The essential publication for BSAVA members

Puppy Farms
What can the
legislators do to
make a difference?
P4
Clinical Conundrum
Assessment and
anaesthesia of a
paediatric patient
P8
companion
JANUARY 2010
Journal Anniversary
50 years of the
Journal of Small
Animal Practice
P24
How to manage
feline urethral
obstruction
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companion
3 Association News
Frank Beattie Award report
47 Puppy Farms
John Bonner on what the legislators are up to
811 Clinical Conundrum
Assessment and anaesthesia of a paediatric patient
1216 How To
Manage feline urethral obstruction
17 Education
Courses from the BSAVA
1820 GrapeVINe
From the Veterinary Information Network
21 Petsavers
Dr Penny Barber Awards
2223 Congress
How to make the most of the exhibition
2425 Publications
Celebrating 50 years of JSAP
2628 WSAVA News
The World Small Animal Veterinary Association
2930 The companion Interview
Lord Soulsby
31 CPD Diary
Whats on in your area
Main cover photo: Kathy Holmes, All Aspects Photography
Additional stock photography Dreamstime.com
Htuller | Dreamstime.com; Jmpaget | Dreamstime.com;
Ksoloits | Dreamstime.com; Leigh Prather | Dreamstime.com
companion is published monthly by the British Small
Animal Veterinary Association, Woodrow House,
1 Telford Way, Waterwells Business Park, Quedgeley,
Gloucester GL2 2AB. This magazine is a member
only benefit and is not available on subscription. We
welcome all comments and ideas for future articles.
Tel: 01452 726700
Email: companion@bsava.com
Web: www.bsava.com
ISSN: 2041-2487
Editorial Board
Editor Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVS
Senior Vice-President Ed Hall MA VetMB PhD DipECVIM-CA MRCVS
CPD Editorial Team
Ian Battersby BVSc DSAM DipECVIM-CA MRCVS
Esther Barrett MA VetMB DVDI DipECVDI MRCVS
Simon Tappin MA VetMB CertSAM DipECVIM-CA MRCVS
Features Editorial Team
Caroline Bower BVM&S MRCVS
Andrew Fullerton BVSc (Hons) MRCVS
Design and Production
BSAVA Headquarters, Woodrow House
No part of this publication may be reproduced in any form without written permission
of the publisher. Views expressed within this publication do not necessarily represent
those of the Editor or the British Small Animal Veterinary Association.
For future issues, unsolicited features, particularly Clinical Conundrums, are
welcomed and guidelines for authors are available on request; while the publishers
will take every care of material received no responsibility can be accepted for any loss
or damage incurred.
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possible and companion is printed on paper made from sustainable resources and
can be recycled. When you have finished with this edition please recycle it in your
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companion at www.bsava.com .
New Year
Resolutions
Whether it is saving money, learning
new things, finding ways to make life
easier, or making new friends, let
BSAVA help you fulfil your New Year
resolutions for 2010
Make sure Ive sent my card back to the
RCVS Trust Library before 31 January if Im
choosing to add this to my BSAVA benefits
(see December edition of companion for
details or email administration@bsava.com
before the end of January for more information).
Make new friends by getting to know other
BSAVA members in my region visit
www.bsava.com to find your local contact
Make sure my BSAVA membership is
renewed in January
Download the free MP3s from Congress so
I can catch up on those lectures I missed
Plan my CPD for 2010 and check
www.bsava.com for up-and-coming
courses in my region
Register for Congress early (before end of
Jan) so I can get my 25 voucher to spend
on the BSAVA Balcony
Dont miss out on BSAVA offers throughout
the year make sure I keep my details
up-to-date by checking my profile at
www.bsava.com
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SCHOLARSHIPS
Nicola Bromley BVSc CertSAM MRCVS
was the 2009 winner of the BSAVA Frank
Beattie Travel Scholarship. She received
her award of 2000 at Congress 2009,
given to help a BSAVA member undertake
a trip abroad to study a particular aspect
of veterinary practice. Here she describes
her time at TUFTS University in America
Frank Beattie
Scholarship
E
arlier this year I was fortunate enough to be
awarded the Frank Beattie Scholarship. I used
this award to fund two weeks spending time at
the ICU department at TUFTS University in New
England. The experience has been incredibly valuable
and inspiring. I have been exposed to a vast array of
cases, new techniques, drugs and treatment
modalities which are not commonly used in the UK.
TUFTS
TUFTS has a worldwide reputation for emergency
critical care, due to its respected faculty members and
their areas of expertise and research. They are
incredibly well equipped with an onsite Idexx
laboratory, MRI, 16 helical slice CT, fluoroscopy, linear
accelerator and haemodialysis machine. They have a
comprehensive 24-hour service with a well equipped
ICU staffed by an excellent team of technicians,
residents, interns and faculty members.
Learning curve
During my two-week stay I saw five patients managed
on a ventilator, four dogs undergoing renal
haemodialysis, multiple sepsis patients and an array of
acute abdomens, acute renal failure (ARF) and
respiratory patients. The management of these patients
was very interesting, with lots of interdepartmental
liaison. I gained comprehensive knowledge of ventilator
usage in the critical care setting and saw more ARF
cases than I would normally see in 12 months, due to
the prevalence of leptospirosis in the United States.
Overall medical case management tends to follow
similar trends in the US, but due to differences
historically and with cascade drug usage there are
some differences. I had some interesting discussions
with the teams over different case and
pharmacological management of cases, notably
those with IMHA and ARF.
Keep learning
The experiences have inspired me to continue to learn
and read more about this exciting field of veterinary
medicine. I now intend to try and impart my new
knowledge and skills to my team back home! My
take-home messages are to keep reading articles,
keep attending CPD and dont get stuck in a rut there
is always so much more to learn.
The world of veterinary medicine is becoming
much more evidence-based, which has to be a good
thing. It is good to question protocols and methods
and look for new solutions to problems. The whole
experience was rejuvenating for my passion in
veterinary medicine. I qualified 10 years ago but still
feel that I have loads to learn, which is very exciting. n
See the Awards pages in the Congress section at www.bsava.com for
details about all BSAVA Awards, nominations and applying for the Frank
Beattie Scholarship.
ABOUT NICOLA
Nicola, who achieved her Certificate in Small
Animal Medicine in 2006, is an individual
whose passion for the profession has never
diminished over the course of 10 years and
who thrives on the constant new challenges
that the job brings on a daily basis. Over the
last two to three years Nicola has become
especially interested in emergency medicine
and critical care, and her current skills base
means that she works in such areas as
gastroenterology, endocrinology, urology and
oncology. She works for the Grove Lodge
Veterinary Group in West Sussex.
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PUPPY FARMS
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PUPPY FARMS

S
everely underweight with a bad cough and a purulent nasal
discharge, the two Labrador puppies were not the bargain that
their new owner hoped they would be. The lady knew that they
had been bred on a puppy farm in west Wales, yet believed that they
would be in good health and had been assured by the seller that they
had been checked by a vet before they were delivered to her.
When the puppies were presented at her practice, these were not
the first sickly puppy farm products that Cat Henstridge had examined
and without major changes in the attitudes of breeders and owners,
they are unlikely to be the last. The West Midlands practice where she
works is near the Welsh border and puppies can be delivered directly
to owners who never see the conditions in which their pet was reared.
Cat is angry and frustrated that the trade continues and questions
whether the profession could be doing more to close it down. Puppy
farmers can get illegal imports of vaccines and drugs but surely they
must have to seek veterinary advice at some point. The welfare of the
puppies and bitches is severely compromised on these farms and it is
our responsibility to deal with that.
Down on
the farm
Tough new rules on commercial dog breeding have
been promised by the Welsh National Assembly to
curtail the activities of the Principalitys notorious puppy
farmers. Yet this is not the first time that legislators have
tried to stop the production of substandard, unhealthy
pups by unscrupulous breeders. John Bonner asks
veterinary surgeons what they would wish for in an
effective new licensing system
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PUPPY FARMS

Campaigning groups
Clients of practices throughout the country have
suffered the emotional and financial impact of buying
puppies that need immediate veterinary treatment.
This has given rise to three campaigning groups which
direct most of their anger at the two Dogs 4 Us pet
stores in Manchester and Leeds, which provide major
outlets for farmed pups. Other suppliers the sort that
arrange for puppies to be handed over at motorway
service stations are more difficult to track down.
The three groups banded together to organise
Puppy Farm Awareness Day on 19 September 2009.
The BVA and BSAVA both offered their support for the
initiative but the organisers told them that their support
was not welcome. Their view seems to be that the
veterinary profession benefits from the trade because
we get to treat the animals, so they see us as part of
the problem and not the solution, notes Stockport
practitioner and BVA president elect Harvey Locke.
Current breeding rules
For anyone who remembers the key role played by the
veterinary bodies in persuading the UK Government to
introduce the Breeding and Sale of Dogs (Welfare) Act
1999, that accusation is particularly galling. The Act
may not have achieved everything that the profession
had hoped for, but it did introduce appropriate
measures to address the problem of indiscriminate
dog breeding. It defined breeding establishments as
any site breeding five or more litters in a 12-month
period. It also defined the number and frequency of
litters that can be produced from a particular bitch and
placed restrictions on where and when their pups can
be sold.
The Act also established rules on the inspection
and licensing of commercial breeding establishments.
However, when the Welsh Assembly ordered a 2009
survey of unlicensed premises it found 249 sites in
Wales alone. Part of the reason for this local
concentration has been the grants available from both
Defra and the devolved assembly for farmers to
diversify out of more traditional livestock breeding.
So the proposed new rules being discussed by the
Assembly members in Cardiff will try to curb a trade
which they were partly responsible for creating.
Loopholes and issues
So why wasnt the 1999 Act successful in putting a
stop to the trade? Chris Laurence, now veterinary
director of the Dogs Trust, was involved in the coalition
of veterinary bodies, welfare charities and other
groups that lobbied for the legislation. The main
problem, he points out, is that it is very difficult for the
local authorities responsible for enforcing the rules to
gather the evidence needed to show that a premises is
producing five or more litters a year.
Down on the farm
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PUPPY FARMS
it is vital that the
market drives a change
in behaviour. Thinking we
can simply regulate our
way out of the problem
is not going to work
PUPPY FARMS
Setting four as the maximum number of litters that
can be produced by a hobby breeder was always
going to create enforcement problems, Mr Laurence
suggests. This figure was reached as a compromise
between the welfare organisations which supported a
limit of two litters a year and bodies like the Kennel
Club, which wanted the bar set higher. One useful
element in the rules that eventually emerged was the
insistence that the licence applied to the premises
rather than an individual, avoiding the risk that
breeders could get around the law by insisting that the
various bitches kept at the kennels belonged to
different family members.
Once the puppies have left the premises, it
becomes even more difficult for the licensing
authorities to control the trade. Tracing the place of
origin may be tricky because the documentation
given by puppy farmers to the new owners is likely to
be unsatisfactory, or even non-existent. Hence the
Welsh Assembly is proposing to introduce a
requirement for the compulsory microchipping of all
dogs. However, an unfortunate consequence of the
controversy last year about the health of pedigree
dogs is that many prospective owners believe they are
actually more likely to obtain a healthy pup if it isnt
Kennel Club registered.
Way ahead
In revisiting the issue of regulating puppy farms,
legislators will again face the challenge of trying to
define a puppy farm in the first place. Lancashire
practitioner Gill Mostyn believes it is unwise to assume
that small-scale hobby breeders will necessarily
produce a better quality product than a commercial
operation. She cites a client who has switched from
rearing pigs to breeding Labrador puppies. Yes, the
pups are born in a barn but the new owners get to see
the pups with their dam, and they are vaccinated, hip
scored and properly socialised, she says.
Harvey Locke agrees that making a simple
distinction between commercial and hobby breeders
may not be helpful in tackling the issue of unhealthy
puppies. The same puppy farm label can be applied
to breeders raising dogs under very different welfare
conditions and there is no guarantee that their physical
or mental health will be any worse than the puppies
reared in a conventional family home.
For this reason, many are reluctant to put all their
faith in legal remedies. Many veterinary organisations
and welfare charities believe that the solution is to
reduce the demand for farmed puppies rather than
trying to control the supply. BSAVA president Richard
Dixon says that improved public awareness and
education is of fundamental importance. It would be
helpful for clients to be more aware of the different
ways to acquire a new puppy and that high welfare
standards should be among the important
considerations when making a choice.
Our role
Richard believes veterinary surgeons and particularly
VNs need to take a prominent role in promoting ideas
that allow clients to make an informed choice
whether it be through initiatives like the Kennel Clubs
Accredited Breeder Scheme or by establishing a
kite mark to verify the source of puppies sold
through the pet shop route.
Veterinary surgeons will also have a key role in
educating those responsible for enforcing any new
regulations. It is a strange anomaly that veterinary
inspections are required for the licensing of
establishments such as riding stables, yet have very
little role in the process for assessing standards on
puppy farms. In the past, the BVA has worked with
local government bodies in drawing up guidelines to
help the environmental health officers who carry out
most of these inspections. It would be timely for these
guidelines to be re-examined and re-issued, Chris
Laurence suggests.
It would also be helpful for the advice to be more
prescriptive this time around, as part of the problem
before was that different local authorities and even
the different officials working for them had the
freedom to develop their own interpretation of the
rules. So any new system must also achieve a balance
between the carrot and the stick.
Driving puppy farms underground or outside the
UK would be counterproductive, which is why it is vital
that the market drives a change in behaviour. Thinking
we can simply regulate our way out of the problem is
not going to work. There needs to be an effective
system of regulation but also a motivation for breeders
to operate within that framework, not outside it,
Richard Dixon observes.
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CLINICAL CONUNDRUM
Clinical
conundrum
List the five areas that will need
consideration when planning the
anaesthesia for this puppy
Problems can arise from many areas:
Patient
Presenting complaint
Pre-existing disease
Procedure
Post-operative care.
This approach to patient assessment results in a
list of problems that may need addressing in the
peri-operative period. Note that the majority of the
problems relate to anaesthetic management and not to
specific drugs.
First, consider the patient. What specific
concerns do you have with respect to
anaesthesia in a 7-week-old puppy?
Paediatric patients are physiologically different from
adult dogs of the same body mass. This altered
physiology presents different challenges compared to
anaesthesia in an adult patient. The different body
systems can be considered as follows:
Cardiovascular system
Low haematocrit makes them poorly tolerate
blood loss.
Cardiac output is rate-dependent until about 1012
weeks and there is no response to pre-load (fluids),
and so bradycardia must be avoided.
Respiratory system
Compared to adults, paediatric patients have a
higher respiratory rate, higher tissue oxygen
demand, higher airway resistance, lower functional
residual capacity (FRC).
Combined, all these factors mean that there is a
high risk of hypoventilation and atelectasis and of
rapid-onset hypoxaemia.
Hepatic function
Drug metabolism reaches normal by about 12
weeks and is less of a problem from 8 weeks. In
addition, glycogen storage is limited in the
paediatric liver predisposing to hypoglycaemia.
Renal function and plasma albumin
Renal function is essentially normal by 8 weeks
of age.
Low total protein high body water content
affects protein binding of drugs and volume of
distribution of many drugs.
Body size
Small size can result in difficulties with equipment,
obtaining IV access, accurate drug dosing,
hypothermia and monitoring. Body size will also
influence intubation and breathing system
selection.
Other factors
Other factors to consider in this case include the
incomplete primary vaccination course infection
control measures will be needed whilst hospitalised.
Many drugs are also not licensed for paediatric
patients, including the common induction agents.
Outline your anaesthesia considerations
The eye is painful and a grade I/VI murmur was heard
on auscultation. The puppy is not systemically ill.
Louise Clark of Davies Veterinary Specialists
invites companion readers to consider the
assessment and anaesthesia of a
paediatric patient
Case presentation
A 7-week-old, 1.4 kg Jack Russell cross puppy is presented to you
for general anaesthesia for enucleation following rupture of a globe
which occurred when the dog got too close to the owners elderly
cat. The owners had been offered referral to attempt to save the eye
but declined. The eye appears painful, but the puppy is otherwise
very bright and lively. He ate about 6 hours ago. He has only been
with his current owners for two days and has received his first
routine vaccination.
Physical examination reveals a grade I/VI left sided murmur but
is otherwise within normal limits.
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CLINICAL CONUNDRUM

What potential problems could occur

during the surgery and how could this
affect this patient?
Risk of haemorrhage poorly tolerated by
paediatric patient.
Oculocardiac reflex, potentially resulting in
profound bradycardia associated with traction on
the globe.
Pain NSAID and other analgesic licensing and
suitability.
Duration hypothermia and hypoglycaemia.
What will be your initial post-operative
care considerations?
Analgesia provision
Feeding prevention of hypoglycaemia.
Infection control vaccination status etc.
Is there any further information, for
example from pre-operative testing, you
consider beneficial prior to anaesthesia?
It is useful to have a pragmatic approach to further
pre-anaesthetic testing. When the results of tests will
affect the anaesthetic technique or intra-operative
management, and where finances permit, then these
tests may be useful. Blanket testing is not justified as it
is unlikely to yield clinically significant information in
most cases. Obtaining blood samples from, or
performing a conscious echocardiogram on, a lively
and wriggly puppy may cause practical problems!
A sensible approach based on the history and
presentation would suggest that the murmur is likely to
be an innocent puppy murmur, there is likely to be
little bleeding at surgery and, given an otherwise
unremarkable history, further testing is unlikely to be
useful. The possibility of a sinister cardiac anomaly or
other systemic occult disease cannot be excluded but,
based on available evidence, is less likely.
Now we have reviewed and evaluated
potential problems and issues specific to
this patient, how would you approach
this case? What will you do and why?
Consider each aspect of the anaesthesia. Remember
that anaesthesia starts at the time of administration of
the pre-anaesthetic medication and monitoring, and
support should start at this point.
Pre-operatively
Keep the puppy warm and observed ideally in an
incubator from time of administration of pre-
anaesthetic medication.
What premedication?
Avoid premedication with drugs that undergo
extensive hepatic metabolism where possible.
Acepromazine is a very long-acting drug and may
be best avoided in paediatric patients. Generally,
good sedation can be obtained by the
administration of an opioid alone for example
pethidine or methadone.
The alpha 2 agonists are probably best avoided in
this patient group. They have the advantage of
being reversible but they also cause profound
bradycardia that the paediatric cardiovascular
system may not tolerate. Medetomidine and
dexmedetomidine are not licensed for use in dogs
less than 12 weeks of age.
Traditionally, anticholinergics such as atropine
have been used in paediatric patients in order to
dry up airway secretions (Figure 1). In reality this
may just make them more viscous. It is useful to
have atropine available in order to manage
inappropriate bradycardia, particularly in this case
when manipulation of the globe is involved, but
there is probably no benefit to its routine use.
Figure 1:
Anticholinergic
drugs atropine
and Robinul
(glycopyrrolate)
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CLINICAL CONUNDRUM

Clinical conundrum
Induction
To minimise risks of hypothermia, the environment for
induction of anaesthesia should be warm. The patient
should never be placed on a cold surface and should
be actively warmed from induction of anaesthesia,
preferably with a circulating warm air blanket and
ideally with a fluid-warming device. If this is not
possible, warming bags, hot hands and warmed fluids
should all be available. Insulation of the extremities
with bubblewrap has been shown to be effective and
is cheap. Clipping and surgical preparation time
should be minimal and the use of large volumes of
cold fluid avoided.
Induction agent and method
This dog is large enough that IV access can be
obtained prior to the induction of anaesthesia.
Induction of anaesthesia with a short-acting injectable
agent is preferable to mask induction where the patient
is more likely to become stressed and the deleterious
cardiovascular effects are greater. Avoidance of mask
induction would be even more of an issue if the eye
was to undergo repair. Trauma during induction is very
likely, as are increases in intraocular pressure.
Note that the data sheet for Alfaxan (alfaxalone)
states The safety of Alfaxan in animals less than 12
weeks of age has not been demonstrated and that for
PropoFol (propofol) PropoFol has not been evaluated
in dogs less than 10 weeks of age. However, this does
not entirely preclude their use it places the onus for
risk assessment on the veterinary surgeon.
Avoid overheparinisation ideally use normal
saline to flush IV catheters, etc. This is more of a
problem in critically ill patients who have multiple
intravenous/intra-arterial access points.
Puppies have bigger tongues and smaller airways
than might be expected. Use a laryngoscope for
intubation, avoid red rubber endotracheal tubes and
only cuff tubes with extreme care. If tolerated,
pre-oxygenation might be useful, as the onset of
hypoxaemia is much more rapid in puppies. Avoid
excessive resistance in the breathing system use a
T-piece (i.e. without valves) and an adequate fresh gas
flow to prevent rebreathing (NB higher respiratory
rates). Minimise dead space in the breathing system;
ideally, use capnography to monitor ventilation and
support it manually if required (Figure 2).
Intra-operative monitoring
May be difficult! Ideally, use all the monitoring that you
have available, as access to the patient may be
difficult under drapes. Paediatric patients have a
slightly lower blood pressure than adults and this will
be reflected under anaesthesia (Figure 3). Ideally,
oesophageal temperature should be constantly
monitored throughout anaesthesia.
Hypoglycaemia is a potential risk in paediatrics. It
is useful to check plasma glucose levels at induction of
anaesthesia and half hourly where possible. In this
case a saphenous vein may be accessible for
sampling during surgery. Hypoglycaemia under
anaesthesia presents without clinical signs and it is
therefore important that glucose is monitored and
supplemented appropriately. It is imperative that
sampling is not done from the same site/ line through
which glucose containing fluids are administered.
What is our plan if one of the potential
peri-operative problems does develop?
Hyperglycaemia
There is some evidence that hyperglycaemia (certainly
above the renal threshold of about 10 mmol/l) is
deleterious, so supplementation in the face of
Figure 2: Minimising deadspace
and use of capnography and
pulse oximetry
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CLINICAL CONUNDRUM CLINICAL CONUNDRUM
hypoglycaemia should aim to keep glucose within the
normal range. Administration of 5% (or greater) glucose
solutions through a peripheral vein can cause
thrombophlebitis, thus it is easiest to use a
commercially available glucose-containing fluid.
Remember that glucose solutions are hypotonic once in
the body and they do not contribute to volume support
in the animal. Thus, glucose-containing solutions should
be administered in addition to routine intra-operative
fluid therapy. In practice a rate of 24 ml/kg/hour of
0.18% NaCl and 4% glucose is usually adequate.
Cardiovascular problems
The paediatric cardiovascular system does not
tolerate excessive fluid therapy. The low total protein
will also tend to promote oedema. Fluid therapy
should still be administered to ensure normovolaemia
(35 times maintenance rates are reasonable) but
avoid bolus administration of fluids unless there is
surgical haemorrhage.
Haemorrhage during the surgical procedure will
probably be minimal. However, paediatric patients
tolerate blood loss quite poorly. Given that the dog is
only 1.5 kg in bodyweight, we can expect its
circulating blood volume to be about 135 ml. Thus
even 15 ml of blood loss will be haemodynamically
significant. It is important that accurate swab counts
are carried out and that communication with the
surgeon maintained.
Avoid bradycardia that can be potentiated by
opioids and by hypothermia. There is a theoretical
risk of bradycardia during surgery due to the
oculocardiac reflex but this is not a real problem.
Globe traction should be avoided to prevent iatrogenic
contralateral blindness.
Hypothermia
Hypothermia decreases the volatile agent requirement
i.e. MAC falls. If the puppy becomes cold it is
important that the volatile agent is decreased to avoid
hypotension. Hypothermia will also lead to a
prolonged recovery and strenuous effort should be
taken to avoid it.
Analgesia
Carprofen and meloxicam are both licensed in dogs
more than 6 weeks of age and one of them should be
administered in the peri-operative period. The author
sometimes administers NSAIDs after surgery rather
than prior to, or during surgery, to ensure
normotension and adequate renal perfusion during
anaesthesia in these small patients however there is
no good evidence to support this!
Recovery
At the end of the procedure the puppy should be
allowed to breathe oxygen until extubated. It should be
returned to a warm environment and monitored
constantly until fully recovered and ambulatory. The
risk of hypoglycaemia persists into the recovery
period, so encourage food intake as early as possible
if the puppy does not eat, consider glucose
supplementation/monitoring. Pain management should
be planned and pain regularly assessed. Pethidine is a
useful opioid in paediatrics it is reasonably short-
acting and does not tend to result in profound
sedation. Barrier nursing is prudent given the puppys
vaccination status.
Summary
The altered physiology and small size of this patient
will provide a challenge with respect to anaesthesia.
A logical and thorough approach to the identification
of problems and the development of strategies to
deal with these problems should lead to a
successful outcome. Note that the influence of drugs
is only one of many components for the safe
management of any anaesthetic.
Figure 3: Use of
a Doppler device
for blood
pressure
monitoring. ECG
leads and pads
are also visible.
Hypothermia will
also lead to a
prolonged recovery
and strenuous effort
should be taken
to avoid it.
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HOW TO
How to
F
eline urethral obstruction is much more common
in male cats than females due to the narrower,
longer and more tortuous urethra. The most
frequent causes of obstruction in cats are urethral
plugs (mucous or mucocrystalline), urinary calculi or
urethral spasm; however, regardless of the underlying
cause the consequences are the same. Many cats
presenting with urethral obstruction are relatively
stable, but a proportion have significant electrolyte
and acidbase changes and these patients demand
more aggressive management.
Presenting signs and the minimum
database
The most common presenting sign is unproductive
straining, although owners often also report perianal
licking and vocalisation. If the initial clinical signs are
missed then cats become anorectic, progressively
more lethargic, may vomit and will eventually become
comatose. Diagnosis is based on bladder palpation
and this typically reveals a large, firm urinary bladder
which is often painful. Cats may be clinically
dehydrated and a proportion will be bradycardic due
to hyperkalaemia.
In order to decide on the most appropriate
management the following minimum database would
ideally be obtained:
Packed cell volume (PCV) and total solids (TS)
Urea and creatinine
Potassium.
It is important that cats with urethral obstruction
have an intravenous catheter placed a short time after
admission (from which blood can sometimes be
acquired for the tests listed above) so that fluid therapy
can begin. Many cats are hypovolaemic due to fluid
deficits (a consequence of severe dehydration) and
poor cardiac output (secondary to bradycardia and
possible acidaemia leading to reduced myocardial
function) which leads to poor tissue oxygenation.
Clinical signs of hypovolaemia in the cat depend on
the severity but can include tachycardia or
bradycardia, reduced pulse quality progressing to
absent peripheral pulses, mental depression,
hypothermia and pale mucous membranes.
Packed cell volume and total solids evaluation may
help to provide a more objective measure of the cats
hydration status, both being increased in the face of
significant dehydration. Urethral obstruction leads to
back pressure within the kidneys and the development
of post-renal azotaemia. This azotaemia can often be
quite marked (creatinine >500 mol/l) but, assuming
the urethral obstruction is successfully relieved and
adequate fluid therapy is administered, will resolve.
Any cat presenting with bradycardia or an
arrhythmia should have serum potassium measured
and if possible an electrocardiogram (Lead II) should
be obtained. It is important to note that hyperkalaemic
cats can also have normal or fast heart rates and the
measurement of serum potassium provides valuable
information in all cats with urethral obstruction. The
severity of clinical signs, including ECG abnormalities
does not correlate well with the severity of the
hyperkalaemia. Serum potassium increases for a
number of reasons but it is primarily the result of
decreased renal excretion. Hyperkalaemia may cause
generalised muscle weakness but its most serious
complication is its effect on the conduction system of
the heart. ECG changes seen include bradycardia,
decreased amplitude or absent P waves, widened QRS
complexes and peaked T waves (Figure 1).
Relief of the urethral obstruction and intravenous
fluid therapy (0.9% sodium chloride or Hartmanns) is
often all that is required to resolve hyperkalaemia;
however, cats with profound bradycardia (<80 bpm)
may require more intensive management (Box 1). Cats
should not be sedated or anesthetised if they are
significantly hyperkalaemic and are bradycardic or
arrhythmic, until action has been taken. As well as poor
potassium excretion by the kidney, hydrogen ion
excretion is also reduced. This can lead to a metabolic
acidosis (pH <7.2, reference range 7.317.46) which can
result in cardiac arrhythmias, decreased myocardial
function and central nervous system depression.
Manage feline
urethral obstruction
David Walker of North Downs Specialist
Referrals outlines the key points to dealing
successfully with one of the most common
emergencies seen in small animal practice
companion
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13
HOW TO

Relieving the obstruction

Appropriate restraint is needed to unblock the feline
urethra and sedation or general anaesthesia should
be considered if the patient is not moribund. Patients
must be stable prior to sedation or general
anaesthesia, and animals with severe bradycardia (or
other heart rhythm disturbances) as a consequence of
hyperkalaemia should be managed appropriately.
Hypovolaemia should also be corrected with fluid
therapy. Boluses (1020 ml/kg) of crystalloid (0.9%
NaCl or compound sodium lactate (Hartmanns))
should be administered over 1020 minutes and the
heart rate, pulse quality, mucous membrane colour
and capillary refill time reassessed.
Animals can be sedated with a combination of
ketamine (2.55 mg/kg) and midazolam (0.25 mg/kg)
given intravenously or intramuscularly (lower dose i.v.)
and this will typically provide sedation for approximately
1520 minutes. Ketamine is excreted renally and
recovery can be prolonged in animals with urinary tract
obstruction. In many animals sedation is inadequate
and general anaesthesia is required. If the patient is not
sufficiently relaxed then the risks of urethral rupture or of
failing to relieve the obstruction are increased.
Urethral plugs often lodge near the external
urethral orifice and the exposed distal penis should be
gently massaged to loosen any obstructing material
present and extrude it from the urethra. The penis is
exposed by caudal pressure on the preputial skin. In
some cats penile massage alone will relieve the
obstruction; however, the majority of cats will require
urethral catheterisation and saline flushing.
Figure 1: Lead II
ECG trace
(25 mm/s) from a
hyperkalaemic cat
showing flattened
P waves, widened
QRS complexes
and peaked
T waves. The
heart rate is
inappropriately low
Box 1
MANAGEMENT OF HYPERKALAEMIA
1. Relieve the obstruction! However this may not be possible until the patients condition has been
stabilised. Consider cystocentesis.
2. Fluid therapy (0.9% NaCl or compound sodium lactate (Hartmanns))
3. Calcium gluconate (slow intravenous injection 0.51.0 ml/kg 10% solution) antagonises the effects of
hyperkalaemia (although the actual serum potassium value does not change, it improves the cardiac
rhythm). Effects last for 2030 minutes.
4. Insulin and glucose administration. Insulin drives potassium into cells, reducing the serum potassium
concentration. Although insulin can be administered with glucose, as an intravenous infusion (0.25
0.5 IU/kg regular insulin with 12 g of 25% glucose/unit of insulin to prevent hypoglycaemia), this should
only be done if a fluid pump is available and intense monitoring is possible. A more practical approach is
to administer glucose (12 ml/kg of a 50% dextrose solution) and rely on the endogenous production of
insulin by the patient.
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HOW TO

Selection of a urinary catheter

When selecting a urinary catheter an open-ended
catheter is preferable to a side-ended catheter for
relieving the obstruction. Many are available on the
market; an excellent guide to choosing the most
appropriate feline urethral catheters and a guide to
catheterisation featured in the April 2008 edition of
companion and is available at www.bsava.com.
Regardless of the type of catheter used, the penis
should be retracted caudally and dorsally to straighten
out the urethra (see Figure 2) prior to catheterisation.
KY jelly should be used to lubricate the catheter and
sterile saline to flush the urethra. Walpoles solution
should NEVER be used. Walpoles is a weak acid and
is likely to cause further damage to an already irritated
urethra and urinary bladder. Pushing of any
obstruction should never be attempted as this is likely
to result in the catheter traumatising the urethral wall.
Once the catheter has reached the level of the
obstruction gentle flushing should begin (10 ml syringe
filled with sterile saline). The catheter should be gently
advanced whilst flushing, if there is resistance to
flushing, back the catheter out a little. This process
should be repeated as frequently as is necessary to
clear the obstruction.
For a comprehensive discussion regarding
clearing urethral obstructions readers are referred to
the article in the April 2008 edition of companion and
for some tips when handling difficult cases to Box 2.
After clearing an obstruction
Once the obstruction has been cleared, a urine
sample is obtained for urinalysis (urine specific gravity,
dipstick and sediment examination) and ideally urine
culture. The bladder is then flushed copiously with
sterile saline, generally until what you get back out is
as clear as what you put in! Any particulate material
can be submitted for analysis and an indwelling
catheter is then placed. As before, the penis must be
extended caudally to ease catheter placement. If a
Slippery Sam catheter was used for unblocking this
Manage feline
urethral obstruction
Prepuce
Pelvic symphysis
Urethra
Urinary bladder
Penis
Ductus
deferens
Descending colon
Ureter
Testicular
vessels
Glans penis
Testicle
Bulbo-
urethral
gland
Rectum
Prostate gland
Figure 2: Anatomy of the feline male lower urinary tract, highlighting the
flexure in the urethra that needs to be straightened prior to catheterisation
(used with kind permission from Hills Pet Nutrition)
TIPS FOR DIFFICULT
CASES
1. Increase the voluntary muscle relaxation: if the
patient is only lightly sedated, sedate it more;
if the patient is well sedated, consider
anaesthetising it.
2. Failure to straighten the penis effectively can
make the catheter difficult to pass. Some
people prefer to put the cat into dorsal
recumbency rather than lateral, to facilitate
catheter passage. Have an assistant
exteriorise the penis.
3. Decompressive cystocentesis reducing the
hydrostatic pressure in the bladder may make
retrograde flushing of plugs easier. Also if the
obstruction cannot be relieved then this allows
a short time for the patients condition to be
further stabilised before trying again or whilst
calling in some help!
Box 2
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HOW TO
can be used as the indwelling catheter; the soft
silicone hub is very comfortable for the patient;
however, this PTFE catheter is not as soft as some
others on the market. If this catheter is used, a luer
lock will be required to form a closed collection
system. Soft red rubber urethral/feeding tube catheters
are very comfortable. Silicone Tomcat catheters are
also generally well tolerated; the disadvantage is the
rigid catheter hub. Regardless of the type of catheter
used it should be sutured in place and a closed
collection system attached. This can simply be a new
intravenous fluid set and empty 500 ml or 1 l fluid bag.
Veterinary closed urinary collection systems are
available; however, these will be significantly more
expensive. This author believes that there is no need to
attach the urine collection system to the cats tail. The
urinary catheter is typically left in place for 2472
hours. Most cats will need to wear an Elizabethan
collar during this time. If the animal was unblocked
very easily and a good urine stream is obtained
following relief of the obstruction, you may decide not
to place an indwelling catheter; however, you may
regret this decision later!
Cystocentesis?
The use of decompressive cystocentesis is
controversial. The concern is that when the needle is
inserted into the bladder there is inevitably some
leakage of urine around the needle into the abdomen;
however, provided the urine is sterile this is of no great
consequence as it will rapidly be reabsorbed and
excreted. The only occasions when urine leakage is
more serious is if there is a UTI present (which is
uncommon in patients with urethral obstruction), if
bladder rupture occurs because the wall is severely
devitalised (in which case rupture may well have
occurred without cystocentesis!) or if there is
subsequent urethral obstruction. Cystocentesis does
not need to be performed in most patients but can be
a valuable tool in very unstable patients that require
sedation/anaesthesia or when relief of the urethral
obstruction is proving problematic. Cystocentesis can
be achieved using a 22 gauge needle attached to an
extension set, three-way tap and syringe. The needle
should enter the ventral aspect of the bladder wall and
be angled caudally.
What to do next
Unless there is evidence of bacterial infection (on urine
sediment examination), it is recommended that
antibiotics are avoided whilst a urinary catheter is in
place to avoid the development of multidrug resistant
infections. Once the catheter has been removed, a
710 day course of antibiotics would be
recommended; ideally antibiotic selection would be on
the basis of urine culture or culture of the urinary
catheter tip. Urine culture will also allow the antibiotics
to be stopped after 23 days in those cats that dont
have a urinary tract infection (approximately 50%!).
Penicillins (amoxicillin, ampicillin, amoxicillin
clavulanate) and cephalosporins (cefalexin) are
reasonable empirical choices. The use of
fluoroquinolones or 3rd generation cephalosporins
(cefovecin) is generally discouraged unless indicated
by the results of urine culture and sensitivity.
Following relief of a urethral obstruction cats are
often uncomfortable due to a combination of penile
manipulation, urethral inflammation and urinary
catheterisation. Non steroidal anti-inflammatory drugs
are generally best avoided due to the presence of
post-renal azotaemia. Partial agonist opioids such as
buprenorphine (0.02 mg/kg s.c., i.m., i.v. every 68
hours) are generally sufficient for analgesia.
Prednisolone therapy is never warranted. The majority
of cats will begin eating within 1224 hours of relief of
the obstruction
Fluid therapy is mandatory following the relief of
urinary obstruction. Post-obstructive diuresis often
results in increased fluid requirements. Another
advantage of the closed urine collection system (as
well as reducing the risk of infection) is that urine
output can be accurately assessed and fluid ins-and-
outs can be matched so that fluid rates are adequate.
A balanced electrolyte solution (compound sodium
lactate (Hartmanns)) is appropriate and rates of
410 ml/kg/h are often initially required. Urine output
should be at least 1 ml/kg/h. Azotaemia usually
resolves within 24 hours; it does not matter how high
the creatinine concentration was it will almost always
resolve with relief of the obstruction and appropriate
fluid therapy. Once the azotaemia has resolved then
fluid rates can generally be decreased. Measurement
of serum potassium following obstruction is useful as
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HOW TO
ACKNOWLEDGEMENTS
Thanks go to Dr Virginia Luis Fuentes MRCVS and
Zoe Halfacree MRCVS for providing some of the
images included in this article. This article
appeared in a longer form in the March 2009
edition of Irish Veterinary Journal and is
reproduced with thanks.
BSAVA MANUAL
OF NEPHROLOGY
AND UROLOGY
Edited by Jonathan Elliott
and Gregory F. Grauer
New features:
Clinical staging of kidney disease
Blood pressure measurement
Cystoscopy
Lithotripsy
Dialysis
Member price: 49.00
Price to non-members: 75.00
For more information or to buy the manual
visit www.bsava.com or call 01452 726700
Manage feline
urethral obstruction
post-obstructive diuresis can lead to hypokalaemia.
This can be addressed by the addition of potassium
chloride to the intravenous fluids.
Monitoring
Ideally PCV, TS, urea, creatinine and potassium
would be measured daily for the first 4872 hours.
Cats should be hospitalised after the urinary catheter
is removed until they have been seen to produce a
good stream of urine. If the cat cannot urinate it
must be re-evaluated. A plug or stone should be
detected with catheterisation; if the catheter passes
easily, urethral spasm should be suspected. This
can be managed by placing an indwelling urinary
catheter and administering phenoxybenzamine
(0.51 mg/kg p.o. q12h). This drug must be
continued for 35 days before its efficacy can be
accurately determined; the urinary catheter can be
removed after this time.
Perineal urethrostomy
Around 3040% of cats that have an episode of
urethral obstruction (whether the result of a plug, stone
or idiopathic) will become blocked again in the future
and owners should be warned of this.
The main indication for perineal urethrostomy
(Figure 3) is for treatment of those cats with recurrent
Figure 3: Male cat 2 weeks after perineal urethrostomy. This is a technically
demanding procedure; although surgery reduces the risk of obstruction it
does not prevent cats from showing signs of feline lower urinary tract
disease (FLUTD)
episodes of urethral obstruction. It must be
understood that this technique (if performed well)
reduces the risks of obstruction but does not
prevent these cats from showing other signs of feline
lower urinary tract disease. Too often this procedure is
performed as treatment for FLUTD (for which it is of no
benefit) or because of difficulty relieving an
obstruction. It is a technically demanding procedure
and the inexperienced surgeon should consider
referral to a specialist. Complications of the technique
include urine extravasation, stricture formation with
recurrent obstruction, recurrent UTIs, urinary and
faecal incontinence, rectourethral fistula formation,
rectal prolapse and perineal hernia.

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EDUCATION
Get to grips with endocrinology
Medicinal management of
lower urinary tract disease
D
elegates on this course on the
25th February 2010 at Thorpe Park
Hotel in Leeds will explore urinary
tract infections, urolithiasis, idiopathic feline
lower urinary tract disease (iFLUTD),
bladder tumours, urinary incontinence and
urine retention. During the day diagnostic
imaging techniques will be reviewed and
new, non surgical methods for dealing with
stones will be highlighted.
The day will start with a series of
interactive cases on stone disease
emphasising the ways in which these
problems can be managed without
resorting to surgery. While some of the
newer technologies (e.g. Lithotripsy) are
only ever likely to be available in speciality
practice some of the methods that will be
described, such as voiding
urohydropulsion, require no specialist
equipment and can easily be performed in
general practice. Guestimation of the
likely composition of stones will also be
reviewed so that delegates will leave the
course feeling confident that they can
Vets in general practice
know how important it is
to be able to focus on
problems and current
issues in endocrinology in
order to have confidence
when it comes to the
diagnosis and
management of particular
endocrine diseases
diabetic, discuss the use of trilostane and
investigate calcium abnormalities.
Interspersed between tutorials will be a
series of case based Q+A discussions. A
basic level of knowledge will be assumed
and participation will be encouraged.
Topics covered will include: The
approach to PU/PD, diagnosing and
treating hyperadrenocorticism,
hypothyroid or sick euthyroid, diabetes
insipidus and hyperthyroid cats.
Endocrinology can pose many problems
in private practice, some clinical and
others practical. This course will provide
lots of useful tips for dealing with these
cases and help delegates feel more
confident when confronted with a dog or
cat with PU/PD and /or endocrine alopecia.
Speaker Ian Ramsey
Ian Ramsey graduated from Liverpool in
1990, completed his PhD in Glasgow on
feline leukaemia virus in 1993 and his
identify the patients for which medical
management is most appropriate.
After the morning break urinary tract
infections and feline lower urinary tract
disease (FLUTD) will be discussed in
detail. A step-wise approach to
differentiating resistant, relapsing and
recurrent infections will be outlined with
appropriate courses of action to be taken
in each instance. The evidence for different
treatments for idiopathic FLUTD will be
discussed as well as considering different
theories as to the aetiology of this
frustrating condition. This course will not
provide the solution for all of your difficult
feline cystitis cases but it should at least
show you that you are not alone in
struggling to know how best to treat them.
In the afternoon we will briefly consider
the treatment of bladder and urethral
tumours in dogs and cats before taking a
more in-depth look at micturition
disorders. Causes of both urine retention
and urinary incontinence will be
considered in turn and the advantages
residency at Cambridge in 1997. He
gained his European and RCVS diplomas
in small animal medicine in 1997 and
since 1998 he has worked at Glasgow
University and became Professor of Small
Animal Medicine in 2009. He has been
active in the field of endocrinology for
more than 10 years but he enjoys all
aspects of small animal internal medicine.
Ian is the current editor of the BSAVA
Small Animal Formulary. n
and disadvantages of the various surgical
and non surgical methods for managing
these disorders discussed. The
emergency management of urethral
obstruction in both dog and cat will also
be highlighted. Throughout the day there
will be case examples used and the
opportunity to ask questions.
Speaker Hattie Syme
Hattie is currently Senior Lecturer in Small
Animal Internal Medicine at the Royal
Veterinary College, London with her main
clinical interests being in the fields of
urology/ nephrology and endocrinology.
She is involved in ongoing clinical research
investigating the factors important in the
progression of chronic kidney disease in
the cat. n
For further details or to book visit www.bsava.com or call 01452 726700.
B
SAVA has a course on the 23rd
February 2010 in Gloucester, taught
by Ian Ramsey, that will help you to
distinguish between hypothyroidism or
sick euthyroidism, deal with the difficult
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VIN
Tanya M. Ten Broeke, DVM, Gladstone Vet Clinic, Portland, OR
I saw a 5 yr old female bearded dragon for dragging of the left hind limb, decreased activity and decreased
appetite. She lived in a glass terrarium with millet seed substrate, no UV light, no access to water, heat lamp
and heat rock but no thermometer to measure temperature, and a diet of crickets (gut-loaded with veggies),
cilantro, carrots, peppers, celery, lettuce, and cucumber. The owner supplemented with calcium approx once a
month or when she seemed like she needed it. She laid eggs once about a year ago with no problems.
On exam she had poor color, was very thin, is gravid with multiple eggs, weak, and dragging the left hind limb
but had a little strength in the limb. There were no palpable fractures/rubbery bones/evidence of past
fractures. An x-ray read by a radiologist suggested normal bone density except for a questionable lucency in
the left femur suspected to be an abscess. Blood work showed an elevated TP of 4.4, low glucose at 141, and
low Ca at 6.9.
The lizard was started on calcium glubionate 24mg/kg PO BID, amoxicillin 20mg/kg PO BID, and Baytril 9mg/kg
PO q24h. The owner was instructed to get a thermometer (shielded) and get temp up to at least 85 degrees F,
purchase a quality UV bulb, remove heat rock or block access, provide a water dish, use commercial gut-loader
for crickets and offer variety of worms/insects pinkies.
At recheck 2 weeks later she has lost another 24 grams, will not eat on her own, is still gravid, is still not using
the left hind limb, and is noticeably weaker. The temp is 90, she has a UV light. The owner is force feeding
chicken baby food once a day, and water EOD, still on all 3 medications.
Questions: Is there any way to get her to lay the eggs? Do I have to remove them surgically? What can you
force-feed a beardie (I rec. worm slurry too)? Does she have a prayer and is there anything else I can do?
Thank you so much!
Jim Wellehan DVM, VIN Consultant, Zoological Medicine Service, UFVMC, Gainesville, FL
Tanya-
>>> An x-ray <<<
Please post it.
>>>Blood work showed an elevated TP of 4.4, low glucose at 141, and low Ca at 6.9<<<
Please post all results. Do you have a CBC?
Tanya Ten Broeke
Sorry about the delay! We did not do a CBC (finances were limited)
Chem: AST 24, CK 1221, LDH 348, ALB 2.4, TP 4.4, GLU 141, Ca 6.9, Phos 6, Uric Acid 0.7
I have attached the radiograph (single view).
Tanya
GrapeVINe
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 have specialised knowledge and skills. In this regular feature,
VIN shares with companion readers a small animal discussion that has recently
taken place in their forums
Discussion: Bearded Dragon with egg retention and
poor husbandry
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19
VIN

Jim Wellehan
Tanya-
The bone density is not good. See how it just fades out in the distal limbs? The cortices also look thin.
>>> Ca 6.9, Phos 6 <<<
Yep, thats pretty severe hypocalcemia, especially for a gravid female. The Ca:Phos ratio is also concerning
that phosphorus is comparatively high. The question with the femur is whether you are dealing with
osteomyelitis, pathologic fracture due to Ca issues, neoplasia, or other. Osteomyelitis would be my top ddx
based on the image, and I would be concerned that it may have thrown septic thrombi to the kidneys and
ovaries as well. Id push for a CBC.
Brad Lock DVM, VIN Consultant, Zoo Atlanta, Atlanta, GA
Tanya,
I would try and give some nutritional support, fluids and then take her to surgery and spay her. From what you
describe the prognosis is guarded to poor with eggs in her.
Kenneth Harkewicz VMD, VIN Consultant, Berkeley Dog & Cat Hospital, Berkeley, CA
Tanya,
I agree with Brad and with Jims comments.
Stabilize as well as you can first, then surgically remove the eggs and spay.
Impress upon the client husbandry.
No UV/B light, poor nutrition, etc, and youll have a dead lizard if returned to these conditions.
Tanya Ten Broeke
Any ideas on how I can improve nutrition if anorexic? Can you force-feed full worms or do you make a slurry?
Andrea Sobon DVM, New Berlin Animal Hospital, New Berlin, WI
Has she been given the correct substrate to lay the eggs?
They will not lay unless they have a dirt type substrate that they can dig into and make a fairly deep depression
into. In my own females, I have taken a 1/2 log and placed it onto of a mound of potting soil and started a hole
for her. If she gets the idea and isnt too weak to dig it might work. Otherwise surgery is her only chance.
You can force feed meat and veggie baby food. I usually use chicken and either green bean or apple sauce.
A lot of times they will eat eagerly with a syringe. Add a phos free calcium supplement to the baby food, or
Nekton Rep multivitamin. I would probably give a dose of injectable calcium gluconate too. It would help the
uterine contractions.
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VIN

GrapeVINe
I cant tell with your rads, but they can have spondylosis and pathologic fractures in the spine which cause
paresis/paralysis that is not reversible. That could be another reason she is dragging the leg. She is likely a
victim of MBD

and cant lay due to lack of muscle contraction as well.

Good luck
Jim Wellehan
>>> Any ideas on how I can improve nutrition if anorexic? <<<
I would be very cautious about putting food in the GI tract of a severely hypocalcemic and potentially septic
animal. Severely hypocalcemic animals will have impaired GI peristalsis, and putting food in there to rot will be
counterproductive. This animal needs to have its other issues addressed before feeding.
Tanya Ten Broeke
I spoke with my owner again. She laid 3 eggs last week before the owner provided a sandy nesting area. There
have been no eggs since but she is moving better, using her left hind limb, and ate a meal worm on her own
without being force-fed. My inclination is to wait and see where this goes Id like to avoid surgery but I dont
want to put her at risk by unnecessary delay. Is it ok to wait if she seems to be improving clinically?
Jim Wellehan
Tanya
I would at a minimum recheck some blood work. The lytic lesion on the femur is concerning, and if
osteomyelitis, is quite likely to throw septic emboli to the eggs. If you wait until the animal is doing poorly, the
prognosis is much worse.
Tanya Ten Broeke
Just an update the lizard has laid 2 more eggs and continues to be more active so the owner has elected to
continue to monitor. Thank you so much for all your help I will let you know if things change.
All content published courtesy of VIN with permission granted by each quoted VIN Member.
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. Discussions may appear in an edited form.
This thread appears in an edited form. To read the full thread and access the links mentioned
visit http://www.vin.com/Members/boards/discussionviewer.aspx?DocumentId=4064765
Originator of this discussion, Tanya Ten Broeke, provided companion readers with the following
update on this case
After the events above the client stopped returning phone calls and was completely lost to follow-up.
Recently I discovered that the bearded dragon died several months after the period of illness described
above. Thanks for your help everyone!

Editors note:
MBD = metabolic
bone disease
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PETSAVERS
Improving the health of the nations pets
T
hese awards were founded in memory of the late
Dr Penney Barber, who was a prominent
member of the small animal veterinary
community, specialising in the field of feline medicine.
Penneys clinical research into secondary renal
hyperparathyroidism and hyperphosphataemia
resulted in several peer-reviewed publications and
Penney also received the International Renal Interest
Society (IRIS) Award in 2000. It was therefore fitting
that the awards in her name are given for studies into
the diagnosis and treatment of diseases in cats.
This year awards were made by Penneys parents
Kneale and Elsie Barber to Dr Alan Radford at the
University of Liverpool, where Penney was a senior
lecturer, and to Dr Matthias Kleinz, Dr Yoel Berhane
and Prof. Jonathan Elliott at the Royal Veterinary
College, where Penney was a graduate student in the
field of veterinary nephrology under the supervision of
Prof. Elliott. Here they report their findings.
Feline calicivirus
Dr Radfords study investigated the temporal and
spatial distribution of feline calicivirus strains in the UK.
Between April and June 2006, 57 different vets
collected a total of 1350 oropharyngeal swabs from
feline patients. From the 1350 samples, Dr Radford and
his team isolated 145 FCV isolates, giving an overall
prevalence of approximately 11%. With Petsavers
funding, RNA sequences have been generated and
analysed for 70 of the FCV isolates; among these
70 sequences, 48 distinct strains of FCV have been
identified. The next stage will be to compare the viruses
identified to FCV strains that have been collected at
other times from the same practices. This information
will help improve how vaccines are designed for FCV.
Uraemic toxins and renal hypertension
The second study undertaken at the Royal Veterinary
College investigated uraemic toxins and hypertension
in cats, in particular whether parathyroid hormone
(PTH) regulates vascular tone. The project builds upon
many of the observations made by Dr Barber in her
innovative PhD work on PTH in the aging cat. Chronic
For more information about the awards made by Petsavers please visit the
charitys section at www.bsava.com or email g.waterhouse@bsava.com
kidney disease (CKD) is a common condition in the cat
and is associated with high blood pressure. When
untreated, high blood pressure can lead to
cardiovascular complications, blindness and further
kidney damage.
Parathyroid hormone
More than 80% of cats with CKD also have elevated
levels of PTH, a hormone that regulates calcium and
phosphate handling in the kidney. It has also been
shown that PTH regulates blood vessel function in
humans and other animal species. Thus it was
hypo thesised that increased PTH in cats with CRF
would contribute to the development of hypertension.
The hypothesis was tested by the comparison of
plasma PTH, phosphate and calcium levels in
normotensive and hypertensive cats that had kidney
disease. Levels of plasma PTH, phosphate and
calcium were significantly higher in hypertensive cats.
There was a significant positive correlation of mean
arterial blood pressure with PTH plasma levels.
The researchers also looked at the direct effect of
PTH on vascular function of feline resistance vessels
and whether the presence of pathologically high
levels of PTH (comparable to those seen in kidney
disease) affect the vascular responses to
endothelium-dependent vasodilators. This was
achieved using arteries taken from uteri, removed
from pet cats at routine neutering. The owners
consented to this use.
The research suggested that PTH impairs vascular
relaxation and that PTH may have a role in the
development of high blood pressure, strengthening the
rationale for the use of treatments which control PTH
secretion in CKD.
Both of these projects have implications for the
future treatment of cats with CKD or FCV and special
thanks must go to Kneale and Elsie Barber for making
these awards in their daughters name.
Dr Penney Barber Awards
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CONGRESS
Bigger, better
and brimming
with bounty
W
eve noticed a trend emerging at BSAVA
Congress more and more delegates are
taking a break from the lecture halls to make
sure they get around the Exhibition in the NIA and
spending more time looking around when they get
there. The reason? At a time when value for money and
making wise buying decisions has become crucial, at
Congress our delegates know they can tap into the
widest range of industry expertise, learn about the
latest innovations and launches, and, importantly, take
advantage of some superb offers and discounts.
One-stop shop
Space in the main Exhibition arena had pretty much
sold out by last summer, and even though weve
extended our use of the concourse again, we have a
waiting list, illustrating just how much industry values
Sometimes big is best certainly when it
comes to a veterinary exhibition. At the largest
small animal exhibition in Europe you know that
youll get choice, value and variety, and it is
worth spending time exploring your options in
the NIA this April
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CONGRESS
spending time with you at BSAVA Congress. Even
when many commercial budgets are being cut,
Congress remains a good place to do business for
buyer and seller alike. Which is why many companies
plan their launches and best deals all around this
event it works well for everyone.
How to get even more
The Exhibition Vouchers book is
your passport to bargains, special
offers and prizes. You will get it
when you pick up your delegate
bag. Dont, whatever you do,
mistake this for just another
booklet. Many of our key exhibitors
use this not only to promote special
offers, but also to offer holders of
the vouchers additional, exclusive benefits and the
chance to win some big prizes. Take it back to your
hotel or sit down with it over lunch to go through it with
a fine-toothed comb for the ones you like best.
Free stuff
Even if you arent coming to Congress with a huge
shopping list youll still want to spend some time in
the NIA because thanks to our sponsors there are
some fantastic complimentary treats for you within
the Exhibition. This is where you collect your ice
creams, lunches and tea and coffee. Then of course
there are all the gifts that are given away from the
stands and there are some especially great
goodies for members on the BSAVA Balcony. So if
any of the exhibitors offer you a free bag take it,
youll need it for your swag!
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PUBLICATIONS
In the beginning
The object of our new enterprise
[JSAP] is not only to disseminate
information amongst our members,
but to exchange both information and
ideas with similar organizations in
other countries we hope to print
articles of interest from all over the
civilized world...It is a great venture
that has been launched by our
Association and the BSAVA is to be
complimented on its enterprise and
foresight.
so said S.F.J. Hodgman, then
President of BSAVA, in the first issue of
JSAP in 1960. JSAP was created to meet
a new need for the practising vet of the
time, to enable access to clinical
information and to provide a vehicle for
scientific record. With multi-centre
collaborations and increasingly global
contributions to, and readership of, JSAP,
those goals have been realised.
Right up to date
Veterinary information is becoming
increasingly specialised though, with many
new journals. Like the BSAVA, JSAP
welcomes the increasing strength of the
speciality groups and recognises their role
in developing veterinary knowledge.
However, it is clear that the general
practitioner, still the mainstay of the
profession, requires a journal that is
relevant to their life.
You can contribute
This can best be achieved if the
readership, particularly BSAVA members,
start once again to produce the content for
the journal. Many of the conditions seen
weekly by vets in general practice (such as
pyometra, and ear canal foreign bodies)
are almost never seen by referral
practitioners. The journal content is entirely
determined by what is submitted general
practitioners can take ownership of their
journal by producing their own studies and
publishing their own data.
You can contribute your own research
as an original paper, a case report or a
letter to the Editor. Contributions must be
worthy of record for reasons of scientific
validity or clinical novelty. Submitting a
paper to an academic journal can be
daunting for those for whom this is not part
of everyday life, and we hope to start some
seminars at BSAVA Congress to provide
some guidance on writing and assessing
scientific papers.
Joint effort
JSAP is now stronger than ever, with more
submissions, increasing impact factor and
a dedicated Editorial Board. The recent
JSAP your journal
The Journal of Small Animal Practice has completed 50 years of publication!
JSAP Editor Katie Dunn looks behind the scenes at how the journal works and
how BSAVA members can get involved
successes of the journal are a
testament to the sterling efforts of
the entire team working on the
journal, and I would like to thank all
those who have been involved in the
careful scientific scrutiny of papers
and the production team who help to
deliver such an attractive publication.
So how does it work?
JSAP is overseen within BSAVA by the
Journals Management Committee, which
meets three times a year and helps to
ensure that JSAP fulfils its remit as a
primary member benefit as well as an
increasingly international academic
journal. Responsibility for the editorial
strategy and content of the journal lies
with the Editor and the Editorial Board. The
Editor makes the final decisions on papers
and ensures there is a good flow of
material. The Editor also determines the
make-up of each issue, including writing
an editorial or commissioning guest
editorials.
The Editorial Board comprises 36
international experts covering the full range
of subjects that the journal publishes. The
core of the Editorial Board are the 14
Associate Editors, who usually meet
annually, in November.
Thorough peer-review, rapid
publication
In academic environments there is
increasing pressure for clinicians to
produce regular publications. Publication
times are one of the main concerns of
anyone interested in submitting an article,
but a balance has to be struck to ensure
that rigorous scientific standards are
maintained. The JSAP team continually
strives to keep times to a minimum, while
ensuring thorough peer-review.
Papers should be prepared in
accordance with the journals author
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PUBLICATIONS
guidelines, which are available at www.
blackwellpublishing.com/JSAP. Papers are
submitted through the journals online
submission system (http://mc.
manuscriptcentral.com/JSAP) and those
that the Editor considers to be suitable for
review are assigned to be looked after by
the Associate Editor relevant to the subject
area. The Associate Editor will invite
appropriate reviewers a minimum of two
per paper who assess the submission
and recommend whether it is suitable for
the journal or how it needs to be revised
before it can be published.
Reviewers will report objectively on
whether the paper is scientifically valid,
adds to the veterinary literature and
whether the study conforms to UK
standards of animal welfare. Over the past
two years, the average time from article
submission to reaching this first decision
stage has been around 36 days.
Where changes are required before
publication, the reviewers provide
suggestions as to how a paper can be
revised and improved, which are fed back
to the author. The revised paper is
reviewed again, which takes on average a
further 24 days.
Overall, around 3540% of papers are
accepted for publication, but the
acceptance rate is higher for papers from
the UK, with around two-thirds of papers
eventually being published.
Papers that have been accepted are
then transferred to the publisher, Wiley-
Blackwell, to go through the production
stages of copy-editing, typesetting, proof
checking and corrections. Papers are
then allocated to an issue, which is
published online and in print. On average,
papers are published within 35 months
of acceptance.
The global community
Over the past year, papers have been
submitted to JSAP from 38 different
countries around the world (see following
Figure), and the papers that have been
published span more than 20 countries. It
is pleasing to see such international
interest in JSAP and recruitment to the
Editorial Board reflects the increasingly
international basis of submissions.
Top ten institutions
downloading JSAP articles
in 2008
As well as being circulated to all BSAVA
members, JSAP is available in several
thousand libraries across the globe. From
the (ever-increasing) number of article
downloads recorded, it is clear that JSAP
papers are read all around the world the
table below lists the top ten institutions
from which JSAP articles were downloaded
during 2008 it is interesting to see that
seven of these are outside the UK.
1 Royal Veterinary College, UK
2 Royal College of Veterinary Surgeons,
UK
3 University of Sydney, Australia
4 University of Pennsylvania, USA
5 Universiteit Gent, Belgium
6 ENV de Toulouse, France
7 North Carolina State University, USA
8 University of Cambridge, UK
9 National Taiwan University, Taiwan
10 University of Zurich, Switzerland
HAPPY BIRTHDAY JSAP
To celebrate 50 years of JSAP, your January issue will include a special publication
looking back over the achievements of the journal over the past five decades, and the
changes that have taken place in veterinary practice during this time. This issue
revisits some of the landmark papers published in JSAP, with expert commentaries
putting the papers into their contemporary context.
Most
wanted
Radiographic
appearance of
cardiogenic
pulmonary
oedema in
23 cats was the most
downloaded paper in
JSAP in 2009. Livia
Benigni of the RVC
explains the background
to this paper
A
lthough it is mentioned in
various texts and articles that
cardiogenic pulmonary oedema
in cats appears as a patchy or
localised infiltrate with a variable
distribution within the lung, a
satisfactory set of illustrations
depicting the disease is not available.
This paper provides illustrations of a
wide range of radiographic
appearances compatible with feline
cardiogenic oedema. Therefore it can
serve as a reference to the vet
presented with a cat with acute
respiratory signs to make the correct
diagnosis or at least include it in the
differential diagnosis list. I was pleased
to hear that my paper has been widely
read and hope that it will prove useful
for those in clinical practice. n
Article submissions by country,
Nov 2008Oct 2009
UK
Other
Spain
Korea
Brazil
France
Belgium
Australia
Germany
Japan
Turkey
Italy
USA
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A new WSAVA editor
WSAVA is pleased to welcome
Dr Veronica Yin-Ming Leong to
the Executive Board
Dr Leong graduated from the National Taiwan
University in Taiwan and received her Masters in Avian
Medicine from the University of Georgia, USA. She
then became a Diplomate of the American College of
Poultry Veterinarians in 1995. She has broad
professional experience in different areas including
small animal practice, animal health management,
setting up grandparent and parent broiler breeder
farm projects, providing technical services for
integrators in Asia and an international pharmaceutical
company, and managing the companion animal
business unit of an international company in Hong
Kong/China. She is now Hong Kong SAR Government
Official and participates in the control of avian
influenza in the region. She has served as an
Honorary Editor Panel Member of Global Pets
Science Magazine in Shanghai and as an Executive
Board Member of the GZVA. She is the Immediate
Past President of the Hong Kong Veterinary
Association and co-Founder and Honorary Secretary
of the Federation of Asian Small Animal Association
(FASAVA). We congratulate Dr Leong and welcome
her to the Executive Board.
I
n July, Dr Veronica Leong was elected to the
WSAVA Executive Board by the General Assembly
in So Paulo, Brazil. She will be taking care of the
marketing plan of WSAVA and will also be the new
editor for the WSAVA Monthly News and News Bulletin
starting in January 2010. Dr Leong has been helping
and promoting WSAVA in Asia since 2001. She
assisted the Shanghai Small Animal Veterinary
Association and the Guangdong Small Animal
Veterinary Association (GZVA) in their applications for
WSAVA membership. Dr Leong dedicates her time to
developing CE via WSAVA and the European School
for Advanced Veterinary Studies initiatives in Asia. She
also actively promotes animal welfare and rabies
control in China and has given more than 50 lectures
and presentations in China within the past 5 years.
Geneva 2010: update
Working towards
greater collaboration
between veterinary
and human medicine
O
ne health or one medicine is
the central theme of WSAVA
2010. This concept proposes
the unification of the medical and
The concept is not a new one a
number of enlightened individuals
historically practised one medicine and
are regarded as the initiators of this field.
One such individual was Sir John
McFadyean (18531941) who was qualified
both as a veterinary surgeon and a
medical physician, and who undertook
research into major zoonotic diseases
largely at the Royal Veterinary College. Sir
John also founded the Journal of

veterinary professions with the

establishment of collaborative ventures in:
clinical care; surveillance and control of
cross-species disease; education; and
research into disease pathogenesis,
diagnosis, therapy and vaccination. The
concept encompasses the human
population, domestic animals and wildlife,
and the impact that environmental
changes such as global warming will have
on these populations.
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WSAVA NEWS

CE in Latin America
D
r Luis Tello coordinated the very first WSAVA CE event in Costa Rica,
which was enjoyed by 150 delegates. The CE topics were radiology
and ultrasonography, presented by our guest speaker, Dr Daniel Saez.
The audience was very appreciative as WSAVA is one of the very few CE
providers in the country. In Panama, at the second WSAVA CE event that we
have held in that country, Dr Saez presented a similar programme. Eighty
practitioners participated and the feedback was very good.
Dr Javier Green provided CE lectures in Uruguay and Argentina, covering
neurology and neurosurgery. The attendance was excellent in both countries
95 in Uruguay and more than 200 in Argentina and again very good
comments were received on the quality of the lectures.
Please visit the WSAVA CE Meetings page at www.wsava.org for more
information on past and upcoming events.
The second phase of the
WSAVA CE programme in Latin
America was a great success
WSAVA CE in
Latin America
Comparative Pathology in 1888, which
remains an important vehicle for
dissemination of research in this area.
Pre-Congress ESVC Day
A pre-Congress event will be held on
Wednesday 2 June 2010 by our newest
affiliate member, the European Society of
Veterinary Cardiology (ESVC). This CE
event will examine the most important
diagnostic and therapeutic features of
canine and feline heart diseases.
Emphasis is placed on disorders of
greatest relevance to small animal practice.
Lectures in the morning and early
afternoon will be supplemented by a
session of active audience participation
using case studies and multi-media.
Please visit the ESVC website for more
information (http://esvcardio.com/site/
view/137408_EventDetails.pml).
The new WSAVA Executive Board
President: Mr David Wadsworth
President Elect: Prof Jolle Kirpensteijn
Vice President: Prof Peter Ihrke
Past President: Dr Brian Romberg
Honorary Secretary: Dr Walt Ingwersen
Honorary Treasurer: Dr Diane Sheehan
Executive member: Dr Veronica Leong
The new FASAVA Executive Board
Chairman: Dr Parntep Ratanakorn
Past Chairman: Dr Roger Clarke
Honorary Secretary: Dr Veronica Leong
Honorary Treasurer: Dr Matthew Retchford
Executive member: Dr Geoffrey Chen
All change
The new Czech Small Animal Veterinary
Association President
President: Dr Milos Urban
Thanks and best wishes to Past President Dr Jiri Beranek
for all his good work organizing the WSAVA World
Congress in Prague.
International Veterinary Ear, Nose and
Throat Association
New WSAVA representative: Dr Gert ter Haar
ESVC WSAVAs newest affiliate member
The European Society of Veterinary Cardiology (ESVC) is
a non-profit association of veterinary cardiologists,
non-specialist veterinarians who have an interest in
veterinary cardiology, and non-veterinarians with an
interest in veterinary cardiology. For further information,
please visit ESVC website www.esvcardio.com.
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WSAVA NEWS

Asian veterinary associations do not

share a common language, but share
a common geography in which small
animal veterinary medicine is a
relatively new and rapidly growing field.
F
ASAVA arose from a realisation by a
group of vets in the Asia-Pacific area
that there was a need for an
international small animal veterinary group
to act as a forum for their specific regional
needs. Asian veterinary associations do
not share a common language, but share a
common geography in which small animal
veterinary medicine is a relatively new and
rapidly growing field.
In 2002, a group from various small
animal veterinary associations across Asia
met at the 27th WSAVA Congress in
Grenada, Spain, to discuss the formation of
such an organisation. As the Chairman of
WSAVA CE in Asia, Dr Roger Clarke was
asked to assist, and representatives from
Australia, China, Hong Kong, Iran, Japan,
Korea, Malaysia, New Zealand, Thailand
and Taiwan were involved over the following
three years. Finally, at a WSAVA CE
meeting in Taipei in 2005, the decision to
form FASAVA was made. The 1st FASAVA
conference was held in conjunction with the
WSAVA 2007 Congress in Sydney.
FASAVA is an association of
associations, in a similar manner to
WSAVA, and applications can be accepted
from all associations in the region. FASAVA
grew out of the WSAVA and will work in
partnership with the WSAVA whenever the
two come together.
Three days in Bangkok
The 2nd FASAVA Congress 2009 was held
in Bangkok, Thailand, on 35 November,
2009, with a theme of A Drive for Asian
Synergy. The congress was a great
success and was the largest standalone
small animal veterinary conference in Asia,
with more than 2000 participants attending.
The Princess of Thailand hosted the
opening ceremony and gave a warm
welcome to the guests from all over the
world. There were more than 50 lectures of
different disciplines including endoscopy,
imaging, dentistry, practice management,
cardiology, gastroenterology, urology,
welfare, clinical pathology, anaesthesiology,
endocrinology, internal medicine,
neurology, dermatology, soft tissue surgery,
orthopaedics, nutrition, parasitology,
acupuncture, behaviour, avian medicine,
rehabilitation, veterinary leadership, and
veterinary public health. Two State-of-the-
Art Lectures (SOTALs) were presented, one
by Dr Michael Lappin on zoonotic issues of
the cat and the other by Dr Takuo Ishida
covering canine and feline clinical
pathology.
The 2011 meeting of FASAVA will be
held in conjunction with the WSAVA
Congress in Jeju, South Korea. Please visit
the FASAVA website (www.fasava.org) for
more information.
FASAVA facts
More than 2000
delegates enjoyed the
2nd FASAVA Congress in
Bangkok, just four years
after the Association was
formed so how did
FASAVA come about?
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THE companion INTERVIEW
Lord
Soulsby
Q
You have become well known within the
profession through your work in the Lords.
When were you ennobled and why do you
think you were chosen for this honour?
A
I was ennobled in 1990. I believe I was chosen
because the House of Lords needed someone
with veterinary experience. I had created a
nuisance of myself when the Riley Committee
recommended closure of the Cambridge Veterinary
School, of which I was Dean. I spent a lot of time
lobbying ministers to keep the school open and in the
end we were successful.
Lord Soulsby, or Ernest Jackson Lawson Baron Soulsby of Swaffham Prior,
to use his full title, is a distinguished microbiologist and parasitologist
Has your experience as a veterinary surgeon been
helpful in the Lords?
As the only veterinary surgeon in the House of Lords,
indeed in either House, many consider me as a fount
of knowledge about animals, their health, breeding
and welfare. I hope they are not too disappointed
when I plead ignorance on certain points. However, in
the House of Lords, there are many peers who have
strong associations and experience with livestock and
farming and they speak with authority on animal
issues, especially when passing an opinion on the
role of Defra in farming. Possibly my particular
He was born on 23 June 1926 in Haltwistle, Northumberland, before his farming
parents took him and his brother to live in Sowerby. After leaving the Queen Elizabeth
Grammar School in Penrith he did his veterinary degree in Edinburgh, graduating in
1948, when he spent some time in general practice in Cumbria. He completed a PhD
at Edinburgh and received an MA from Cambridge in 1954. Lord Soulsby began an
impressive academic career as a lecturer at Bristol and Cambridge, before becoming
Professor of Parasitology, University of Pennsylvania (19641978) and Chairman of the
Department of Pathobiology (19651978). He then returned to the UK to become
Professor of Animal Pathology at the University of Cambridge and Dean of the School
of Veterinary Medicine (19781993). He also has Honorary Degrees from the
Universities of Pennsylvania, Edinburgh, Leon, Peradeniya, Glasgow, Liverpool,
St Georges, Grenada and Lincoln, and is an Honorary Fellow of the Royal Society of
Medicine, Royal College of Veterinary Surgeons and Royal College of Pathologists, and
a Founding Fellow of the Academy of Medical Sciences. Lord Soulsby is also a Past
President of both the Royal Society of Medicine and the Royal College of Veterinary
Surgeons. Added to this impressive record, Lord Soulsby is an author or co-author of
14 books and more than 200 articles in scientific journals, and in 2009 received the
JA Wight Memorial award from the BSAVA
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THE companion INTERVIEW
my experience indicates
the profession needs to
have a stronger lobby
in parliament

strength lies in my detailed experience of animal

disease, both in this country and in the developing
world, and in zoonotic diseases. When opinions are
sought of me there is usually a coincidence of opinion.
There is strong support for the veterinary profession,
though I believe the profession could do more to
publicise the wide range of abilities and concerns it
has. My experience indicates the profession needs to
have a stronger lobby in parliament.
What differences/similarities did you notice
between the academic world at Cambridge
Veterinary School and the House?
There are more similarities than differences between
the Lords and academic life. Many peers have
experience in their previous professional life of
expressing their opinion in an orderly manner. That is
also the way debates are conducted in University
Academic Boards and College Councils. So
participants in both situations have the ability to give
way to another speaker and await their turn to speak. It
is always a delight to hear a well constructed and
honed speech, comparable to one in a University
Senate and free of interruptions.
Your academic career as a veterinary parasitologist
also took you to the University of Pennsylvania
(19641978). How did the experience of working at
a US university compare with life back home?
I very much enjoyed working in the American
university system, especially at the University of
Pennsylvania. At that institution, authority is very much
devolved to the heads of departments and Dean,
unlike the more centralised system at Cambridge. Both
the university and the USA in general were very kind to
me. I served on several senior national and
international committees and developed good
contacts with people in Washington, such as the
National Institutes of Health and the US Senate.
What have been your main interests outside work?
My hobbies are collecting antique maps, gardening
and travel.
Who has been the most inspiring influence on your
professional career?
In the wider world, that would be Sir Winston Churchill.
In the veterinary sphere, I would say Sir William
Weipers, the Dean of the Glasgow Veterinary School.
Sir William had remarkable foresight in the areas of
veterinary education and the need to promote
research at the schools. I was fortunate that we
became good friends.
What is the most significant lesson you have
learned so far in life?
The importance of honesty.
If you were given unlimited political power, what
would you do with it?
I would greatly strengthen the Government role in
animal health and welfare, including companion
animals. I would also re-establish the separate Animal
Health Division with an independent CVO.
If you could change one thing about your
appearance or personality, what would it be?
As I am wheelchair-bound it would be good to have
my right leg back! It was amputated three and a half
years ago. Otherwise a few more inches to my height
would be useful but it is too late now!
What is your most important possession?
My house and home which, of course, includes my
wife, Annette.
What would you have done if you hadnt chosen to
be a vet?
I would have read law to become a barrister.
THE companion INTERVIEW
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31
CPD
DIARY
7
January
Thursday
Two-part lecture: I have an itchy
dog & the top 10 tips for itchy cats
Speaker Natalie Perrins
University of Plymouth, Drake Circus,
Plymouth PL4 8AA. South West Region
Details from southwestregion@bsava.com
EVENING
MEETING
14
January
Thursday
Update on lymphoma & other
common neoplasms
Speaker David Argyle
VSSCo, Lisburn. Northern Irish Region
Details from Shane Murray, shane@
braemarvetclinic.co.uk, or VetNI, 028
25898543, info@vetni.co.uk
EVENING
MEETING
20
January
Wednesday
Maxillofacial surgery
Speaker Dick White
Potters Heron Hotel, Romsey SO51 9ZF.
Southern Region
Details from southern@bsava.com
EVENING
MEETING
24
January
Sunday
Fixators & cruciates, with parallel
VN session on surgical nursing
& physiotherapy includes AGM
12:30pm
Speakers Noel Fitzpatrick & Donna Carver
L.A Lecture Theatre R(D)SVS, Edinburgh.
Scottish Region
Details from Adam Gow, 07886 686473,
adam.gow@dsl.pipex.com, or Andrew
Francis, 07961 071761, andrew.francis@
ed.ac.uk
DAY
MEETING
26
January
Tuesday
Critical care medicine:
maximising survival
Speaker Amanda Boag
BSAVA, Woodrow House, 1 Telford Way,
Waterwells Business Park, Quedgeley
GL2 2AB
Details from BSAVA, 01452 726700,
administration@bsava.com
DAY
MEETING
28
January
Thursday
Reptile medicine & surgery
Speaker Simon Girling
The Holiday Inn, Gatwick, Horley RH6
0BA. Surrey & Sussex Region
Details from Jackie Casey, 01483 797707,
Jackie.casey@greendale.co.uk
DAY
MEETING
9
February
Tuesday
A practical approach to treating
psittacines
Speaker Neil Forbes
Potters Heron Hotel, Romsey SO51 9ZF.
Southern Region
Details from southern@bsava.com
EVENING
MEETING
11
February
Thursday
The coughing dog
Speaker Simon Swift
David Lloyd Leisure, Moss Lane,
Whittle-le-Woods, Chorley PR6 8AB.
North West Region
Details from Simone der Weduwen, 01254
885248, beestenhof@ntlworld.com
EVENING
MEETING
13
January
Wednesday
Physiotherapy: Getting Tom,
Jerry & Spike fit again
Speaker Lowri Davies
Park Inn, Llanederyn, Cardiff CF23 9XF.
South Wales Region
Details from southwalesregion@bsava.com
EVENING
MEETING
21
January
Thursday
Managing pancreatitis in dogs
& cats
Speaker Penny Watson
Russell Hotel, 136 Boxley Rd, Maidstone,
Kent ME14 2AE. Kent Region
Details from Hannah Perrin,
hannah@burnhamhousevets.com
EVENING
MEETING
24
January
Sunday
Companion animal anaesthesia:
how to take the stress & worry
out of the problem cases
Speaker Andy Bell
Ramada Hotel, Leeds Road, Wetherby
LS22 5HE. North East Region
Details from Chris Dale, 01422 833960,
07884 231307, chris.j.dale@btinternet.com
DAY
MEETING
28
January
Thursday
Urinary Tract I: kidney disease in
the dog & cat: an evidence-based
approach to diagnosis &
management
Speaker Hattie Syme
Thorpe Park Hotel & Spa, 1150 Century
Way, Thorpe Park, Leeds LS15 8ZB
Details from BSAVA, 01452 726700,
administration@bsava.com
DAY
MEETING
5
February
Friday
Rehabilitation & acupuncture in
companion animals (for vets &
nurses)
Speaker Siobhan Menzies
VSSCo, Lisburn. Northern Irish Region
Details from Shane Murray, shane@
braemarvetclinic.co.uk, or VetNI,
028 25898543, info@vetni.co.uk
EVENING
MEETING
10
February
Wednesday
Murmurs in puppies & kittens
(also includes AGM)
IDEXX laboratories, Grange House,
Sandbeck Way, Wetherby LS22 7DN.
North East Region
Details from Chris Dale, 01422 833960,
07884 231307, chris.j.dale@btinternet.com
EVENING
MEETING
11
February
Thursday
Perineal disease: lavatory
tumour
Speaker Gerry Polton
Holiday Inn, Gatwick, Horley RH6 0BA.
Surrey & Sussex Region
Details from Jo Arthur, 01243 841111,
joarthur85@btinternet.com, or Jackie
Casey, 01483 797707, Jackie.casey@
greendale.co.uk
HALF WAY
MEETING
19
January
Tuesday
Dentistry for the generalist
Speaker Alex Smithson
Cottons Club Hotel, Manchester Road,
Knutsford WA16 0SU. North West Region
Details from Simone der Weduwen, 01254
885248, beestenhof@ntlworld.com
DAY
MEETING
A broad network of regional
branches gives you the
potential to meet like-minded
colleagues in your area and
delivers high-quality CPD on
your doorstep. For further
details of events in your area,
visit www.bsava.com
Want more in-depth information? BSAVA can give you that too
For those unexpected
patients a new edition of the
original Exotic Pets Manual offering
you a rm foundation to your exotics knowledge
Exotic
excellence
Member price: 49
Non-member price: 75
A starting point, designed to provide busy
practitioners with a quick guide and the basic
knowledge that enables them to deal professionally
with a particular species, even if it is unfamiliar.
Anna Meredith, Cathy Johnson-Delaney
Available February 2010
see website for more details
Completely updated and revised
Expanded coverage of: Amphibians; African pygmy
hedgehogs; Marsupials
Featured for the rst time: Alligators; Skunks; Ostriches
Standard format within chapters to aid information retrieval
Filled with beautiful colour images