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The essential publication for BSAVA members

Test your
diagnostic
imaging skills
P9
Update on
the Veterinary
Surgeons Act
P3
The out-of-hours
obligation
P6
companion
JULY 2008
Successful
surgery
How to carry out
a gastropexy
companion
2 | companion
CONTENTS
3 Latest News
Update on the Veterinry
Surgeons Act
45 A Tartan Affair
Ross Allan reports on the
Scottish Congress
68 Around The Clock
John Bonner on the challenges
of emergency care
913 Clinical Conundrum
Approaches to gastrointestinal
disease and abdominal pain
1417 How To
Select and carry out a
gastropexy procedure
1819 Formulating the Formulary
Ian Ramsey on the making of
the indispensible pocket guide
2021 Petsavers
Fundraising news
22 International Affairs
BSAVAs supporting the
profession worldwide
2325 WSAVA News
World Small Animal
Veterinary Association
26 The companion Interview
Julian Hector
27 CPD Diary
Whats on in your area
companion is produced by BSAVA exclusively for its members.
BSAVA, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB.
Telephone 01452 726700 or email companion@bsava.com to contribute and comment.
ON YOUR
DOORSTEP
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B
SAVA has 13 regions covering the UK
and Ireland, run by committed
volunteers. Members can access
regional CPD at greatly reduced prices
(sometimes theres no charge at all), meet
other local professionals and even get
involved in choosing the subjects covered in
the programme. Regional events are a really
simple and cost-effective way of topping up
your knowledge on a regular basis.
Your local
Wherever you live there will be a team of
regional representatives working on your
behalf to deliver relevant courses on a wide
range of topics but you are not tied to
one region. Many members live on the
borders between two, or even three or
four regions and you can access courses
at any of them.
Quality
Throughout the year BSAVA regional
committees organise courses that are
aimed at the practitioner who is looking to
update their current knowledge and
techniques. Many of our speakers are
international experts who travel to the
regions for one-day or evening meetings,
allowing members to access the latest
advances in a wide range of subjects. In
answer to demand, many courses adopt a
problem-oriented approach, with
appropriate hypothetical and actual
cases and discussions to consolidate the
theory learned.
Get in touch
For more information about regional
CPD visit the Courses section at
www.bsava.com, see the Diary in the
back of this edition of companion, or
email customerservices@bsava.com to
get contact details for your own
regional representative.
BSAVA Regions
East Anglia
Kent
Metropolitan
Midland
North East
North West
Northern Ireland
Regional CPD allows you to
access courses without
spending more time in the
car than you do in the
classroom
Republic of Ireland
Scotland
South Wales
South West
Southern
Surrey & Sussex
companion | 3
LATEST NEWS
BALANCING
ACT
E
FRACom announced its enquiry into
the Veterinary Surgeons Act 1966 in
July 2007. The terms of reference
were to examine whether the provisions of
the 1966 Act were out of step with
developments in the veterinary and related
professions, and whether there was a need
to replace the Act. Written submissions
were invited, and 42 received, amongst
them a submission from BSAVA. Oral
evidence was also taken from a number
of individuals and bodies, including the
RCVS, Defra, BVA and Lord Rooker,
Minister for Sustainable Food, Farming
and Animal Health.
Process and history
In 2003 Defra carried out a public
consultation, whilst the RCVS had
previously held two consultations with the
veterinary profession, in 2003 and 2005, to
review whether a new Act would be
desirable. Discussions have also been held
between RCVS and Defra since 2003 on
proposals for modernising the regulatory
framework for the provision of veterinary
services, and the RCVS has proposed a
number of changes to the 1966 Act.
However, while Defra initially concluded
that it needed to modernise the Act, and
indeed intended to apply for Parliamentary
time to bring forward new legislation in
20056, this did not happen. Then, during
oral submission to EFRACom, Lord Rooker
surprised everyone by declaring that Defra
has stopped work on this issue, and that the
requisite resources will not be available
until 2011.
Criticisms
The report of EFRACom is critical in a
number of respects. The RCVS is criticised
for failing to sort out the detail in its reform
proposals, given the level of consultation
with the profession and the time which has
elapsed since that consultation. In addition,
Defra is strongly criticised for its decision
to halt work entirely on the new legislation,
and for a failure to communicate this at an
early stage to the RCVS.
The overall conclusion is that the
veterinary profession must work together
to establish exactly what it wants in terms
of regulatory reform, before reform is
imposed upon it by government. We
understand it is the intention of the RCVS
to set up a working party to investigate the
professions needs.
Way forward?
It remains important to safeguard the health
and welfare of animals, and to protect them
and their owners from those who offer
treatments without sufficient knowledge or
training. Fundamental to this is the
acknowledgement that the veterinary
profession must meet modern day standards
of quality of service, and must have the
transparent and accountable regulatory
procedures demanded by the public.
The veterinary nursing profession has
evolved to a stage where it also warrants
its own framework for regulation. But it
is less clear how best to ensure that
other paraprofessionals providing animal
services are regulated to ensure animal
health and welfare.
Additional concepts intertwined with
these elements of reform do not have, say
EFRACom, the widespread support of the
veterinary profession. These include a
mandatory practice standards scheme and
mandatory continuing professional
development and revalidation.
While it is clear that excellent practice
standards and ongoing individual
professional development should be aspired
to by all, it is perhaps more constructive to
promote the benefits of the current
voluntary practice standards scheme, and to
encourage CPD for all.
BSAVA position
The BSAVA will be arguing for the
development of:
Specific proposals to amend the
disciplinary process for veterinary
professionals, with the aim of
producing a new Bill for introduction
earlier than 2011
The development of a specific
regulatory framework for the veterinary
nursing profession.
The BSAVA will also willingly
co-operate with the RCVS if it wishes
to conduct a cost-benefit analysis of
the impact of mandatory CPD and
revalidation on the profession.
Have your say
Comments from members of the BSAVA
on any aspect of the EFRACom report
and the proposed way forward are
welcome, and should be directed to
customerservices@bsava.com
An update on the Report of the House of Commons
Environment, Food and Rural Affairs Committee
(EFRACom) on the Veterinary Surgeons Act 1966


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4 | companion
A TARTAN AFFAIR
The 23rd BSAVA Scottish Congress occurred on the
weekend of 911 May and was a huge success. The event
took place in the Fairmount Hotel in St Andrews and
combined a picturesque location, great accommodation
and first-rate CPD. Ross Allan reports
T
he principal speakers for Mays
Scottish Congress weekend were
Clare Knottenbelt from the
University of Glasgow and Alasdair Hotston
Moore from Bristol University. Both
presented a series of excellent lectures to
the attending delegates, who left armed
with more knowledge and skills to take
back to practice. Mark Moran also
delivered a series of talks to receptionists
throughout the weekend, which proved
extremely popular.
New format
For the first time this year, a series of
workshops took place during the
afternoons, delivered by a wide range
of expert speakers. These increased the
range of topics available to delegates,
with subjects as diverse as renal disease
to heart failure; suture materials to
anaesthesia. A total of 95 vets, 125 nurses,
25 receptionists and 125 exhibitors (from
42 companies) attended the weekend.
Nightlife
A vital part of the Scottish Weekend is
what goes on once the lectures have
finished. This year on the Friday evening
delegates enjoyed a Grease The Movie
themed night, where those so-inclined went
all-out with their fancy dress costumes.
SCOTTISH CONGRESS
There is always a reason to swing your partner at the annual ceilidh where
traditional attire begs that eternal question about men in kilts
4 | companion
companion | 5
Speakers Clare Knottenbelt and
Alasdair Hotston Moore with
Barbara Anne Innes of the
Scottish Committee
SCOTTISH CONGRESS
On the Saturday there was a stunning
Gala Dinner, where traditionalists
donned kilts for the ceilidh. After the
dinner and the presentation of prizes,
Mary Fraser, BSAVA Scottish Region
Chair, thanked her committee for
their hard work. Then Richard
Dixon, President Elect of BSAVA,
highlighted the contribution that the
Scottish region makes in the development
of BSAVA, and encouraged members to
consider joining their local group.
Exhibition
Throughout the weekend, the commercial
exhibition was attracting delegates looking
to take advantage of all the industry
expertise on offer, with a total of 42
exhibitors attending. While many exhibitors
were return visitors, some were attending
for the first time, and all were pleased with
the opportunity to meet delegates in a
more relaxed environment than the
practice office.
2009 date
With this event now a fond memory, the
Scottish region is making plans for next
year. The dates for 2009 are 810 May and
already talks have begun to create a CPD
programme that will bring delegates back
for more.
Grease was the word and the
motion on Friday night where
Pink Ladies showed other
delegates how to get into the
spirit of the evening
companion | 5
6 | companion
LEGISLATION
AROUND

THE CLOCK
Providing emergency care at night
and at weekends is no longer the
chore it once was for many small
animal practitioners, with dedicated
out-of-hours clinics having opened
up in most large towns across the
country. But for colleagues working
in mixed practices this traditional
professional obligation is causing
increasing practical, economic and
legal problems. John Bonner reports
companion | 7
LEGISLATION
AROUND

THE CLOCK
Vets see it as a real professional challenge
and for many this sort of caseload is the
reason why they wanted to be vets in the
first place.
In many areas where there is no
external provider, groups of practices
operate shared out-of-hours rotas or a
single large practice runs the emergency
services for the rest. John Bowers hospital
practice in Plymouth has operated an
emergency service for other practices in
the city for several years and about 18
months ago set up a dedicated team that
does not participate in the normal day rota.
These night staff approach their work
with greater keenness, he says, knowing
that they will not have to begin a full shift
the next day, as would often happen under
a traditional on-call rota. There is always
the temptation to try to put clients off until
the next morning if you are working on call.
But with a proper team in place they will
say to clients If you are worried, come on
in. Moreover, the practice works more
efficiently during the day and has been able
to improve its service to its regular clientele
by extending its normal consultation hours,
he adds.
Impact of the profession
Richard Dixon believes that the growth in
emergency clinics has been good for the
veterinary profession as a whole, as it has
stimulated interest in emergency medicine
as a distinct clinical discipline. Dealing with a
regular supply of emergency cases has
enabled staff to hone their skills and they
are eager to pass on their knowledge to
others by lecturing at CPD events and to
students at the veterinary schools. That is
important because the more undergraduates
are trained in emergency medicine, the
higher will be their expectations of the care
they can deliver when they go out into
practice, he points out.
Out of town
However, it is a very different story away
from the major population centres where
traditional mixed practices are struggling to
provide an economically viable emergency
service and face difficulties in recruiting
young veterinary surgeons willing to take on
the challenge of treating all species. Those
problems will multiply if rural practices find
they have to adhere to the letter of the
European Working Time Directive, which
would set a limit on the number of hours
worked and impose mandatory rest periods
after any time spent on call.
Sharing an out-of-hours rota with a
neighbouring practice is not an option
normally open to those businesses
operating in less densely populated areas.
Steve Grills, a partner in a four vet practice
in Ivybridge, Devon, says the idea has been
discussed informally with neighbours but
is a non-starter because of the equine
element to his practices caseload. There
are only a few areas of the country where
there are enough horses to make this
work. We looked and realised that we
would need to cover an area that stretched
pretty all the way from the north to the
south coast of the county, so it simply
wouldnt be practical.
Under review
The RCVS is well aware of the difficulties
that mixed practices are currently facing
and has convened a working party to
look for possible solutions. Jerry Davies,
Royal College Treasurer and chair of the
working party, said it would be consulting
W
orking rabbits arent exactly
two a penny so one would
expect an owner to provide the
best possible care for such a rare beast.
But not the magician who rang Phil
Hydes newly opened emergency clinic in
Cardiff asking for an estimate. He didnt like
what he was told and decided he would wait
for an appointment with his usual vet. As a
consequence of the delay, the rabbit died,
the owner blamed Phil and took his
grievance to the Royal College.
After looking at the evidence, the
RCVS preliminary investigation committee
accepted that the complaint was
unfounded. Yet, dealing with resentful
clients from other practices was not the
only problem Phil faced in 1996 when he
set up his clinic the first of its kind
outside London. Initially, probably three
out of four practices that I approached
offering to take over their out-of-hours
work said No. They were very concerned
about supersession and I had to work really
hard to persuade them to come on board.
Even now we still have to be careful what
our staff say and do, to prove that we are
Honest Joes.
Staff recruitment
Building up enough business to ensure that
the clinic would not have to rely on cross
subsidies from his daytime clinic was
another major challenge. But to Phils
surprise, recruiting staff prepared to work
through the night was never a problem.
That has also been the case for Richard
Dixon, who founded the Vets Now group in
2002, which now operates 32 emergency
clinics around the country. The sort of
work that we do in these clinics is very
different from routine veterinary practice.
LEGISLATION
AROUND THE CLOCK
widely both within the profession and
with the animal-owning public over the
next few months.
Alan Marshall, a partner in a seven vet
mixed practice in Dumfries, is pessimistic
about the likelihood of finding a simple
answer. When it last looked at the issue of
emergency care, the RCVS changed the
wording in the Guide to Professional
Conduct, advising members that they
should make provision for 24-hour cover
rather than necessarily providing it
themselves. But he points out that the
problems for mixed practice are much
broader. These include the long-term
economic woes of the livestock sector and
the changing demographics of the
profession, which has reduced the numbers
Recent months have seen an increase in
the prices that cattle farmers have been
receiving for their products but neither
Steve nor Alan is yet convinced that this will
translate into a sustained recovery for UK
farm animal practice. Unless things do
change for the better, it is very difficult to
see where out-of-hours provision for farm
animal clients is going to be in 20 years
time, Steve warns.
But although both fear for the future,
neither is willing to surrender the principle
that mixed and farm animal vets should be
prepared to go out and see a clients
animals around the clock for 365 days a
year. There is certainly an option for
veterinary surgeons to follow their
colleagues in many GP practices in
withdrawing from a 24-hour service and
passing responsibility to NHS call centres
or the local hospital A&E department.
I dont think we would want that this is
something that we signed up for a very long
time ago and I believe we should continue
to provide it, Alan says.
of young vets willing to take part in a
demanding on-call rota.
The RCVS may have to consider some
radical ideas to allow mixed practices to
meet their traditional obligations on
out-of-hours cover. One idea that has
been suggested is moving towards an
American system in which farm vets visit
clients for herd health consultations but
emergency cases are brought into the
practice for treatment.
Mixed response
Steve Grills doubts whether such a system
would work under UK conditions. Leaving
aside the issue of the welfare implications
of transporting a typical bovine emergency,
such as an abdominal surgery or dystocia
case, he believes farmers would be
unwilling on cost grounds to transport
animals over long distances. I think this
would lead to a similar situation that we
have already with sheep, that if the farmer
cant deal with the cow himself he will
simply shoot it.
8 | companion
24-HOUR
EMERGENCY COVER
ACROSS EUROPE
A recent survey asked
National FECAVA
representatives about
the provision of OOH in
their countries
Questions asked
1. Is 24-hour emergency cover
a mandatory requirement in
your country?
2. If so, is delegation to
another practice or dedicated
out-of-hours service allowed?
Country Q1 Q2
UK Yes Yes
Norway No
Bulgaria No
Ireland Yes Yes
Switzerland For clinics No
Lithuania No
Poland For clinics
Malta Yes Yes
Finland No
Sweden No
France No
Estonia No
Portugal For clinics Yes
Belgium For clinics Yes
Germany For clinics
Luxembourg Yes Yes
Serbia Yes Yes
Latvia No
Turkey No
Netherlands No
companion | 9
CLINICAL CONUNDRUM
CLINICAL
CONUNDRUM
Case Presentation
A 9-year-old male neutered
Labrador is presented with a
history of intermittent vomiting
and diarrhoea over the preceding
8 months, which has worsened
acutely. On presentation he is
depressed, appears to be in pain
and has a distended abdomen.
This Clinical Conundrum
from Esther Barrett of
Bristol Veterinary School
Imaging Department invites
you to consider your
diagnostic imaging approach
to a case presenting with
chronic gastrointestinal
disease and acute
abdominal pain
Loops of gas-filled intestine are easily
appreciated on radiographs, but can
hinder a thorough ultrasonographic
examination. In a case with acute
obstruction and multiple gas-filled
intestinal loops, X-ray examination may
well provide a rapid diagnosis without
the need for ultrasound.
The information gained from an
ultrasound examination is very
operator-dependent, and is also
influenced by the quality of the
equipment available.
The general location of an abdominal
mass is often easier to appreciate using
X-rays, but determination of the organ
of origin may require ultrasonography.
Free abdominal fluid results in a marked
loss of abdominal detail, limiting the
information to be gained from
radiographic examination. Conversely,
free fluid allows excellent transmission
of sound waves, therefore facilitating
ultrasonographic examination.
Wall thickening and GI motility cannot
be assessed on plain radiographs, but
are readily evaluated with ultrasound.
Any suspicion of neoplasia is an
indication for thoracic radiography,
looking for evidence of metastases.
Abdominal radiography
Thorough radiographic investigation of the
abdomen requires a minimum of two views,
typically a lateral and a ventrodorsal (VD)
projection. In some cases, such as the
investigation of a suspected foreign body,
adding the opposite lateral and dorsoventral
(DV) projections is indicated in order to
alter the distribution of gastrointestinal gas
and fluid, thereby providing more
information about gut contents. For animals
Abdominal radiography or
ultrasonography which will be
most useful?
This is a common clinical dilemma,
especially when funds are limited.
Radiography and ultrasonography are
complementary imaging techniques and
ideally you would perform both. Abdominal
radiography is best performed first, as this
should provide a better overview of the
abdominal contents, and may help to direct
the ultrasound examination.
Honorata Kawecka | Dreamstime.com
10 | companion
CLINICAL CONUNDRUM
CLINICAL CONUNDRUM
also undergoing abdominal ultrasonography,
it is common practice (but not ideal) to take
a single lateral abdominal radiograph.
Gastrointestinal radiography
what should you look for?
As with all radiographs, it is important
that the entire film is read in a logical
manner, ensuring that attention is paid to
peripheral structures as well as to the
abdominal contents.
The normal position, shape and size
of the abdominal organs should be
assessed; the presence of any abnormal
structures and their relationship to
adjacent organs should be noted.
The GI tract should be assessed for
the size of the stomach and intestinal
loops, the nature of their contents and
the distribution of the intestinal loops.
Possible gastric distension is a fairly
subjective judgment in many cases.
However, various parameters are
used for evaluating small intestinal
diameter. In the dog, it is suggested
that normal intestine should not
exceed twice the width of the 12th
rib. Intestinal diameter that exceeds
four times the width of the last rib
should be considered pathological.
In the normal fasted dog, the GI
tract should contain a mixture of
fluid and gas, with variable amounts
of faecal material present within the
colon. In dogs that scavenge,
incidental small mineralized
fragments may be seen throughout
the intestine. Abnormal dilation of
small intestine loops with gas or
fluid opacity should be considered
as grounds to suspect intestinal
obstruction. A localised
accumulation of small mineralised
opacities (a gravel sign) often
occurs just proximal to a chronic
partial obstruction. Intestinal foreign
bodies may be radiopaque and easily
detected, but are frequently
radiolucent and harder to visualise
on plain radiography.
Small intestinal loops should have
a smooth curving appearance
and should be fairly evenly
distributed throughout the mid
and caudal abdomen.
An assessment should be made of the
peritoneal cavity.
The visible serosal detail of the
abdominal organs should be
evaluated. In a normal animal, fat
within the mesentery is more
radiolucent than adjacent soft tissue
structures, allowing the serosal
margins of the abdominal organs to
be distinguished from each other. A
loss of this distinction (serosal
detail) typically occurs when the
mesentery becomes infiltrated with
fluid, inflammatory or neoplastic
cells and the normal fat opacity is
lost. Instead the mesentery takes on
a soft tissue opacity, merging with
the surrounding organs and causing
their margins to become obscured.
A lack of abdominal fat in very
young or thin animals will have the
same effect.
The peritoneal cavity should be
carefully examined for the presence
of free gas. Larger pockets of free
gas are most easily seen on lateral
radiographs highlighting the
caudodorsal aspect of the
Figure 1: Lateral abdominal radiograph revealing a poorly defined mid-abdominal mass displacing the small intestine
dorsocaudally, small intestinal corrugation, poor serosal detail and several gas lucencies suggestive of free abdominal gas
companion | 11
CLINICAL CONUNDRUM
diaphragmatic line. Smaller pockets
are harder to identify and may
appear as irregular gas lucencies
throughout the abdomen, but
outside the GI tract. The presence
of free gas together with a loss of
serosal detail is commonly seen
after laparotomy, but should be
considered suspicious for GI
perforation and secondary
peritonitis if there is no history of
recent surgery.
Contrast radiography may be
used to provide additional
information about the GI tract. As
intestinal walls and fluid intestinal
contents are both represented as a
soft tissue opacity, they cannot be
distinguished from each other and it
is not possible to make a judgment of
wall thickness from plain radiographs.
The use of a positive contrast agent
(typically liquid barium, administered
orally) allows assessment of wall
thickness, outlines the mucosal
surface of the intestine, can help to
highlight obstructive lesions and
foreign bodies, and provides a
semi-quantitative assessment of GI
motility. In many cases,
ultrasonography is now used as a
more efficient alternative to contrast
studies. The use of barium is
contraindicated where GI
perforation is suspected.
In the case being discussed, lateral
abdominal and thoracic radiographs were
taken. The thorax appeared unremarkable.
The abdominal radiograph (Figure 1)
demonstrated a poorly defined mid-
abdominal mass, approximately 8 cm in
diameter, displacing the small intestine
dorsally and caudally. It was not possible
to determine the origin of this mass from
this radiograph and a VD view would have
been useful in providing more information
about its location.
There was no evidence of intestinal
dilation, but several loops of small intestine
have lost their normal smooth curvature and
have an abnormal corrugated appearance
(Figure 2). A generalised loss of serosal
detail was evident throughout the abdomen,
and several small irregular gas lucencies
suggesting free gas were identified.
Ultrasonography what should
you look for?
When performing any ultrasound
examination, it is important to be as logical
as possible. Ideally the GI tract should be
examined as part of an ultrasonographic
assessment of the entire abdomen.
Particular attention should be paid to the
stomach, small intestine, large intestine, the
surrounding mesentery and mesenteric
lymph nodes, and the presence of any free
abdominal fluid. Should an abdominal mass
be found, every effort should be made to
identify the organ of origin.
The GI tract
Examination of the GI tract is often
hindered by the presence of gas, which
effectively blocks the transmission of the
ultrasound waves. In most cases, changing
the position of the dog, the contact point of
the probe and being patient will
overcome this problem. For elective cases,
an overnight fast is advised to reduce
gastrointestinal contents.
The walls of the GI tract should be
examined for evidence of normal wall
layering and thickness. They are
characterised by having a 5-layered
structure (mucosal surface, mucosa,
submucosa, muscularis, subserosa),
which should be clearly seen with a
reasonably high frequency (7.5+MHz)
transducer. Normal wall thickness in the
dog is up to 5 mm for the stomach, up
to 4.8 mm for the small intestine and up
to 2 mm for the large intestine. A loss of
the normal layered appearance, together
with a marked increase in thickness, is
suggestive of GI neoplasia. Inflammatory
disease typically results in increased wall
thickness, but with retention of the
layering. Longitudinal corrugation of the
wall structure may be seen with a linear
foreign body (often visible in the lumen)
or with local irritation of the intestine
(e.g. due to peritonitis).
Ultrasound allows a real time assessment
of GI motility. Peristalsis within the
stomach and proximal duodenum should
be approximately 45 waves/minute and
within the rest of the small intestine
approximately 13/minute.
Intestinal luminal contents and
diameter should also be assessed. Gas,
dense materials and faecal material
Figure 2:
Enlarged
image of loop
of small
intestines with
corrugated
appearance
12 | companion
CLINICAL CONUNDRUM
typically cause acoustic shadowing,
which prevents the visualisation of the
far wall, making it impossible to
measure luminal diameter at that point.
Most foreign bodies present a brightly
reflective interface, the shape of which
depends on the shape of the foreign
body, and cast an acoustic shadow deep
to this interface. Intestinal obstruction
is characterised by loops of dilated
intestine proximal to the lesion, with
the intestine distal to the obstruction
often being empty. Depending on the
duration of the obstruction, intestinal
motility may be increased or decreased.
The surrounding mesentery and
lymph nodes
The normal mesentery contains
variable amounts of fat, usually
appearing hyperechoic compared to
the intestinal walls. Infiltration with
inflammatory or neoplastic cells or
the presence of free fluid will
typically cause a marked increase in
mesenteric echogenicity.
With a high frequency (8.5+MHz)
transducer, normal mesenteric
lymph nodes are frequently observed
adjacent to the mesenteric vessels.
These should be moderately echogenic,
homogenous in appearance and
fusiform in shape, and are typically less
than 68 mm in diameter. Lymph nodes
that appear markedly enlarged,
heterogenous, rounded or irregular are
likely to be abnormal.
Abdominal fluid
Free abdominal fluid is readily
identified on ultrasonography,
typically as anechoic-to-hypoechoic
spaces separating out the abdominal
organs. Increased echogenicity and
the identification of swirling echoes
within the fluid are consistent with
increased cellularity of the fluid, for
example with abdominal haemorrhage
or peritonitis.
Abdominal masses
Ultrasound is very sensitive for the
detection of abdominal masses, but
identification of the organ of origin can
be challenging. It is often possible to
CLINICAL CONUNDRUM
follow the mass back to a recognisable
structure, but this can become
increasingly difficult with increasing
mass size. The presence of gas within a
mass lesion should raise the index of
suspicion for GI involvement.
Figures 3 and 4: Abdominal ultrasonograms revealing a hypoechoic mass with
hyperechoic region consistent with gas, contiguous with normal intestine
companion | 13
CLINICAL CONUNDRUM
In this case, a large and fairly well
defined hypoechoic mass was observed
caudal to the spleen, consistent with the
mid-abdominal mass identified on the
radiographs. The mass contained an
eccentrically located intensely
hyperechoic area, consistent with gas,
suggesting that it was likely to be of GI
origin (Figures 3 and 4).
This was confirmed by following the
lesion back to normal-appearing small
intestine. The local lymph nodes were
markedly enlarged (up to 2 cm in diameter),
heterogenous and irregular in shape. A
moderate amount of free abdominal fluid
was present; this contained some swirling
echogenic debris (Figure 5). Several
corrugated loops of small intestine, with
normal wall layering and thickness, were
identified in the caudal abdomen.
Differential diagnoses
The additional information provided by
the ultrasound examination suggested
that the most likely diagnosis for the
mid-abdominal mass was intestinal
neoplasia. The presence of intralesional gas,
complete loss of any layering structure
within the lesion and evidence of marked
local lymphadenopathy are typical findings
for a malignant GI neoplasia.
Benign GI tumours are less common,
and are more likely to arise from a single
wall layer (especially the muscle layer),
leaving the rest of the layering intact. The
most common differential diagnoses for
malignant GI neoplasia in the dog would
include adenocarcinoma and lymphoma.
Other differential diagnoses for the
intestinal mass are less likely.
Granulomatous intestinal disease can
appear ultrasonographically identical to
intestinal neoplasia, but is usually of
fungal origin and, although endemic in
other parts of the world, is very rare in
the UK. Lymphangiectasia has been
reported as a focal intestinal mass but this
is also rare; a more typical ultrasonographic
presentation for this disease would be a
normally layered intestinal wall structure
with echogenic striations identified within
the normally hypoechoic mucosal layer.
Overall wall thickness is sometimes, but
not always, increased.
The loss of serosal detail noted on
the abdominal radiograph was confirmed
to be due to free abdominal fluid.
Differential diagnoses for ascites are
numerous. A transudate may be seen
secondary to hypoproteinaemia, right-sided
heart failure and portal hypertension.
Causes of abdominal exudates include
leakage of bile or urine, haemorrhage,
neoplasia, sterile inflammation and
peritonitis. In this case, the corrugated,
irritated appearance of the small intestinal
loops, noted on both radiographic and
ultrasonographic examination, was typical
of peritonitis. Together with the
radiographic suspicion of free abdominal
air, it was considered likely
that the mass lesion had resulted in
intestinal perforation.
Diagnosis and outcome
Intestinal perforation with secondary
peritonitis should be considered a
surgical emergency. On exploratory
laparotomy, a 10 cm diameter mass was
found arising from the descending
duodenum, with a single area of intestinal
perforation identified.
Three markedly enlarged lymph nodes
were located adjacent to the mass, and
there was evidence of generalised
peritonitis. Given the poor prognosis, the
dog was euthanised at the request of the
owner. Histopathology was consistent with
lymphoma involving the duodenum, adjacent
jejunum and local lymph nodes.
Figure 5: Abdominal ultrasonogram revealing hypoechoic free abdominal fluid
(arrowed) with swirling echogenic debris adjacent to the spleen
Contribute a Clinical Conundrum
If you have an unusual or interesting case that you would like to share
with your colleagues, please submit photographs and brief history,
with relevant questions and a short but comprehensive explanation
in no more than 1500 words to companion@bsava.com
All submissions will be peer-reviewed.
14 | companion
HOW TO
SELECT AND CARRY OUT
A GASTROPEXY PROCEDURE
HOW TO
A
gastropexy is the surgical
attachment of the stomach to
the abdominal wall, most
commonly as a means of preventing
recurrence of gastric volvulus.
Prophylactic gastropexy
Due to the success of gastropexy in
preventing recurrence of GDV, it would
appear logical to offer prophylactic
gastropexy in those breeds or lines at
most risk from GDV. In bitches, such
a procedure could be readily carried out
at the same time as a routine
ovariohysterectomy.
Clearly the risks of occurrence of
GDV need to be weighed against the risk
of anaesthesia and elective surgery in an
otherwise healthy animal. From a surgeons
and an anaesthetists point of view there is
less risk in carrying out a planned elective
procedure than performing emergency
surgery on a GDV patient.
Recently the risks versus benefits of
prophylactic gastropexy have been
examined by comparing the lifetime
probability (risk) of a dog dying from GDV
against the expected cost-effectiveness of
prophylactic gastropexy. In the group of
American dogs studied, it was shown that
although prophylactic gastropexy would
reduce mortality from GDV, it is only
cost-effective in very high risk patients.
There are also ethical issues in considering
carrying out such a prophylactic procedure,
which are outside the scope of this article.
John Williams of Oakwood Veterinary Referrals
outlines the keys to successful surgery
PRACTICAL TIP:
A gastropexy procedure
should be performed in all
cases of gastric dilatation
volvulus (GDV) or gastric
dilatation (GD)
Table 1: Gastropexy techniques
Technique Adhesions Advantages Disadvantages
Simple suturing Poor
adhesions
Relatively quick High probability of
recurrence
Tube gastropexy Adequate
adhesions
Low probability of
recurrence. Relatively
quick to carry out
Patient interference.
Increased morbidity.
Increased hospitalisation
Incisional
gastropexy
Strong
adhesions
Low probability of
recurrence
Belt-loop
gastropexy
Strong
adhesions
Low probability of
recurrence
Circumcostal
gastropexy
Strong
adhesions
(probably the
most secure)
Low probability of
recurrence
Technically demanding. Risk
of rib fracture. Risk of
pneumothorax
Incorporating
(linea alba)
gastropexy
Strong
adhesions
Low probability of
recurrence
Not generally suitable as the
gastric fundus is sutured into
the midline laparotomy
closure. There is a risk of
gastric perforation if any
further abdominal surgery is
carried out
Gastrocolopexy Low probability of
recurrence
Possibly higher potential for
recurrence
Laparoscopic
gastropexy
Strong
adhesions
Low probability of
recurrence
Generally not suitable for
the acute case. Specialist
equipment required
A gastropexy should always be
carried out when surgery is performed in
the management of gastric dilatation
volvulus (GDV). In cases of simple
dilatation, which can be managed initially by
gastric decompression and when surgery
can be delayed, gastropexy should always
be an elective procedure. When there is
acute GDV the patient must be stabilised
prior to anaesthesia and surgery. This is
outside the scope of this article and the
reader is referred to the BSAVA Manual of
Canine and Feline Abdominal Surgery.
Given that dogs that have had one
episode of gastric dilatation (GD) are at an
increased risk of repeated episodes, a
gastropexy aids in prevention of future
volvulus. However, it does not decrease the
risk of gastric dilatation.
In cases that present with GDV,
recurrence rates can be as high as 80% if
gastropexy is not carried out; gastropexy
reduces the risk of recurrence to less than
10%. Furthermore, there is a dramatic
increase in median survival in gastropexy
(547 days) compared with non-gastropexy
(188 days) patients. A number of gastropexy
techniques have been described and are
summarised in Table 1.
companion | 15
HOW TO
HOW TO SELECT AND CARRY OUT
A GASTROPEXY PROCEDURE
BELT LOOP GASTROPEXY
This is the authors preferred method of
creating a gastropexy as it provides
excellent adhesions and is the authors
technique of choice in both acute cases and
for elective gastropexy. It is also technically
feasible for the unassisted surgeon.
Technique
Patient positioning: Dorsal recumbency
Assistant: Not essential, but can be useful
until the surgeon becomes experienced
with the technique
Equipment extras: Balfour abdominal
retractor; large abdominal swabs
Surgical procedure
1
A routine, midline abdominal
incision.
2
A tongue of seromuscular tissue is
created from the stomach wall over
the pyloric antrum; the author tries to
incorporate at least two short gastric
arteries (Figure 1).
3
Two parallel incisions are made in
the transversus muscle of the
abdominal wall, caudal to the costal arch
and a tunnel, wider than the flap, is created
by blunt dissection with long artery forceps
(Figure 2).
4
The seromuscular pedicle is drawn
gently by means of stay sutures, or
Babcock forceps through the tunnel
(Figure 3) and then sutured into its
original bed in the gastric wall (Figure 4).
5
The pedicle is anchored into place
with simple interrupted 2 or 3
metric monofilament synthetic suture
material. Absorbable sutures such as
polydioxanone, glycomer 631 or
polyglyconate or non-absorbable
polypropylene are suitable choices.
Figure 1: A tongue of seromuscular tissue is created from
stomach wall over the pyloric antrum, incorporating two
short gastric arteries
Figure 2: Two parallel incisions are made in the transversus
muscle of the abdominal wall, caudal to costal arch; a
tunnel, wider than the flap, is created by blunt dissection
with artery forceps
Figure 3: The seromuscular pedicle is drawn gently through
the tunnel with Babcock forceps
Figure 4: The flap is sutured into its original bed in the
gastric wall
16 | companion
HOW TO
HOW TO SELECT AND CARRY OUT
A GASTROPEXY PROCEDURE
Figure 5: Foley catheter being drawn
into the abdominal cavity
Figure 7: Omentum wrapped around
catheter. ( John Williams)
Figure 9: Chinese
finger trap suture.
( John Williams)
Figure 6: Foley catheter being
introduced into the stomach (pyloric
antrum) after pre-placing a purse-
string suture
Figure 8: Relative positions of
catheter, stomach and body wall
TUBE GASTROPEXY/
GASTROSTOMY
Tube gastropexy has the advantage of
being quick to perform and allowing
gastric decompression postoperatively.
Though easy to place there is increased
morbidity and longer hospitalisation
periods associated with this technique.
Technique
Positioning: Dorsal recumbency
Assistant: Not essential, but is useful
Equipment extras: Balfour abdominal
retractor; large abdominal swabs; long
artery forceps
Surgical procedure
1
A routine, midline abdominal
incision.
2
A subcutaneous tunnel is made by
means of blunt dissection with long
artery forceps, from a stab incision in the
skin lateral to the laparotomy wound, and
caudal to the last rib on the right.
3
A Foley catheter is then drawn
through the tunnel into the
abdominal cavity (Figure 5).
4
A purse-string suture of 2 metric
polydioxanone or glycomer 610 is
preplaced in the wall of the pyloric antrum
5
A stab incision is made within the
suture into the gastric lumen.
6
The Foley catheter is placed into
the stomach (Figure 6), the
balloon inflated and the purse-string
suture tightened.
7
Omentum is mobilised and
wrapped around the Foley catheter
(Figure 7).
8
Traction is then placed on the
catheter to draw the pyloric antrum
into firm contact with the abdominal wall
and an absorbable synthetic suture
material is used to suture the gastric
serosa to the abdominal wall (Figure 8).
9
The catheter is fixed in place either
with a Chinese friction finger trap
suture pattern (Figure 9) or by means of
zinc oxide butterfly tapes.
Postoperative care
The tube can be removed a minimum of
57 days after placement in order to allow
firm adhesions to form and thus prevent
leakage of gastric contents into the
abdominal cavity. The bulb of the Foley
catheter is deflated and the tube is pulled
out. The small hole in the body wall will
granulate closed in 24 hours.
Complications include premature
dislodgement and inflammation around
the stoma.
companion | 17
HOW TO
Key to success
Choose the most appropriate technique that you are most familiar with.
If you are unfamiliar with gastropexy, carry it out as an elective procedure
so that its use in the acute case will be straightforward.
The key to successful management of acute GDV is prompt stabilisation
followed by surgery to create a gastropexy.
Failure to create a gastropexy will inevitably lead to recurrence.
HOW TO SELECT AND CARRY OUT
A GASTROPEXY PROCEDURE
CIRCUMCOSTAL
GASTROPEXY
This is a technically difficult procedure
for which an assistant is essential.
Though it produces strong adhesions if
carried out incorrectly, there is the
potential to fracture the rib and/or
induce a pneumothorax. This technique
is therefore more appropriate for a
prophylactic gastropexy, rather than on
an emergency basis.
LAPAROSCOPIC
GASTROPEXY
Laparoscopic stapled gastropexy and
laparoscopic-assisted gastropexy have
been described. These minimally invasive
techniques offer alternatives to open
abdominal surgery, but access to
specialised equipment is required for
these techniques and they will not be
described here.
INCISIONAL GASTROPEXY
This is the simplest technique to use as it is
straightforward and relies on healing
between the edges of a peritoneum
transversus abdominis muscle incision and a
seromuscular incision in the pyloric antrum.
Technique
Positioning: Dorsal recumbency
Assistant: Not required, but is useful
Figure 10: Partial thickness incision in
the pyloric antrum
Figure 11: Incision in the right lateral
body wall through the peritoneum and
transversus abdominis muscle
Figure 12: Suturing the gastric
incision edges to the edges of the
body wall incision with a simple
continuous suture pattern (caudal
edges are sutured in same manner)
Equipment extras: Balfour abdominal
retractor; large abdominal swabs
Surgical procedure
1
A routine abdominal midline
incision.
2
A 45 cm incision is made in
the pyloric antrum (taking care
not to penetrate the submucosa)
(Figure 10).
3
A similar incision is made through
the peritoneum into the transversus
abdominis muscle 68 cm from the
laparotomy wound edge on the right
(Figure 11).
4
Using 3 or 2 metric monofilament
absorbable suture material the
wound edges are sutured together (Figure
12). The two cranial incisions are closed
first and then the caudal incisions.
Acknowledgement
Table 1 and the line diagrams in
this article have been reproduced
from the BSAVA Manual of Canine
and Feline Abdominal Surgery,
edited by John Williams and Jacqui
Niles. The diagrams were drawn
by Samantha Elmhurst BA Hons
(www.livingart.org.uk) and are
printed with her permission.
352 pages
Published
October 2005
Member price:
49.00
18 | companion
FORMULATING
THE FORMULARY
I
t started with the phone call Would I
consider becoming Editor-in-Chief (EIC)
of the BSAVA Formulary, as Bryn Tennant
had decided to hang up his red pen? The
Formulary is probably one of the most
tangible and most regularly used benefits of
BSAVA membership. So this was like
being asked to look after someones
family silver. It was both a privilege and
a responsibility.
Having edited a BSAVA Manual (the
infectious diseases one) a few years
previously, I knew that this project
would consume about a year of my life.
The first stop was to consult with
colleagues about my
involvement. The
reaction of several
was you must be
mad! Others were
more supportive
perhaps recognising that this project
was the sort of forensic academic
(anally retentive?) work that I enjoy. I was
also encouraged by the fact that, having
worked with BSAVA Publications and in
particular the Publishing Manager Marion
Jowett, I knew that there was considerable
technical support and plenty of experience
to guide me through.
Facelift
The BSAVA had decided that the Formulary
would benefit from a bit of a facelift for its
6th edition. I was keen to see a splash of
colour and suggested to the BSAVA that
each drug name should be distinguished by
a bright, identifiable colour. The idea of
tabs down the side was inspired by a
telephone directory.
In the future it is planned to use
the database of material now
gathered to power a web-
based version of the
Formulary, with additional features, such
as enhanced searchability and references.
We are also considering adding doses for
species not normally considered to be small
animals a dose for alfaxalone for a
crab-eating macaque, perhaps?
The Editorial Panel
Assembling the Editorial Panel was not
initially straightforward the supply of
experts in each area is limited and they are
busy people with demanding day jobs. They
do a huge amount of work, without which
the Formulary would not exist. We all owe
them a great deal of thanks for giving up
their time.
To assemble the database, each
member of the panel had to take the old
text, check every word, and update/rewrite
many sections. New drugs had to be
identified from the VMD website and
company press releases. In addition, the
material was reorganised into a new
standard format so that it could be
parsed into a database. This was like
taking the family silver, smashing it
into 415 different bits, and then
sticking it back together and hoping
that it would still look roughly the
same. It was a daunting task.
The BSAVA Small Animal
Formulary is one of the
Associations most valued
member benefits. As Editor-
in-Chief of the 6th edition,
Ian Ramsey describes what
it takes to produce this
invaluable pocket guide
Ian Ramsey with BSAVA
Publishing Manager,
Marion Jowett
PUBLICATIONS
companion | 19
BSAVA members entitled
to a free copy of the
BSAVA Formulary
Every BSAVA member is entitled to one complimentary
copy of the new edition. This process began at
Congress where delegates were able to pick it up hot
off the press from the designated stand on the balcony.
Those who could not collect it at Congress were sent
their copies by post during May and June. If you have
not had your copy please contact customerservices@bsava.com.
Additional copies can also be purchased online at www.bsava.com or call
01452 726700 for further information.
Drugs new to the 6th edition
44 new drugs
Aglepristone
Alfaxalone
Arnica
Carbamazepine
Carbomer 981
Cefovecin
Ceftiofur
Clonazepam
Clopidogrel
Deltamethrin
Dexmedetomidine
Difloxacin
Dirlotapide
Firocoxib
Fluticasone
Gabapentin
Heparin (low molecular weight)
Hydrocortisone aceponate
Imipenem
Imipramine
Ispaghula
Leflunomide
Levetiracetam
Loratadine
Lorazepam
Maropitant
Metaflumizone
Mitratapide
Moxidectin
Mycophenolic acid
Nimesulide
Osaterone
P07P
Paroxetine
Piperacillin
Piroxicam
Pyriprole
Resocortol butyrate
Salbutamol
Sertraline
Sulfadimethoxine
Tacrolimus
Tramadol
Travoprost
Drugs deleted from the 5th edition
28 drugs deleted
Albendazole
Alfaxalone/Alfadolone
Alimemazine
Anti-bacterial
immunoglobulin
Auranofin
Aurothiomalate
Benzyl penicillin
Calcitonin
Cefalonium
Cefoxitin
Chlorpropamide
Clorazepate
Dexamfetamine sulphate
Digitoxin
Dipropionate
Disopyramide
Etidronate
Flunixin meglumine
Griseofulvin
Ipecacuanha
Levamisole
Methylphenidate
Netilmicin
Penicillin V
Pyriproxyfen
Sulfadiazine
Sulfamethoxazole
Testa triticum tricum
Getting stuck in
My role was to act as an academic
reviewer of all submissions. I raised
questions on diverse issues, such as which
drugs should be dropped, which doses
were defendable, which species we should
exclude. Of particular concern were the
chemotherapeutic agents that represent
significant health hazards to the people that
handle them. Add to these the esoteric
antibacterials that should only be used in
exceptional circumstances, controlled drugs
with addictive properties, and many drugs
not authorised for veterinary use with little
published data, and the number of questions
became huge.
Slowly but surely the editors and I
worked our way through them. Over
1000 emails were sent and received.
Eventually, after nine months, we
succeeded in generating a complete
document from the database ready for the
BSAVA Publishing Team at Woodrow
House to work their magic.
The information in the Formulary
contains the very best and most accurate
information available to us at the time of
creation. However, it seems every week a
new dose, indication or drug is published.
The sooner we hear about it, the sooner
we can put it into the database ready for
the next edition. If you find something you
think should be included, excluded or
improved then please contact me at
formulary@bsava.com.
Achievement
Editing the Formulary was a steep learning
curve. Not only did I have to get to grips
with many drugs in a large range of species
but also learned about parsing into
databases, using those databases to extract
useful lists, and websites. The thrill of
seeing it finally in print at Congress was
amazing and there is not a day that I
regretted the decision to do this, even
when the going was tough.
PUBLICATIONS
20 | companion
PETSAVERS
Improving the health of the nations pets
MARATHON EFFORT
had been wondering what to do to pass that
time. However, watching yourself and other
people around you on a big screen, admiring
the fancy dress costumes and enjoying this
remarkable warm sunshine made the time
fly. I had thought I would be nervous but, on
the contrary, I felt pretty relaxed, whether
that was due to the good weather or to
that tiny amount of red wine I had had the
night before the first drop of alcohol for
many months.
Getting off the blocks
I had begun training about eight months
prior, as soon as I knew I had received a
London Marathon place via Petsavers. To be
one of the 35,000 runners who run the
Flora London Marathon each year you can
either enter a lottery system, where you
only hear in December whether you have a
place, or you can run for a charity that has
already organised an entry. Most charities
request that the runner raises a minimum
sponsorship of 1500 and this was indeed
what Petsavers asked me to do (as well as
running the 26 miles!). Raising this amount
of money was somewhat daunting and I
thought the earlier I started, the better.
Show me the money
Anybody who has done something for
charity may by now be shaking his or her
head because, as I found out, people dont
like to give money when the event is still
many months away. It was around
Congress time that I started to panic
because I had only managed to raise the
halfway mark and the Marathon was just
two weeks away.
From the Petsavers stand at the
NIA a campaign was launched, and old
colleagues of mine must have regretted
walking past the Petsavers stand this year.
Then a miracle happened thanks to one
extremely generous donation I was out of
the woods. The pressure of fundraising
now lifted, I was relieved and worried
at the same time: it started to look like
I had no excuse but would actually run
this Marathon.
Mind, body and soles
The commitment of running 26 miles being
made, to become physically fit you first
need to become mentally focussed.
Previously, every day seemed to contain a
mental battle wanting to exercise but
finding other things to do instead. Making
Simone der Weduwen describes the pleasure and pain of
running the London Marathon to raise funds for Petsavers
A
fter months of training in British
winter weather, Sunday 13 April
Marathon day started with
glorious sunshine. I was more prepared
for gale-force winds, rain, hail and even
snow, but not for running under a burning
sun. When I saw people putting on sun
cream I had to admit that my preparations
for race day had lacked this optimism in
the British weather.
Race day nerves
The atmosphere at Greenwich Park was
amazingly relaxed. Due to early roadblocks
most runners are dropped off at least two
hours before the start of the event and I
companion | 21
PETSAVERS
PHOTO COMPETITION
T
he theme for the 2009 Petsavers
photography competition is Pets at
holiday time. This is a great opportunity
for vets and pet owners alike to demonstrate
their amateur camera skills, with great prizes
on offer and a chance to have their work
displayed publicly in the ICC during BSAVA
Congress 2009.
This also provides a great opportunity to
talk to your clients about the work of Petsavers
and how they can get involved.
Further details will be outlined here in
companion, on the Petsavers website, and in
emails over the coming months. If you want to
know more about getting some promotional
material for your practice, email info@
petsavers.org.uk or call 01452 726700. n
the decision to put exercise before other
tasks was an effort in itself, but I knew the
training needed to be done above and
before everything else.
I had done a fair amount of training in
the past, though I knew you will always wish
you had done more. Especially when,
around mile 19, things dont seem to be
going so smoothly anymore and you start to
wonder whether you will ever reach the
finish line. On the day, although the first 12
miles or so had been in glorious sunshine,
this suddenly changed and a cool rain came
down which, at first, was rather nice.
However, when the rain proved
relentless it was a completely different
story. It was then time for the runners to
applaud the people watching, rather than
the other way around. I dont know how I
got through from mile 19 to mile 23, but
that is what the marathon is all about. It is
absolutely crazy to choose to run a distance
of 26 miles, yet with mind over matter we
all got there.
All worthwhile
Never, never, never again goes through your
mind when going over the finish line, but
once you collect your medal and goodie bag
and have limped towards your supporters
to receive their congratulations on your
achievement, the euphoria begins. It wasnt
so bad after all, you tell yourself. Plus,
4 hours 18 minutes is a reasonably good
time for someone in the category of vets!
I would like to thank everybody who
sponsored me, helping to raise around
3000 for Petsavers. Supporting an
important cause isnt always about just
putting your hand in your pocket you
can also put on a running vest. So now
its your turn n
GRANT APPLICATIONS
REMINDER
Applications for Petsavers
grants to be submitted by
1 September 2008
Each year Petsavers awards grants as part
of its commitment to moving veterinary
medicine forward. The results of the
funded research are published in the
Journal of Small Animal Practice and other
channels to ultimately improve the health
of all small animals.
Clinical Research Projects
Qualified veterinary surgeons are invited
to apply for funds to support a clinical
study in small animal pets, the objective of
which is to advance the understanding of
the cause and/or management of a clinical
disorder. The projects should not involve
experimental animals and should further
the knowledge of the small animal
practitioner. Joint applications between
veterinarians in practice and academia are
welcome. Funding is available for grants
between 1,000 and 8,000.
If you are interested in applying,
call Petsavers on 01452 726737 or
email info@petsavers.org.uk for more
information. n
Suprijono Suharjoto | Dreamstime.com
22 | companion
INTERNATIONAL AFFAIRS
INTERNATIONAL
AFFAIRS
SUPPORTING SOUTH AFRICA
ANIMAL HEALTH
STRATEGY
PET PASSPORTS
L
ast year BSAVA Council voted to support a CPD meeting in Malelane, South
Africa, in conjunction with WSAVA. The meeting was held in April at the
Malelane Intervet farm, close to the Mozambique border, and the topic was
Anaesthesia and Pain Control (including the use of local anaesthetic).
The speaker was Dr Kenneth Joubert, a specialist anaesthetist and world class
speaker who works in specialist practices in and around Johannesberg. There were 33
delegates, including 24 from Mozambique, plus local state vets. Evidently a significant
number of vets are unable to attend other CPD events because of cost, and so they
were very appreciative of a free course presented by such an excellent lecturer. n
T
he European Parliaments vote to extend the derogation
(which applies to the UK, Ireland, Sweden, Finland and
Malta) of the Non-Commercial Movement of Pet Animals
Regulation (EC No 998/2003) to 30 June 2010 is good news.
The UKCG needs to make the best use of this extension to
argue our case for making the special arrangements permanent,
and to this end have set up a working group to produce a
position paper and action plan.
UEVP congratulates the Commission of the European
Parliament on producing a concise and well balanced report, but
has several points to make with regard to preventing the spread
of rabies and tick-borne disease to those countries which are
islands, as wildlife cross-border transmission is less likely.
These include insisting on the treatment of animals with a
product containing praziquantel before entry, that the passport
be amended to certify that the veterinary surgeon has
administered the tick and tapeworm treatment, increased
surveillance and data collection on the spread of tick-borne
disease, and the compulsory registration of all microchipped
animals on a central European database. n
T
he EU Animal Health Strategy was established in 2004, and
initially evaluated EU animal health policy from 1995 to 2004.
The Communication on Animal Health Strategy (CAHS) for
20072013 was published on 19 September 2007. In broad terms it
aims to promote animal welfare and health, and thereby prevent the
spread of disease.
The BSAVA International Affairs Committee (IAC ) has
raised concerns that companion animal issues are being dumbed
down in favour of the farm animal side. Both BSAVA and the
Union of European Veterinary Practitioners (UEVP) are keen to get
companion animal issues moved up the agenda and have identified
six areas on which they wish to lobby the Commission, which
include: registration of companion animals moving across borders;
infectious disease surveillance; education on control measures to
prevent the spread of disease; wider acceptance of the European
Convention for the Protection of Pet Animals (including in the UK);
the economic value of pet ownership; and companion animal
representation on the Advisory Committee to the Commission.
For further details on The Communication on Animal Health
Strategy, visit www.defra.gov.uk/animalh/ahws n
Concerns have been raised that companion
animal issues are being dumbed down in
favour of the farm animal approaches
Jo Arthur from BSAVAs International
Affairs Committee reports on the
opportunity to extend the UKs special
arrangements
companion | 23
WSAVA NEWS
ANIMAL WELFARE UPDATE
T
he British Veterinary Association
(BVA) used World Veterinary Day
to showcase the global role of the
veterinary profession in raising standards of
animal welfare by signing up to the
Universal Declaration on Animal Welfare
(UDAW). Further demonstrating its
commitment to animal welfare, the BVA
has also formally supported the UDAW.
The Declaration, which represents the
worlds first international agreement on
animal welfare, is an agreement amongst
people and nations to recognise that
sentient animals are capable of pain and
suffering, deserving consideration and
respect, and calls for effective animal
welfare legislation to be developed and
enforced around the world. It is hoped that
the Declaration will ultimately be adopted
by the United Nations.
Presidential endorsement
BVA President Nick Blayney stated I am
delighted that BVA is supporting this vital
campaign to recognise the responsibilities
that humans have towards the welfare of
sentient animals. I wholeheartedly endorse
the inclusion within the Declaration of the
Five Freedoms as the guiding principles of
animal welfare.
I strongly believe that the veterinary
profession should be part of this important
global initiative, and hope that other
veterinary associations around the world
will sign up to this campaign. I also fully
support the proposal to take the campaign
to the United Nations, and hope that the
Declaration will represent a huge step
forward in gaining international recognition
that animal welfare matters.
Justine Smith, the World Society for
the Protection of Animals (WSPA)
spokesperson for the campaign, said
WSPA is delighted to have BVA backing
for the campaign this will go far in
terms of building recognition for the
UDAW from overseas governments, as
well as in the UK. Vets have a vital role to
play in promoting animal welfare.
Reaching overseas
The BVA Overseas Group, which provides
an essential link between the BVA and
veterinary organisations and individuals
and animal welfare charities across the
developing world, firmly opines that the
profession should play a key role in defining
the future of animal welfare on a global
level by supporting the progress of
UDAW. Speaking on behalf of the Group,
Sean Wensley said Animal welfare is
gaining ever-increasing importance across
the world, and is increasingly being used
as a measure of the social progress of
nations. Over a billion people around the
world rely directly on animals for their
livelihoods as well as for companionship,
and good animal welfare frequently benefits
human welfare.
The veterinary profession is pivotal
in maintaining and restoring the strong
bond that exists between humans and
animals across the world. Wherever
animals are influenced by humans, whether
on farms, in research institutions, in zoos
or in peoples homes, members of the
profession are present to ensure that
animals remain healthy and happy, and
that provision for their good welfare
remains paramount. Veterinarians are also
key contributors to ethical review
processes, speaking with authority and
pragmatism as the animals advocate.
VPAT signs up
The Veterinary Practitioners Association of
Thailand (VPAT) continues to strive to
develop its role in better serving society; in
a step to better fulfil this role, VPAT has
taken the opportunity to help raise
standards of animal welfare by signing up
to the UDAW.
VPAT President, Dr Siraya
Chunekamrai, said I am delighted that
VPAT is supporting the Universal
Declaration on Animal Welfare to
emphasise the responsibilities that
veterinarians have towards the welfare of
sentient animals. The stand generated from
this Declaration is in accordance with the
veterinary professions commitment to be
in stewardship of all animals, and creates a
social impact on the way we as human
beings treat life itself. Consequential to this
BVA and VPAT sign the
Universal Declaration on
Animal Welfare
24 | companion
WSAVA NEWS
ANIMAL WELFARE
UPDATE
WSAVA NEWS WSAVA NEWS
Declaration, the veterinary profession will
be aligned to make this become a society
that respects animal life and life itself.
Saneekan Rosamontri, the WSPA
Regional Programme Manager in Asia for the
UDAW, said WSPA is delighted that VPAT
B
lue Dog is aimed at teaching children
of 37 years of age (and their
parents), to recognise and avoid
potential risk situations when dealing with
their dog at home. It has been developed by
a group of multidisciplinary professionals,
under the umbrella of the Blue Dog Trust.
Its development was prompted by scientific
evidence that most bite injuries occur in
children, usually in their own home, by a
dog that is familiar to them.
Young children are much more likely
to suffer severe injuries to the head and
neck, and a significant number go on to
develop post-traumatic stress disorders. It
has further been shown that many of the
dogchild interactions that trigger the bite
are initiated by the child.
Sadly the problem seems to be getting
worse. In the UK, National Health
statistics reported in 2008 show the
number of people attending Accident and
Emergency Departments following dog
attacks has risen by more than 40%
in the last four years. Despite the
evidence to the contrary, the
reaction of governments is to
put the blame on dangerous breeds and
rely on breed-specific legislation; a strategy
that has been shown to be misguided.
Going global
The English version of Blue Dog was
successfully launched at the 2006 WSAVA/
FECAVA Congress in Prague. Since then,
the parent guide has been translated into
Norwegian, Dutch, Serbian and German,
with the Czech, Polish, Italian, Danish,
American, Flemish and French versions all
due for publication in 2008.
The German version was successfully
launched in November 2007 at the DVG
Congress in Berlin, along with Blue Dog
stickers, balloons and cuddly toys! Thanks
to the enthusiastic efforts of Suzanne
Aldinger, Hildegard Jung and their team, it
has achieved good sales among DVG
members. In the Netherlands, the
programme is managed by the LICG. They
successfully negotiated local government
funding and Leen den Otter presided over a
successful launch in October 2007. Nikoleta
and Denis Novak have worked tirelessly on
the Serbian version, which was launched in
January 2008. The BSAVA has agreed to
distribute Blue Dog within the UK, and
negotiations are in progress with
Veterinary Ireland as to how
best to launch there.
Tiny De Keuster and Ray
Butcher presented an oral
presentation and poster at
the most recent International Association
of Human Animal Interaction Organisations
(IAHAIO) conference in Tokyo in 2007, and
attracted much interest from delegates.
A Japanese version may be the result.
Further developments
The programme is managed by the Blue
Dog Trust, a registered charity which is
committed to reinvest all financial
surpluses achieved from royalty payments
into further research and development
into dog bite prevention issues.
In 2008 the Blue Dog Trust initiated
the production of a promotional DVD,
which can be shown in the waiting rooms
of veterinary clinics; it is also looking
into ways of enhancing the website. In
addition, a new project has been initiated
to investigate ways of developing
resources suitable for getting the message
across in a classroom setting.
The Blue Dog Trust is also supporting
scientific research. Kerstin Meints of the
Child Psychology Department of Lincoln
University (UK) will be investigating how
young children investigate novel situations,
hoping to explain the high incidence of
head and neck bites in young children. The
Trust also hope to initiate some research
into the trigger factors that cause bites in
other cultures, with a view to developing
appropriate educational material. It is
hoped that this will have an impact on
rabies control strategies.
is the first Thai Veterinary Association
backing the UDAW and urges other Asian
veterinary associations to also support the
UDAW officially. It is essential that the
Declaration be supported by the veterinary
profession. Veterinary support of an
international declaration on the sentience of
animals would be an important step towards
building recognition for the UDAW from
Asian governments, as well as in Thailand.
The full UDAW document can be
viewed at www.udaw.org
HELPING PREVENT DOG BITES
Blue Dog is an interactive
CD-ROM with a printed
parent guide, which is
proving a valuable tool in
the prevention of dog bites
companion | 25
WSAVA NEWS
I
n addition to the long-standing WSAVA
Walthams International Award for
Scientific Achievement, the WSAVA
Walthams Service to the Profession
Award, and the WSAVA Hills Excellence in
Veterinary Healthcare Award, two new
WSAVA Awards, will be presented this year.
WSAVA Hills Pet Mobility
Award
This award recognises the outstanding
work of a clinical researcher in the field of
T
he control of free-roaming dog
populations remains a major welfare
issue in many parts of the world.
These dog populations may be associated
with many problems, including:
Direct injury to people, livestock or pets
Indirect injury to people and pets from
road traffic accidents
Source of infection (especially rabies)
Pollution from faeces and urine
General nuisance from noise.
The financial costs involved with these
can be high, and so municipalities have often
turned to mass slaughter as a way of
addressing the problem. Often inhumane
methods are used, which are not only a
welfare problem, alienating many of the
stakeholders, but may also be
indiscriminate, with risks to humans and
their pets. These methods are also
invariably unsuccessful in the medium term.
Strategy framework
Accordingly, in 1990, the World Health
Organisation (WHO) and the World Society
for the Protection of Animals (WSPA)
formulated joint guidelines, which provided a
framework on which a strategy might be
developed. The key elements were:
Legislation
Registration and identification
Garbage control
Neutering of owned and un-owned dogs
Control of breeders and sales outlets
Education.
All of these elements are important,
although the priorities in different situations
may vary. However, it is essential that all the
major stakeholders agree a common
strategy and that population studies are
carried out to help formulate the most
appropriate strategy.
Ray Butcher, Co-Chairman
of the WSAVA Welfare
Committee, outlines the
new guidelines available on
humane stray dog control
Updated guidelines
Much has happened since 1990, and recently
the International Companion Animal
Management (ICAM) Coalition was formed
to share information and ideas on
companion animal population dynamics.
Currently, ICAM is made up of
representatives from WSPA, the Humane
Society International (HSI), the
International Fund for Animal Welfare
(IFAW), the international arm of the Royal
Society for the Protection of Animals
(RSPCA International), the Universities
Federation for Animal Welfare (UFAW),
WSAVA and the Alliance for Rabies
Control (ARC).
In January 2008 ICAM published a
document entitled Humane Dog Population
Management Guidance. This essentially builds
on and replaces the original WHO/WSPA
framework, and is illustrated by a number of
real-life case studies.
The WSAVA Welfare Committee
strongly recommends this to WSAVA
members. The document can be
downloaded from the WSAVA website
(www.wsava.org).
NEW AWARDS FOR DUBLIN
canine and feline orthopaedic medicine and
surgery. Through improvements in the
mobility and quality of life of pets, this
persons research has contributed
significantly to the wellbeing of pets lives
and to the humananimal bond worldwide.
WSAVA Presidents Award
This award will be presented on a time-to-
time basis by the President to a member of
the WSAVA in recognition of the recipients
outstanding contribution to the Association,
as selected by the Executive Board.
These new awards provide two more
reasons to attend the WSAVA World
Congress in Dublin, in addition to the
various extensive continuing education
offerings, dynamic social events and
culturally rich city of Dublin.
For those that have not yet registered,
dont delay as the Congress is only a
month away. For more information,
visit the WSAVA Congress website at
www.wsava2008.com. See you there!


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CONTROL OF
STRAY DOGS
26 | companion
companion INTERVIEW
Julian Hector is editor of the BBC Radio Natural History Unit in Bristol. His father was in
the Colonial Service and Julian was born in Kenya in 1958, the middle one of three
brothers. After independence, the family returned to England. He took a degree in zoology
at the University of Bristol where he stayed on to complete a PhD on the reproductive
endocrinology of albatrosses. He worked for the British Antarctic Survey, Bristol Zoo, the
Wildfowl and Wetlands Trust and in academia before joining the BBC in 1992
THE
companion
INTERVIEW
What exactly does your job involve?
Whatever changes have occurred in the rest
of the BBC, the Natural History department
has always been bi-media. So it produces
both radio and television programmes, and
more recently on-line content. My role is to
develop ideas and obtain commissions for
radio programmes, sold mainly to Radio 4
and some to World Service. I also sit on the
board of the NHU and our job is to stitch
together the different broadcast platforms
a good example of this is the major series
World on the Move which runs to the end of
the year and involves all three elements of
our output.
The units television output is
justifiably famous, its radio less so.
How do you generate an interest in
natural history without using pictures?
Some people do think that natural history
radio is all about sound effects it isnt.
Most of our radio output involves finding
and talking to people, who are specialists in
their subject and passionate about it. We
use them to get as close as possible to the
nature concerned, whether its an ancient
oak tree or a guillemot. That combination
of knowledge and real life experience is
ideal for the sort of story and ideas-led
content that radio is so good at.
What aspect of your broadcasting
career has given you most
satisfaction?
The World on the Move project is probably
the most exciting thing that I have been
involved in. It is doing many things that are
new for natural history radio, beginning
with its sheer size. The commission is for
40 live programmes through the year, when
you would normally expect a commission
for three of four programmes. It also
involves collaborations with research
institutes and NGOs (non-governmental
organisations) to get close to migrating
animals and tell their stories.
Who has been the most inspiring
influence on your career?
One person with extraordinary vision,
determination and passion was the late Sir
Peter Scott, who I knew when I worked for
the Wildfowl Trust. We talked a lot about
conservation and much of what he
predicted in the early 1980s has since been
proved true. Another major influence on
my media career is a field biologist called
Peter Prince, my superior when working for
the BAS on South Georgia. Both of these
people I met very early during my career
and their legacy has been lasting.
Imagine you have been given an
unlimited programme budget, what
would you do with it?
I would like to find a way to bring together
the worlds leading ecologists, the most
important religious and other thinkers,
and the worlds greatest economists to
show how all three can develop a
sustainable approach to the future of
the Earth. I believe that these three
populations of people could work
together to shed new light on our
understanding of the natural world.
If you could change one thing about
your appearance or personality what
would it be?
I hurt my neck when diving during a
filming trip and subsequently I had to go
and see a physiotherapist. He told me
that I have a slightly vulturine posture.
So I guess my answer would be the ability
to stand up straight.
Whats your most important
possession?
My most loved possession is my boat but
my most important is my Breitling watch.
Without a watch I am not very good at
knowing what time of day it is. During my
career I have been on maybe 3000 marine
dives; my watch has been with me every
time and it has helped keep me alive.
What would you have been if you
hadnt been a broadcaster?
I suppose I would have liked to have been
a news journalist. But I also have a boys
own style passion for aeroplanes and boats.
I guess I would have liked to have done
something with one or other of those
probably the boats.
What is the most important lesson
you have learned in life?
I have three children from my first marriage.
The lesson I learned from that period of my
life is that whatever you do, you have to
look after your children.
CPD DIARY
companion | 27
5
October
Sunday
Practical dentistry
Speaker Norman Johnstone
Day meeting at the Dunkeld House
Hotel, Dunkeld. Scottish Region.
Details from Susan Macaldowie,
telephone 07711 633698,
email smacaldowie@btinternet.com
8
October
Wednesday
Feline chronic
gingivostomatitis
Speaker Diane Addie
Evening meeting at IDEXX, Wetherby.
North East Region.
Details from Karen Goff,
telephone 01943 462726,
email northeastregion@bsava.com
8
October
Wednesday
Geriatrics
Speaker Stijn Niesson
Evening meeting at The Holiday Inn,
Haydock. North West Region.
Details from Simone der Weduwen,
email beestenhof@ntlworld.com
10
September
Wednesday
Oncology in practice
Speaker Rob Harper
Evening meeting at Park Inn, Cardiff.
South Wales Region.
Details from Susanna Brown,
email southwalesregion@bsava.com
13
September
Saturday
Annual Dinner at
Horncliffe Mansion
North West Region.
Details from Simone der Weduwen,
email beestenhof@ntlworld.com
14
September
Sunday
Fracture management
Speaker Andy Torrington
Day meeting at Normanton Golf Club,
Wakefield. North East Region.
Details from Karen Goff,
telephone 01943 462726,
email northeastregion@bsava.com
16
September
Tuesday
Infectious diseases in
neonates
Speaker Susan Dawson
Evening meeting at Corus Hotel,
Romsey. Southern Region.
Details from Michelle Stead,
telephone 01722 321185,
email mmstead@btinternet.com
18
September
Thursday
Clinical pathology in practice
Speaker Tim Jagger
Evening meeting at LA Lecture Theatre,
Royal (Dick) School of Veterinary
Studies, Edinburgh. Scottish Region.
Details from Susan Macaldowie,
telephone 07711 633698, email
smacaldowie@btinternet.com
CPD
DIARY
21
September
Sunday
Case-based endocrinology
Speakers Grant Petrie and Lucy Davison
Day meeting at The Cambridge Belfry,
Cambridge. East Anglia Region.
Details from Gerry Polton,
email eastanglia.region@bsava.com
23
September
Tuesday
Kidney disease
Speaker Hattie Syme
Day meeting (modular course) at BSAVA
HQ, Gloucester. Organised by BSAVA.
Details from BSAVA Customer Services,
telephone 01452 726700,
email customerservices@bsava.com
22
October
Wednesday
Heart murmurs in cats
Speaker Adrian Boswood
Evening meeting at Corus Hotel,
Romsey. Southern Region.
Details from Michelle Stead,
telephone 01722 321185,
email mmstead@btinternet.com
14
October
Tuesday
Immune-mediated disease
Speaker Sheena Warman
Afternoon meeting at Park Inn, Cardiff.
South Wales Region.
Details from Craig Connolly,
email southwalesregion@bsava.com
15
October
Wednesday
Wildlife and exotic
emergencies
Speakers Anna Meredith and
Sharon Redrobe
Day meeting at Hilton, Bromsgrove.
Organised by BSAVA.
Details from BSAVA Customer Service,
telephone 01452 726700,
email customerservices@bsava.com
22
October
Wednesday
Current feline issues
Speakers Rachel Dean and Sheila Wills
Day event at Janson Laboratories, High
Wycombe. Metropolitan Region.
Details from Allison van Gelderen, email
allivetuk@yahoo.co.uk
23
October
Thursday
Small animal dispensing
course
Speakers Phil Sketchley, Steve Dean, John
Hird, Fred Nind and Peter Gripper
Day meeting at Basingstoke Country
Hotel, Basingstoke. Organised by BSAVA.
Details from BSAVA Customer Service,
telephone 01452 726700,
email customerservices@bsava.com
24
September
Wednesday
SA endocrinology I
Speaker Peter Graham
Day meeting (modular course) at BSAVA
HQ, Gloucester. Organised by BSAVA.
Details from BSAVA Customer Services,
telephone 01452 726700,
email customerservices@bsava.com
2527
September
ThursdaySaturday
BVA Congress
Speakers Gary Clayton Jones and
Peter Bedford
2-day meeting at the Royal College of
Physicians, London. Metropolitan Region.
Details from Pedro Martin Bartolome,
email pmbartolome@googlemail.com
BSAVA CPD
For more information or to book please contact Customer Services
on 01452 726700 or email customerservices@bsava.com
or visit www.bsava.com
Small Animal Dispensing Course
Date: Thursday 23 October
Speakers: Fred Nind
John Hird
Peter Gripper
Steve Dean
Philip Sketchley
Venue: Basingstoke Country Hotel
Course Fees: BSAVA Members: 176.00 + VAT (206.80 inc. VAT)
Non Members: 236.00 + VAT (277.30 inc. VAT)
Wildlife and Exotic Emergencies
for Vets and Veterinary Nurses
Date: Wednesday 15 October
Speakers: Anna Meredith
& Sharon Redrobe
Venue: Hilton, Bromsgrove
Course Fees: 140.00 + VAT (164.50 inc VAT)
Urinary Tract I
Kidney disease in the dog and cat
Date: Tuesday 23 September
Speaker: Hattie Syme
Venue: Woodrow House, Gloucester
Course Fees: BSAVA Members: 161.70 + VAT (190.00 inc. VAT)
Non Members: 315.00 + VAT (370.13 inc. VAT)
Urinary Tract II
Lower urinary tract diseases in the dog and cat
Date: Tuesday 28 October
Speaker: Hattie Syme
Venue: Woodrow House, Gloucester
Course Fees: BSAVA Members: 161.70 + VAT (190.00 inc. VAT)
Non Members: 315.00 + VAT (370.13 inc. VAT)
Sponsored by Axiom
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