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The essential publication for BSAVA members

Coping with the


cascade
P7
NEW Veterinary
Information
Network discussion
P18
Happiness and
work-life balance
P4
companion
AUGUST 2008
Haemorrhagic
vomiting
Test your
diagnostic skills
companion
2 | companion
CONTENTS
3 Latest News
Hydatid Disease, Practice
Standards, Montenegro guests
46 Dont Worry, Be Happy
Pete Wedderburn reviews NI
Congress success
79 Coping with the Cascade
John Bonner on prescribing
new medicines
1013 Clinical Conundrum
A collapsed dog with profound
haemorrhagic vomiting
1417 How To
Navigate the Pet Travel Scheme
1819 Letters from America
New feature selected
discussions from the Veterinary
Information Network
20 Petsavers
Fundraising news
21 Getting Tough on Seizures
Simon Platt looks at the
treatment options
2225 WSAVA News
World Small Animal
Veterinary Association
26 The companion Interview
Victoria Roberts
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 companion@bsava.com to contribute and comment.
KNOWLEDGE
BANK
Additional stock photography Dreamstime.com
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Vicente Barcelo Varona | Dreamstime.com
H
ow does BSAVA contribute to your
personal professional development?
As well as companion as a
BSAVA member you also get a
complimentary subscription to
the Journal of Small Animal Practice (JSAP)
and one free copy of each new edition of
the BSAVA Small Animal Formulary plus
the opportunity to build your library of
BSAVA Manuals at significant discounts.
August sees the release of the new
Manual of Raptors, Pigeons and Passerine
Birds, which promises to be a valuable
addition to the series. Edited by John Chitty
and Michael Lierz, with contributions from
some of the most prominent experts on the
subject, the manual will be available from
the end of this month.
Other new titles planned for the coming
year include:
Manual of Canine and Feline Advanced
Veterinary Nursing, 2nd edition
Manual of Canine and Feline Wound
Management and Reconstruction,
2nd edition
Manual of Rodents and Ferrets
Manual of Canine and Feline Abdominal
Imaging
As these are released they can be
purchased online at www.bsava.com or
you can of course find all the latest releases
when you visit the Publications stand at
Congress. In April the Publications stand
will have a brand new home offering an
even more comprehensive service on the
balcony in the NIA.
For more information visit the website,
email customerservices@bsava.com or call
01452 726700.
companion | 3
LATEST NEWS
COMMENT ON STANDARDS
B
SAVA would like to invite members
to comment on updating the RCVS
Practice Standards scheme.
Pam Mosedale sits on the BSAVA
Membership Development Committee.
She is actively involved in the scheme as
an RCVS Practice Standards Inspector.
In addition Pam is leading the BSAVA
initiative to produce more online tools for
members in practice the latest resource is
a sample Clinical Governance Policy, which
can be adapted specifically for your
practice. Find this online in the Resource
section at www.bsava.com. Pam would
like to hear your comments both on the
Practice Standards scheme and the clinical
governance policy document. Email
companion@bsava.com n
MONTENEGRO BENEFITS AT BSAVA
s part of BSAVAs commitment
to support small animal veterinary
associations in developing
countries, BSAVAs International Affairs
Members of the Montenegrin delegation with BSAVA president Frances Barr at
BSAVA Congress 2008. From left: Nebojsa Scekic, Frances Barr (BSAVA President
20072008), Wolfgang Dohne (International Affairs Committee Member and
organiser of the Visit Programme), Dusanka Kazic and Savo Nikovic
Committee arranged for a small group of
surgeons from Montenegro to be guests of
honour at this years BSAVA Congress.
The majority of veterinary surgeons
practicing in Montenegro are graduates
from Belgrade and, although now an
independent state, Montenegro is still very
closely connected with neighbouring Serbia,
which meant that delegates had to travel to
Belgrade for their UK visas.
As there is currently not enough
demand for small animal medicine in
Montenegro to support 100% small
animal practices, all the invited vets were
working in mixed practice. However with
increasing economic wealth they were
beginning to see an increasing demand for
small animal work.
Only very few clinics are currently using
gaseous anaesthesia and with the average
cost for a bitch spay at 50, expenses still
have to be kept to a minimum. There is no
established pet insurance scheme in
Montenegro and dogs are by far the main
small animal species treated. Montenegrin
delegates were amused to learn that a year
old tortoise can cost well over 100 in the
UK, considering that the same animals are a
fairly common sight in their own gardens.
The guests from Montenegro took full
advantage of the BSAVA Congress Scientific
and Social programme, and were delighted
to have a meeting with then President
Frances Barr. n
HYDATID DISEASE CAMPAIGN
been known as a hot-spot for the disease,
regular supervised worming of farm dogs is
taking place and those dogs are then being
monitored. During the campaign all farms in
the area will be given the opportunity to
participate in the scheme and those involved
will be visited four times during the year.
Rural Affairs Minister Elin Jones said,
Hydatid disease can be dangerous to
humans and it can be avoided by the simple
procedure of regular worming of dogs.
More information and a poster can be found
online at www.wales.gov.uk/
animaldiseases. n
T
he regular worming of dogs is the
best protection against Hydatid
Disease, which can affect both dogs
and people, so the Welsh Assembly
Government is funding a campaign for
control of Echinococcus granulosus.
In South Powys, which has previously
A
4 | companion
CPD
Pete Wedderburn reports on the happiness
programme at the BSAVA/SPVS/BVNA weekend
in Northern Ireland in May
mountain biking, a climbing wall, and the
usual conference-related social events. By
the end of the weekend there was no
excuse to return to work feeling stressed,
and delegates were well briefed on
techniques such as deep breathing, direct
talking and anger management.
Awareness
Most vets are now acutely aware of the
professions increased risk of succumbing to
drug/alcohol abuse and mental health issues.
Yet, despite this wider awareness, the
general public still sees vets as cosy,
companionable, relaxed James Herriot
types. Ironically, Alf Wight, the author of
the James Herriot books, suffered from
severe depression himself in the early
1960s, before writing his books.
Self-awareness of the problem within
the profession is just the first stage in
dealing with this major issue. Over the
next decade, much work still needs to be
done in addressing and publicising an issue
that remains, at some level, a subject of
social taboo.
Suicide is clearly the worst of all
stress-related events. The rate of suicide
among vets is three to four times higher than
the national average, higher than for any
other profession or sector of population.
The problem of the high suicide rate
amongst veterinary surgeons was first
publicly highlighted when an article was
published in the British Medical Journal in
1983. A number of publications confirming
the statistics followed. Work published in
the Australian Veterinary Journal showed a
similar high incidence of suicide, suggesting
that the trend may be a global problem in
the profession. In 2005 Richard Mellanby, a
specialist in small animal internal medicine
now at Edinburgh University, published an
update in the Veterinary Record on these
earlier statistics on veterinary suicide.
Studying the causes
There is still much debate about the
reasons for the high suicide rate. Intuitively,
onlookers suspect that the biggest
contributory factor is vets access to
lethal drugs, and knowledge about the
practical procedure of euthanasia. Most
suicides among vets, both males and
females, are by drug overdose and
markedly more vets use this method than
other sectors of the population.
The veterinary profession has reacted
proactively to reports of stress-related
O
ver the past twenty years, the
problem of stress-related crises in
the veterinary profession has
repeatedly been highlighted in the
veterinary media and the profession has
been finding ways of addressing the mental
health issue. The Society of Practising
Veterinary Surgeons recently organised an
innovative programme at the joint
conference with the Northern Ireland
branches of BSAVA and BVNA. The theme
of the weekend was Happiness and
WorkLife Balance, with lecturers drawn
from research psychologists, life coaches
and television comedians. As well as
lectures, delegates took advantage of
DONT WORRY, BE HAPPY
John Hill, President of SPVS
with partner Susie Turner
companion | 5
CPD
problems, including suicide. The RCVS has
chaired various working parties that have
looked into the problem. More recently, it
has been recognised that if appropriate
preventive action is to be taken, more
specific research is needed into the precise
nature of the issue.
David Bartram, a 1988 graduate of the
RVC, is currently working on this subject.
David has been working with research
psychiatrists at Southampton University, and
has been designing and analysing a
questionnaire that has enabled a thorough,
objective assessment of the problem.
In late 2007, he sent out the
questionnaire to a stratified random sample
that represented 20% of the practising
profession, including all who were using
their MRCVS in any form. In total, 3200 out
of 16,000 vets were contacted. Around
1800 questionnaires were returned,
representing a response rate of 56%. It is
unusual to achieve higher than a 40%
response rate to postal questionnaires, and
David feels that this high return rate may
reflect the fact that vets feel that the stress
problem is highly relevant to their daily
lives. The research provides very
comprehensive coverage of the profession,
from new and recent graduates through
to vets approaching retirement, and from
vets in all types of work from different
types of practice through to industry,
government and academia. The parameters
measured are compared with those for
the general population and for other
related professions.
David says, The questionnaire was
designed to adopt a holistic approach,
looking at positive aspects of veterinary
careers (so-called satisfiers) as well as the
stressors. Previous research has
demonstrated that doctors believe that
the feel good bits of their job mean that
they are able to deal with more stress than
they would otherwise be able to do. This
same principle may apply to vets. Davids
results are currently being collated and he
hopes that they will be ready for
publication in 2009.
Additional work is being carried out by
Richard Mellanby, who is undertaking a
study with Professor Keith Hawton, head
of the Centre for Suicide Research at the
University of Oxford. Their research aims
to explore further the circumstances
immediately preceding veterinary suicides,
through examination of coroners reports
and interviews with friends and family of
the deceased. A further questionnaire-
based survey of the mental health status
of the profession is also planned, funded
by the Veterinary Benevolent Fund, RCVS
and Hills Pet Nutrition.
It is hoped that the culmination of
the various ongoing research projects
will allow objective, evidence-based
recommendations to be made as to how
vets should try to address the alarming
incidence of suicide. The profession will
then be in a much stronger position to
identify subgroups of the population at risk,
as well as specific stressors that predict
poor health.
Todays support
Even without the benefit of detailed
research into the background to the
problem, a number of initiatives have been
set up in an attempt to deal with the stress
affecting veterinary surgeons.
Several years ago, the Veterinary
Benevolent Fund, with a core aim of
supporting vets in financial difficulties,
merged with the two other organisations
that were providing support to the
profession:
1) The Veterinary Surgeons Health
Support Programme (VSHSP) was
established by the veterinary profession in
March 1999 to help combat problems of
alcohol, drugs, eating disorders and other
addictive and mental health issues. The
programme was based on similar schemes
that had been available to members of the
dental and pharmaceutical professions. The
last independent clinical audit described the
VSHSP as highly efficient and effective.
The scheme is completely confidential and
is run by a National Coordinator who is a
health professional. VSHSP treatment
DONT WORRY, BE HAPPY
An older delegate helping a younger
participant on the climbing wall
4 | companion
CPD
Pete Wedderburn reports on the happiness
programme at the BSAVA/SPVS/BVNA weekend
in Northern Ireland in May
mountain biking, a climbing wall, and the
usual conference-related social events. By
the end of the weekend there was no
excuse to return to work feeling stressed,
and delegates were well briefed on
techniques such as deep breathing, direct
talking and anger management.
Awareness
Most vets are now acutely aware of the
professions increased risk of succumbing to
drug/alcohol abuse and mental health issues.
Yet, despite this wider awareness, the
general public still sees vets as cosy,
companionable, relaxed James Herriot
types. Ironically, Alf Wight, the author of
the James Herriot books, suffered from
severe depression himself in the early
1960s, before writing his books.
Self-awareness of the problem within
the profession is just the first stage in
dealing with this major issue. Over the
next decade, much work still needs to be
done in addressing and publicising an issue
that remains, at some level, a subject of
social taboo.
Suicide is clearly the worst of all
stress-related events. The rate of suicide
among vets is three to four times higher than
the national average, higher than for any
other profession or sector of population.
The problem of the high suicide rate
amongst veterinary surgeons was first
publicly highlighted when an article was
published in the British Medical Journal in
1983. A number of publications confirming
the statistics followed. Work published in
the Australian Veterinary Journal showed a
similar high incidence of suicide, suggesting
that the trend may be a global problem in
the profession. In 2005 Richard Mellanby, a
specialist in small animal internal medicine
now at Edinburgh University, published an
update in the Veterinary Record on these
earlier statistics on veterinary suicide.
Studying the causes
There is still much debate about the
reasons for the high suicide rate. Intuitively,
onlookers suspect that the biggest
contributory factor is vets access to
lethal drugs, and knowledge about the
practical procedure of euthanasia. Most
suicides among vets, both males and
females, are by drug overdose and
markedly more vets use this method than
other sectors of the population.
The veterinary profession has reacted
proactively to reports of stress-related
O
ver the past twenty years, the
problem of stress-related crises in
the veterinary profession has
repeatedly been highlighted in the
veterinary media and the profession has
been finding ways of addressing the mental
health issue. The Society of Practising
Veterinary Surgeons recently organised an
innovative programme at the joint
conference with the Northern Ireland
branches of BSAVA and BVNA. The theme
of the weekend was Happiness and
WorkLife Balance, with lecturers drawn
from research psychologists, life coaches
and television comedians. As well as
lectures, delegates took advantage of
DONT WORRY, BE HAPPY
John Hill, President of SPVS
with partner Susie Turner
companion | 5
CPD
problems, including suicide. The RCVS has
chaired various working parties that have
looked into the problem. More recently, it
has been recognised that if appropriate
preventive action is to be taken, more
specific research is needed into the precise
nature of the issue.
David Bartram, a 1988 graduate of the
RVC, is currently working on this subject.
David has been working with research
psychiatrists at Southampton University, and
has been designing and analysing a
questionnaire that has enabled a thorough,
objective assessment of the problem.
In late 2007, he sent out the
questionnaire to a stratified random sample
that represented 20% of the practising
profession, including all who were using
their MRCVS in any form. In total, 3200 out
of 16,000 vets were contacted. Around
1800 questionnaires were returned,
representing a response rate of 56%. It is
unusual to achieve higher than a 40%
response rate to postal questionnaires, and
David feels that this high return rate may
reflect the fact that vets feel that the stress
problem is highly relevant to their daily
lives. The research provides very
comprehensive coverage of the profession,
from new and recent graduates through
to vets approaching retirement, and from
vets in all types of work from different
types of practice through to industry,
government and academia. The parameters
measured are compared with those for
the general population and for other
related professions.
David says, The questionnaire was
designed to adopt a holistic approach,
looking at positive aspects of veterinary
careers (so-called satisfiers) as well as the
stressors. Previous research has
demonstrated that doctors believe that
the feel good bits of their job mean that
they are able to deal with more stress than
they would otherwise be able to do. This
same principle may apply to vets. Davids
results are currently being collated and he
hopes that they will be ready for
publication in 2009.
Additional work is being carried out by
Richard Mellanby, who is undertaking a
study with Professor Keith Hawton, head
of the Centre for Suicide Research at the
University of Oxford. Their research aims
to explore further the circumstances
immediately preceding veterinary suicides,
through examination of coroners reports
and interviews with friends and family of
the deceased. A further questionnaire-
based survey of the mental health status
of the profession is also planned, funded
by the Veterinary Benevolent Fund, RCVS
and Hills Pet Nutrition.
It is hoped that the culmination of
the various ongoing research projects
will allow objective, evidence-based
recommendations to be made as to how
vets should try to address the alarming
incidence of suicide. The profession will
then be in a much stronger position to
identify subgroups of the population at risk,
as well as specific stressors that predict
poor health.
Todays support
Even without the benefit of detailed
research into the background to the
problem, a number of initiatives have been
set up in an attempt to deal with the stress
affecting veterinary surgeons.
Several years ago, the Veterinary
Benevolent Fund, with a core aim of
supporting vets in financial difficulties,
merged with the two other organisations
that were providing support to the
profession:
1) The Veterinary Surgeons Health
Support Programme (VSHSP) was
established by the veterinary profession in
March 1999 to help combat problems of
alcohol, drugs, eating disorders and other
addictive and mental health issues. The
programme was based on similar schemes
that had been available to members of the
dental and pharmaceutical professions. The
last independent clinical audit described the
VSHSP as highly efficient and effective.
The scheme is completely confidential and
is run by a National Coordinator who is a
health professional. VSHSP treatment
DONT WORRY, BE HAPPY
An older delegate helping a younger
participant on the climbing wall
6 | companion
CPD
programmes vary but are designed to suit
an individuals addictive state.
Often people with a problem of
addiction dont recognise that they have an
issue, or delude themselves that they can
handle it. Family, friends and colleagues are
often the first to realise that someone needs
help, and they are encouraged to contact
the VSHSP. The VSHSP is autonomous and
totally confidential both for those needing
help and for those seeking help for others. It
is recognised that the path to recovery
offered by the professions own Health
Support Programme is not the only one
available to a veterinary surgeon but it is
hoped that those seeking help or advice will
make use of this freely available, confidential
service by contacting the VSHSP Programme
Coordinator on 07946 634220.
2) The Vet Helpline There are currently
twenty-five anonymous and unpaid
volunteer helpers that run this 24-hour
service. They are largely veterinary surgeons
or their spouses and offer empathetic
discussion of emotional, addictive or
financial problems, referring callers on for
specialist advice where appropriate. Tel:
07659 811118 (local call rates apply; 24-hour
rapid response answer phone).
The Veterinary Support Working
Party, whose chairman is Dr Wendy
Harrison, is a group which was formed with
representatives from all the main veterinary
organisations in response to concern over
the high rate of suicide and depression
within the veterinary profession. A new
website, www.vetlife.org.uk, was
launched in October 2007. The website
aims to provide information about the
support available to veterinary students,
veterinary nurses and veterinary surgeons
on a wide range of issues from both the
established veterinary care organisations
and from outside the profession.
The veterinary profession has learned
much about the fact that it has a stress
problem in the past twenty years. It
seems that now, at last, we may be on
the way to learning how to deal effectively
with our problem.
DONT WORRY,
BE HAPPY
Delegates about to head out mountain biking
B
eautiful weather and a spectacular
location dominated by the
mountains of Mourne provided the
backdrop for a conference combining
excellent clinical lectures with a
programme on Happiness and WorkLife
Balance. Learning how to manage stress
was the main SPVS theme at this years
combined SPVS, BSAVANI and
BVNANI Congress 2008, which took
place over three days in late May at the
beautiful Slieve Donard Resort and Spa
in Newcastle, Co. Down.
The happiness lectures, delivered by
Joe Griffen, Des Rice and Nuala McKeever,
included a series of thought-provoking
seminars on how to cope with life as a
modern practitioner. As well as coaching
delegates on how to manage workloads
and how to ensure that we all have
adequate amounts of rest and exercise,
therapies such as Emotional Freedom
Therapy (EFT) and Neurolinguistic
Programming (NLP) were explored.
BSAVANI supplemented this with
excellent lectures on dermatology by Steve
Shaw, ophthalmology by Pip Boydell, and
alternative therapies from the BVNA.
These were lively and informative and
included plenty of practical information for
vets and nurses to implement when they
returned refreshed to their own practices.
The closing Keynote Lecture included
warmth, wit and wisdom on lessons learnt
in practice in the Dales from Jim Wight,
who shares the same gift of story telling as
his father Alf (James Herriot).
The Northern Ireland BSAVA
weekend is traditionally a family affair,
HAPPY DELEGATES
AT NI CONGRESS
with a vibrant social programme for all
ages, and a superb crche to ensure that
vets, nurses and spouses can enjoy
lectures and some quality chill-out time,
safe in the knowledge that the kids are
having fun too. John Hill, the immediate
Past-President of SPVS and an Ulsterman,
merged the successful SPVS Annual
Conference format with the regular
Northern Ireland weekend, and it was
hard to find a less-than-smiley face
anywhere, as delegates from far and wide
mingled enthusiastically over salsa dancing,
photography, laser clay target shooting,
climbing walls, mountain biking, and a
spectacular Gala Dinner.
Both John Hill and Shane Murray
(BSAVA NI Chairman) were grateful for
the tremendous support from industry,
which ensured a top-class weekend. Over
160 delegates were able to linger over
stands representing 40 companies and
charities in the beautiful Chandelier Suite
overlooking Murlough Bay and the
mountains beyond.
Overall, the conference demonstrated
that when you get the balance right, work
and play can be successfully combined,
resulting in very contented vets.
Jim Wight, son of Alf Wight, with
John Hill, President of SPVS
companion | 7
COPING WITH
THE CASCADE
The rapid progress being
made by the animal health
industry in developing new
medicinal products can
cause problems for
veterinary practitioners.
John Bonner reports
M
any of the drugs in the veterinary
armamentarium were originally
developed for human use and many
have never been specifically tested in
domestic animal species. However, increasing
numbers of medicines have been launched in
recent years for use in companion animals
after a rigorous examination of their safety,
efficacy and quality. Whilst that makes life
easier for us, it also creates difficulties,
notably when a licensed veterinary drug
arrives to replace a product previously
borrowed from the human pharmacy. As the
new product will have been through a costly
registration process, it will inevitably be
considerably more expensive.
Seeking advice
This issue was highlighted by a letter to the
Veterinary Record from Oxfordshire
practitioner Martin Whitehead (VR May 3,
p599). He complained about being forced to
use the veterinary licensed drug Prilactone
(CEVA Animal Health) to treat canine heart
failure. This replaced use of a human generic
drug spironolactone, which he had been
using successfully for many years, and which
he insists is equivalent in safety and efficacy
to the licensed product. In short, I use
Prilactone because the law demands it, not
because I have been provided with any
evidence or reason to think that the change
will make a significant difference to my
patients, he explained.
Dr Whitehead asked for advice from
the regulator on whether he would be
obliged to switch to the licensed product
when treating patients whose condition was
stabilised under the generic drug. Steve
Dean, chief executive of the Veterinary
Medicines Directorate, said his organisation
does take account of a veterinary surgeons
clinical judgement and would not oblige him
or her to interrupt successful treatment
but any new patients would be expected
to be treated with the licensed drug.
VMD position
However, in an article published in
Veterinary Times earlier this year (VT
February 25, p16), Mr Dean reminded
veterinary surgeons of their responsibilities
under the cascade. He insisted that the
changes introduced with the Veterinary
Medicines Regulations 2005 were partly a
response to the lax way that practitioners
had interpreted the requirements of the
cascade... to the extent that human-
authorised products were used routinely,
despite the availability of suitable authorised
veterinary products. Where the only
consideration applied is the cost of the
medication, and particularly where no
clinical judgement is applied, the cascade
derogation does not, and has never,
permitted this.
Mr Dean went on to warn practitioners
against assuming that the biological activity
of a human generic product will necessarily
be equivalent to that of the licensed
veterinary drug. That assumption cannot be
reached unless the appropriate studies are
carried out and there are many additional
reasons why it would be preferable to use
the licensed formulation, such as a lack of
technical support from the manufacturer of
the human product, he said.
Industry view
Juliet Penaliggon, small animal marketing
manager for CEVA, points out that the
safety and efficacy studies carried out in
dogs to obtain a licence for Prilactone have
generated new information that had not
emerged during human tests. They showed,
for example, that in the canine gut the drug
is absorbed more effectively when given
with food.
DISPENSING
8 | companion
DISPENSING
Support from veterinary practice in
using the licensed product is essential if the
company is to generate the income needed
for further studies on the drug. Currently,
Prilactone is only licensed for the
treatment of heart failure due to mitral
valve disease but the company is now
carrying out work to obtain a data sheet
indication for the treatment of the other
main canine heart condition, dilated
cardiomyopathy, she added.
Meanwhile, Phil McGuire, regulatory
affairs manager with the company, suggests
that with a veterinary licensed product now
available, more dogs are likely to be given
an effective treatment for their congestive
heart failure. He believes that practitioners
like Dr Whitehead are in a minority in the
UK profession. CEVA have carried out
independent research into the dosages and
contraindications of the human drug, but
most vets would prefer to wait until there is
a data sheet available, rather than taking the
risks of using a product off-label.
Client concerns
Dr Whiteheads concern is for the welfare
of his own clients animals. He points out
that the licensed drug is only used in
combination with a number of other drugs,
all of which have to be paid for by the client.
Clearly, the cost of using the licensed
product depends on the size of the dog and
the dosage needed but in a 30 kg animal he
calculates that a client would pay another
20 a month on an already considerable
drugs bill.
John Foster, chairman of the BVA
medicines group, warns that owners of dogs
with mitral valve disease are not the only
ones that may have to face some difficult
decisions about the future of their pets.
Although there is an increasing array of
products available to treat chronic disease
in companion animals, some patients will be
unable to benefit. New licensed products
for conditions such as epilepsy will cost
owners many times more than the old
generic product. It is very difficult for
practitioners to square the circle, simply
because a lot of pet owners dont have
much money, he notes.
There are, of course, other ways of
financing the cost of veterinary treatment.
Some owners may be eligible for help from
one of the animal welfare charities and
others may have been prudent enough to
take out a pet insurance policy. But as Mr
Foster who also acts as a veterinary
advisor to the pet insurance industry
points out, the expense of long-term
treatment for chronic disease is one of the
factors driving up the cost of pet insurance
premiums. So owners may find it
increasingly difficult to obtain policies with
appropriate cover.
Cascades purpose
The cascade system was designed to
protect the public, and particularly
consumers of animal-derived products, by
ensuring that all veterinary medicines are
used responsibly. It was seen as providing a
rational balance between the legislative
requirement for veterinary surgeons to
prescribe and use authorised veterinary
medicines where they are available, and the
need for professional freedom to prescribe
other products where they are not. It was
also intended to guarantee that a range of
medicines is available for use by veterinary
surgeons by ensuring that the companies
who invest in research are rewarded
appropriately for their efforts.
On that basis, the system has been
largely successful, and representatives of the
profession meet regularly with officials from
the VMD to sort out any problems as they
arise. However, no system is perfect and
practitioners are likely to face increasing
tensions between their responsibilities
under the legislation and their duties
towards their clients and their animals.
As Mr Dean explained in his article, the
VMD feels that on too many occasions in
the past practitioners have erred in favour
of their clients. So it has now withdrawn its
former guidance that the use of human
generics might be acceptable in the
exceptional circumstances where an
animals health and welfare could be
compromised because the owner lacked
funds. He said this was necessary because
of the way practitioners had interpreted the
advice in a way that was not within the
spirit of the legislation or guidance.
Professions concerns
For colleagues working in farm practice,
euthanasia on economic grounds has always
been a fact of life and so it may become
with increasing frequency in companion
animal practice, Mr Foster warns. It is a
very difficult situation for practitioners to
find themselves in they know what the
diagnosis is and they know what the best
treatment is but they cant use it for
financial reasons. They will have to say, I am
sorry but I have to put your animal to sleep.
That is an awful position to be in.
COPING WITH THE CASCADE
companion | 9
Guidance from the Veterinary Medicines
Directorate on the Cascade
1
states that: If
there is no medicine authorised in the UK
for a condition affecting a non food-
producing species, the veterinary surgeon
responsible for treating the animal(s) may, in
particular to avoid unacceptable suffering,
treat the animal(s) in accordance with the
following sequence:
(a) a veterinary medicine authorised in
the UK for use in another animal
species or for a different condition in
the same species;
or, if there is no such product:
(b) either
(i) a medicine authorised in the UK for
human use; or
(ii) in accordance with an import
certificate (see VMG Note 7), a
medicine authorised for veterinary
use in accordance with Directive
2001/82 (as amended) in another
Member State;
or, if there is no such product:
(c) a medicine prepared extemporaneously,
by a veterinary surgeon, a pharmacist or
a person holding an appropriate
manufacturers authorisation, as
prescribed by the veterinary surgeon
responsible for treating the animal.
As stated in the article, the Veterinary
Medicines Directorate . does take
account of a veterinary surgeons clinical
judgement. The following cases are
practical examples of prescribing under
the cascade.
Case One
You have diagnosed a chronically
vomiting dog with lymphoplasmacytic
gastritis and gastric ulceration by
endoscopy, and the owner is enquiring
about treatment. What drugs, under the
Cascade, can you prescribe?
Zitac (cimetidine (Intervet)) is the only acid
blocker with a veterinary market
authorisation for the oral treatment of
gastritis in dogs, and if cimetidine is your
drug of choice you must prescribe this
product. You cannot choose a different
product containing the same active
molecule just because it is cheaper. Thus,
you cannot prescribe potentially cheaper
human products (e.g. Tagamet (GSK)) or
generic cimetidine. Clients may prefer to
buy these products over the counter at
their local pharmacy, but you must
prescribe Zitac. However, as the authorised
therapy is a POM-V, the veterinary surgeon
should strongly recommend the use of the
veterinary product given that the human
products are not authorised for veterinary
use and the dosage and directions for use
could well be different to those described
for humans on the label. Should there be an
adverse reaction related to the treatment
using a human product, the responsibility
would rest with the owner and a veterinary
surgeon would be expected to strees the
risks involved in this course of action.
You may make a clinical judgement that
you should prescribe a different acid
blocker because the potential side-effects
of cimetidine are of concern in a particular
case and an alternative product may have
additional properties that would be useful
in a specific case. Ranitidine, for example, is
at least as efficacious as cimetidine, may
not have some of the side-effects
associated with cimetidines cytochrome
P
450
inhibition and, perhaps importantly in
chronic gastritis, has a prokinetic effect.
Chronic gastritis is often associated with
delayed gastric emptying and where this is
suspected as a complication a prokinetic
may be beneficial. As there is currently no
veterinary licensed ranitidine preparation,
the cascade would permit you to
recommend a product authorised for
human use such as Zantac (GSK). The
owner should be made aware of the
reasons for the recommendation and the
potential risks associated with the
unauthorised medicine.
If the gastric ulceration is severe you
may make a clinical judgement to use
sulcrafate and a proton pump inhibitor.
There is no veterinary licensed version of
sucralfate, and so you could prescribe the
preparation Antepsin (Chugai Pharma)
authorised for human treatment.
Omeprazole does have a veterinary market
authorisation for horses (GastroGard
(Merial)), but the concentration of active
ingredient in the paste makes safe
administration to dogs impossible.
Therefore, where safety is an issue, a
human licensed preparation (e.g. Losec,
AstraZeneca) could be prescribed.
If a suitable veterinary authorised proton
pump inhibitor became available it must
be prescribed.
In addition symptomatic treatment
with a low-fat, highly digestible diet or an
exclusion diet may resolve the problem.
Of course, if you believe in Helicobacter as a
cause of gastritis, antibiotic therapy alone
may be beneficial.
2
Case Two
You wish to give an antiemetic to a cat
with acute persistent vomiting.
Cerenia (maropitant (Pfizer)) has a market
authorisation for the treatment of vomiting
in dogs, but is not licensed for use in cats.
There is no other formulation of maropitant,
but the use of a similar human licensed
product, aprepitant [Emend (Merck)], as well
as being foolhardy because there is no safety
data for its use in animals, would not be not
allowed under the Cascade.
There is reliable evidence that Cerenia
is safe and effective in cats even though not
specifically licensed in cats
3
. However, you
can make a clinical judgement to use an
established anti-emetic such as
metoclopramide. This judgement must be
based on its potential efficacy and safety in
cats, and not on cost.
1
http://www.vmd.gov.uk/General/VMR/
vmg_notes07/VMGNote15.pdf
2
Leib MS, Duncan RB & Ward DL. Triple
antimicrobial therapy and acid suppression in dogs
with chronic vomiting and gastric Helicobacter spp.
Journal of Veterinary Internal Medicine 2
3
Hickman MA, Cox SR, Mahabir S, et al. Safety,
pharmacokinetics and use of the novel NK-1
receptor antagonist maropitant (CereniaTM) for
the prevention of emesis and motion sickness in
cats. Journal of Veterinary Pharmacology and
Therapeutics. 2008: 31: 220229
PRACTICAL EXAMPLES OF PRESCRIBING UNDER THE CASCADE
The popular BSAVA Small
Animal Dispensing Course takes
place in Basingstoke on 23
October. Places are limited.
Please email customerservices@
bsava.com or call 01452 726700
for more information.
DISPENSING
10 | companion
CLINICAL CONUNDRUM
CLINICAL
CONUNDRUM
Case Presentation
A 4-year-old female neutered
Hamilton Stovare presented
collapsed, as an emergency.
Twenty four hours prior to
presentation the dog had stolen a
large amount of homemade
flapjack from a work surface in the
owners kitchen. During the
course of the following day the dog
vomited numerous times. Initially
the dog brought up undigested
flapjack; however, 6 hours prior to
presentation the vomit became
haemorrhagic (Figure 1).
Clinical examination revealed
pale mucous membranes, a
moderate tachycardia and poor
peripheral pulses. A large
haematoma, with bruising, was
present at the site of previous
venepuncture (Figure 2). Dark
tarry melaenic faeces were
present on the thermometer
after the patients temperature
was taken.
Simon Tappin of Dick White
Referrals invites you to
consider your approach to a
collapsed dog presenting
with profound
haemorrhagic vomiting
Figure 1: Marked haematemesis
shortly after presentation
10 | companion
CLINICAL CONUNDRUM
CLINICAL
CONUNDRUM
Case Presentation
A 4-year-old female neutered
Hamilton Stovare presented
collapsed, as an emergency.
Twenty four hours prior to
presentation the dog had stolen a
large amount of homemade
flapjack from a work surface in the
owners kitchen. During the
course of the following day the dog
vomited numerous times. Initially
the dog brought up undigested
flapjack; however, 6 hours prior to
presentation the vomit became
haemorrhagic (Figure 1).
Clinical examination revealed
pale mucous membranes, a
moderate tachycardia and poor
peripheral pulses. A large
haematoma, with bruising, was
present at the site of previous
venepuncture (Figure 2). Dark
tarry melaenic faeces were
present on the thermometer
after the patients temperature
was taken.
Simon Tappin of Dick White
Referrals invites you to
consider your approach to a
collapsed dog presenting
with profound
haemorrhagic vomiting
Figure 1: Marked haematemesis
shortly after presentation
companion | 11
CLINICAL CONUNDRUM
What differential diagnoses
should be considered at this
stage?
Pale mucous membranes, a moderate
tachycardia and poor peripheral pulses
suggest hypovolaemia. Marked
haematemesis and melaena suggest that the
hypovolaemia is likely to have resulted from
blood loss originating from the upper
gastrointestinal tract, with gastric or
duodenal ulceration most likely. An oral or
pharyngeal injury should also be considered,
as this could lead to blood being ingested.
Given the haematemesis, melaena and
haematoma, a coagulopathy should be
strongly suspected.
Given that a coagulopathy is
considered, what are the next
steps?
Trauma and handling should be kept to a
minimum to avoid further bleeding. Blood
samples for planned diagnostic tests should
be taken from peripheral veins (cephalic or
saphenous) as bleeding after sampling will be
less severe and can be controlled more easily
with pressure than at a jugular site.
Gastroprotectants such as sucralfate,
H2 receptor antagonists and proton pump
inhibitors may help protect the gastric
mucosa, limiting further bleeding. As
hypovolaemia is present, replacing circulating
fluid volume is essential; crystalloids should
be considered in the first instance, with
blood products being considered later to
replace red cells, platelets and coagulation
factors as appropriate.
Is a primary or secondary
coagulopathy present?
Primary coagulation describes the
formation of a platelet plug over the area of
blood vessel wall that is damaged. This is
then stabilised by a fibrin meshwork, which
is the product of the secondary coagulation
pathways. Defects in primary haemostasis
are caused by inadequate platelet numbers,
abnormal platelet function or reduced levels
of von Willebrand factor, and usually lead to
petechial haemorrhages. Petechial
haemorrhages, which may coalesce into
ecchymoses, are the hallmark of primary
coagulation defects and were not seen in
this case. Defects in secondary coagulation
are caused by reduced levels of one or
more of the coagulation factors and are
usually associated with large volumes of
blood loss; examples include epistaxis,
melaena and haemothorax.
In this case the clinical signs are most
consistent with a secondary coagulopathy;
however, a primary coagulation defect
cannot be excluded by clinical signs alone,
and tests of haemostatic function are
needed to investigate the underling cause
(see Table 1).
Blood samples were taken which
revealed a low PCV (18%) and low total
solids (54 g/l; reference interval 6080 g/l),
consistent with acute haemorrhage.
A blood smear revealed normal platelet
numbers and buccal mucosal bleeding time
was normal, both of which excluded a
primary coagulopathy. Blood taken into an
ACT (activated clotting time) tube did not
clot after 5 minutes; this, in the presence of
normal platelet numbers, suggested a
secondary coagulopathy. This was
confirmed by the laboratory finding of
markedly elevated APTT and PT (both
10-fold greater than the control samples).
D-dimers were normal, revealing no
evidence of fibrinolysis. This suggested
disseminated intravascular coagulation
(DIC) was unlikely, which was supported by
normal platelet numbers.
What differentials should be
considered for a secondary
coagulopathy?
Secondary coagulopathies can be inherited
or acquired. Inherited coagulopathies are
rare but the most common are haemophilia
A (factor VIII deficiency) and haemophilia B
(factor IX deficiency). Haemophilia A and B
are sex-linked diseases, usually seen in
young male dogs, and are diagnosed either
by genetic tests or by factor assays. Other
factor deficiencies have been occasionally
reported, such as factor X deficiency (most
commonly reported in American Cocker
Figure 2: Brusing and haematoma
formation at the site of previous
venepuncture
12 | companion
CLINICAL CONUNDRUM
CLINICAL CONUNDRUM
Spaniels) and factor VII deficiency (most
commonly reported in Beagles). In this case
both the APTT and PT were elevated,
implying that either coagulation factors in
both the intrinsic and extrinsic pathways or
a single factor in the common pathway was
affected (Figure 3). This could be further
evaluated by individual factor analysis.
Acquired secondary coagulopathies are
more common and can result from: liver
disease leading to decreased factor
production; Angiostrongylus infection; or the
antagonism of vitamin K. Vitamin K is
required for the activation of factors II, VII,
IX and X and in its absence the intrinsic
(factor IX), extrinsic (factor VII) and
common pathways (factors II and X) are all
affected. As factor VII has the shortest
half-life (6 hours compared with 14 hours
for factor IX) the PT will be elevated before
changes are seen in the APTT, but both are
usually elevated at the point clinical signs
develop. The most common cause of
Vitamin K antagonism is rodenticide
toxicity; however, decreased vitamin K
absorption is also possible and can be
associated with exocrine pancreatic
insufficiency, biliary duct obstruction and
lymphangiectasia.
Diagnosis
Further investigation revealed the dogs
liver function was normal on the basis of a
bile acid stimulation test. No signs of
intestinal disease or biliary tract
obstruction were present on ultrasound
examination, revealing no evidence of a
disease process affecting vitamin K
absorption. Angiostrongylus infection was
excluded on the basis of negative thoracic
imaging and faecal parasitology.
D-dimers and platelet numbers were
normal, suggesting DIC was unlikely, with
investigations revealing no evidence of an
underlying trigger such as pancreatitis or
haemangiosarcoma. Although there was no
known history of exposure to rodenticides,
rodenticide toxicity was considered the
most likely cause on the basis of the results
obtained and appropriate management was
commenced. Serum was submitted for
analysis for first- and second-generation
rodenticides, and was negative for both;
however, a markedly increased ratio of
vitamin K to vitamin K epoxide was
present. This is extremely suggestive of
rodenticide toxicity: vitamin K epoxide
accumulates in the presence of rodenticides
as they inhibit vitamin K epoxide reductase
(Figure 4).
Studies have shown this is a sensitive
way to differentiate dogs that have been
exposed to rodenticides from dogs that
have not, with the accumulation of the
epoxide becoming most marked after
vitamin K treatment, allowing samples to be
collected after treatment has commenced
(see box opposite). Second-generation
rodenticides, such as bromodiolone, are
commonly used in the UK. These are highly
protein-bound, which means they can be
absent from serum screens by the time
clinical signs develop.
In this case a definitive diagnosis can not
be made, as a toxin has not been identified.
Table 1: Tests to investigate haemostasis
Tests of Primary Haemostasis
Primary haemostasis relies on normal platelet numbers, normal platelet function and
adequate levels of von Willebrand factor.
Platelet numbers can be checked by routine automated haematology analysers,
but numbers must be confirmed manually by examining a fresh blood smear. The
blood smear is checked for platelet clumps and the platelets counted in the mono
layer just behind the feathered edge. In this region one platelet per X100 field is
equivalent to a circulating platelet count of approximately 15 x 10
9
/l. If platelet
clumps are present an accurate count is not possible, but the presence of clumps
usually suggests that adequate platelet numbers are indeed present.
Platelet function and levels of von Willebrand factor can be assessed crudely by
the buccal mucosal bleeding time (BMBT). Platelet numbers should be checked
prior to performing a BMBT as thrombocytopenia will lead to markedly increased
bleeding time. The BMBT is performed by making an incision on the oral mucosa
with a standard device such as the Simplate II

. The upper lip is usually folded and


tied back to allow the incision to be made; once made, excessive bleeding is
absorbed using a swab, taking care not to touch the actual incision site. Normal
BMBT times are approximately 12
1
/2 minutes for the cat and 1
1
/24
1
/2 minutes in
the dog. Both von Willebrand factor and platelet function can be assessed in
more detail using laboratory-based tests.
Tests of Secondary Haemostasis
Secondary haemostasis relies on adequate levels of coagulation factors to allow
stabilisation of the platelet plug by a fibrin mesh.
The whole blood coagulation time (WBCT) crudely assesses both the intrinsic
and common pathways. Blood is taken into a warm glass tube and tilted every 30
seconds until it clots. At 37C this should normally occur within 67 minutes.
The activated clotting time (ACT) test is a more sensitive way to examine the
intrinsic and common pathways and uses a commercial tube with a clay activator.
Blood is taken into the tube and, whilst being warmed at 37C, the tube is tilted
every 10 seconds until a clot is seen. Blood should clot within 5075 seconds in
cats and 60120 seconds in dogs. The I-Stat analyser can also run ACT as a
bedside test.
More detailed coagulation times can be run at external laboratories or on bedside
analysers such as the Idexx Coag Dx analyser. The prothrombin time (PT) allows
investigation of the extrinsic and common pathways of coagulation, with the
activated partial thromboplastin time (APTT) allowing investigation of the
intrinsic and common pathways. These tests are run on citrated blood samples;
test results >25% longer than the control samples are abnormal.
companion | 13
CLINICAL CONUNDRUM
Test centre
Measurement of vitamin K
1
and vitamin K
1
epoxide and screens for first-
and second-generation rodenticides can be performed at the Human
Nutristasis Unit of Guys and St Thomas Hospital, London. Two millilitres
of serum is required for each of the two tests and samples should be
protected from strong light as this will inactivate vitamin K. Further
information is available at www.nutristasis.com or by contacting the
laboratory directly (tel: 0207 188 6816).
Diagnostic importance of vitamin K1 and its epoxide measured in serum of dogs exposed
to an anticoagulant rodenticide. Mount M.E. & Kass P.H. (1989) Am. J. Vet. Res. 50
17041709
However, there is very strong evidence to
support a diagnosis of rodenticide toxicity
an elevated vitamin K epoxide ratio, the
presence of a coagulopathy, and an
appropriate clinical response response to
vitamin K.
Treatment and outcome
Whilst investigations were undertaken an
intravenous catheter was placed and the
dog was given two 10 ml/kg boluses of
lactated Ringers solution each over 15
minutes. During this period the dogs
peripheral pulse quality, tachycardia and
demeanor all improved. Once vitamin K
antagonism was suspected and all diagnostic
samples were collected, vitamin K1 was
given at 5 mg/kg subcutaneously into several
sites. Splitting the injection volume over
multiple sites helps to minimize injection-
related haematoma formation. To replace
vitamin K-dependent coagulation factors,
15 ml/kg of fresh frozen plasma was
administered intravenously over the course
of 60 minutes, whilst monitoring closely for
transfusion reactions. An ACT performed
after transfusion was normal.
The dog received antiemetics and was
started on intravenous gastroprotection,
which was continued orally for 7 days once
the vomiting had stopped. Oral vitamin K1
was commenced and continued for 28 days
(2.5 mg/kg q12h). The dog made a good
clinical recovery over the course of the
next 24 hours and was discharged.
At re-examination 4 weeks after
discharge the dog was clinically very well
and a repeat PT performed 48 hours after
the withdrawal of vitamin K1 was normal;
this confirmed that the toxicity had
resolved. As factor VII has the shortest half-
life, checking that the PT is normal 48 hours
after the withdrawal of vitamin K1 ensures
adequate treatment has been given. If the
PT were still elevated, treatment would be
continued for a further 4 weeks and the PT
checked again at the end of therapy. At this
stage the PCV had also returned to normal
and the owner reported she had discovered
a neighbour had been using rat poison on
land the dog was walked on, 3 days prior to
initial presentation.
In circumstances of suspected toxicity,
identification of the rodenticide ingested
allows vitamin K treatment to be tailored to
the specific toxin: first-generation coumarin
rodenticides, such as warfarin, are treated
with vitamin K for 7 days; second-
generation coumarin rodenticides, such as
brodifacoum and bromodiolone, are treated
for 46 weeks; and indaniones, such as
diphacinone, are treated for 34 weeks.
Most cases reported are due to second-
generation coumarin products; thus, when
rodenticide toxicity is suspected but the
toxin is unknown, treatment is usually
instigated for 46 weeks.
Figure 3: The coagulation pathways
Intrinsic
Common
APTT PT
Contact/Platelets
Factor XII
Tissue Factor
Factor VII
Factor XI
Factor X
Fibrin
Thrombin
(
II
)
Factor V
Factor IX
Factor VIII
Extrinsic
Figure 4: The role of vitamin K in clotting factor production
Vitamin K
Epoxide
Reductase
Active
Vitamin K
Inactive
Vitamin K
Epoxide
Inactive
Clotting Factors
(II, VII, IX & X)
Active
Clotting Factors
(II, VII, IX & X)
14 | companion
HOW TO
NAVIGATE THE
PET TRAVEL SCHEME
HOW TO
The Animal Health Rabies Operation branch, Chelmsford Animal Health Divisional
Office, offers essential advice for vets in practice as a follow-up to our June article
The Quarantine Question
companion | 15
HOW TO
NAVIGATE THE
PET TRAVEL SCHEME
T
he introduction of the UK Pet Travel
Scheme (PETS) on 28th February
2000 heralded a much campaigned
for end to a quarantine period being the
only option for cats and dogs travelling into
the UK with their owners. However there
was also a predictable fear factor in
potentially opening our shorelines to a
disease as notorious as rabies.
The scheme had a lot to prove in its
infancy. Was it robust enough to do a job
that had been effectively carried out for
generations by the convenience of being an
island coupled with a rigorous quarantine
system? Modern animal identification
techniques and effective vaccines meant that
the argument for maintaining quarantine,
for most cats and dogs, from many
countries, was becoming obsolete and less
durable. However the alternative had to
provide the same level of protection that
quarantine had given for so long.
Todays scheme
The current legislation is now governed by
an EC Regulation, which covers the
non-commercial movement of pet animals
between listed qualifying countries. The
UK, Republic of Ireland, Malta and Sweden
have been allowed to retain, for a
transitional period, additional requirements
for blood sampling and parasite treatment
that were already included in their
domestic legislation at the time the
Regulation came into force.
Eight years on the success of the
scheme, and popularity with the pet owning
public, is due in part to its simplicity.
The 4 key steps to the
successful entry into the UK
Step 1: Identification
Firstly an animal must be unquestionably
identifiable as that described in the
documentation accompanying it. The form
of identification must be tamper proof and
unique. These criteria are met by the
subcutaneous implantation of a microchip.
Step 2: Vaccination
The animal is vaccinated against rabies. In
order to show that the vaccine has provided
an adequate level of immunity, a blood test
is taken and sent to a recognised laboratory.
The sample must indicate a neutralising
antibody titration at least equal to 0.5 IU/ml.
Step 3: 6-month waiting period
To be sure that the antibody level indicated
by the blood test is due to the vaccine
rather than exposure to disease, the animal
must remain in a qualifying country for
6 months from the date that a blood
sample which gives a satisfactory result
was taken to ensure clinical signs of disease
do not develop.
Step 4: Additional requirements
The Department of Health have added in
additional treatments for ticks and
tapeworms 2448 hours before checking in
to travel to the UK. This aims to prevent
the entry to the UK of other exotic
zoonotic diseases that can be carried by
cats and dogs. The treatment must be
administered by a vet practising in the
country of treatment. Section VI of the
passport must then be completed by this
vet, specifying the manufacturer of the
treatment, the product used and the date
and time of treatment. This entry must be
signed and stamped by the vet. Collars
impregnated with acaricide should not be
used. In the case of Echinococcus
multilocularis treatment, the same details
must also be recorded in Section VII of the
companion | 15
HOW TO
NAVIGATE THE
PET TRAVEL SCHEME
T
he introduction of the UK Pet Travel
Scheme (PETS) on 28th February
2000 heralded a much campaigned
for end to a quarantine period being the
only option for cats and dogs travelling into
the UK with their owners. However there
was also a predictable fear factor in
potentially opening our shorelines to a
disease as notorious as rabies.
The scheme had a lot to prove in its
infancy. Was it robust enough to do a job
that had been effectively carried out for
generations by the convenience of being an
island coupled with a rigorous quarantine
system? Modern animal identification
techniques and effective vaccines meant that
the argument for maintaining quarantine,
for most cats and dogs, from many
countries, was becoming obsolete and less
durable. However the alternative had to
provide the same level of protection that
quarantine had given for so long.
Todays scheme
The current legislation is now governed by
an EC Regulation, which covers the
non-commercial movement of pet animals
between listed qualifying countries. The
UK, Republic of Ireland, Malta and Sweden
have been allowed to retain, for a
transitional period, additional requirements
for blood sampling and parasite treatment
that were already included in their
domestic legislation at the time the
Regulation came into force.
Eight years on the success of the
scheme, and popularity with the pet owning
public, is due in part to its simplicity.
The 4 key steps to the
successful entry into the UK
Step 1: Identification
Firstly an animal must be unquestionably
identifiable as that described in the
documentation accompanying it. The form
of identification must be tamper proof and
unique. These criteria are met by the
subcutaneous implantation of a microchip.
Step 2: Vaccination
The animal is vaccinated against rabies. In
order to show that the vaccine has provided
an adequate level of immunity, a blood test
is taken and sent to a recognised laboratory.
The sample must indicate a neutralising
antibody titration at least equal to 0.5 IU/ml.
Step 3: 6-month waiting period
To be sure that the antibody level indicated
by the blood test is due to the vaccine
rather than exposure to disease, the animal
must remain in a qualifying country for
6 months from the date that a blood
sample which gives a satisfactory result
was taken to ensure clinical signs of disease
do not develop.
Step 4: Additional requirements
The Department of Health have added in
additional treatments for ticks and
tapeworms 2448 hours before checking in
to travel to the UK. This aims to prevent
the entry to the UK of other exotic
zoonotic diseases that can be carried by
cats and dogs. The treatment must be
administered by a vet practising in the
country of treatment. Section VI of the
passport must then be completed by this
vet, specifying the manufacturer of the
treatment, the product used and the date
and time of treatment. This entry must be
signed and stamped by the vet. Collars
impregnated with acaricide should not be
used. In the case of Echinococcus
multilocularis treatment, the same details
must also be recorded in Section VII of the
16 | companion
HOW TO
passport. This treatment must contain
praziquantel as the active ingredient.
This 4-step procedure, the order of
which is paramount, ensures that the cat or
dog in question poses no disease risk to the
human and animal population of the UK.
Success or failure?
Eight years on, what are the main problems
that have arisen with the scheme?
Unfortunately simplicity often creates
the most complexity. It is the responsibility
of the authorised carrier, be it a ferry
company, Eurotunnel or airline, to ensure
that the pets they transport comply with
the requirements of the scheme. Animal
Health audit checks of these carriers have
identified some problem areas with the
scheme as well some unexpected surprises.
So, what can the practising veterinary
surgeon, struggling with a flow of clients
keen to travel hassle-free with their pets,
learn from the problems encountered in
the past?
Worm and tick worries
Approximately 65% of pets entering the UK
come through the South Eastern seaports
or channel tunnel. Animal Health at Dover
audits these particular routes, and its
experience in dealing with queries is likely
to provide a representative insight into
what requirements of the scheme have
created the most queries.
Over the last 12 months 50% of the
queries have related to problems with tick
and tapeworm treatments. This can involve
one treatment missing, type of treatments
not recorded, date or time of treatment
missing, or wrong date and time recorded.
The best advice a UK vet can give a client is
to ensure they visit a veterinary surgeon in
the country of departure to receive
appropriate treatment and to check that
Section VI and VII of the passport have
been completed with the correct and
complete information. Clients should also
be made fully aware of the window of travel
time and any treatments that are not
acceptable under the legislation.
Blood concerns
Seventeen percent (17%) of queries related
to the blood test. Information may be
missing from the passport or may be
incorrectly entered. A proportion of blood
sample queries will be due to owners
attempting to travel before the 6-month
waiting time has elapsed. Advice in this case
should be to ensure that Section V of the
passport has been completed with the date
of sampling and signed and stamped by the
vet. Making clients aware of the 6-month
waiting period is the responsibility of the
veterinary surgeon and stressing this point
to avoid misunderstanding can prevent an
unpleasant souring of the vetclient
relationship in the future.
Microchip mistakes
Microchip problems constitute 11% of
queries. The date of insertion may not have
been appropriately recorded or may have
been incorrect. Unfortunately there are
also times when a microchip will fail. It is
prudent for a veterinary surgeon to check
that the microchip is working properly
during routine visits to the surgery and
always before an entry is made in the
passport, such as before a rabies
vaccination booster is administered.
In the event of a chip failure it is vital
that the correct procedure is followed to
ensure continuity of identification. The failed
microchip must be located and removed
under anaesthetic. A new microchip must be
implanted at the same time and the details
of that new chip recorded in the passport.
The veterinary surgeon should then send
the failed chip to the manufacturer who will
confirm the failure and provide documentary
evidence that the number corresponds to
that originally recorded in the passport.
Once the vet is in possession of this
evidence, a declaration should be made in
section XI (Others) of the passport to
indicate that the original chip was removed
and replaced with another microchip on the
same date and that the manufacturers have
confirmed the number of the original chip
that could not be read. If this procedure is
followed the scheme does not need to be
re-started.
Process problems
Confusion over the order of progression
through steps 1 to 3 accounts for 8% of
queries. In some of these cases, actions will
NAVIGATE THE
PET TRAVEL SCHEME
companion | 17
HOW TO
genuinely have been performed in the
wrong order but in a significant proportion
the pet owner states the dates recorded in
the passport are incorrect and may either
have supporting documentation with them
or be able to obtain correct information
from the vet.
Where the veterinary surgeon has not
followed the correct order of preparation
there is no choice but to re-start the
scheme. This will include a repeat rabies
vaccination and adherence to the 6-month
waiting time following a satisfactory blood
test result before the pet is eligible for
travel into the UK. This will include a repeat
rabies vaccination and adherence to the
6-month waiting time following a
satisfactory blood test result before the
pet is eligible for travel into the UK.
Proper procedures
There cannot be many more unpleasant
ways to end a trip abroad than to be told
that your pet will have to remain in
quarantine for 6 months. The only way to
avoid this eventuality is for the vet issuing
the passport to ensure that the procedure
has been followed correctly and if not take
any appropriate action, advise the client
that their pet is not eligible to travel and for
what period of time.
If there is any doubt enquiries should be
made to ensure that all dates entered in the
passport are correct and reflect the correct
order of preparation. The remainder of the
queries regard the inaccurate recording/
missing of the vaccination valid until dates
or in circumstances where the vaccine
appears to have expired. Careful recording
of all necessary information should avoid
this problem.
Avoiding the issues
To avoid the problems listed above it is
paramount that the vet ensures that all
information is completed accurately and
indicates correct order of preparation and
full compliance with requirements for entry
to the UK.
Out of the control of the UK veterinary
practitioner, but of real concern, is the
importation of a breed or type of dog listed
NAVIGATE THE
PET TRAVEL SCHEME
under the Dangerous Dogs Act (DDA).
Unfortunately as the range of countries
participating in the scheme has increased,
dogs that may be considered pit bull types
have been brought to the attention of
Animal Health by the authorised carriers.
These dogs may be described in their
passports as American Bulldog, American
Staffordshire or Irish Staffordshire Bull
Terriers but the difficulty encountered is that
if the dog is PETS compliant, there is little
Animal Health can do. At present there is no
provision within the existing DDA to prevent
the importation of such dogs. All that Animal
Health can do in these cases is to refer the
details of the dog, including photographs, to
the police at the final destination who, along
with the district local authority, are the
competent authority named in the DDA to
act on this information.
Owner tactics
People will always be passionate about their
pets and unfortunately normally law-abiding
citizens may feel the need to take illegal
action to ensure their pet remains in their
possession and avoids quarantine. Owners
may be fully aware that their pet does not
qualify for entry to the UK and will still
attempt to travel with them, hiding them in
vehicles and not declaring their presence.
Thankfully these incidences are rare.
What now?
At the time of writing, the EC Regulation
governing the movement of non-commercial
pet animals is under review. The transitional
period that allowed the UK to retain the
additional requirements for entry has been
extended but there is no guarantee that
these will be kept indefinitely. If we are
required to harmonise with other Member
States there is a chance that the blood
sampling and tick and tapeworm treatment
procedures will be removed.
However that is for the future. For now,
the Pet Passport Scheme has proved itself
to be an effective method of disease
control. It has allowed pets are now able to
travel with their families around the world,
and more importantly, to come home again.
As long as issuing veterinary surgeons are
conversant with the requirements and able
to make these clear to their client, the
successful outcome will see many more
travelling pets in the future.
For more information, including
factsheets for distribution to clients, visit
http://www.defra.gov.uk/animalh/
quarantine/index.htm
When pit bull type dogs are identified at Dover during entry into the UK, the local
authority and police at its destination are informed
18 | companion
VIN FORUMS
The Veterinary Information Network brings
together veterinary professionals from
across the globe to share their experience
and expertise. At vin.com users get
instant access to vast amounts of
up-to-date veterinary information from
colleagues, many of whom who have
specialized knowledge and skills. In this new
feature, VIN shares with companion
readers a small animal discussion that has
recently taken place in their forums.
Discussion Creator
Jessie is a 4 year old Springer who got into the
laundry hamper.
Four days later he came to see me for his vomiting.
I ended up removing 52 of his jejunum. I was able to keep
his ileum and a few feet of his upper SI.
It is now day three post-op. He is eating well, his Jackson-
Pratt drain has had minimal discharge and he has been
weaned off of IV fuids and IV antibiotics.
Jessie is having explosive/liquid bowel movements. He
does not have urgency and seems to have no anxiety/
discomfort.
I seem to remember that the remaining bowel will
compensate for the lost bowel over a period of time. When
would I expect to see some form to his stool?
I estimate I removed 50% of his bowel.
I used the GIA/TA for the R&A as well the Jackson-Pratt
drain. The staplers have sped up my surgery considerably
and the JP drain gives piece of mind. I did not use an LDS
for this procedure, but ordered one as soon as I was
finished, it is AMAZING how quick you can ligate with the
proper instruments. Intestinal surgery is now FUN!!
Discussion Creator
....and just when I thought all was well, Jessie decided to
eat his vetwrap bandage! I didnt know if it would pass, so
ended up inducing vomiting to regain possession.
(Did I mention he also had a gastrotomy as well? That TA
makes it fast!)
Reply 1
I dont know what the rule is for how much gut they can
use (Im sure theres a formula somewhere), but one of the
first times I ever posted on VIN was a similar case.
Rottweiler with whips and intussusception. Ended up
removing about 4 feet on SI with a little ileum thrown in.
He was blowing out for about 3 or 4 days. Im a surgery
wimp and the boss was out of town, so I was on my own.
The surgery gurus here said not to worry, and sure enough
he straightened out.
Good luck!
LETTERS FROM
AMERICA
18 | companion
VIN FORUMS
The Veterinary Information Network brings
together veterinary professionals from
across the globe to share their experience
and expertise. At vin.com users get
instant access to vast amounts of
up-to-date veterinary information from
colleagues, many of whom who have
specialized knowledge and skills. In this new
feature, VIN shares with companion
readers a small animal discussion that has
recently taken place in their forums.
Discussion Creator
Jessie is a 4 year old Springer who got into the
laundry hamper.
Four days later he came to see me for his vomiting.
I ended up removing 52 of his jejunum. I was able to keep
his ileum and a few feet of his upper SI.
It is now day three post-op. He is eating well, his Jackson-
Pratt drain has had minimal discharge and he has been
weaned off of IV fuids and IV antibiotics.
Jessie is having explosive/liquid bowel movements. He
does not have urgency and seems to have no anxiety/
discomfort.
I seem to remember that the remaining bowel will
compensate for the lost bowel over a period of time. When
would I expect to see some form to his stool?
I estimate I removed 50% of his bowel.
I used the GIA/TA for the R&A as well the Jackson-Pratt
drain. The staplers have sped up my surgery considerably
and the JP drain gives piece of mind. I did not use an LDS
for this procedure, but ordered one as soon as I was
finished, it is AMAZING how quick you can ligate with the
proper instruments. Intestinal surgery is now FUN!!
Discussion Creator
....and just when I thought all was well, Jessie decided to
eat his vetwrap bandage! I didnt know if it would pass, so
ended up inducing vomiting to regain possession.
(Did I mention he also had a gastrotomy as well? That TA
makes it fast!)
Reply 1
I dont know what the rule is for how much gut they can
use (Im sure theres a formula somewhere), but one of the
first times I ever posted on VIN was a similar case.
Rottweiler with whips and intussusception. Ended up
removing about 4 feet on SI with a little ileum thrown in.
He was blowing out for about 3 or 4 days. Im a surgery
wimp and the boss was out of town, so I was on my own.
The surgery gurus here said not to worry, and sure enough
he straightened out.
Good luck!
LETTERS FROM
AMERICA
companion | 19
VIN FORUMS
Reply 2
52 inches of small bowel in a Springer sized dog
is a lot of bowel. There is a fair chance that he
will end up with short bowel syndrome, but it is
too soon to say.
All content published courtesy of vin.com. The names of participants have been removed from this feature. For more details about the
Veterinary Information Network visit vin.com. 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.
His weight prior to sx was 41 lb, he now weighs 40.6 lb and
is at an ideal weight.
I found a JAVMA article that suggests the ileum can
hypertrophy as can the remaining small intestine. Would
this dog need supplementation/testing now, or is the
cobalamin he had prior to his sx sustain him until his bowel
recovers?
Vin members can access the link to the
JAVMA article:
http://www.vin.com/Members/Viewer/Viewer.
ashx?FileId=2766802&FileTypeId=6&IsOld=0
I was assuming the liquid BM was a consequence of his
shortened bowel and may resolve over time. How do I
know if its a problem that needs medical attention?
He seems to be doing great otherwise, hes boarding at my
clinic for another week, so I get to keep a close eye on
him. Hes back to normal as far as attitude and energy.
Im just not sure how worried I need to be. Id rather nip a
problem early if it needs to be addressed.
Thank you for the help!
Vin Consultant
I agree, short bowel might be a
concern but usually you can get away
with 70-80%. At least you steered
clear of the ileocecocolic valve its when you lose that,
you really have problems.
What diet is he on? Id go with something highly digestible
like EN, low res in small frequent feedings (46/day).
You could add soluble fibre. I doubt youll need cobalamin,
questran etc if the ileum is intact, although it might be
worth checking a cobalamin/folate.
A course of tylan and a probiotic wouldnt hurt either :)
Discussion Creator
>>> 52 inches of small bowel in
a Springer sized dog is a lot of
bowel. <<<
I agree!
Jessie measures 24 inches from the back of his skull to his
tailhead.
Im using the measurement of 4X this length is the
approximate bowel length, and 75% of this may be
removed without seeing short bowel syndrome.
Total bowel length = 96, so percent removed is
52/96=54%.
Hes on I/D right now.
Vin Consultant
>>> Would this dog need
supplementation/testing now, or
is the cobalamin he had prior to
his sx sustain him until his bowel recovers? <<<
No, as I mentioned above with the ileum intact cobalamin,
bile salts etc should not be an issue but you could check
levels if the diarrhea persists.
>>> How do I know if its a problem that needs
medical attention? <<<
Time :) But as I said, keep with small frequentt meals and
tylan (for 6 weeks) and a probiotic sol. fibre wont hurt.
20 | companion
PETSAVERS
Improving the health of the nations pets
T
he Petsavers products available
from your wholesaler represent
really great value for money, plus
they are designed specifically to meet the
requirements of small animal practice.
A royalty is paid to Petsavers for each
and every product bought and this
provides a valuable source of income,
which in turn is used to fund studies that
advance our knowledge of small animal
medicine and surgery.
PETSAVERS PRODUCTS FOR PRACTICE
When you buy Petsavers merchandise through your
wholesaler you get the highest standard products whilst
raising essential funds for the charity
These items are listed under Petsavers in your
wholesalers product catalogue. If you have any difficulty
ordering products or would like more information, please
contact Petsavers on 01452 726700 or email info@
petsavers.org.uk.
The money raised through these purchases really
helps to continue to fund research into conditions that
affect the animals that we treat.
Protective collars
These are available in either clear plastic or
opaque finishes. Assembly is easy and they
come in a range of sizes. Every practice uses
these, so why not use the Petsavers
protective collar and help fund the future of
veterinary expertise.
Recovery blankets
Compared to some blankets, these are
very tough indeed. They are made of
polyester and retain 95% of radiated
body heat. The blankets can be used
with a hypothermic patient and are
great for preventing hypothermia
during the anaesthetic period. They
are also radiolucent and so diagnostic
radiographs can be taken whilst the
animal remains wrapped in the
recovery blanket.
Pet carriers
These cardboard or plastic pet carriers
are inexpensive and very popular with
clients. They also help to advertise
Petsavers with our logo and website
address on the side. The hardwearing
wire carrier is easily cleaned and has a
hinged lid that allows full access to the
interior of the carrier, making it easy to
get pets into and out of, especially in
the surgery.
Heated pads
The Petsavers heated pad has been
hugely popular since it was introduced
in 2006. It is ideal for cats, small dogs
and other small pets when you need to
minimise the risk of postoperative
hypothermia or just to keep them warm.
The key features of the pad are:
Detachable plug allowing wire to
be passed through
cage bars
Low operating
voltage (12v) for
increased safety
Thick durable
cover to cope with
normal wear and
tear, and which
can be easily
cleaned.
companion | 21
GETTING TOUGH
ON SEIZURES
Simon Platt, Associate Professor in the Neurology
Service at the University of Georgia and co-editor
of the BSAVA Manual of Canine and Feline Neurology,
looks at treatment options in managing epilepsy
C
ontrol of canine epilepsy is only
possible in 7080% of cases with
phenobarbital (PB) alone. Success
may be improved if combination therapy
with potassium bromide (KBr) is used.
More recently, several human drugs have
been evaluated for seizure therapy in
veterinary patients. Such polytherapy has
several potential disadvantages, including
the increased cost, the need to monitor and
to interpret serum concentrations of
multiple drugs, potential drug interactions,
and more complicated dosing schedules.
Before polytherapy is started, all reasonable
options for monotherapy should be tried. If
the initial drug is ineffective, a second drug
should be added.
What are the available drug
options for canine refractory
epilepsy?
If treatment with PB and/or KBr is not an
option for reasons of toxicity for instance,
or if treatment with a combination of both
has not been successful, there are now
some human anticonvulsants that can be
considered for use in the dog. Their safety
and pharmacokinetics have been
investigated and their clinical use in a small
number of refractory epileptics have been
evaluated. However, there is nothing to
prevent their use in the appropriate
circumstances as sole therapy.
1. Gabapentin
Gabapentin has primarily been used as an
adjunctive drug for humans with
uncontrolled partial seizures with and
without secondary generalisation.
Gabapentin is well absorbed from the
duodenum in dogs, with maximum blood
levels reached in 1 hour after oral
administration. The elimination half-life of
gabapentin in dogs is 34 hours, meaning
that it may be difficult to attain steady state
levels with q8h dosing. The currently
estimated required dose to achieve some
effect in dogs is 1020 mg/kg q8h. In dogs,
gabapentin is metabolised in the liver;
therefore, liver function needs to be closely
evaluated when dogs are on this treatment.
The author has used this drug with no
deleterious effects as a third drug for dogs
refractory to PB and KBr. At this point,
about 50% of dogs seem to respond well to
this addition, though sedation may be a
problem in some dogs.
2. Levetiracetam
Studies show that levetiracetam displays
potent protection in a broad range of
animal models of chronic epilepsy.
Levetiracetam is not metabolised by the
liver, is excreted by the kidneys and is free
of significant drugdrug interactions;
therefore, this is potentially a very safe drug
to use in dogs and even cats. The dose
range suggested for dogs is 1020 mg/kg
orally q8h. No therapeutic range has been
established and in humans serum levels do
not seem to correlate with efficacy. No
long-term trials have been undertaken
evaluating the safety and efficacy of this
drug; however, a recent short-term clinical
trial demonstrated that using it as a third
anticonvulsant decreased seizure frequency
by over 50% in epileptic dogs.
3. Zonisamide
This drug has been shown to be effective for
both focal and generalised seizures in human
patients. Zonisamide is metabolised mainly
by hepatic microsomal enzymes, and the
half-life in dogs is approximately 15 hours.
The dose suggested for use as an add-on
drug in dogs is approximately 5 mg/kg orally
q12h. A high safety margin has been
demonstrated in chronic dosing studies in
Transverse (cross-sectional) MRI
(T2-weighted) image indicating the
presence of bilateral symmetrical
oedema (arrowed) subsequent to
prolonged generalised tonic seizure
activity. Such oedema may lead to
long-term damage and may create a
more difficult to treat seizure focus
PUBLICATIONS
dogs, but the drug is sulphonamide-based. A
recent clinical trial has shown that the use of
zonisamide has decreased seizure frequency
by over 50% in approximately 50% of dogs
on polytherapy, additionally enabling a
reduction in the concurrent dose of PB.
These options may be expensive but
provide owners with something further to
try. Over the next few years, even more
therapeutic options are to become available
for the treatment of canine epilepsy and so
we may anticipate a future with less
problematic canine seizure cases. For now,
they remain a common clinical problem in
our practices. n
companion | 21
GETTING TOUGH
ON SEIZURES
Simon Platt, Associate Professor in the Neurology
Service at the University of Georgia and co-editor
of the BSAVA Manual of Canine and Feline Neurology,
looks at treatment options in managing epilepsy
C
ontrol of canine epilepsy is only
possible in 7080% of cases with
phenobarbital (PB) alone. Success
may be improved if combination therapy
with potassium bromide (KBr) is used.
More recently, several human drugs have
been evaluated for seizure therapy in
veterinary patients. Such polytherapy has
several potential disadvantages, including
the increased cost, the need to monitor and
to interpret serum concentrations of
multiple drugs, potential drug interactions,
and more complicated dosing schedules.
Before polytherapy is started, all reasonable
options for monotherapy should be tried. If
the initial drug is ineffective, a second drug
should be added.
What are the available drug
options for canine refractory
epilepsy?
If treatment with PB and/or KBr is not an
option for reasons of toxicity for instance,
or if treatment with a combination of both
has not been successful, there are now
some human anticonvulsants that can be
considered for use in the dog. Their safety
and pharmacokinetics have been
investigated and their clinical use in a small
number of refractory epileptics have been
evaluated. However, there is nothing to
prevent their use in the appropriate
circumstances as sole therapy.
1. Gabapentin
Gabapentin has primarily been used as an
adjunctive drug for humans with
uncontrolled partial seizures with and
without secondary generalisation.
Gabapentin is well absorbed from the
duodenum in dogs, with maximum blood
levels reached in 1 hour after oral
administration. The elimination half-life of
gabapentin in dogs is 34 hours, meaning
that it may be difficult to attain steady state
levels with q8h dosing. The currently
estimated required dose to achieve some
effect in dogs is 1020 mg/kg q8h. In dogs,
gabapentin is metabolised in the liver;
therefore, liver function needs to be closely
evaluated when dogs are on this treatment.
The author has used this drug with no
deleterious effects as a third drug for dogs
refractory to PB and KBr. At this point,
about 50% of dogs seem to respond well to
this addition, though sedation may be a
problem in some dogs.
2. Levetiracetam
Studies show that levetiracetam displays
potent protection in a broad range of
animal models of chronic epilepsy.
Levetiracetam is not metabolised by the
liver, is excreted by the kidneys and is free
of significant drugdrug interactions;
therefore, this is potentially a very safe drug
to use in dogs and even cats. The dose
range suggested for dogs is 1020 mg/kg
orally q8h. No therapeutic range has been
established and in humans serum levels do
not seem to correlate with efficacy. No
long-term trials have been undertaken
evaluating the safety and efficacy of this
drug; however, a recent short-term clinical
trial demonstrated that using it as a third
anticonvulsant decreased seizure frequency
by over 50% in epileptic dogs.
3. Zonisamide
This drug has been shown to be effective for
both focal and generalised seizures in human
patients. Zonisamide is metabolised mainly
by hepatic microsomal enzymes, and the
half-life in dogs is approximately 15 hours.
The dose suggested for use as an add-on
drug in dogs is approximately 5 mg/kg orally
q12h. A high safety margin has been
demonstrated in chronic dosing studies in
Transverse (cross-sectional) MRI
(T2-weighted) image indicating the
presence of bilateral symmetrical
oedema (arrowed) subsequent to
prolonged generalised tonic seizure
activity. Such oedema may lead to
long-term damage and may create a
more difficult to treat seizure focus
PUBLICATIONS
dogs, but the drug is sulphonamide-based. A
recent clinical trial has shown that the use of
zonisamide has decreased seizure frequency
by over 50% in approximately 50% of dogs
on polytherapy, additionally enabling a
reduction in the concurrent dose of PB.
These options may be expensive but
provide owners with something further to
try. Over the next few years, even more
therapeutic options are to become available
for the treatment of canine epilepsy and so
we may anticipate a future with less
problematic canine seizure cases. For now,
they remain a common clinical problem in
our practices. n
22 | companion
WSAVA NEWS
F
ollowing a 2004 publication in the
Journal of the American Veterinary
Medical Association that identified
marked discrepancies in the
histopathological evaluation of
gastrointestinal biopsies, a group of
veterinarians specialising in GI diseases
approached the WSAVA with the concept
of standardising the collection and
assessment of GI biopsies. (See Willard MD,
et al. Interobserver variation among
histopathological evaluation of intestinal
tissues from dogs and cats. J Am Vet Med
Assoc 2004; 220: 1177).
Based on similar goals and the ultimate
success of the Liver Disease Standardization
Group (www.wsava.org/LiverStandard.htm),
a formal GI Standardization Group was
organised, consisting of Drs Washabau
(chair), Bilzer, Day, Guilford, Hall, Jergens,
Mansell, Minami, Wilcock, and Willard, and
its remit set. With support from Hills Pet
Nutrition, the group has enjoyed
tremendous productivity, including:
Histopathological Standards for the
Diagnosis of Gastrointestinal
Inflammation in Endoscopic Biopsy
Samples from the Dog and Cat: A
Report from the World Small Animal
Veterinary Association Gastrointestinal
Standardization Group. ( J Comp Path
2008;138:S1S44) This monograph
presents a standardised pictorial and
textual template of the major
histopathological changes that occur in
inflammatory disease of the canine and
feline gastric body, gastric antrum,
duodenum and colon.
Standardized GI Endoscopy Reporting
Forms available online www.wsava.
org/StandardizationGroup.htm
The group recognised early the need to
also standardise endoscopic examination
and sampling of the GI tract to ensure the
highest procedural diagnostic yield. These
endoscopy report forms help address this,
namely that endoscopic examination is
complete and thorough.
Development of an ACVIM
Consensus Statement on IBD
The ACVIM Board of Regents invited the
WSAVA Gastrointestinal Standardization
Group to develop, present and publish an
ACVIM Consensus Statement on
Histopathologic Standards for Canine and
Feline IBD. This was presented in a special
session at the 2008 ACVIM Forum in San
Antonio and is awaiting ratification and
eventual publication in the Journal of
Veterinary Internal Medicine.
Dr Robert Washabau proposed the
Consensus Statement on IBD, based on the
work of the WSAVA Standardization
Group, at the 2008 ACVIM Forum in San
Antonio, Texas. Congratulations to the GI
GI STANDARDIZATION
GROUP
Standardization
Group for their
outstanding
contribution to
the betterment
of of medicine
and hence the
lives of dogs
and cats
throughout the world.
For more information visit their
committee page on the WSAVA website.
LATEST
WSAVA
NEWS
P
eriodically, WSAVA produces a
News Bulletin that highlights the
initiatives and accomplishments of
the association, its committees,
member associations, and individual
members. The most recent News
Bulletin is now available for viewing
online www.wsava.org
companion | 23
WSAVA NEWS
N
EWStat is the American Animal
Hospital Associations bi-weekly
email newsletter. NEWStat includes
easy-to-digest briefs on timely topics and
breaking news in companion animal
practice. It has a convenient format thats
easy to read and share with others, and has
links to additional information.
WSAVA MEMBER
ASSOCIATION
UPDATES
While password protected and not
freely available online, AAHA has agreed to
make this resource available to WSAVA
members via their www.aahanet.org
website. Username and password can be
requested and provided through your
specific WSAVA member associations to
determine if you are a WSAVA member,
AAHA makes NEWStat and Trends magazine
available to WSAVA members
please access the Member Association
pages for more details www.wsava.org/
Handbook.htm.
Additional resources that AAHA
has made available for WSAVA
members include:
Trends Magazine ( trends.aahanet.org/
eweb/) a resource providing
information on management, business,
and other workplace issues designed for
the entire veterinary clinic staff
Healthy Pet ( www.healthypet.com/) a
pet owner online information resource
AAHA Standards of Accreditation
(www.aahanet.org/accreditation/index.
aspx) AAHA, along with a group of
veterinary experts, developed the
AAHA Standards of Accreditation as
benchmarks of excellence to raise the
level of care being provided to
companion animals. Username and
password access can be obtained as for
NEWStat above.
T
he WSAVA 2008 Dublin Congress
scientific proceedings will be
available online to coincide with
the opening of the Congress in Dublin,
Ireland. The proceedings contain exciting
scientific information that includes more
than 200 lectures from 70 different
speakers in more than 20 different
disciplines and cover three different levels
WSAVA WORLD CONGRESS
PROCEEDINGS ONLINE
of interest advanced/specialist, general
companion animal, and new to/refresher
companion animal medicine. Additionally,
the proceedings will include three State-of-
the-Art Lectures (SOTALs) as well as the
free communications/abstracts. So, if you
cant attend in person, the scientific
information is still at your finger tips at
www.wsava.org
24 | companion
WSAVA NEWS
Peruvian Small Animal Veterinary
Medical Association
WSAVA NEWS
WSAVA NEWS WSAVA NEWS
W
ith more and more veterinary professionals outside the
UK wanting to benefit from the range of CPD
resources on offer to its members, the British Small
Animal Veterinary Association is pleased to offer its new overseas
membership category, at a discounted subscription rate.
With more than 700 hours of Congress MP3s available online,
this alone is worth the membership fee. Along with these valuable
scientific lectures overseas members will also be able to access the
BSAVA Small Animal Formulary, the Journal of Small Animal Practice and
companion online at www.bsava.com anytime, day or night.
However, not all the benefits are online Overseas Members
will also be entitled to significant discounts on the wide range of
BSAVA manuals with savings of more than a third off the non-
member price.
Prof. Ed Hall, President of BSAVA, says, We already have many
members outside the UK, and wanted to offer those who arent
able to come to our Congress each year, or attend one of our
courses in the UK, an opportunity to be a part of this growing
association and access the other benefits we offer, such as the
Congress MP3s. With our new website going live in the early part
of 2009 there will be even more resources available and we would
encourage the global perspective an international membership
would bring.
Overseas Members must have a permanent home and work
address outside of the UK and Eire. They must also be a registered
overseas member of the RCVS (or equivalent body). If you would
like more information regarding joining the BSAVA please email
customerservices@bsava.com. The current fee for 2008 is 92
(compared with 184 for Full Membership).
BSAVA OFFERS
MORE TO
INTERNATIONAL
COLLEAGUES
First Persian Veterinary Forum
The Persian Veterinary Forum is an online information
resource consisting of 24 departments covering various fields
of veterinary medicine, such as large animal medicine, small
animal medicine, surgery, poultry, wild animals, etc. The forum
was established in 2005 and is now in its 4th year with more
than 2500 articles available online in Persian (Farsi). The Forum
has two major sections, one on special veterinary medicine,
which is suitable for veterinary surgeons, students and
academics, and the other is the public section, including
discussions on various veterinary topics. Access is free and
membership is easy please visit www.ardalan.id.ir/forum
On 1 May 2008, WSAVA and Hills Pet Nutrition sponsored a
continuing education seminar by Dr Jesus Paredes from the
University of Mexico on soft-tissue surgery in Lima, Peru,
which was well received by the packed room of attendees. Also
in attendance were dignitaries from various veterinary medical
associations. Pictured from left to right Drs Gilberto Santillan
(Vice President AMVEPPA), Jesus Paredes (speaker), Rau
Benavente (President AMVEPPA), Ronald Torres (Treasurer
AMVEPPA), Vladimir Valdivia (Secretary AMVEPPA), Richard
Arguezo (Chair AMVEPPA/WSAVA CE Committee), and
Guillermo Rico (Peruvian speaker).
companion | 25
WSAVA NEWS
T
he control of free-roaming dog
populations remains a major
welfare issue in many parts of the
world. These may be associated with
many problems such as:
Direct injury to people, livestock
or pets
Indirect injury to people and pets
from road traffic accidents
Source of infection (esp. rabies)
Pollution from faeces and urine
General nuisance from noise.
The financial costs involved with
these can be high, and mass slaughter
has been chosen as one way of
addressing the problem. Often
inhumane methods are used which
are not only a welfare problem,
alienating many of the stake holders,
but may also be indiscriminate with
risks to humans and their pets. These
methods are also invariably unsuccessful
in the medium term.
Accordingly, in 1990, the World
Health Organisation (WHO) and the
Word Society for the Protection of
Animals (WSPA) formulated joint
international arm of the Royal Society for
the Protection of Animals, the
Universities Federation for Animal
Welfare (UFAW), the World Small
Animal Veterinary Association
(WSAVA) and the Alliance for Rabies
Control (ARC).
In January 2008, ICAM published a
document titled Humane Dog Population
Management Guidance. This essentially
builds on and replaces the original
WHO/WSPA framework, and is illustrated
by a number of real life case studies. To
access this document, visit the Animal
Welfare page of the WSAVA website
(www.wsava.org/AnimalWelfare.htm)
The WSAVA Welfare committee
strongly recommends this to WSAVA
members. The document can be
downloaded from the WSAVA website as
a pdf document.
NEW GUIDELINES ON
HUMANE STRAY DOG
CONTROL AVAILABLE
guidelines providing a framework on which
a strategy might be developed. The key
elements were:
Legislation
Registration and identification
Garbage control
Neutering of owned and un-owned dogs
Control of breeders and sales outlets
Education.
All elements are important, though
the priorities in different situations may
vary. However, it is essential that all the
major stakeholders agree a common
strategy and that population studies are
carried out to help formulate the most
appropriate strategy.
Much has happened since 1990, and
recently the International Companion
Animal Management (ICAM) Coalition
was formed to share information and
ideas on companion animal population
dynamics. Currently, ICAM is made up
of representatives from the World Society
for the Protection of Animals (WSPA),
the Humane Society International (HSI),
the International Fund for Animal Welfare
(IFAW), RSPCA International (the
26 | companion
companion INTERVIEW
Victoria Roberts grew up in rural Suffolk, with an elder brother and sister, surrounded by
horses, dogs, poultry and farmland. Having run a pure breed visitor attraction and
breeding programme before attending Liverpool Vet School, she has made her name as a
leading avian expert. As well as contributing to BSAVA publications, Victoria has been a
valued volunteer for the Association for many years.
THE
companion
INTERVIEW
What childhood memories remain
with you?
Aged 4, I was sent to prevent the
Christmas turkeys from fighting by ringing
a railway bell in their ears! A bucket of
water was the usual method, but of course
I was too small for this. If missing, I could
always be found in the cowshed or piggery
at the neighbouring farm and enjoyed the
sport of trying to catch escaped piglets in
our large garden.
What did you do before graduating
from Liverpool as a mature student?
I ran an outdoor pure breed poultry
attraction on 23 acres with about 80 breeds
and 3,000 birds to look after. I had an
incubator that I could walk in to and we
hatched about 300400 chicks, ducklings,
goslings and turkey poults weekly in the
season. I became highly skilled at multi-
tasking as we had a poultry shop, caf,
school parties, plus a Childrens Farm
Berkshire piglets were a grand attraction
and also very good to eat. I began writing
books as I was tired of answering the same
questions about poultry, (including two
while I was an undergraduate, but my book
on poultry diseases had to wait until I could
add the magic letters after my name in
2000). Fortunately, I had decided early on
not to have children and can be heard to say
that all mine have fur or feathers.
Had veterinary medicine been a
long-held ambition or did you
experience a late epiphany?
I knew I wanted to be with animals and
when six years old, and considered joining
the circus or running a zoo. Veterinary
medicine was discussed briefly as a career
option but dismissed by my father who was
afraid I would end up in an inner city
treating only cats and dogs. So I was
removed from the science stream at
school (which I loved) and took English
and History A levels in those days you
did what you were told! It took many
years to realise that veterinary medicine
was a possibility and then I had to obtain
the correct A levels (aged 42) before
attending Liverpool.
Did you find that being an older
student was a problem or an
advantage?
Certainly an advantage, since I had moved
heaven and earth to get on the course and
therefore was very focussed the older
brain needed pins sticking in it frequently
but the greatest problem was that I could
no longer drink all night and work all day,
unlike the other much younger
undergraduates!
How did you get involved in BSAVA
and contributing to the manuals?
I got involved with BSAVA North East
region immediately on graduating and then
joined the Publications Committee. With
the amalgamation of mixed and farm
practices over the past few years, it became
more likely that SA vets would be presented
with farm-type species, so the idea of the
BSAVA Farm Pets Manual was to cover these
and of course, I was keen to do the chicken
chapters it was a very interesting
experience co-editing the whole book,
however. I am also interested in exotics and
have been editing the British Veterinary
Zoological Society publications for 10 years.
Have you always worked as a locum?
I have. When I graduated I was too old to
start my own practice and had already run
my own business, so just wanted just to
treat animals. It seems to work and of
course I go back to the same places on a
regular basis. I have taught bird and small
furry anatomy, physiology and handling at
Liverpool since 1998, and subsequently also
teach clinical poultry, since backyard
poultry are becoming more popular and
owners want the same high standard of care
that their dogs and cats receive. I am the
Honorary Veterinary Surgeon to The
Poultry Club, have been on their Council
for 15 years, a Panel B judge, Secretary of
the Dorking Breed Club for 18 years and
just finished editing the 6th edition of British
Poultry Standards.
What do you consider to be your most
important achievement?
Enhancing the welfare of backyard poultry.
Who has been the most inspiring
influence on your career?
John Cooper, a fellow enthusiast and
teacher.
What would you have done if you
hadnt been a vet?
I never considered the possibility of not
graduating once my mind had been made up.
I am delighted to say that being a vet has
exceeded all my expectations.
C
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CPD DIARY
companion | 27
5
October
Sunday
Practical dentistry
Speaker Norman Johnstone
Day meeting at the Dunkeld House
Hotel, Dunkeld. Scottish Region.
Details from Susan Macaldowie,
telephone 07711 633698,
email smacaldowie@btinternet.com
8
October
Wednesday
Feline chronic
gingivostomatitis
Speaker Diane Addie
Evening meeting at IDEXX, Wetherby.
North East Region.
Details from Karen Goff,
telephone 01943 462726,
email northeastregion@bsava.com
8
October
Wednesday
Geriatrics
Speaker Stijn Niesson
Evening meeting at The Holiday Inn,
Haydock. North West Region.
Details from Simone der Weduwen,
email beestenhof@ntlworld.com
10
September
Wednesday
Oncology in practice
Speaker Rob Harper
Evening meeting at Park Inn, Cardiff.
South Wales Region.
Details from Susanna Brown,
email southwalesregion@bsava.com
13
September
Saturday
Annual Dinner at
Horncliffe Mansion
North West Region.
Details from Simone der Weduwen,
email beestenhof@ntlworld.com
14
September
Sunday
Fracture management
Speaker Andy Torrington
Day meeting at Normanton Golf Club,
Wakefield. North East Region.
Details from Karen Goff,
telephone 01943 462726,
email northeastregion@bsava.com
16
September
Tuesday
Infectious diseases in
neonates
Speaker Susan Dawson
Evening meeting at Corus Hotel,
Romsey. Southern Region.
Details from Michelle Stead,
telephone 01722 321185,
email mmstead@btinternet.com
18
September
Thursday
Clinical pathology in practice
Speaker Tim Jagger
Evening meeting at LA Lecture Theatre,
Royal (Dick) School of Veterinary
Studies, Edinburgh. Scottish Region.
Details from Susan Macaldowie,
telephone 07711 633698,
email smacaldowie@btinternet.com
CPD
DIARY
21
September
Sunday
Case-based endocrinology
Speakers Grant Petrie and Lucy Davison
Day meeting at The Cambridge Belfry,
Cambridge. East Anglia Region.
Details from Gerry Polton,
email eastanglia.region@bsava.com
23
September
Tuesday
Kidney disease
Speaker Hattie Syme
Day meeting (modular course) at BSAVA
HQ, Gloucester. Organised by BSAVA.
Details from BSAVA Customer Services,
telephone 01452 726700,
email customerservices@bsava.com
22
October
Wednesday
Heart murmurs in cats
Speaker Adrian Boswood
Evening meeting at Corus Hotel,
Romsey. Southern Region.
Details from Michelle Stead,
telephone 01722 321185,
email mmstead@btinternet.com
14
October
Tuesday
Immune-mediated disease
Speaker Sheena Warman
Afternoon meeting at Park Inn, Cardiff.
South Wales Region.
Details from Craig Connolly,
email southwalesregion@bsava.com
15
October
Wednesday
Wildlife and exotic
emergencies
Speakers Anna Meredith and
Sharon Redrobe
Day meeting at Hilton, Bromsgrove.
Organised by BSAVA.
Details from BSAVA Customer Service,
telephone 01452 726700,
email customerservices@bsava.com
22
October
Wednesday
Current feline issues
Speakers Rachel Dean and Sheila Wills
Day event at Janson Laboratories,
High Wycombe. Metropolitan Region.
Details from Allison van Gelderen,
email allivetuk@yahoo.co.uk
23
October
Thursday
Canine lymphoma
Speaker Gerry Polton
Evening meeting at Leatherhead
Golf Club, Leatherhead. Surrey and
Sussex Region.
Details from Jo Arthur,
telephone 01243 841111, email
surreyandsussexregion@bsava.com
24
September
Wednesday
SA endocrinology I
Speaker Peter Graham
Day meeting (modular course) at BSAVA
HQ, Gloucester. Organised by BSAVA.
Details from BSAVA Customer Services,
telephone 01452 726700,
email customerservices@bsava.com
2527
September
ThursdaySaturday
BVA Congress
Speakers Gary Clayton Jones and
Peter Bedford
2-day meeting at the Royal College of
Physicians, London. Metropolitan Region.
Details from Pedro Martin Bartolome,
email pmbartolome@googlemail.com
CPD DIARY
companion | 27
5
October
Sunday
Practical dentistry
Speaker Norman Johnstone
Day meeting at the Dunkeld House
Hotel, Dunkeld. Scottish Region.
Details from Susan Macaldowie,
telephone 07711 633698,
email smacaldowie@btinternet.com
8
October
Wednesday
Feline chronic
gingivostomatitis
Speaker Diane Addie
Evening meeting at IDEXX, Wetherby.
North East Region.
Details from Karen Goff,
telephone 01943 462726,
email northeastregion@bsava.com
8
October
Wednesday
Geriatrics
Speaker Stijn Niesson
Evening meeting at The Holiday Inn,
Haydock. North West Region.
Details from Simone der Weduwen,
email beestenhof@ntlworld.com
10
September
Wednesday
Oncology in practice
Speaker Rob Harper
Evening meeting at Park Inn, Cardiff.
South Wales Region.
Details from Susanna Brown,
email southwalesregion@bsava.com
13
September
Saturday
Annual Dinner at
Horncliffe Mansion
North West Region.
Details from Simone der Weduwen,
email beestenhof@ntlworld.com
14
September
Sunday
Fracture management
Speaker Andy Torrington
Day meeting at Normanton Golf Club,
Wakefield. North East Region.
Details from Karen Goff,
telephone 01943 462726,
email northeastregion@bsava.com
16
September
Tuesday
Infectious diseases in
neonates
Speaker Susan Dawson
Evening meeting at Corus Hotel,
Romsey. Southern Region.
Details from Michelle Stead,
telephone 01722 321185,
email mmstead@btinternet.com
18
September
Thursday
Clinical pathology in practice
Speaker Tim Jagger
Evening meeting at LA Lecture Theatre,
Royal (Dick) School of Veterinary
Studies, Edinburgh. Scottish Region.
Details from Susan Macaldowie,
telephone 07711 633698,
email smacaldowie@btinternet.com
CPD
DIARY
21
September
Sunday
Case-based endocrinology
Speakers Grant Petrie and Lucy Davison
Day meeting at The Cambridge Belfry,
Cambridge. East Anglia Region.
Details from Gerry Polton,
email eastanglia.region@bsava.com
23
September
Tuesday
Kidney disease
Speaker Hattie Syme
Day meeting (modular course) at BSAVA
HQ, Gloucester. Organised by BSAVA.
Details from BSAVA Customer Services,
telephone 01452 726700,
email customerservices@bsava.com
22
October
Wednesday
Heart murmurs in cats
Speaker Adrian Boswood
Evening meeting at Corus Hotel,
Romsey. Southern Region.
Details from Michelle Stead,
telephone 01722 321185,
email mmstead@btinternet.com
14
October
Tuesday
Immune-mediated disease
Speaker Sheena Warman
Afternoon meeting at Park Inn, Cardiff.
South Wales Region.
Details from Craig Connolly,
email southwalesregion@bsava.com
15
October
Wednesday
Wildlife and exotic
emergencies
Speakers Anna Meredith and
Sharon Redrobe
Day meeting at Hilton, Bromsgrove.
Organised by BSAVA.
Details from BSAVA Customer Service,
telephone 01452 726700,
email customerservices@bsava.com
22
October
Wednesday
Current feline issues
Speakers Rachel Dean and Sheila Wills
Day event at Janson Laboratories,
High Wycombe. Metropolitan Region.
Details from Allison van Gelderen,
email allivetuk@yahoo.co.uk
23
October
Thursday
Canine lymphoma
Speaker Gerry Polton
Evening meeting at Leatherhead
Golf Club, Leatherhead. Surrey and
Sussex Region.
Details from Jo Arthur,
telephone 01243 841111, email
surreyandsussexregion@bsava.com
24
September
Wednesday
SA endocrinology I
Speaker Peter Graham
Day meeting (modular course) at BSAVA
HQ, Gloucester. Organised by BSAVA.
Details from BSAVA Customer Services,
telephone 01452 726700,
email customerservices@bsava.com
2527
September
ThursdaySaturday
BVA Congress
Speakers Gary Clayton Jones and
Peter Bedford
2-day meeting at the Royal College of
Physicians, London. Metropolitan Region.
Details from Pedro Martin Bartolome,
email pmbartolome@googlemail.com
420 pages
Published August 2008
ISBN 978 1 905319 04 6
Non-member price: 84.00
Member price: 54.00
336 pages
Published April 2005
ISBN 978 0 905214 76 4
Non-member price: 78.00
Member price: 49.00
Replaces Manual of Raptors,
Pigeons and Waterfowl
Health, husbandry and disease
Formulary
Biology and husbandry
Practical examination techniques
Disorders by body system
Diagnostic algorithms
Related titles from the BSAVA
BSAVA, Woodrow House, 1 Telford Way,
Waterwells Business Park, Quedgeley,
Gloucester GL2 2AB
Tel: 01452 726700 Fax: 01452 726701
Email: customerservices@bsava.com
Web: www.bsava.com
Contact BSAVA Customer Services for further information
28 OBC.indd 1 22/7/08 14:23:32