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The essential publication for BSAVA members

companion
JUNE 2011
RSPCA
Memorandum of
Understanding
P4
Clinical Conundrum
Multiple cutaneous
masses
P8
How To
get the best from
liver samples
P14
Focus on feline
ophthalmology
01 OFC.indd 1 19/05/2011 11:42
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companion is published monthly by the British Small
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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 Grant Petrie MA VetMB CertSAC CertSAM 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
Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS
Features Editorial Team
Caroline Bower BVM&S MRCVS
Andrew Fullerton BVSc (Hons) MRCVS
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3 Super Scottish Congress
Update on the 26th Annual BSAVA Scottish Congress
47 Understanding the Memorandum
How can the profession work with the RSPCA more
effectively?
811 Clinical Conundrum
Consider an unusual case of multiple cutaneous masses
1213 Publications
Updating the nursing classic
1418 How To
Get the best from liver samples
1920 CPD
Taking a better look focus on ophthalmology
21 Petsavers
Latest fundraising news
2223 BVA Congress
BSAVA small animal programme
24 Publications
Medicines information: client leaflets
2527 WSAVA News
The World Small Animal Veterinary Association
2829 The companion Interview
Dr Clare Rusbridge
30 Meet Your Region
Spotlight on Scottish Region
31 CPD Diary
Whats on in your area
Additional stock photography Dreamstime.com
Cleo; Dink101; Evangelos Thomaidis; Indigofish; Lian Deng; Sean Gladwell
B
SAVAs scientific journal, the Journal of Small Animal
Practice, celebrated its 50th Anniversary not so long
ago. So we felt it was time we got to know your
thoughts on both JSAP and companion. How does JSAP fit in
with your information requirements? Wed like to know how you
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and why? And for companion we want to know which bits
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Congress
H
aving changed the timing into
the summer and moved the
location to the beautiful city of
Edinburgh, BSAVA Scottish Congress has
a renewed position in the veterinary CPD
calendar, and now has the kind of
unrivalled social, exhibition and,
importantly, science programme that
makes it an extremely attractive way to
spend your CPD budget.
The overall aim of Scottish Congress
is to provide top-quality CPD, accessible
to vets and nurses from Scotland and
even further afield. We are proud to
welcome delegates from all regions,
as well as from every veterinary career
path, to join us in celebrating our
profession and to keep abreast of
advances in an ever-changing clinical
world. Scottish Congress is the highlight in
the calendar for the Scottish Region of
BSAVA, and we want to see as many
people join us as possible to have a
weekend full of learning, socialising and
meeting friends and faces we may not
have seen since the same time last year,
says the regions Chairman Ross Allan.
Where, when and what
Delegates gave superb feedback on the
Edinburgh Conference Centre (ECC) last
year so we are going back again. As ever
the gala dinner will be on the Saturday
night, and this years amazing venue is the
Corn Exchange. Our theme this year is
based on the popular kids cartoon
character Bob the Builder Can we fix it?
Together we can! We will be looking at the
many aspects of what is new in veterinary
thinking, with a bias this year toward
treatment and care of older pets. That
particular category represents the majority
of patients that we all see on a daily basis.
Saturday and Sunday are split into
lectures in the mornings and seminars in
the afternoons, with plenty of time built in for
visiting the exhibition. Our keynote speakers
for the Nursing Stream include Emma
Super Scottish
Congress
SCOTTISH CONGRESS
The 26th Annual BSAVA Scottish Congress takes
place in Edinburgh from 2628 August and has a
programme worth travelling North for
Keeble who will be speaking to delegates
about exotic animals and wildlife, and
Samantha Lindley who will give an overview
of rehabilitation, pain management and
hydrotherapy. For the vets we have called
upon Norman Johnson to take us through
dentistry in practice, and Angie Hibbert will
be speaking on feline geriatric medicine,
including renal disease, hypertension and
osteoarthritis management.
The event will also feature a case
presentation competition for vets and
nurses to present the interesting and
unusual cases they have seen in the
past 12 months to an audience of their
peers. The deadline for submitting a
potential case is 15 June (see the website
for details).
For more information about the
science, the social and the exhibition, or
for details about location and
accommodation visit www.bsava.com/
scottishcongress or email
b.dales@bsava.com.
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MEMORANDUM
Discussions are planned between the RSPCA
and BVA on updating the Memorandum of
Understanding between the charity and private
practitioners, designed to ensure that
professional treatment is available for all sick
and injured animals. First signed in 1939, the
agreement has not been looked at since 2006
and now needs urgent attention as some
believe the relationship between the two sides
is in poor health and could even be starting to
break down. John Bonner reports
I
t is better to give than to receive especially when it
comes to a clinical examination. However, North
Wales practitioner Evelyn Barbour-Hill found himself
on the receiving end when he rang the RSPCA national
call centre to obtain the log number he would need to
be reimbursed for the treatment of a stray cat brought
in with a bad eye injury.
After being given what he says seemed like a
clinical examination on his plans for dealing with the
case, he was told that the charity would refund him the
cost of the drugs to be used in treating or euthanasing
the unfortunate animal but not for his time spent in
dealing with the case.
The following conversation, he recalls, went
something like this:
E.B-H: I think you are misinterpreting the rules
RSPCA: No, I have been doing this telephone job
for a year and that is how I have been trained. Any of
my colleagues would tell you the same
E.B-H: You mean, if I were presented with a cat
with a broken leg, and I splinted the leg thus stabilising
its condition and relieving pain, and also gave a
pounds worth of analgesic drug, RSPCA would only
pay a pound?
RSPCA: Yes, that would be the payment.
As the discussion went on, the exchanges became
increasingly ill-tempered, concluding with a stern
Understanding
the Memorandum
Understanding
MEMORANDUM
04-07 RSPCA.indd 4 19/05/2011 11:46
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MEMORANDUM
THE MoU STATES THE
FOLLOWING:
The RSPCA is willing to financially assist veterinary
surgeons in their initial emergency treatment or
euthanasia of emergency cases, as well as the
reasonable cost of a visit to the scene of an
accident where the owner of the animal is unknown
and the case has been referred to the veterinary
practice by the public or if it is a wild animal.
Small wild animals and birds should be
treated free of charge if brought to the surgery
during normal practice hours but a reasonable fee
can be charged for a visit to an accident or as an
out-of-hours surcharge.
The practice must inform the National Call
Centre of the IET or euthanasia as soon as
practicable and before any further treatment is
undertaken. The NCC will issue a log number which
must be quoted in all correspondence, including
the detailed invoice which should be sent by the
practice to the relevant regional headquarters.
The RSPCA will contribute a maximum of 60*
towards the provision of emergency care, as
deemed necessary by the veterinary surgeon. But
only in exceptional cases should the IET include
procedures such as X-rays, etc. Such procedures
should be discussed and agreed with staff of the
regional headquarters.
It is the RSPCAs intention that the veterinary
surgeon be paid their expenses and a reasonable
fee for their time in the circumstances, but equally
the RSPCA trusts that the fees rendered will be
reasonable and subject to any discount agreed
between the RSPCA or branch and veterinary
surgeon from time to time.
The RSPCA accepts that it will often be the
case that any fees paid constitute a contribution to
costs rather than full reimbursement and
acknowledges the partnership in welfare shared
with members of the veterinary profession.
*The memorandum notes that this sum should be
reviewed every three years to take account of retail price
index inflation and a revised sum agreed.
admonition from the call centre operator to the effect
that he would be marking the case record drugs only.
A wider problem?
As a senior practitioner with nearly 40 years
experience, Mr Barbour-Hill says, I was very surprised
to be spoken to in that way. He started a thread on the
VeterinarySurgeon.org online discussion group, asking
if any colleagues had experienced similar difficulties in
their dealings with the call centre staff. The response
revealed that there is a groundswell of resentment
among practitioners over the way that the RSPCA has
been handling emergency treatment for wildlife
casualties and injured strays.
Andrew Mellor from Blackpool believes the situation
began to change around a year ago. He says it is not
unusual now to be told that the practice will only receive
payment for drugs at cost price with no injection fees,
call out or consultation fees. There is a lot of bad
feeling out there. We share on-call with another practice
and have even discussed stopping doing any more
RSPCA work. Of course that is not really possible; we
have a professional duty to relieve pain in all
emergency cases and so we have to uphold our side of
the bargain. But who exactly is the charity here?
Initial Emergency Treatment
Messrs Mellor, Barbour-Hill and other contributors to
the online debate all stress that they enjoy cordial
relations with their local RSPCA branches, their only
gripe is with the national organisation. The local groups
and national RSPCA are run as separate charities and
one of the reasons for having the Memorandum of
Understanding (MoU) in place is to ensure clarity for
those dealing with this complicated and potentially
confusing arrangement. The MoU covers various
aspects of the working relationship between
practitioners and the society at both local and national
level. But it is the section on Initial Emergency
Treatment (IET) which has generated the controversy.
From the wording of the MoU, it is clear that the
call centre operative that Mr Barbour-Hill encountered
was mistaken in his belief that IET payments do not
cover professional fees. Yet was that the result of a
genuine misunderstanding or does the RSPCA want to
scrap the agreement?
04-07 RSPCA.indd 5 19/05/2011 11:46
MEMORANDUM
Understanding the Memorandum
RSPCA and the Profession
BVA President Mr Harvey Locke says the
Associations officers have met their counterparts at
the RSPCA to discuss these problems and have been
assured that there is no intention of the latter
withdrawing from the arrangement. But it is clear that
the charity is equally concerned about the way that
the IET procedures are followed.
RSPCA spokesman Andy Robbins says that the
national charity is currently spending about 2 million
a year to support the scheme and that over recent
years these costs appear to have been rising at
above the rate of inflation. He points out that, in
addition, the charitys local branches will often take
responsibility for supporting the costs of further
ongoing treatment.
Mr Robbins also states that some practitioners
seem not to realise that the sum of 60 stated in the
current agreement is a maximum and not a flat rate
fee. So the RSPCAs national control centre is now
asking vets about the treatment provided and what the
costs were when they call, and agreeing the payment
on the telephone at that point.
This figure is then added to our incident log so
that our regional finance departments can see the
agreed price and pay only what has been agreed, he
explained. We understand the financial pressures
faced by practices but, in the face of difficult economic
conditions, the RSPCA needs to be careful how our
finite resources are spent.
However, the problems encountered by Mr
Barbour-Hill are not unique. So is the charity
encouraging its call centre staff to test the limits of the
current agreement in an effort to constrain the costs of
IET? Some practitioners may feel that the present
problems may be the result of a deliberate instruction
by the charity; although another explanation is that its
an old-fashioned cock-up.
The people manning the national call centre are
not RSPCA staff but are employed by a private
company, Ventura, which provides the charity with the
24/7 service that it needs. While they do receive some
training, they are not animal welfare specialists, as the
company provides a similar service for a range of
other clients in different sectors.
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MEMORANDUM
but with the great majority in the
middle on both sides, they do
realise the importance of keeping a
good working relationship
MEMORANDUM
Consultation fees
Much of the current tension appears to have been
produced by a simple misunderstanding about what
vets mean by a consultation fee. Those call centre staff
had been told by the RSPCA that a consultation can
only be carried out with the animals owner, since it
should involve history taking and a discussion of the
prognosis. The charity prefers the term clinical
assessment where the main goal is to work out the
immediate treatment needed to relieve suffering.
However, staff at the national call centre have now
been told that the two phrases can be used to
describe the same thing and hopefully any confusion
has been cleared up, said Mr Robbins.
Difficult times
While the RSPCA is recognised as one of the wealthiest
charities in the UK, it is not immune from the effects of
the current recession and many local branches have
struggled to cope with the effects of both a reduction in
income and, in some areas, a shortage of willing
volunteers. The consequence has been a number of
closures and mergers between local groups, which
can have knock-on effects for practices like Andrew
Mellors which find much of their kennel space filled
with welfare charity cases with nowhere to go.
All change
Although the profession and the RSPCA are
supposed to meet regularly to update the document,
there is little incentive to re-open discussions when it
is operating relatively smoothly and this was
certainly the case when the economy was more
buoyant. However, the current difficulties have
convinced both parties that it needs urgent revision
and their representatives will be going through the text
line by line this summer, Mr Locke explained.
Indeed, the BVA and RSPCA were already
planning to look at the agreement in the light of
changes introduced last September to the latters
policy on the use of pentobarbital for euthanasing
animals injured in road traffic accidents. The RSPCA
realised that the permission granted long ago by the
Home Office for its non-veterinary field staff to use the
drug could be challenged under current legislation.
This was another reason for taking the MoU off the
shelf and dusting it down. There was concern that the
changes could put more pressure on practices by
having to call out veterinary staff to the scene of the
accident. So far we havent had any complaints from
our members and we are hoping that it may not be so
much of an issue, Mr Locke notes.
Typically, RSPCA field officers were having to use
the drug on around 500 such animals a year and if
those incidents were spread evenly around the country
that would mean that a practice would experience a
call out less than once a year. But it is possible that a
disproportionate number of those cases may occur
within the catchment area of a relatively small number
of practices, and so far the BVAs optimistic attitude
has not been tested over a full year, in which there can
be considerable month-to-month variation in risk.
More cooperation
BSAVA President Andrew Ash believes that whilst there
is a general consensus that the current system has its
limitations, it is essential that the profession finds a way
of working alongside the RSPCA. He says, The
existing scheme continues to generate some difficulty
for many practices and a review would certainly be an
advantage. However every vet will want to contribute to
the welfare of any animal and will see the benefit of a
productive and mutual relationship, not only with the
RSPCA but with the other rescue centres in their area.
We should all be working towards a more effective and
transparent relationship.
Mr Locke says the BVA is keen to see the
agreement updated to re-establish more satisfactory
contacts between two groups whose common
interests greatly outweigh their differences. The charity
has been a valuable ally for the profession in lobbying
for a number of important initiatives covering wild,
laboratory and farm animals, as well as pets.
Once the agreement has been clarified, the two
sides can resume having effective cooperation on
welfare issues at both a local and national level. There
will always be some members of the profession who
think that the RSPCA are failing in their responsibilities
just, as some RSPCA people, I am sure, may think we
are too interested in our fees, says Harvey Locke.
But with the great majority in the middle on both
sides, they do realise the importance of keeping a
good working relationship.
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CLINICAL CONUNDRUM
Clinical
conundrum
Mat Hennessey of the Nantwich Veterinary
Group and Elizabeth Villiers of Dick White
Referrals invite companion readers to
consider an unusual case of multiple
cutaneous masses
Case presentation
A one-year-old male entire Border Collie presented with a 24-hour
history of lethargy and numerous cutaneous lumps covering his
body.
The dog had been seen on two previous occasions, 5 and 6
months previously. On the first occasion the owners had noticed
peripheral lymphadenopathy, the dog was clinically well and the
lymphadenopathy resolved spontaneously over a 7-day period. On
the second occasion the dog was presented again with
lymphadenopathy as well as marked conjunctivitis. Fine-needle
aspirates of the popliteal lymph nodes were taken and were
consistent with reactive lymphadenopathy and mild lymphadenitis.
After the conjunctivitis failed to respond to topical ocular
medication, a biopsy of the conjunctiva was taken and
histopathology was consistent with nodular granulomatous
episcleritis. The lymphadenopathy resolved spontaneously as it had
done previously. Similarly the episcleritis resolved following a short
course of topical steroid.
Outline your broad differentials for the
problems identified
Cutaneous nodules
Inflammatory
Infectious (generalised bacterial furunculosis
syndromes, subcutaneous and deep bacterial
and fungal infections, mycobacterial skin
disease, demodicosis)
Sterile (urticaria, sterile granuloma/pyogranuloma
syndrome, sterile panniculitis, reactive
histocytosis, eosinophilic granulomas, dermal
calcium deposition)
Neoplastic (intracutaneous cornifying epithelioma,
histiocytoma, cutaneous lymphoma, mast cell
tumour, metastatic disease)
Pyrexia
Infectious: bacterial (e.g. pyelonephritis,
discospondylitis); viral (e.g. distemper); protozoal
(e.g. Neospora, Toxoplasma); fungal (e.g.
aspergillosis); parasitic (e.g. Angiostrongylus
vasorum)
Immune-mediated (e.g. meningitis/
meningioencephalitis, polyarthritis, vasculitis)
Neoplasia (e.g. haemangiosarcoma, lymphoma,
leukaemia, malignant histiocytosis)
Non-septic inflammation (e.g. pancreatitis)
Idiopathic pyrexia
Physical examination
The dog was very bright and in good body condition
(BCS 2.5/5). Rectal temperature was elevated at
39.5C. Numerous small, firm, hairless, pink cutaneous
nodules were present over the thorax and abdomen
(Figure 1). Peripheral lymphadenopathy was present,
with the popliteal lymph nodes being most prominent.
Based on the information so far
assimilate your problem list
Cutaneous nodules
Pyrexia
Lymphadenopathy
Lethargy (considered to be secondary to the other
problems)
Figure 1: Firm hairless pink cutaneous nodules on
thorax and abdomen
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CLINICAL CONUNDRUM
Lymphadenopathy
Reactive
Lymphadenitis
Neoplasia (lymphoma, metastatic)
Based on the information presented so
far which of your differentials are more
likely and why?
Given the acute onset of pyrexia, lymphadenopathy
and numerous cutaneous nodules, it is reasonable
to assume all are related and to problem-solve for
a common cause. All these signs could be the
result of a number of inflammatory, infectious or
neoplastic diseases.
Cutaneous nodules caused by infectious diseases,
may bear draining sinuses (which are not present in
this case). Furthermore, such conditions usually have a
chronic course.
Neoplastic disease is less likely given the young
age of the patient but notably histocytomas are
seen in young dogs (< 4 years). These tumours are
usually solitary but occasionally individuals bear
multiple lesions.
The pyrexia, acute onset and smooth appearance
of the cutaneous nodules make an immune-mediated
or inflammatory cause of disease most likely. Urticarial
reactions could cause similar looking lesions but these
are not usually associated with lymphadenopathy and
there may be a noted inciting event. Finally, the history
of a waxing and waning lymphadenopathy is more
consistent with an inflammatory aetiology.
How would you investigate this case?
Justify your approach
Investigation was focused on the cutaneous nodules
and lympadenopathy, as this was felt most likely to
yield information leading to a specific diagnosis.
Fine-needle aspirates of the cutaneous lesions and
popliteal lymph nodes were taken for cytological
examination to determine whether the nodules were
inflammatory, infectious or neoplastic in origin.
A complete blood count, serum biochemistry, and
urinalysis (cystocentesis sample) were performed as a
minimum database. These were performed to assess
for haematological changes consistent with an
inflammatory, infectious or neoplastic process.
Furthermore, occult causes of pyrexia (e.g.
pyelonephritis) and paraneoplastic syndromes
(e.g. hypercalcaemia, hypergammaglobulinaemia)
could be identified. Urine culture was performed to
check for an occult UTI.
Initial findings
The CBC, serum biochemistry and urinalysis were
unremarkable.
Cytology of the aspirates of the lymph node is
shown in Figures 2 and 3. Cytology of the skin masses
produced a similar picture.
Figure 2: Cytology of lymph node aspirate (X50)
Figure 3: Cytology of lymph node aspirate (X100)
08-11 Clinical Conundrum.indd 9 19/05/2011 11:38
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CLINICAL CONUNDRUM
Clinical conundrum
Is the cytology consistent with
inflammatory, infectious or neoplastic
disease?
The lymph node aspirates showed a very mixed
population of lymphoid cells, with approximately 60%
small lymphocytes and 40% lymphoblasts as well as
small numbers of plasma cells. There were also
significant numbers of histiocytic cells. These are
large round cells with a large round nucleus and
abundant light-staining cytoplasm (arrowed). The
nuclei contain finely, or sometimes coarsely, stippled
chromatin and occasionally have a single nucleolus.
The cytoplasm sometimes contains phagocytosed
cellular debris, but intracellular organisms were not
observed. There were small to moderate numbers of
non-degenerate neutrophils. Fungal elements were
not observed.
The mixed population of lymphocytes is consistent
with a reactive lymph node. Infectious organisms and
degenerate neutrophils were not present, which makes
an infectious cause less likely, although this does not
completely exclude it. The infiltration of well
differentiated histiocytic cells is consistent with
histiocytic disease. Other differential diagnoses
include steroid-responsive granulomatous
lymphadenitis or lymphadenopathy associated with
underlying infection, such as fungal disease or
bartonellosis.
Histocytic disease of dogs can be broadly
subdivided into two categories.
Inflammatory (Reactive)
1. Cutaneous histiocytosis single or multiple
waxing and waning cutaneous lesions without
spread of histiocytes beyond the draining
lymph node.
2. Systemic histiocytosis skin lesions as in
cutaneous histiocytosis but lymph nodes and
mucous membranes including nasal and
ocular mucosa are often involved and
histiocytic infiltration of body organs occurs.
Neoplastic
1. Canine cutaneous histiocytoma benign
spontaneously regressing tumour of
young dogs.
2. Langerhans cell histiocytosis Multiple
cutaneous lesions histologically identical to
canine cutaneous histocytoma. However, unlike
histiocytoma, rapid systemic metastasis
occurs. Very rare.
3. Histiocytic sarcoma and disseminated
histiocytic sarcoma (malignant histiocytosis)
solitary or disseminated disease caused by
malignant histiocytes which may present as a
subcutaneous mass, splenic mass or multiple
infiltrates in internal lymph nodes, spleen, liver,
lung and bone marrow. Cutaneous involvement
is uncommon but can occasionally accompany
infiltrates in these other sites.
In this case the histiocytic cells do not exhibit
criteria of malignancy, although cells in histiocytic
sarcoma complex can sometimes appear cytologically
bland and malignant disease cannot be excluded on
the basis of a single cytological examination. However
the breed, normal haemogram, serum biochemistry
and extensive cutaneous lesions make malignant
histiocytosis unlikely. Similarly histocytoma is rarely
multiple and has very rarely been documented
spreading to the lymph node. Since no infectious
agents have been identified, an infectious cause is
considered unlikely although not entirely excluded.
Systemic histiocytosis is considered the most likely
differential diagnoses.
How would you further investigate the
extent of disease?
Survey imaging of the thorax and abdomen was
performed to check for systemic organ involvement.
Thoracic and abdominal radiographs were taken
under general anaesthesia (to allow inflated views of
the thorax to be taken). The thoracic radiographs were
unremarkable and abdominal radiographs revealed a
prominent splenic silhouette with an irregular border.
Abdominal ultrasonography was performed (Figure 4).
How do you interpret these findings?
The ultrasound examination revealed the splenic
parenchyma to be diffusely patchy with a mixed
echogenicity, and there was enlargement of the medial
iliac lymph nodes.
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CLINICAL CONUNDRUM
Fine-needle aspirates of the spleen were obtained
using ultrasound guidance.
Cytology of the splenic aspirates showed results
similar to the samples taken from the skin lesions and
lymph nodes, with a mixed population of lymphoid
cells and well differentiated histiocytes.
Can a diagnosis be reached at this
stage?
A tentative diagnosis of systemic histiocytosis was
made based on the presence of well differentiated
histiocytes in the cutaneous, lymph node and
splenic aspirates.
Do any further tests need to be
completed at this stage?
Definitive diagnosis requires histopathology, and a
popliteal lymph node was excised and submitted.
Given that systemic histiocytosis has occasionally
been found associated with fungal or Bartonella
infection, blood samples were submitted for Bartonella
PCR, and fungal stains (PAS and ZiehlNeelsen) were
requested along with the histology of the lymph node.
The Bartonella PCR was negative and the histology
also negative for the presence of fungal organisms
and acid-fast bacteria.
To distinguish systemic histiocytosis definitively
from Langerhans cell histiocytosis and histiocytic
sarcoma, extensive immunohistochemical analysis is
required (performed at the University of California,
Davis). Since Langerhans histiocytosis is so rare,
because mucosal involvement was present which is
typical of systemic histiocytosis, and because of
financial constraints, immunohistochemistry was
not performed.
In light of this diagnosis, comment on the
dogs previous history
It is likely that the initial episodes of lymphadenopathy
and nodular granulomatous episcleritis were early
manifestations of the histiocytic disease process.
How would you treat this case?
Some cases of reactive histiocytosis will wax and
wane, even spontaneously regress, and may not
Figure 4: Ultrasound image of the spleen
require treatment. However, typically, systemic
histiocytosis is progressive and in patients with
persistent clinical signs, immunosuppressive therapy
is needed. Immunosuppressive doses of
corticosteroids are occasionally effective but most
dogs require other immunosuppressive drugs.
Ciclosporin A or leflunomide have been shown to be
particularly effective and both drugs are potent
suppressors of T cell activation. Given the expense
and potential adverse effects of these drugs, trial
treatment with corticosteroids is always justified.
Outcome
The dog was monitored for signs of spontaneous
regression over the following 7 days, during which time
his body temperature remained elevated and his
appetite had started to wane. Immunosuppressive
therapy was initiated with prednisolone at 2 mg/kg
q12h with concurrent gastroprotective treatment
(cimitidine and sucralfate).
After 24 hours of treatment pyrexia had
resolved, and during the following 14 days the
lymph nodes returned to normal size and the skin
lesions resolved.
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PUBLICATIONS
E
arly in the writing of this new edition the RCVS
released the latest syllabus for veterinary nurse
training, which saw the biggest changes in VN
teaching for many years. The syllabus now has core
units that require trainee veterinary nurses to learn
about a wider range of animals at a more basic level
before specializing in their chosen pathway, e.g. small
animal. Most notably, this involved the inclusion of
horses and other equine species at core unit level.
Integrated learning
Rather than just add in extra chapters on horses, the
Editors have sought to incorporate the new content
within the existing chapter framework, allowing
comparative learning and reflecting modern teaching.
Many chapters therefore now cover dogs and cats,
horses (and donkeys) and the common exotic pets
(small mammals, birds and reptiles), within an
integrated whole.
The addition of a specialist equine Consulting
Editor (Professor Tim Greet from Newmarket) and
authors that work primarily in equine nursing, has
ensured that this new content is as accurate and up to
date as possible. Fortunately, all three of our main
Editors have also either worked in mixed practice or
own horses themselves as does our freelance
illustrator so we have expertise throughout the
team, although it has been a challenge for some to
remember all they might once have known about
horses. For our copy-editors at Woodrow House,
usually fluent in the language of BSAVA Manuals, it
has also been a steep learning curve, but they are
now conversant with terms such as quidding, frogs
(a whole new meaning!) and clinches.
Updating the
nursing classic
Rising to the equine challenge
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The BSAVA Textbook of
Veterinary Nursing (formerly
Joness Animal Nursing)
remains the core textbook for
veterinary nursing students
and throughout its many
editions has always adapted
to reflect the changes in
requirements for VN training
and qualifications. The fifth
edition, to be published in
Autumn 2011, is no exception
but has provided the editors
and authors with some new
challenges
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PUBLICATIONS
Complete coverage
The intention was to provide complete coverage of the
syllabus for those training to be small animal veterinary
nurses. However, it soon became obvious that the
inclusion of horses and their cohorts was at a level that
required equine content through a whole range of
subjects, including anatomy and physiology, animal
management and handling, laboratory medicine,
anaesthesia, diagnostic imaging, and reproduction.
The finished product therefore will be essential reading
for all those training to be veterinary nurses, whether
equine or small animal. The addition of the new
material has not been at the expense of ensuring that
the small animal content is up to date and of a level
that reflects the ongoing development of small animal
practice. The only question is how big a bag the
student nurses will need to take this book to college!
Health and safety
With the inclusion of all things equine, important new
topics include how to safely achieve the following:
Putting on a bridle with a bit
Twitching (nothing to do with birds apparently)
Grooming/bathing a horse
Removing a horses shoe
Safe management of horses for anaesthesia
and surgery.
H&S is, of course, not just important around
horses. Safety considerations for other animals,
including awareness of aggressive behaviour and
infectious zoonoses, are considered throughout. There
is a new special emphasis on MRSA and associated
relevant hygiene measures, and incorporation of the
new BVA/BSAVA/GVS waste management regulations.
As the legislation in the area of Health and Safety
evolves continuously, the reader is also referred to
useful websites where the latest information can be
found, not forgetting the BSAVAs own website.
Nursing models and care plans
Alongside the increasing development of the
professional role of veterinary nurses, there has been
an emphasis on the importance of developing
up-to-date evidence-based nursing practice through
the implementation of care plans. These allow nursing
care to be systematically planned and delivered by
nurses, with effectiveness of care being evaluated by
the whole veterinary team. In this new edition, the
information has been expanded and widened into a
stand-alone chapter. The nursing process and a range
of nursing models are described, with case examples
given for dogs, cats, horses and rabbits.
The role of the veterinary nurse
Since the last edition of Joness the nursing profession
has advanced its own professional status, with the
designation of Registered Veterinary Nurse and a new
Guide to Professional Conduct. These changes are
reflected in revised coverage of legal and professional
responsibilities, and an updated discussion of the
application of ethics within veterinary nursing.
Ultimately, getting these things right is about
having a good education in the first place, and there is
no doubt that the new edition of Joness will
contribute to this.
Main picture:
Svetlana Mihailova;
Dreamstime.com
All other pictures
reproduced from BSAVA
Textbook of Veterinary
Nursing, 5th edition
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HOW TO
How to
Get the best from
liver samples
Susana Silva of Great Western Referrals
guides us through the selection of
appropriate techniques to achieve
diagnostic liver biopsies
T
he diagnosis of most hepatic diseases relies on
histopathological examination of a liver biopsy
sample. However, biopsy comes at the end of a
diagnostic pathway which includes a complete history,
clinical examination, clinicopathological data and
imaging such as ultrasonography.
Examination of liver samples is needed to achieve
a gold standard diagnosis, to direct therapy and to
offer prognostic information. However it is important to
remember that liver biopsy will produce only a small
sample of the liver tissue as a whole and as such
might not be a representative sample of ongoing
pathology. Although in most cases biopsy is required
to achieve a diagnosis, in some cases it is possible to
obtain sufficient information by less invasive methods
such as cytology.
To avoid frustration for clinicians and inappropriate
expectations from the owners, it is very important to
understand the indications, limitations and possible
complications associated with each specific
technique of sampling hepatic tissue.
When to consider sampling the liver
Potential situations in which obtaining hepatic tissue
should be considered are:
Evidence of hepatic dysfunction, such as elevated
bile acids or jaundice of hepatic origin
Diffuse changes in echogenicity on
ultrasonography
Discrete hepatic lesions
Hepatomegaly of undetermined cause
Persistently elevated liver enzymes without a
detectable inciting cause
Evaluation for the presence of a breed-specific
hepatopathy.
Techniques for obtaining liver samples
There are several different techniques by which
hepatic samples may be obtained. These are:
Fine-needle liver aspiration (FNA) under
ultrasound guidance
Needle biopsy
Surgical biopsy (laparoscopic or via coeliotomy).
These techniques all have indications, advantages
and contraindications (Table 1).
Cytology samples
FNA is the least invasive technique and is usually
performed under ultrasound guidance using a 22G
needle of an appropriate length; for most cases a 22G
1.5 inch needle is appropriate (Figure 1).
Hepatic FNA can often be performed with the
patient conscious, although sedation or general
anaesthesia will be necessary in a nervous or less
cooperative patient. As the size of the needle is small,
the risk of post-FNA bleeding is minimal and therefore
multiple sites can be sampled without major risk.
Provided there is no evidence of haemostatic
problems with previous venipunctures, it is not
mandatory to assess clotting times.
Table 1: Practical considerations regarding the different methods of obtaining hepatic tissue
Fine-needle
aspiration
Surgical biopsy
Tru-Cut needle biopsy Laparoscopic Coeliotomy
Anaesthesia +/ + + +
Ultrasound-guided + +
Invasiveness + ++ +++
Cost + ++ +++ +++
Experience needed ++ ++ +
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HOW TO
Get the best from
liver samples
The areas to be sampled should be carefully
chosen so as to be as representative as possible while
avoiding structures like the gallbladder and blood
vessels. The needle is introduced into the liver tissue
under ultrasound guidance, targeting the specific
areas to be sampled. To avoid haemodilution, it is
preferable to use the needle alone rather than having a
syringe attached and applying negative suction. The
needle should be rapidly moved in and out of the
parenchyma (a so-called woodpecker-like motion)
and a slight twisting motion applied to maximise the
cell yield. Afterwards, the cells should be carefully
transferred on to a microscope slide and smeared. The
spreader slide should not be pushed down too
vigorously as this will increase the likelihood of cell
lysis and risk non-diagnostic sampling.
Overall, liver cytology is usually the initial
diagnostic test in most cases of hepatic disease.
FNA yields cells without the presence of structural
architecture and therefore is mainly useful in cases
where a diagnosis can be obtained from individual
cells (e.g. lymphoma). Criteria such as architectural
changes, the presence and location of inflammation
within a lobule, and location and degree of fibrosis are
important when assessing a hepatic biopsy sample
and are impossible to evaluate on liver cytology,
thereby contributing to the rate of poor agreement
between the two techniques.
Studies documenting the agreement between
cytology and surgical wedge liver biopsy have
shown a poor correlation between the final
diagnosis. However, clinicians should not feel
discouraged from obtaining hepatic FNAs as they
can prove worthwhile. The suspicion of vacuolar
hepatopathy and neoplasia (especially lymphoma) are
the main indications for hepatic cytology, and for these
specific groups of disease the agreement with liver
histology is better than in cases of chronic
hepatopathies or in vascular anomalies where
cytology is unlikely to provide useful information.
FNA can also be used to collect bile for cytology
and culture, especially in cases of feline inflammatory
liver disease when bacteria are thought to be
involved. Care should be taken to empty the
gallbladder as much as possible to reduce the
possibility of leakage; this technique is
contraindicated in cases of extrahepatic bile duct
obstruction. Although a transhepatic approach was
previously recommended, this is no longer the case
and any approach is considered reasonably safe.
If cytology does not provide or is thought unlikely
to provide sufficient information, hepatic biopsy should
be considered.
Histopathology samples
General anaesthesia is usually recommended to
collect samples for histopathology and therefore
fasting is essential; a full stomach might also
interfere with sample collection. The presence of
liver disease reduces the bodys ability to
metabolise drugs and therefore the protocol chosen
for sedation and/or anaesthesia should take this
into account.
It is important to assess coagulation status by
evaluating activated partial thromboplastin time
(APTT), prothrombin time (PT) and platelet count
ideally less than 24 hours before the procedure; a
buccal mucosal bleeding time (BMBT) test should also
be considered, especially in breeds predisposed to
von Willebrands disease. The liver produces all the
clotting factors except for factor VIII and bleeding is
indeed the most frequent complication of liver biopsy.
Liver biopsy should be avoided in patients with
clotting abnormalities or severe thrombocytopenia
(< 80 x10
9
platelets per litre).
Even though normal clotting times make significant
bleeding less likely, it is possible to have abnormalities
that are not detectable by changes in PT and APTT.
While it is possible to apply compression during
surgical (laparoscopic and coeliotomy) biopsy this is
not feasible with needle biopsy (e.g. Tru-Cut), making
significant bleeding a very realistic possibility.
The method chosen to acquire hepatic tissue is
influenced by the size of the liver, the presence or
absence of ascites, the main differential diagnoses,
and the clinical condition of the patient. For example, if
the liver is small it is unlikely that meaningful
information will be obtained from cytology as the main
differentials would be either vascular disease or a
chronic hepatopathy with cirrhosis; in this instance
Tru-Cut liver biopsy would also be contraindicated due
to microhepatica. Additionally, if there is biochemical
and ultrasonographic evidence of a vascular problem
such as a congenital portosystemic shunt, an
exploratory surgery with portovenography shunt
ligation and biopsy would be preferred over
laparoscopic assessment and biopsy.
Figure 1: Example of a liver mass that could be
sampled via FNA with a 1.5 inch needle; the scale in
centimetres on the right side of the screen allows
estimation of the depth of the nodule
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HOW TO
Get the best from liver samples
What constitutes a good specimen?
An ideal sample should be of appropriate size and
representative of the primary hepatic pathology.
In diffuse diseases any area is likely to be
representative, whilst in focal or regional disease it
might be more difficult to get a representative sample
and therefore ultrasound and/or direct inspection are
valuable tools. If the pathology seems focal then
samples should be collected from both the
abnormal-looking areas and from the normal-looking
areas, as it is not uncommon for what seems normal
to actually be abnormal.
Ideally two or three samples should be obtained
from separate areas. As needle biopsy samples are
smaller, the potential for non-representative samples is
greater. Most authors suggest avoiding the use of 18G
needles, as the samples get easily fragmented and
tend not to have enough portal areas to be diagnostic;
the sizes most commonly used are 16G needles for
cats and small dogs, and 14G needles for larger dogs.
Needle biopsy
There are two main types of needle used for liver
biopsy; with these a small cylinder of tissue is
obtained. The Menghini technique involves tissue
aspiration, usually blind, using a syringe attached to a
large-bore hollow needle. This technique has been
largely superseded by the use of Tru-Cut type needles
and it will not be discussed here.
Tru-Cut needle biopsy is usually performed under
ultrasound guidance, even though it is possible to use
this type of needle blindly in cases of very severe
hepatomegaly. The Tru-cut needle is composed of an
outer cannula and an inner notched stylet in which the
specimen becomes lodged (Figure 2). The notched
stylet is advanced first and the hepatic tissue fills the
2 cm notch. Then the outer cannula (with sharp cutting
edges) is advanced over the stylet and the liver
parenchyma is cut, leaving a sample in the notch
(Figure 3). Afterwards, the whole needle is withdrawn
and the inner stylet is exteriorized again to expose the
sample obtained.
There are three types of Tru-Cut needle: manual,
semi-automatic, and those used with a gun-type device.
The manual needles are difficult to control and
their use is not advisable unless under direct
visualization.
The semi-automatic type needles are the most
expensive ones and can be used in both dogs
and cats.
Biopsy guns fire the needle, at high speed, once
the trigger is pushed. The speed at which the
needle is fired makes the process of obtaining
samples from a hard fibrotic liver easier. Biopsy
guns are a costly piece of equipment and, while
Figure 2: Tru-Cut biopsy needle with the stylet
extruded and showing the notch in the stylet where
the tissue sample becomes lodged
Figure 3: Step-by-step view of the Tru-Cut needle as
the sample is collected. Please note that this would
be the happening inside the organ. (A) The loaded
Tru-Cut needle is inserted into the organ. (B) The
Tru-Cut needle loaded and with the stylet advanced.
Note that the stylet is extending about 2 cm deep to
the initial placement site. During this step the
hepatic parenchyma fills the notch of the stylet.
(C) Tru-Cut needle fired. The piece of parenchyma
that had previously filled the notch has been cut out
and is contained within the outer sheath; the needle
is ready to be removed. Again note that the tip of the
needle is about 2 cm deeper within the target organ
than the original placement site
A
B
C
the biopsy needles used are then not very
expensive, the initial cost is high; therefore this
technique is most commonly used in hospitals
where a large number of needle biopsies are
performed. The use of an automated gun-type
device is contraindicated in cats due to the
potential for vagal-induced shock (often fatal) due
to the sudden impact wave in the liver.
While the automatic gun device fires both the inner
stylet followed by the outer sheath, the semi-
automatics only fire the outer sheath after the inner
needle core is manually advanced by the operator.
If it is economically feasible to have only one
type of needle, then semi-automatic Tru-Cut needles
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HOW TO
Performing a
Tru-Cut liver
biopsy overleaf
Figure 4: Inspecting the liver
Reproduced from the BSAVA Manual of Canine and Feline
Endoscopy and Endosurgery
Figure 5: Biopsy of the liver
Reproduced from the BSAVA Manual of Canine and Feline
Endoscopy and Endosurgery
Figure 6: Liver post biopsy with a small amount of
haemorrhage
Reproduced from the BSAVA Manual of Canine and Feline
Endoscopy and Endosurgery
have the advantage that they can be used in both
dogs and cats.
The decision to perform a Tru-Cut liver biopsy
should be not made lightly. The potential for
complications is real and bleeding from the biopsy site
can be significant, especially if a main vessel is
damaged. Additionally, the experience of the operator
is critical to minimise the risk of complications. Tru-Cut
needles will advance approximately 2 cm deeper than
the tip of the needle. Therefore when selecting a site
for biopsy a 2 cm depth in front of the needle should
be devoid of major vessels or biliary ducts.
Tru-Cut liver biopsy should be avoided in patients
with prolonged clotting times or thrombocytopenia.
Microhepatica, significant abdominal effusion and
operator inexperience are also contraindications.
Surgical biopsy
Laparoscopic biopsy
Obtaining liver samples is one of the most common
indications for laparoscopy as it can be accomplished
reasonably quickly and with minimal trauma to the
patient. The samples obtained with the cupped
forceps are smaller than those obtained via coeliotomy
but bigger than those obtained via Tru-Cut biopsy.
Care should be taken to ensure that the sample
contains not only subcapsular superficial tissue but
also deeper tissue, as the former may not be a
representative sample.
With this technique it is possible to inspect the liver
(Figure 4) and the rest of the abdomen, to sample
macroscopically abnormal areas (Figure 5) and to
visualise and apply direct pressure for haemostasis
caused by the biopsy (Figure 6). Laparoscopy requires
special equipment, training and is more expensive
than Tru-Cut biopsy.
Coeliotomy
A celiotomy will also allow good visualisation of the
abdominal contents but also allow more detailed
investigation of the biliary tree and vasculature. As with
laparoscopy, it is important that the samples collected
have sufficient tissue and that not only superficial
areas are obtained; a 1 to 2 cm depth is
recommended. In cases of diffuse disease, at least
two areas should be sampled. If the pathology is
localized then normal and abnormal areas should
be sampled.
Conclusion
Liver biopsy is essential in the investigation of almost
all hepatic diseases. There are several options
available to the clinician, with various pros and cons
attached to each procedure. Consideration of these
points will help make the right decision for each patient
and their owner.
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HOW TO
Get the best from liver samples
PERFORMING A TRU-CUT LIVER BIOPSY
It is a sensible policy to keep the
animals hospitalized for a minimum
of 12 hours so that the vital
parameters can be monitored and,
in case of suspicion of bleeding, the
abdomen can be examined with
ultrasound.
If there is evidence of bleeding
post-biopsy the patient should be
closely monitored and the use of
fresh frozen plasma should be
considered to supply additional
clotting factors.
It is uncommon for emergency
surgery to be needed due to
uncontrolled bleeding after Tru-Cut
biopsies of the liver unless big
vessels were damaged during the
procedure.
1. Answer the following questions:
a. Are liver samples deemed
necessary?
b. Considering your differential
diagnoses, what information
are you expecting to obtain by
liver biopsy?
c. Would it be possible to obtain the
same information with cytology?
(If so consider performing FNA
prior to biopsy).
d. Does the patient have significant
ascites or microhepatica? (If so
consider other techniques)
e. Is a vascular anomaly one of the
main differentials? (If so consider
other potential techniques)
f. How many biopsy samples do
you think are needed and what
are they going to be tested for?
(Check with the laboratories the
requirements for special tests
and make sure the containers
needed are available).
g. How many biopsy samples do
you estimate can be safely
obtained in this specific case?
2. Check the clotting times and platelet
count no more than 24 hours prior to
the procedure.
If the clotting times are prolonged
delay the procedure, consider
administering parenteral vitamin K1
and rechecking the clotting times
48 hours later.
3. Immediately prior to the biopsy
choose the areas to sample using
ultrasonography and estimate the
number of potential samples that can
be safely obtained; remember that
representative samples are needed.
4. Make sure that you have all the
material required (Figure 7).
5. Surgically prepare the skin,
allowing for generous areas of
clipped and scrubbed skin around
the entry points.
6. Using a scalpel blade, make a small
incision of the skin on the site where
the needle will enter the abdomen; the
use of sterile gloves is recommended.
Special sterile sleeves are available for
the ultrasound probes. If these are not
available, the probe should be
thoroughly cleaned with the scrubbing
solution and the operator should be
careful to avoid touching the probe with
the biopsy needle.
7. Examine the Tru-Cut needle for any
problems and fire it once outside the
patient to make sure it is working
appropriately (this is also the time to
make sure that you understand fully
how the needle works).
8. Re-load the Tru-Cut needle and it is
then ready to be used (Figure 8).
9. Apply a generous amount of sterile
ultrasound gel to the abdomen and,
under ultrasound guidance, carefully
insert the needle into the liver. Take
into account that while with cytology
the area sampled is the area where the
tip of the needle lies, with Tru-Cut
needles the area to be sampled lies
in front of the tip of the needle (see
Figure 3).
10. Double check that there are no
important structures in the 2 cm area in
front of the needle.
Figure 8: Semi-automatic Tru-Cut
needle in a neutral position (A) and in a
loaded position with the fire-trigger
pulled backwards(B)
A
B
Figure 7: Material needed to perform
Tru-Cut biopsy of the liver (Tru-Cut
needle, scalpel blade, sterile gloves,
sterile ultrasound gel)
11. Perform the biopsy and withdraw
the needle.
12. Open the needle and, with the help
of a sterile needle, gently ease the
sample into the
appropriate container.
13. Using ultrasonography, check for the
presence of a significant amount of
free fluid, which is likely to indicate
significant bleeding, and check the
liver parenchyma at the biospy sites
for evidence of active haemorrhage.
14. Repeat the procedure to obtain
more samples.
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CPD
O
phthalmic examination may be pivotal to
making an early diagnosis in neoplastic,
dermatological and neurological diseases,
infectious systemic diseases and endocrinopathies. In
addition, ophthalmologists must also be surgeons,
performing procedures ranging from orbitotomies,
rhytidectomies and complicated blepharoplastic
techniques to microsurgery including corneal grafts,
cataract surgery and endolaser.
Every eye tells a story and it is a bit like being a
Crime Scene Investigator interpreting the findings. For
example, pigment on an anterior lens capsule can be
congenital and associated with persistent pupillary
membrane remnants, or may be the result of contact
with the posterior surface of an inflamed iris after an
episode of uveitis; two totally different events with
differing implications.
If you want to learn how to interpret the evidence,
then enrol for this years BSAVA mini-modular
ophthalmology course, which will be held at the
Crowne Plaza Hotel near Gatwick Airport,
14 September, 12 October, 16 November and
7 December.
The speakers this year are Sue Manning and Jim
Carter, both of whom are RCVS Diploma holders in
veterinary ophthalmology working in private referral
practice. They are both enthusiastic and experienced
lecturers and have structured their modules with the
objective of inspiring the delegates in the subject of
ophthalmology using a mixture of richly illustrated and
interactive lectures, videos and small group seminars.
The modules aim to be practically orientated,
covering most of the presentations and procedures
seen and performed in general practice on a daily
basis. They will also inform delegates of the more
advanced procedures available in cases when they
may provide a better outcome for patient and owner.
Taking a
better look
Ophthalmology has to be one of
the most fascinating subjects.
In what other discipline can you
look at an extension of the brain,
differentiate venous and arterial
vascular disease without
complicated imaging, or
visualise nematode infections
without faecal sampling or BAL?
ABOUT THE OPHTHALMOLOGY
MINI-MODULAR
Speakers: Sue Manning and Jim Carter
Venue: Crowne Plaza, London Gatwick Airport
Fees: Full series: BSAVA Member: 813.00
Non-member: 1219.83
Individual courses: BSAVA Member: 213.83
Non-member: 320.74
OPHTHALMOLOGY 1
Cats are not small dogs: a day of feline
ophthalmology
Thursday 15 September
The aim of this module is to provide delegates with a
complete overview of the approach to feline
ophthalmology. The key to diagnosis of any ophthalmic
disease is the ability to perform a systematic ocular
examination and understand the significance of any
findings. This will be covered at the outset and,
combined with the subsequent presentations, should
provide the knowledge to diagnose and effectively
manage most feline ocular conditions presented in
general practice. The presentations will be well
illustrated with photographs and videos, and will
include case based examples and interactive
discussion. This module will specifically address:
How to perform a comprehensive ocular
examination
Feline infectious and inflammatory ocular surface
disease
Feline uveitis and glaucoma
Feline retinal and orbital disease.
CPD
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CPD
Taking a better look
OPHTHALMOLOGY 2
First aid in ophthalmology: a
first line approach to ocular
emergencies
Thursday 13 October
This will be a purely surgery-based day,
which will cover all surgical cases from
eyelid mass removal and enucleation
through to cataract surgery and endolaser,
as well as covering the principles of ocular
surgery from induction to recovery. This
module will concentrate on providing
delegates with the tools necessary to obtain
the optimal results for those procedures
routinely performed in general practice. It
will also improve awareness of the more
advanced surgical techniques available for
patients that present with sight threatening
conditions such as cataract, glaucoma and
retinal detachment. The presentations will
be well illustrated and include videos of
commonly performed techniques as well as
interactive discussion. This module will
specifically address:
Principles of ocular surgery
Adnexal and corneal surgery
Intraocular surgery; what is available
and emerging?
Anaesthetic considerations in
ophthalmic surgery.
OPHTHALMOLOGY 4
The eyes have it! Ocular
manifestations of systemic
disease
Thursday 8 December
Internists, neurologists, oncologists and
dermatologists all need ophthalmologists!
So many systemic diseases will have
ocular manifestations that the ability to
recognise them may be critical to early
ABOUT THE SPEAKERS
Sue Manning
Sue graduated from the University of Bristol in 1987. She worked in Swansea for 16
years, both in mixed practice and small animal charity practice, and gained her RCVS
Certificate in Veterinary Ophthalmology in 2001. Sue gained her RCVS Diploma in
Veterinary Ophthalmology in 2006 after undertaking a residency at Willows Referral
Service in Solihull. She set up the ophthalmology referral service at Rutland House
Referrals in St Helens, Merseyside, in May 2008. Sue is currently a member of the
BVA/KC/ISDS Eye Panel. Her clinical interests include corneal surgery, lens luxation
and cataract surgery.
Jim Carter
Jim Carter graduated from the RVC in 1996, then spent over three years in farm
animal practice before gaining the RCVS Certificate in Veterinary Ophthalmology in
March 2000. In August 2000 Jim started a clinical training scholarship in Veterinary
Ophthalmology at the University of Bristol under the tutorage of Professor Sheila
Crispin and Dr David Gould, and was awarded the RCVS Diploma in Veterinary
Ophthalmology in 2003.
diagnosis and potentially improve the
outcome. This module aims to illustrate
some of the more common systemic
diseases with ocular involvement that
are presented in general practice, as
well as demonstrate a practical approach
to diagnosis using readily available
investigative tools. The presentations
will be well illustrated with photographs,
and will include case based examples
and interactive discussion. This module
will include:
Ocular manifestations of systemic
disease presentations
Smaller group seminars discussing
diagnostic techniques
Clinical pathology appropriate
laboratory testing in different diseases,
in-house ocular cytology
Diagnostic imaging ocular
ultrasonography, MRI, CT
Interactive case based illustrations.
The aim of this module is to provide
delegates with the techniques and
knowledge to deal with ocular
emergencies that will present in general
practice and result in significant sight and
globe threatening conditions. We will cover
the diagnostic steps for identifying, along
with surgical and medical techniques for
treating, the conditions listed below, as well
as several more. The presentations will be
illustrated with photographs of cases pre
and post treatment, along with videos of
surgery to aid in the explanation and
description of treatment and prognosis.
This module will explore:
Proptosis
Melting ulcers
Acute glaucoma
Lens luxation.
OPHTHALMOLOGY 3
A stitch in time: all you need to
know about small animal
ophthalmic surgery
Thursday 17 November
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PETSAVERS
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21
Improving the health of the nations pets
Q
ualified veterinary surgeons are
invited to apply for funds to support
a clinical study in companion
animals, and in the next round of awards
Petsavers is especially keen to see more
applications from people in practice, who
are likely to have a more representative
caseload than referral practices or
academia. General practitioners might
appreciate the additional support now
available to them in terms of study design
and statistical analysis.
As a practitioner himself and Chairman
of Petsavers, Philip Lhermette says,
However inspired a practitioner may be to
undertake such a project in addition to
their already packed workload, it is often
the case that it is the study design and
analysis that puts them off. That neednt be
the case. BSAVA is an association mostly
made up of people in general practice,
and it is those professionals that we are
determined to support in very practical and
relevant ways. So those in general practice
should apply with confidence that they
wont be alone in their efforts. The BSAVA
will put them in touch with statisticians at
academic institutions in their region who
can assist where necessary.
The terms of the grants indicate that
Petsavers invites applications for funding, and has
additional support available for successful applications
from general practitioners
your study must have the objective of
advancing the understanding of the cause
and/or management of a clinical disorder.
The study must not involve experimental
animals and should further the knowledge
of the small animal practitioner.
Applications are welcome from both
private practice and academia and
funding is available for grants between
1000 and 8000.
If there are any questions about Petsavers
please contact us on 01452 726723 or
email info@petsavers.org.uk.
Funds for fun runners
We are delighted to report that Petsavers has been
over-subscribed with people wanting to take part in
the London 10K this July which has become
something of a summer tradition for the charity
A
round 30 to 40 yellow T shirt-clad joggers will be enjoying the sites of
Westminster and beyond as they puff and pant for Petsavers next month,
raising thousands of pounds along the way. Please help support them and
encourage their efforts by sponsoring them as individuals, or you can do so
collectively anytime at www.justgiving.com/petsavers no amount is too small,
and dont forget to Gift Aid it if you are eligible. Thank you so much we really do rely
on the support of the profession and appreciate your ongoing commitment to helping
us advance veterinary knowledge.
The closing date for Clinical Research
Project applications is the 31 August 2011.
The applications will be considered by the
Petsavers Grants Awarding Committee in
September, with the final vote decision
made in March 2012.
Full guidelines and terms and
conditions can be found on the Petsavers
website: www.petsavers.org.uk
Application forms can also be downloaded
from the Petsavers website.
Petsavers grants 2011
Practitioners wanted
21 Petsavers.indd 21 19/05/2011 11:24
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BVA CONGRESS
T
his year the BVA Congress carries
the theme Vets in a changing world,
and will be held in Central London on
2224 September at the Royal College of
Physicians.
As a result of discussions between
the BVA and BSAVA on better ways of
working together for the benefit of the
profession, it was decided to support
an expansion of the already impressive
BVA programme with the help of
BSAVAs resources and experience in
creating exemplary CPD to companion
animal professionals.
We are delighted to announce the
collaboration between our two
associations, said BVA President Harvey
Locke. BVA Congress is an important date
in the veterinary political calendar, while
BSAVA Congress is internationally
renowned for the quality of its CPD.
BSAVA President Andrew Ash
described the upcoming event as a good
opportunity to combine the experience and
World-class sc ience in the Capital
expertise of the two organisations. We are
keen to inject the excellence of BSAVA
Congress into an already prestigious
event, he said.
Talks of the town
The three clinical CPD streams covering
feline medicine, gastroenterology medicine
and surgery, and cardiorespiratory
medicine, will be delivered by leading
experts, including Alex German, Penny
Watson, Ian Ramsey, Sue Murphy, Hattie
Syme and our own BSAVA Congress
Chairman, John Williams.
The BVA has announced that
Congress will be opened by Defra Minister
Jim Paice MP in a keynote speech titled
Vets in the Big Society, in which the
Minister will outline the Coalition
BSAVA provide clinical programme for BVA
This years annual British Veterinary Association
Congress will see BSAVA team up with BVA to provide
two days of small animal CPD alongside the BVAs
popular political and social programmes
Just because some types
of patient appear regularly
on the consulting room
table doesnt mean that
they are easy cases to
manage. And no matter
how frequently some
conditions are seen,
there is nearly always
scope for carrying out a
faster, smarter and more
cost-effective clinical
work-up, delegates will be
told during BVA Congress
in London
private referral centres. They will be
focussing on feline medicine, on
gastrointestinal medicine/surgery, and on
cardiorespiratory medicine, explains
Professor Ian Ramsey, of the University of
Glasgow veterinary school, who drafted
the menu.
The one thing that these three
disparate areas of practice have in
common is that they provide a constant
challenge to the clinical skills of general
practitioners in small animal and mixed
practices. So Ians idea in choosing the
speakers was to look at disciplines in
which efforts to improve and refresh clinical
knowledge will have immediate
applications in providing a better service to
clients, he explains.
Now that cats have overtaken dogs as
the most commonly kept domestic animal,
is there any need for a particular focus at
the meeting on routine feline conditions?
Prof. Ramsey points out that feline
medicine is still a relatively new discipline
and cats are not the most cooperative of
patients. They hide their symptoms so well
that they are usually at a much more
advanced stage of the disease process by
the time that they are brought in for
treatment than an equivalent case in a dog,
he says. Moreover, the rise in numbers of
B
SAVA has drawn up a high-quality
CPD programme to complement the
political debates at BVAs annual
meeting. This comprises lectures from
leading specialists from university and
22-23 BVA Congress.indd 22 19/05/2011 11:24
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BVA CONGRESS
The Early Bird deadline
is 30 June
cats covered by pet insurance, and the
growing expectations of cat owners, mean
that first opinion clinicians cannot afford to
rest on their laurels.
Meanwhile, the two other streams share
a common feature, focussing on deep
body tissues. It is very much harder to
work out what is going on in the gut or in
the heart compared with, say, dermatology
cases. True there is now a wide range of
advanced imaging techniques available at
referral centres. But if a general practitioner
has only limited experience of these
technologies they may not be able to
properly interpret the report when it comes
back to them, he says.
One of the problems facing busy
practitioners is time pressure, which will
often encourage them to have one eye on
the treatment options when they should be
concentrating on the diagnostic work-up.
So the speakers will be reminding their
audience of the necessity for taking
logical and orderly steps towards reaching
a diagnosis.
Prof. Ramsey will himself be delivering
three presentations in the feline medicine
stream: on polyuria, hyperthyroidism and
diabetes mellitus. The first paper will set
out a useful model for carrying out an
effective diagnostic work up in a wide
World-class sc ience in the Capital
BSAVA provide clinical programme for BVA
Governments view of the role of vets
in the UK today.
With dangerous dogs, vaccination and
pet travel all high on the Governments
agenda, delegates will hear first-hand how
far the Governments Big Society vision
crosses over into private practice, and
debate whether vets are already
contributing enough.
A changing world
BVA Congress will also mark World
Veterinary Year Vet 2011 in recognition of
the 250th anniversary of the foundation of
the worlds first veterinary school in Lyon,
France, and in celebration of the profession
across the globe.
This years contentious issues and
overseas programmes will highlight the
role of vets in a changing world and
discuss how we can adapt to new
challenges as individuals and as a
profession, Mr Locke explained.
The overseas sessions will explore the
role of vets in disaster situations,
comparing and contrasting man-made and
natural disasters and asking when and
where external agencies should intervene.
Under the contentious issues stream,
the scope of a new Veterinary Surgeons
Act will be explored, including the difficult
issue of regulation for paraprofessionals
and veterinary nurses, following reports
that Defra has invited the RCVS to prepare
detailed proposals for a draft Bill.
Questions raised by the current
economic climate also feature prominently
in the programme, with a session on the
impact of rising tuition fees on tomorrows
veterinary graduates and a debate on the
link between a clients ability to pay for
their pets healthcare and the treatment
options available.
Fun and networking
Finally, the all-important social side of
Congress. Both BVA and BSAVA have built
up reputations for the quality of networking
opportunities. Thursday evening will
combine the awards ceremony and
Presidents welcome speech with
exhibition drinks and buffet, providing a
fantastic opportunity for delegates to
socialise, network and celebrate.
The social programme highlight will
take place on Friday night in the exquisite
Ballroom of the 5-star Langham Hotel on
Regent Street. Plus, with all of Londons
major shopping and sightseeing attractions
just minutes away from the Congress
venue, there is plenty for delegates to see
and do to make the most of the weekend.
In recognition of BSAVAs contribution
to BVA Congress, BSAVA members will
receive a member discount of 100 across
the two days, making it a low-cost and fun
way to earn high-quality CPD. More
information and booking is available at
www.bva.co.uk/congress. n
range of clinical situations. There are only
six common causes of polyuria and a few
more which are only seen very rarely. I will
try to show the best approach for
identifying which particular one is
involved, it is just like following a recipe. If
you carry out this test and then take that
step you will arrive at the right answer. It is
when you try to jump a step or take them
in the wrong order that you will have
problems because the results of one test
will help you interpret the results of the
next one in the sequence, he says.
An unusual feature of this CPD event is
that participants will be taking part in a
quiz session at the end, based on what
they have seen and heard during the day.
The idea of the quiz is that it should
provide a little bit of fun at the end of a
tough day but it also has a serious
purpose. Attendees at any CPD event
will only take in a percentage of the
information given in the presentations,
and even then they may not have the
confidence to apply that new knowledge
in the routine work. What we are hoping
to do is to set the information in the
context of a clinical case so that people
will be ready to use what they have
learned as soon as they go back to their
practice, Prof. Ramsey says. n
22-23 BVA Congress.indd 23 19/05/2011 11:24
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MEDICINES
T
he client drug information leaflets
were the idea of Professor Ian
Ramsey, Editor-in-Chief of the BSAVA
Small Animal Formulary. He says, As a
referral vet I write a lot of letters to owners
and vets that include instructions about the
drugs that I am prescribing or dispensing
for a patient. Often these drugs are
unusual or cytotoxic, and are very
commonly only authorized for human
patients. As Editor of the Formulary I am
acutely aware of the responsibility that I
have for making sure owners understand
what these drugs are for and what the side
effects might be.
There is an enormous amount of detail
that should be relayed to clients, and
remembering every detail for every drug is
an unrealistic challenge. Professor Ramsey
also points out that Vets have an
obligation to provide detailed information
on the drugs that they are dispensing to
their clients. The BSAVA client information
leaflets provide a ready source of
information and also help solve the
problem of clients forgetting what they
have been told verbally by the clinician
during a consultation.
Drugs covered
The first batch of client information leaflets
is now available for members to download
Medicines
information:
client leaflets
from the BSAVA website (www.bsava.com)
and more may be added over time. These
leaflets are specifically written for owners
and relate to medications prescribed for
dogs and cats only. Each of the leaflets has
a space for veterinary practices to add their
details before distributing them to their
clients. The leaflets cover some of the
off-label drugs most commonly used for
dogs and cats, including:
Amitriptyline
Atenolol
Chlorphenamine
Digoxin
Famotidine
Ursodeoxycholic acid.
Standard information
In addition to a basic introduction to the
Prescribing Cascade, each of the client
leaflets provides the following information:
What is the drug?
Why has my pet been prescribed the
drug?
How should I store the drug?
How do I give the drug to my pet?
How long will my pet need to take the
drug?
What should I do if I run out of tablets?
What should I do if I miss a dose?
Over recent years advances in veterinary
medicine have outstripped the availability of
drugs that are authorized to treat various
diseases in companion animals. As a result it is
often necessary to utilise the Prescribing
Cascade and prescribe medications off-label.
However, until now there has been no source of
standard information for owners regarding the
use of such drugs. Debbie Grant of the
Publications Committee explains further
PUBLICATIONS
What should I do if my pet is
accidentally given too many doses?
Can my pet take this drug if I am
already giving them other drugs?
What are the possible side effects of
the drug for my pet?
What should I do if my pet is unwell
while taking the drug?
What should I do if a person
accidentally takes this drug?
Whom do I contact if I want to know
more?
The BSAVA client information leaflets
provide an excellent reference
for owners and explain exactly what the
drug does, as well as detail the potential
side effects that may arise. Owner
education is essential to help ensure any
treatment-related problems are spotted
early on, and to manage owner
expectations of success.
24 Publications - Client Info Sheets.indd 24 19/05/2011 11:23
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WSAVA V5 Global Nutrition
Guidelines launched
WSAVA is delighted to
announce a major step
forward with one of its
key campaigns to
ensure that a nutritional
assessment and
recommendation is
made on every patient
during every visit to
the vet
availability via member associations and
the media. It is our goal that every
teaching institution in the world should
formalise this approach in their curriculum
as soon as possible.
Now that the V5 Guidelines have been
published, the committee is working on the
next phase of activity. It has formulated a
plan to build an alliance of global
veterinary organisations to help healthcare
teams and pet owners begin implementing
the guidelines together on an international
basis. These efforts will be coupled with
the Veterinary Companion Animal
Nutritional Consortium founded by AAHA,
of which WSAVA is a charter member.
We believe this project to be important
given the influence of nutrition on every
patient, whether to treating illness,
preserving health or preventing future
health problems, comments Professor
Jolle Kirpensteijn, President of the WSAVA.
Its vital for companion animals as theyre
often fed the same diet at every meal with
little attention paid to the quality or
suitability of the nutrition they are receiving.
Just as we led a global effort to elevate
pain to become the fourth vital
assessment, we also see the need to
elevate a nutritional assessment to become
the fifth vital assessment in a standard
physical exam. We believe a sound
nutritional recommendation from a
veterinarian is crucial because pet owners
are exposed to a myriad of nutritional
myths that if acted upon can actually be
harmful to their pets. To help ensure the
WSAVA V5 Global Nutrition Guidelines are
assimilated worldwide, well be working
towards getting the guidelines published
and encouraging other stakeholders to get
involved. We hope that global veterinary
organisations will join forces with us to
encourage veterinary healthcare teams
and institutions in their respective
geographies to make nutrition a routine
part of their recommendation procedures.
The guidelines can be viewed on the
WSAVA website at www.wsava.org. For
further information on this project, contact
wsavasecretariat@gmail.com.
W
e want this to become known as
the 5th Vital Assessment (5VA),
following the four vital
assessments of temperature, pulse,
respiration and pain, which are already
routinely undertaken.
After a year of development work led
by Dr Clayton MacKay, a Canadian
veterinary consultant, the WSAVA
Guidelines Development Committee has
now finalised and launched its V5 Global
Nutrition Guidelines which are aimed at
helping veterinary surgeons and pet
owners design a nutrition plan which is
tailored to the needs of their specific dog.
The V5 Guidelines are available at, and
are consistent with those produced by, the
American Animal Hospital Association
(AAHA). Were actively promoting their
Dr Clayton MacKay
25-27 WSAVA News.indd 25 19/05/2011 11:22
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WSAVA NEWS
Diagnosing pain and suffering in companion
animals and prescribing appropriate measures
to manage and relieve it is one of the most vital
functions a vet can perform but, as in many
areas of veterinary care, the range of
approaches and techniques varies dramatically
across the world
Moving forward with pain
management introducing
the Global Pain Council
planned but will be dependent on industry
sponsorship. They include:
The creation of a marketing plan and
promotional materials to support the Global Pain
Management Treatise and the CE programme
Further work with regional academic institutions
and associations to ensure progress towards
self-sufficiency/reliance on continued regional
Pain Management CE
Further implementation of CE programme with a
particular focus on academic institutions
Regional lobbying for access to needed pain
management medication
Expansion into pet owner education/awareness.
For further information on this project, please
contact wsavasecretariat@gmail.com.
T
he WSAVA, under the chairmanship of Professor
Karol Mathews, is now moving ahead with an
initiative to promote higher stands of pain
management at a global level. The first step was the
creation of a Global Pain Council (GPC) which has
identified two initial activities:
The collation of pain assessment and management
information into a Global Pain Treatise
The compilation of an inventory of pain
management needs in regions around the globe.
Once these pieces of work have been completed,
they will be used as a basis to help the GPC design
and deliver targeted and customised educational (CE)
programmes. The CE will be delivered in the regions,
at WSAVA Congress, as part of WSAVA member
association CE events, and through online CPD.
Further phases of activity for the GPC are also
25-27 WSAVA News.indd 26 19/05/2011 11:22
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WSAVA NEWS
P
rofessor Dr. med. vet. Peter F. Suter,
aged 80, passed away peacefully on
Saturday, February 12th, 2011, in his
home town of Affoltern am Albis following a
brief but intense battle with pancreatic
cancer. He leaves behind his loving wife of
51 years, Evelyn, his sons Martin, Chris
and Roy, two daughters in law, five
grandchildren and many close friends.
Born and raised in Switzerland, Peter
initially assumed he would step into the
shoes of his father and take over the family
farm. However at the age of twenty he
decided to become a veterinary surgeon
and graduated from the University of
Zurich in 1955. He met his wife while
working at his uncles flower shop to help
fund his studies. They married in 1959 and
moved to Hedingen to raise a family. In
addition to working as a veterinary surgeon
at the Tierspital of the University of Zurich,
Peter opened his own small animal
practice during evenings and weekends.
He soon became a favorite point of call for
local families and farmers.
Impressed with his academic
achievements, teachers and colleagues
encouraged Peter to pursue a full-time
academic career in veterinary medicine.
He was fascinated by the field of radiology,
and soon moved his family to the USA to
pursue his dream. He initially worked as an
Assistant Professor in the radiology
department at the Animal Medical Center in
New York between 1967 and 1969. He then
moved to California to join the radiology
department of the University of California,
Davis, Veterinary School, where he worked
as a Professor from 1969 until 1981.
His ground-breaking research,
publications and passion for teaching
cemented his reputation as one of the
worlds leading radiologists. In 1981 Peter
returned to Switzerland where he took over
the position of Director of the Clinic for
Veterinary Medicine at the University of
Zurich. During the following fifteen years
until his retirement in 1995, Peter was a key
driving force helping to establish Zurich as
a veterinary school and clinic of
international stature.
Throughout his career, Peter was a
prolific author, publishing numerous
textbooks, many of which have become
Some words of
appreciation
Professor Peter Suter
Weve been saddened to hear of the passing of our
illustrious colleague, Peter Suter. His family have
prepared a brief eulogy which we thought you
would like to share. He was a wonderful man and
an exceptional vet
classics with both veterinary students and
practicing veterinary surgeons alike around
the world. A few examples include Canine
Cardiology published together with Stephen
J. Ettinger in 1970, Thoracic Radiography: A
Text Atlas of Thoracic Diseases of the Dog
and Cat published in 1984, and Praktikum
der Hundeklinik republished over many
years in numerous languages together with
Hans Georg Niemand.
Peter Suter was honoured with life-time
achievement awards for his significant
contributions to the field of veterinary
medicine by many international veterinary
associations, among them the American
Animal Hospital Association, the World
Small Animal Veterinary Association, and
the European Association of Veterinary
Diagnostic Imaging.
Peter was an avid gardener all his life,
spending hours planting and tending his
flowers, vegetables and fruit trees. After his
retirement he spent a large part of his time
with his beloved horse Bingo, riding a
horse-drawn carriage together with his wife
Evelyn in the forests and fields where he
grew up.
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THE companion INTERVIEW
Clare Rusbridge grew up just outside Glasgow, attending Milngavie Primary and
Douglas Academy. She was 16 years old when she started at Glasgow University
Veterinary School. Her mother, a biologist, was a secondary school teacher and
also involved in curriculum development with the Scottish Examination Board.
Clares father, a farmers son from Kent, was a nucleic acid research biochemist at
Glasgow University and later head of Applied Biosciences at Glasgow Caledonian
University. Clare has one younger sister who is a social worker specialising in
mental health of the elderly. After graduating from Glasgow in 1991 with distinction
in both veterinary medicine and surgery, Clare completed an internship at the
University of Pennsylvania before spending some time in general practice in
Cambridgeshire. After a BSAVA/Petsavers Residency in Neurology at the RVC
she became a Diplomate of the European College of Veterinary Neurology in 1996
and gained RCVS Specialist status in 1999. She was awarded a PhD from Utrecht
University in 2007. Since August 1997 she has operated a Neurology Referral
and MRI service at the Stone Lion Veterinary Centre in Wimbledon, London.
At BSAVA Congress 2011 Clare was presented with the J.A. Wight Memorial Award
for outstanding contributions to the welfare of companion animals.
THE companion INTERVIEW
Q
How did you did develop your
interest in neurology?
A
I actually planned to specialise in
exotics; however, I decided that
before pursuing this I wanted to
develop a broad base in small animal
medicine and surgery. As a final year
student I was lucky enough to have a
several week externship at North Carolina
State University and I was recommended
to spend some time in neurology. As this
was one of my weaker subjects, I thought
that I should take advantage of the
schools strength. I found it a steep
learning curve and my fascination for the
subject was born. Later, during my
small animal internship at the University
of Pennsylvania, I obtained permission
to return to North Carolina for my
neurology rotation so I could also gain
experience of neurosurgery. It was there
that I met my future mentor Dr Simon
Wheeler and, after a year in general small
Dr Clare
Rusbridge
BVMS PhD DipECVN MRCVS
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THE companion INTERVIEW THE companion INTERVIEW
ethic. He is the only vet I know who can
get an entire audience interested in a
subject that they never imagined they
could possibly be interested in, such as
snails! He is also a prolific writer who uses
every available minute. He taught me that
you can achieve a lot in a spare 10
minutes here and there.
What is the most significant lesson you
have learned so far in life?
Patience, and that it is ultimately
self-destructive to suffer stress from little
things such as clients being extremely late;
referral histories from vets consisting of
10 years worth of extensive computer
printouts, but not accompanied by the
laboratory results or radiographs; and
breeders that write poisonous and untrue
internet posts/articles about me. At least
I try to be patient and unstressed, but
I cant say that I am entirely successful!
What do you regard as the most
important decision you have made in
your life?
I was persuaded by a good friend to
undertake a PhD at Utrecht University to
have something to show for the work I
was doing on syringomyelia. I worked in
private referral practice throughout and it
was hard to fit clinical research and writing
around proper work. I even took the final
oral examination when eight months
pregnant. However, it was an invaluable
experience and one that I gained
immeasurably from.
What is the most frustrating aspect of
your work?
Never getting on top of the huge amount
of email-generated work I receive about
500 work-related emails a week. The only
time I really feel that I have cleared the
in-tray is on an occasional long rail or
plane journey. However, answering emails
only generates more emails, and so it
goes on!
If you were given unlimited political
power, what would you do with it?
I would ban the sale of dogs and cats from
pet shops or from ads in magazines, free
papers or websites with no advertised
minimum standards. I would also make it a
rule that no dog or cat could be made an
ultimate champion without being 5 years
old and having a veterinary examination
and/or a report from their primary vet
indicating that they were free from chronic
health problems.
Which historical or literary figure do
you most identify with?
Mrs Doasyouwouldbedoneby (The Water
Babies by Charles Kingsley) I cannot say
that I am necessarily like her but it is a
philosophy by which I try to live my life.
If you could change one thing about
yourself what would it be?
Where do I start! I have the most appalling
sense of direction and can still get lost with
both map and satellite navigation. I wish my
spelling skills came naturally and not with
the considerable aid of a computer;
however, I think that my ultimate choice
would be a Scottish accent from listening
to me you would never know that I spent
the first 21 years of my life in Scotland!
What is your most important
possession?
My family, but then they are not
possessions, so I would have to choose my
very large collection of digital photos
(personal and professional). To lose them
would be devastating.
What would you have done if you hadnt
chosen to work in the veterinary sphere?
Wh en applying to university for admission
into veterinary science, I also applied to
do a science degree specialising in
genetics. So, had I not been successful in
my first choice, I would have ended up
taking that path.
I try to be patient and
unstressed, but I cant say that
I am entirely successful!
animal practice, I joined the Royal
Veterinary College as his resident.
What do you consider to be your
most important achievement during
your career?
Improving understanding of canine
syringomyelia in 1995 I saw my first
Cavalier King Charles Spaniel with
syringomyelia and associated chiari-like
malformation and I have been working on
this painful inherited disorder ever since.
I have established a worldwide database
of affected dogs and their DNA and
have been involved with the publication
of over 20 scientific papers on the
subject. However, there is still much to
learn about this intriguing disease. We
still dont understand how syringomyelia
develops, how it is inherited, or how best
to treat it.
What has been your main interest
outside work?
My family (Jillian aged 10 and Thomas
aged 4) provide me with a constant source
of interest. However, I also spend several
hours a week doing Pilates and have
recently taken up belly dancing!
Who has been the most inspiring
influence on your professional career?
I hope you will allow me to choose two
people. First my grandfather, Alf Leggatt,
who taught me that problems that seem
insurmountable can be solved with
persistence and ingenuity. He led the
Little Ships from Leigh-on-Sea to Dunkirk
and was captain of the minesweeper that
liberated the Hook of Holland saving the
Dutch inhabitants from starvation at the
end of the World War II. He also
developed the dual echo sound system for
fishing, for which he awarded a MBE
medal in 1956. As a student I was also
influenced greatly by Professor John
Cooper who has an infectious enthusiasm
for natural history and an inspirational work
28-29 Interview.indd 29 19/05/2011 11:20
30
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companion
REGIONS
Meet
Your
Region
Scottish
As part of a continuing series,
this month companion features
Scottish Region
BSAVA Scottish
Committee

Ross Allan Chair
Ross graduated in 2001 from
Glasgow, and after spending a
short time in mixed practice
entered small animal practice
in Glasgow where he is now a
partner. He has been involved
with BSAVA for four years.
Ross has greatly enjoyed being
involved with the organisation
with the opportunity to see the
bigger picture of factors
affecting the profession outside
the consult room. Outside work
Ross road cycles and plays
badminton, where he doesnt
take losing well.

Claire Hughes
Treasurer
Claire graduated from Glasgow
in 1999, and has worked in
small animal practice, and in
an out-of-hours emergency
clinic ever since. Currently
she works for the PDSA in the
east end of Glasgow. Outside
of work Claire enjoys playing
the saxophone, cycling and
snow boarding.

Dermot Mullen
Secretary
Graduating from the University
of Glasgow in 2001, Dermot
spent one year working for
Defra then entered mixed
practice for two years before
joining PDSA in East Glasgow,
where he is Senior Veterinary
Surgeon. He has a rescue dog
called Rosie (a Jack-a-doodle)
who he often takes hillwalking
and camping.
Committee members

Gerard McLauchlan
Gerard graduated from
Glasgow in July 2006 and
undertook an internship at
Davies Veterinary Specialists
near London. Following a
short time in first opinion
practice he returned to
Glasgow in March 2008 to
begin a residency in internal
medicine and oncology.

Graeme Eckford
Graeme qualified from
Liverpool in 2005 and
undertook an elective in
small animal medicine and
surgery at Edinburgh following
qualification. He now works
at the Edinburgh PDSA
PetAid Hospital.

Susan Macaldowie
Susan qualified from Glasgow
and has always worked in small
animal practice. She acquired
a surgery in southern
Edinburgh and she still enjoys
the variety and challenges of
providing good quality general
practitioner care, whilst fully
appreciating the proximity of
local referral centres.

Claire Robertson
Claire qualified from Glasgow
in 2000 and has worked in the
Scottish Borders, Newcastle
and Aberdeen. She currently
works at a small animal
practice in West Lothian.

Barbara-Ann Innes
Barbara has worked as a
veterinary nurse at the Royal
(Dick) School of Veterinary
Studies and as a Head Nurse
in first opinion practice in
Durham. She has been
teaching animal care at
Oatridge College since 2000
and locums for Vets Now
Glasgow and Edinburgh.

Andrew Francis
Andrew qualified from Bristol in
2002. He then moved to
Edinburgh to undertake an
internship in small animal
medicine and surgery, and has
just completed a 3-year
residency in small animal
cardiopulmonary medicine
at The University of
Edinburgh. He is currently
working for Boehringer
Ingelheim Vetmedica.

Carolina Urraca
After graduating in Spain,
Carolina worked in referral
practices in the UK and
Germany. Since then she has
completed an internship in
equine medicine and surgery
at a referral practice in Spain
and an internship in diagnostic
imaging at the Royal (Dick)
School of Veterinary Studies,
where she is now an RCVS
Trust Resident in equine
diagnostic imaging.

Yvonne McGrotty
Yvonne qualified from Glasgow
in 1997, where she also did a
residency in small animal
internal medicine. She then
moved to the RVC where she
gained experience in
emergency medicine and
critical care techniques.
Yvonne now runs her own
medicine referral clinic based
in Stirling.

Helen Sutton
Helen graduated from Glasgow
in 2002, then worked in mixed
practice for a year in Forfar and
Arbroath. She worked in the
department of companion
animal clinical studies, at the
University of Pretoria Veterinary
Hospital, returning to Scotland
in 2006. She is currently
working at Broadleys Veterinary
Hospital in Stirling.

Sharon Macdonald
Sharon graduated from
Edinburghs Telford College.
She has always worked in small
animal practice but has found
her specialty in emergency and
critical care. Currently she
works at the Vets Now Hospital
in Glasgow.
The committee also includes
Val Pate and Trevor Black. The
team is working towards a
superb Scottish Congress
more details on page 3.
30-31 Diary.indd 30 19/05/2011 11:19
companion
|
31
CPD diary
EVENING MEETING
SOUTH WEST REGION
Thursday 9 June
Digital radiography: is it worth it?
Speaker: Nicolette Hayward
Communal Building, School of Veterinary
Science, University of Bristol, Langford,
North Somerset BS40 5DU
Details from southwestregion@bsava.com
DAY MEETING
EAST ANGLIA REGION
Sunday 19 June
Communication skills workshop
with the VDS
Speaker: Christine Magrath
The Cambridge Belfry, Cambourne,
Cambridge CB23 6BW
Details from eastanglia.region@bsava.com
EVENING MEETING
NORTHERN IRELAND REGION
Thursday 8 September
Wound Management
Speaker: Georgie Hollis
VSSCo, Lisburn BT28 2SA
Details from nirelandregion@bsava.com
DAY MEETING
Tuesday 7 June
Emergency medicine part III:
bleeding, anaemia and
transfusion medicine
Speakers: Sophie Adamantos and Dan Chan
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Wednesday 8 June
Feline behaviour
Speaker: Jon Bowen
Crowne Plaza, Gatwick Airport RH11 7SX
Details from administration@bsava.com
DAY MEETING
Tuesday 21 June
Old dogs, new tricks: canine
geriatrics
Speakers: Clive Elwood and Rory Bell
Kettering Park Hotel, Northants
Details from administration@bsava.com
DAY MEETING
Thursday 30 June
GIT I: diseases of the canine and
feline liver and pancreas
Speaker: Penny Watson
Radisson SAS, Manchester Airport
Details from administration@bsava.com
DAY MEETING
Tuesday 28 June
Ill never see a case of this... will I?
Emerging infectious diseases of
dogs and cats
Speaker: Sue Shaw
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Wednesday 14 September
Diabetes
Speaker: Grant Petrie
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Thursday 15 September
Cats are not small dogs: a day of
feline ophthalmology
Speakers: Sue Manning and Jim Carter
Crowne Plaza, Gatwick Airport RH11 7SX
Details from administration@bsava.com
DAY MEETING
Tuesday 20 September
Backyard poultry, problems and
solutions
Speakers: Victoria Roberts
The Park Royal, Warrington WA4 4NS
Details from administration@bsava.com
EVENING MEETING KENT REGION
Wednesday 21 September
Treating the pet chicken
Speaker: Victoria Roberts
Best Western Russell Hotel, 136 Boxley
Road, Maidstone ME14 2AE
Details from kentregion@bsava.com
DAY MEETING
Tuesday 5 July
Emergency medicine part IV:
sepsis, SIRS and support
Speakers: Sophie Adamantos and Dan Chan
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Tuesday 14 June
Introduction to practical cytology
Speakers: Michael Day
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
EVENING MEETING
MIDLAND REGION
Tuesday 14 June
Ultrasonography v radiography for
abdominal imaging
Speaker: Fraser McConnell
The Moat House (Just off M6), Lower
Penkridge Road, Acton Trussell ST17 0RJ
Details from midlandregion@bsava.com
DAY MEETING
SOUTH WEST REGION
Tuesday 6 September
Backyard poultry
Speaker: Victoria Roberts
Sandy Park Conference Centre, Sandy Park
Way, Exeter, Devon EX2 7NN
Details from southwestregion@bsava.com
EVENING MEETING
NORTH WEST REGION
Wednesday 21 September
The rapid neuro exam
Speaker: Raquel Monteiro
Holiday Inn, Haydock
Details from northwestregion@bsava.com
DAY MEETING
EAST ANGLIA REGION
Sunday 25 September
High liver enzymes again:
where next?
Speakers: Roger Powell, Patricia Ibarrola
and Tim Scase
Animal Health Trust, Newmarket, Suffolk
Details from eastanglia.region@bsava.com
DAY MEETING
METROPOLITAN REGION
Wednesday 21 September
Emergency medicine
Speakers: Sophie Adamantos and Dan Lewis
Venue TBC
Details from metropolitanregion@bsava.com
EVENING MEETING
KENT REGION
Wednesday 15 June
Managing elbow dysplasia
Speaker: Christopher Stork
Best Western Russell Hotel, 136 Boxley
Road, Maidstone ME14 2AE
Details from kentregion@bsava.com
DAY MEETING
NORTH WEST REGION
Wednesday 15 June
Abdominal surgery
Speaker: John Williams
Holiday Inn, Haydock
Details from northwestregion@bsava.com
WEEKEND MEETING
SCOTTISH REGION
Friday 26 Sunday 28 August
26th Annual Scottish Congress
Edinburgh Conference Centre,
Heriot-Watt University
For more information visit www.bsava.com or
email scottishregion@bsava.com
30-31 Diary.indd 31 19/05/2011 11:19
British Small Animal Veterinary Association
Woodrow House, 1 Telford Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB
Tel: 01452 726700 Fax: 01452 726701
Email: administration@bsava.com
Web: www.bsava.com
For more information or to
order visit www.bsava.com,
email administration@bsava.com
or call 01452 726700.
Order online to save on
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32 OBC.indd 32 19/05/2011 11:18