on the consulting room floor
and be allowed to investigate its
surroundings whilst a history is being taken
from the owner. A healthy animal will
appear alert and should be active, moving
with a typical arched back posture.
Ferrets resent having their temperature
taken rectally and this may prove
difficult, resulting in an increased
reading. An unbreakable digital plastic
thermometer is best, and the ferret may
be distracted by a treat.
Colour varieties: from left to right, polecat-ferret, sandy, silver mink. (Courtesy of
John Chitty)
Bodyweight Male (hob) 12 kg
Female (jill) 500900 g
Lifespan 515 years, though it is rare to see ferrets older than 10
Body temperature 37.840C
Resting heart rate 200400/min
Resting respiratory rate 3336/min
Biological data for ferrets
companion | 21
Hydration status should be assessed as
in other mammals by skin turgidity.
Dental problems are common, with
similar lesions to cats (dental tartar and
Mucous membranes should be assessed
for signs of anaemia in females.
Cataracts occur in both adult and
juvenile animals and the eyes should
always be checked on clinical
Ear mites ( Otodectes cynotis) are also
common and infection is indicated by
excessive brown waxy discharge.
Peripheral lymph nodes should be
palpated for evidence of enlargement
(which may indicate lymphoma). In fat
animals these may be surrounded by fat
and appear falsely enlarged.
The heart may be auscultated over the
6th8th ribs (more caudal than in dogs
and cats). Heart rate is rapid and may
be difficult to record, particularly in an
excited animal. There should be minimal
lung sounds.
Palpation of the abdomen is aided by
holding the ferret in a semi-vertical
position. Splenic enlargement is
commonly found in older animals
and may be insignificant, although
further diagnostic tests are indicated
if this is found.
Females should be examined for vulval
swelling, which may be associated in the
intact animal with oestrus and in the
neutered animal with adrenal gland
disease or ovarian remnant. An intact
female in oestrus should be examined
Travelling with ferrets
Pet passports can be issued for ferrets. Up-to-date information can be
found on the DEFRA website:
To enter or re-enter the UK from a listed country without quarantine a
ferret must be:
1 microchipped
2 vaccinated against rabies
3 issued with an EU pet passport or a third country official veterinary
certificate and treated against ticks and tapeworms.
The product used for the tapeworm treatment must contain praziquantel.
The product used for the tick treatment must be licensed for that use and
have a marketing authorisation in the country of use. Tick collars are not
The treatment must be carried out not less than 24 hours and not more
than 48 hours before the pet is checked in with the approved transport
company to travel on the return journey to the UK.
The BSAVA Manual of
Rodents and Ferrets,
edited by Emma
Keeble and Anna
Meredith, is available from
BSAVA Publications: tel. 01452
726700; fax 01452 726701;
or go to
Member price: 49.00
Non-member price: 75.00
Careful examination of the teeth in an
older ferret. (Courtesy of John Chitty)
for clinical signs of hyperoestrogenism,
such as anaemia, and problems related
to immunosuppression.
The testicles in males are only palpable
in the scrotum during the breeding
season (December to July).
Seasonal weight loss is common during
summer months.
Health checks and preventive
Owners should be encouraged to have their
pet ferret checked by a veterinary surgeon
yearly, or twice-yearly for older animals.
Common conditions to be ruled out include
ear mite infections, dental disease, cardiac
disease, neoplasia and splenic enlargement.
Ferrets should be vaccinated annually
against distemper virus. There is no product
licensed for use in ferrets in the UK, but
multivalent dog vaccines are generally given
at half the dog dose (seek manufacturers
advice). This should be given initially at
1214 weeks of age (in endemic areas this
should be given at 6 weeks and the dog
regime should be followed).
Flea treatments safely used in ferrets
include fipronil, imidacloprid and lufenuron.
These have all been given at cat doses;
however frequency of dosing has been
reduced due to the greater sebum layer in
ferret skin compared with dogs and cats.
There have been significant changes in
neutering advice over recent years,
particularly in respect of our improved
understanding of the pathogenesis of
adrenal gland disease and the commercial
availability of GnRH analogue implants.
Research has shown that neutering is
associated with an increased risk of the
ferret developing adrenal gland disease.
Current advice for jills and hobs is detailed
in the new BSAVA Manual of Rodents and
22 | companion
Improving the health of the nations pets
percentage of your estate to a charity.
Pecuniary Bequest: You may wish to
leave a fixed sum of money to a charity.
This is known as a pecuniary bequest.
Specific Bequest: You may wish to leave
a specific gift to a charity, which can
then be used by that charity to generate
funds. This could include shares,
property or an item of value.
We hope that you will consider
Petsavers after you have taken care of your
family. Should you need advice on the
wording for certain requests, or for a
codicil for an existing will, we are happy to
help, but please always remember to seek
legal advice when making a will to make
sure that your wishes are conveyed in the
correct legal manner.
Contact Petsavers on 01452 726723 or
Written enquiries should be sent
c/o BSAVA, Woodrow House, 1 Telford
Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB.
ince Petsavers began 35 years ago we
have funded numerous studies into the
treatments of diseases such as
diabetes, cancer, arthritis, heart disease and
many more. Further clinical studies that
have received Petsavers support include
anaesthesia and critical care, internal
medicine, surgery, neurology, parasitology,
diagnostic imaging, ophthalmology,
dermatology, pathology and genetics.
Clinical studies
In addition to helping to fund James Yeatess
study into quality of life for dogs (see page
19), Petsavers is currently funding a number
of other scholarships and training
programmes, including a clinical training
scholarship in anaesthesia and analgesia, a
scholarship in evidence-based small animal
medicine, and a clinical training programme
in small animal behavioural medicine.
Petsavers also funds clinical research
projects into subjects including canine
hepatic encephalopathy, postoperative
analgesia for elbow arthroscopy, and canine
immune-mediated haemolytic anaemia.
To be able to continue this vital work
Petsavers relies on the generosity of
supporters and volunteers. There are many
ways in which you can help, but one not
often considered is leaving a gift to
Petsavers in your will.
Currently over half of Petsavers funding
is raised through legacies; without this vital
source of income Petsavers simply would
not be able to fund the amount of research
or training it currently does. Writing or
updating your will can often seem
complicated, but it does not need to be.
Your solicitor can guide you through the
process and many solicitors operate a free
will-writing service.
Types of bequest
There are three main types of bequest
or legacy:
Residuary Bequest: You may wish to
leave specific sums of money or
possessions to family and friends. Once
those wishes have been fulfilled, the rest
of your assets are known as your
residual estate. You can then leave a
companion | 23
he WSAVA Executive Board met
during the recent North American
Veterinary Conference in Orlando,
Florida, which took place on 1722
January 2009. Key association items
discussed and prioritised during the
Executive Board meetings included:
strategic planning; succession planning/
leadership identification; formalisation of
WSAVA as an incorporated and not-for-
profit association, to include the
establishment of a charitable WSAVA
Foundation; exploring and/or establishing
an Executive Director position to assist
with the day-to-day management of our
ever-growing and busy association; and
more direct WSAVA/member association
involvement in Congress planning and
administration. Discussion papers on many
of the issues will be sent for member
association input prior to our Assembly
meeting in So Paulo. Please take the time
to review and respond in a timely manner
as the future of the WSAVA depends on
your involvement!
The 2008 finances were reviewed and
were reflective of a very strong 2008 for
the WSAVA. Busy agendas of the WSAVA
committees and standardization projects
were also reviewed, including meetings with
the Animal Welfare Committee, the
Financial Advisory Committee, and
Labrador Retriever holds top spot on list of
most popular dogs in USA
For the 18th consecutive year, the Labrador Retriever is
the most popular purebred dog in the United States,
according to 2008 registration statistics released by the
American Kennel Club (AKC). In 2008 more than twice as
many Labradors were registered than any other breed,
making it a likely leader for many years to come. The
Bulldog, which made news the previous year by returning
to the AKCs Top 10 for the first time in more than 70
years, continues to amble its way up the list, jumping up
6 per cent into eighth place.





members of the Standardization Projects. In
addition, the EB had a team-building
exercise, generously sponsored by our
Prime Congress Partner, Hills Pet
Nutrition. The Board also provided opening
remarks at the WSAVA Animal Welfare
Symposium, which was included as part of
the TNAVC scientific programme, and took
the opportunity to catch up with many
colleagues from around the globe, including
many WSAVA member association
Thank you to the wonderful hospitality
of Dr Colin Burrows and the tremendous
TNAVC organization team!
2008 Most Popular Dogs in
the USA
1. Labrador Retriever
2. Yorkshire Terrier
3. German Shepherd Dog
4. Golden Retriever
5. Beagle
6. Boxer
7. Dachshund
8. Bulldog
9. Poodle
10. Shih Tzu
24 | companion
he scientific programme is set and
features over 80 world-renowned
veterinary lecturers covering over
30 disciplines in 9 simultaneous session
streams, including 7 State-of-the-Art
Lectures (SOTALs), a WSAVA Animal
Welfare stream, and a North American
Veterinary Conference stream. This
will not only be complemented by the
vibrancy of So Paulo itself, but also by a
lively social programme.
Opening ceremonies
Presented in English, the opening
ceremonies will take place on Tuesday 21
July 2009 in the Alpha Theater. A lively
dance show will feature many cultural
dances of Brazil, including frevo and samba.
Also included will be greetings from
various dignitaries, as well as the
presentation of the WSAVA awards. This
will be followed by a cocktail and the
opportunity to mingle with your colleagues.
Gala Dinner
The Gala Dinner will be held on Wednesday
22 July 2009 at the Hyatt Hotel, with live
entertainment featuring Brazilian music.
Brazilian Party
Scheduled to take place on Thursday 23 July
2009 at HSBC space (
br) this will be an evening of immersion in
Brazilian culture.
Closing ceremonies
The closing ceremonies will take place on
Friday 24 July 2009 at the Transamerican SP
Congress hotel and will feature a
presentation highlighting the 2010 WSAVA
Congress to be held in Geneva, Switzerland.
Dont delay register today! Do you need a
VISA to enter Brazil? Visit the WSAVA
2009 So Paulo World Congress website at
SO PAULO, 2009





companion | 25
The 5th WSAVA CE meeting was held in
Hamedi Hall, at the veterinary faculty of
the University of Tehran, Iran on 21
November 2008, reports associate
professor Dr Seyed Javid Aldavood. More
than 500 delegates attended the lectures,
mostly undergraduate and postgraduate
students. The lectures were also provided
online and a number of veterinarians from
throughout Iran attended in this way. Mr
Ray Butcher gave four lectures on
veterinary practice management, followed
by an interactive question and answer
session. The lectures given were:
An introduction to assessing
performance and business planning
The team concept
Image and communicating with the
Promoting your clinic.
Sri Lanka
Dr Niranjala de Silva reports on a very
successful and invaluable training
programme from 515 January at
Peradeniya, Sri Lanka. Each day, Dr
Graeme Allan spent 2 hours teaching
veterinary imaging to the students,
delivering an entire semesters
programme during his stay, as well as
providing ultrasound guidance on clinical
cases. On 13 January there was a
practitioners training day with integrated
imaging lectures and a live
ultrasonography demonstration. The
participants were very happy as they
Dr Graeme Allan lectures a class on ultrasonographic technique during his
teaching time in Sri Lanka
benefited a lot and all hoped that Dr Allan
would come back to teach again. Dr Allan,
who also toured the elephant orphanage
during his stay, said that he would love to
return one day to build on what I left
behind, as well as to help them develop
their practical imaging a bit further. Id also
like to help the elephant orphanage vets
start using their elephant radiology facility.
Dr Jess Moreno Lazo, President of the
Asociacin Consejo Cientifico Veterinario
de Cuba, reports on WSAVA-sponsored CE
on veterinary dermatology given by Dr
Babette in October and November 2008
in Piar del Rio City and in Havana.
Registration was 500 delegates and the
lectures were rated as excellent by the
Cuban Small Animal Associations
Arbitration Committee, based on their
high scientific content and masterful
delivery. Despite the
devastating hurricane in Piar del Rio,
which affected many of our members,
there was tremendous attendance, even
including associate members who lost
their houses. This shows WSAVA
members the great prestige that WSAVA
has among our members as well as the
level of cooperation between our two
associations. The Scientific Veterinary
Council of Cuba deeply appreciates the
support of WSAVA to our association,
which was recognized publicly in a rally
commemorating the 100 years of the
Veterinary Association in Cuba, awarding
WSAVA the acknowledgment of
Distinguished Guest.
26 | companion
companion INTERVIEW
Vic Simpson was born in Kings Heath, Birmingham during World War II and grew up in
Warwickshire, initially at Water Orton and later at Kingsbury where his father was head
teacher. Vic is married with two children and has three grandchildren. He was educated at
Coleshill Grammar School, gained his veterinary qualification from Bristol, and later a
Diploma in veterinary tropical medicine at Edinburgh. Vic has now earned a reputation as
a veterinary pathologist with a passionate interest in the diseases of wildlife species, and is
a contributor to the BSAVA Manual of Wildlife Casualties.
You have become known within the
profession through your work
investigating wildlife diseases how
did you first become involved in that
In 1973, whilst working at Sutton Bonington
Veterinary Investigation Centre (now VLA)
near Nottingham, I started an investigation
into mute swan deaths at Trent Bridge and
discovered that they were dying from lead
poisoning due to ingestion of anglers
weights. This eventually led to legislation
banning the use of lead fishing weights.
Did you spend any time in practice
earlier in your career?
Yes, I was an assistant with J Donald and
partners, a mixed practice in Warwickshire,
for four years. I also did some private
practice alongside my government work as
a District Veterinary Office in Kenya.
What do you consider to be your
most important achievement during
your career?
My initial reaction is to say it is the longterm
study I have made on otters. However, on
reflection the most important achievement
has been simply to succeed in carrying out
and promoting the study of wildlife
diseases in the UK. This did not endear me
to my management in MAFF (Defra)!
What has been your main interest
outside work?
Wildlife photography, especially when I was
living in Africa. I also enjoy travelling to
areas of natural beauty.
Who has been the most inspiring
influence on your professional
The late Gordon Scott, lecturer at the
Centre for Tropical Veterinary Medicine,
Edinburgh. He instilled in me the need to
observe & record, observe & record,
observe & record
What is the most significant lesson
you have learned so far in life?
Have confidence in your own judgement
too often in my younger days I was
persuaded that an idea I had was wrong or
unimportant, only then to see others claim
it as theirs!
If you were given unlimited political
power, what would you do with it?
Dont tempt me! Seriously though,
humans are wrecking the world and the
single biggest problem is that our
populations are expanding in a totally
irresponsible way. I would want to enforce
birth control worldwide.
If you could change one thing about
your appearance or personality,
what would it be?
I sometimes wish I was not so
argumentative but what the hell!
What is your most important
My wildlife files and photographs.
What would you have done if you
hadnt been a vet?
As a boy I was a keen taxidermist I had
built up quite a collection by the age of 15
but my father pointed out that I was
unlikely to make a living doing that and I
realized he was right.
How do you see the future for
veterinarians who wish to work
with wildlife?
There has been a remarkable change in
attitude in the last few years. It is now
realized that veterinarians have a major
probably THE major role to play in
identifying emerging diseases, whether
affecting livestock, humans or wildlife.
Job opportunities for wildlife
veterinarians are still limited but at
least one is no longer regarded as a bit
of a crank! n
companion | 27
Imported disease: diseases to
watch out for in travelling pets
Speaker Susan Shaw
Russell Hotel, Maidstone. Kent Region.
Details from Hannah Perrin,
Reading abdominal x-rays
Speakers Nic Hayward and Esther Barrett
Park Inn Hotel, Llanederyn, Cardiff.
South Wales Region.
Details from the Chairman or Secretary,
Endocrinology II
Speaker Mike Herrtage
Thorpe Park Hotel & Spa, Leeds.
Organised by BSAVA.
Details from the Membership and
Customer Service Team, 01452 726700,
BSAVA Cardiology Roadshow
Speakers Rebecca Stepien and Virginia
Luis Fuentes. Canalside, Bridgwater,
South West Region. Organised by BSAVA.
Details from the Membership and
Customer Service Team, 01452 726700,
Cardiovascular medicine
Speaker Jo Dukes McEwan
Thorpe Park Hotel & Spa, Leeds.
Organised by BSAVA.
Details from the Membership and
Customer Service Team, 01452 726700,
Reconstructive surgery: from
simple closures for beginners
to advanced microvascular
techniques for the specialists
Speaker Gary Lewin
IDEXX Laboratories, Wetherby.
North East Region.
Details from Karen Goff, 01924 275249,
Neurology: spinal disease in
dogs and cats
Speaker to be confirmed
Leatherhead Golf Club, Surrey. Surrey
and Sussex Region.
Details from Jo Arthur, 01243 841111,,
or Jackie Casey, 01483 797707,
Rabbit anaesthesia and
Speaker to be confirmed
Holiday Inn, Gatwick. Surrey and
Sussex Region.
Details from Jo Arthur, 01243 841111,,
or Jackie Casey, 01483 797707,
Ocular manifestations of
systemic disease
Speaker David Williams
Potters Heron Hotel, Romsey.
Southern Region.
Details from Michelle Stead, 01722
Is it respiratory or cardiac
disease? Case-based approach
Speaker Clive Elwood
Cambridge Belfry, Cambourne.
East Anglia Region.
Details from Graham Bilbrough,
Endocrinology I
Speaker Ian Ramsey
BSAVA, Woodrow House, Quedgeley.
Organised by BSAVA.
Details from the Membership and
Customer Service Team, 01452 726700,
24th Annual
Scottish Congress
Raising the bar in SA
practice, for veterinary
surgeons & nurses
Speakers Andrew Mackin and Ronan Doyle
Fairmont Hotel, St Andrews.
Scottish Region
Details from Susan Macaldowie, 07711
Infectious diseases
Speaker Susan Dawson
BSAVA, Woodrow House, Quedgeley.
Organised by BSAVA.
Details from the Membership and
Customer Service Team, 01452 726700,
BSAVA Cardiology Roadshow
Speakers Rebecca Stepien and Mike Martin
Day meeting at the Daventry Hotel,
Beaconsfield. Midland Region. Organised
Details from the Membership and
Customer Service Team, 01452 726700,
BSAVA Cardiology Roadshow
Speakers Rebecca Stepien and Virginia
Luis Fuentes
Day meeting at the Bellhouse,
Beaconsfield. Metropolitan Region.
Organised by BSAVA.
Details from the Membership and
Customer Service Team, 01452 726700,
BSAVA Cardiology Roadshow
Speakers Rebecca Stepien and Mike Martin
Day meeting at the Radisson SAS Hotel,
Belfast, Northern Irish Region. Organised
Details from the Membership and
Customer Service Team, 01452 726700,
Wound worries?
British Small Animal Veterinary Association
Woodrow House, 1 Telford Way,
Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB
Tel: 01452 726700 Fax: 01452 726701
Non-member price: 70
Member price: 49
For further information, please
contact the Membership and
Customer Service Team.

Should I close this wound?

How do I promote healing?

How do I use a ap to cover this defect?

How can I maximise the chance of take

in my skin graft?

How do I keep MRSA at bay?

What can go wrong?

These and many more questions are
addressed in this important new edition