The essential publication for BSAVA members

companion
NOVEMBER 2012
Diagnosing feline
nasopharyngeal
diseases
A dogs life
in prison
A pet project with
offenders P4
Clinical Conundrum
Unilateral ocular
discomfort
P8
How To
Approach the patient
with PU/PD
P12
01 OFC November.indd 1 19/10/2012 13:09
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EJCAP ONLINE
Dont forget that as a
BSAVA member you are
enttled to free online
access to EJCAP register
at www.fecava.org/EJCAP
to access the latest issue.
PETSAVERS FUNDED STUDY
Hair nicotne concentratons in
dogs exposed to environmental
tobacco smoke (ETS)
This PetSavers-funded study found that
nicotne concentratons in dog hair appear to
be strongly associated with reported exposure
to ETS, and the range and median were
similar to those reported in children. This
suggests that dog hair could provide a useful
method of determining the amount of ETS
exposure in environments common to pets
and children.
Analysis of 14,008 uroliths from dogs
in the United Kingdom
This study found that associatons between
breed, gender, age and urolith formaton
were similar to those reported elsewhere.
However, temporal trends and novel breed
predispositons were idented.
Questonnaire-based assessment
of owner concerns and doctor
responsiveness for canine
chemotherapy patents
The authors conclude that questonnaire-
based surveys appear to be an eectve tool
companion is published monthly by the British
Small Animal Veterinary Association, Woodrow
House, 1 Telford Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB. This magazine
is a member-only benet. Veterinary schools
interested in receiving
companion should
email companion@
bsava.com. We welcome
all comments and ideas
for future articles.
Tel: 01452 726700
Email: companion@
bsava.com
Web: www.bsava.com
ISSN: 2041-2487
Editorial Board
Editor Mark Goodfellow MA VetMB CertVR DSAM
DipECVIM-CA MRCVS
CPD Editor Simon Tappin MA VetMB CertSAM
DipECVIM-CA MRCVS
Past President Andrew Ash BVetMed CertSAM MBA
MRCVS
CPD Editorial Team
Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS
Tony Ryan MVB CertSAS DipECVS MRCVS
Lucy McMahon BVetMed (Hons) DipACVIM MRCVS
Dan Batchelor BVSc PhD DSAM DipECVIM-CA MRCVS
Eleanor Raffan BVM&S CertSAM DipECVIM-CA MRCVS
Features Editorial Team
Andrew Fullerton BVSc (Hons) MRCVS
Mathew Hennessey BVSc MRCVS
Design and Production
BSAVA Headquarters, Woodrow House
No part of this publication may be reproduced
in any form without written permission of the
publisher. Views expressed within this
publication do not necessarily represent those
of the Editor or the British Small Animal
Veterinary Association.
For future issues, unsolicited features,
particularly Clinical Conundrums, are
welcomed and guidelines for authors are
available on request; while the publishers will
take every care of material received no
responsibility can be accepted for any loss or
damage incurred.
BSAVA is committed to reducing the
environmental impact of its publications
wherever possible and companion is printed
on paper made from sustainable resources
and can be recycled. When you have finished
with this edition please recycle it in your
kerbside collection or local recycling point.
Members can access the online archive of
companion at www.bsava.com .
3 BSAVA News
Latest from your Association
46 Its a dogs life in prison
Pioneering projects inside jails
811 Clinical Conundrum
Unilateral ocular discomfort
1217 How To
Approach the patient with polyuria
and polydipsia
1822 Diagnosing feline
nasopharyngeal diseases
Extracts from the new Foundation
Manual on feline practice
23 Congress Freebies
Making the most of your event
bootie
2425 Congress Psychology in
Practice stream
An example of the fresh new
approach being taken by BSAVA
2627 PetSavers
News, reports, and a chance to run
in the London Marathon
2829 WSAVA News
The World Small Animal Veterinary
Association
3031 The companion Interview
Aimee Llewellyn
33 Focus On
Surrey and Sussex Region
3435 CPD Diary
Whats on in your area
Additional stock photography Dreamstime.com
Indigofish; Katrinaelena; Soland; Steve Mann;
Virgil Naslenas; Vitaly Titov & Maria Sidelnikova;
Vivian Seefeld; Vladyslav Starozhylov
Whats in
JSAP
this month?
Here are just a few of the
topics that will feature in
your November issue:
for communicatng dog owners concerns
regarding chemotherapy and potentally for
monitoring a clinicians atentveness. Owners
expressed concerns at approximately half of
chemotherapy appointments.
A new method of computng the
vertebral heart scale
This study compared a simplied VHS method
with the Buchanan VHS method. Providing
clinicians with precise guidance would
decrease variability and improve the reliability
of results.
Determining the cause of canine
urolith formaton by advanced
analytcal methods
The results of this study appear to conrm
the causatve role of absorbable suture
material in the pathogenesis of hollow
channel structure in some canine
compound uroliths.
Log on to www.bsava.com to access
the JSAP archive online.
02 Page 02 November.indd 2 19/10/2012 13:35
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Regions take
grass roots lead
at strategy weekend
R
epresentatives from all 12 of BSAVAs
regional committees got together in
Oxford in September to produce plans
for offering the very best CPD and
support to members in 2013.
The dedicated and energetic volunteers
that make up the regional committees
demonstrated how committed they are to
finding the most effective ways of
delivering high-quality low-cost
CPD. Ideas flowed freely during the
two-day meeting which takes place
twice a year so experiences can be
shared and new initiatives developed.
One of the big successes of 2012
has been the introduction of TurningPoint
voting technology to allow interactive
regional meetings. Attendees at Congress
will be aware of the great utility of this
technology, and how it can make for a much
more enjoyable lecture experience. This will
become an increasingly prominent feature in
the 2013 diary with more regions offering
interactive events.
The central topic at all these biannual
meetings is a discussion about how BSAVA
can deliver even more to its members,
especially through regional committees.
Offering accessible CPD is a priority, of
course; however, if you have any other ideas
about how we can ensure we give you the
best possible support, then do please give
us your thoughts or even find out more
about becoming a regional volunteer.
Email Ben Dales at b.dales@bsava.com.
W
ith a treasure chest of dedicated
resources the BSAVA invites vet nurses to
benefit from an expanded membership
package in 2013.
VN membership had a quiet launch in 2012
and since then BSAVA has listened to those who came
on board early and worked hard to create a package
that meets the needs of all VNs.
Improved benefits
VN Membership costs just one third of the general
membership fee. With the huge range of FOC CPD
this means that a BSAVA VN Member can get their
entire annual CPD, all from BSAVA, all for just 72.
Along with the nurse pocketbook, a collection of
vital info, stats and doses, that is being launched at
Congress, VN Members in 2013 will also get
complimentary subscription to companion, free
lunchtime webinars, and hundreds of hours of
Congress lecture podcasts.
An especially welcome addition to the benefit
package is that VNs will also now be able to download
all the BSAVA Apps, including the Formulary (available
on iPhone and Android formats), and have access to a
brand new legal helpline.
VNs will of course be entitled to member discounts
too allowing a significant saving on all the Manuals,
CPD and four days at Congress from as little as 103
(in 2013). Of course VN Members also get exclusive
rights too. They can upgrade their Congress
registration to allow attendance at the veterinary
lectures as well as the nursing streams.
VNs to
benefit more
from BSAVA
STOP THE PRESS NEW LEGAL HELPLINE
Watch out in your December issue for news of the new legal helpline for BSAVA
members. Making your membership subscripton worth even more than ever before.
Response on
anaesthesia
consultation
I
n the October issue of companion we invited members to comment on
the role of the vet nurse in monitoring and maintaining anaesthesia.
Thank you for the excellent responses we have already received. You
can still have your say until 30 November at www.bsava.com/
consultations.
Personal or practice investment
BSAVA is offering VN Membership to help nurses who
are keen to expand their clinical knowledge and
achieve all their ambitions. So whether
its an investment in your own career
or is part of the training package
from the practice BSAVA
membership is the most
costeffective way to get all their
CPD requirements and a whole
raft of resources and benefits.
All VNs or practice principals
interested in VN Membership
can contact the BSAVA
membership team either
via www.bsava.com or
call 01452 726700.
03 Page November.indd 3 19/10/2012 12:42
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Its a
dogs life
in prison
S
trouds Digest on the Diseases of Birds is the
first textbook that should be consulted by
anyone who wants to know about the
redemptive power of working with animals. It
was written by a violent career criminal who had been
sentenced to hang for the murder of a prison guard.
But while being held in solitary confinement he found
an injured bird which he nursed back to health. This
led to him being allowed to keep canaries in his cell
and he went on to become a leading authority on the
diseases of caged birds.
Robert Stroud, the famed Birdman of Alcatraz
died aged 73 in a medical centre for federal prisoners
at Springfield, Missouri. In contrast for the 18- to
21-year-old inmates of the Polmont Young Offenders
Institution near Falkirk the future may not be so bleak.
Rebecca Leonardi, a postgraduate student at the
University of Stirling is responsible for a new initiative
aimed at preventing reoffending.
She is running Paws for Progress, a scheme which
offers offenders the opportunity to become involved in
training the dogs at a local rescue kennels so that they
are suitable for adoption by those wanting a well
behaved adult dog. The project, which began in August
2011, is a collaboration between the university, the
Scottish Prison Service and the Dogs Trust, and has the
support of a number of organisations, including the
Society for Companion Animal Studies which promotes
the use of animals in improving human welfare.
Origins of an idea
The idea behind the initiative is that through taking
responsibility for a dog, the behaviour of the young
men will also change; they will become involved with
the educational opportunities available and improve
their chances of getting a job on release.
Ms Leonardi is currently analysing data from the
first year of the scheme as part of her PhD thesis, and
the early indications are that it is achieving its goals.
That is not surprising since the scheme is based on
Project POOCH (Positive Opportunities Obvious
Change with Hounds), a similar programme that has
been successfully changing the lives of young men
What do abandoned dogs and young offenders
have in common? These two groups know only
too well what it feels like to be unwanted and
condemned to spend their days behind bars.
Ina pioneering Scottish project the inmates of
ayoung offenders institution and abandoned
dogs living in welfare charity kennels are helping
each other to develop the behaviour and skills
they will need to be accepted back into
mainstream society. John Bonner reports
04-06 Dogs in Prison.indd 4 19/10/2012 12:41
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5
and their canine charges at the MacLaren Youth
Correctional Facility in Woodburn, Oregon, since 1993.
Project POOCH in turn was based on an initiative that
began 12 years earlier at Purdy Womens prison in
neighbouring Washington State. Similar projects have
since been launched at prisons in Australia, Canada,
South Africa and Spain.
This has been a mutually beneficial
project for all involved. The young men at
Polmont have enhanced their
employability and literacy skills and, as a
result of their involvement in Paws for
Progress, have even been awarded a
Scottish Qualifications Certificate. I look
forward to reading Ms Leonardis
findings in the future and seeing how this
research can be utilised to improve the
efficiencies of the prison estate.
Kate Donegan, Governor at Polmont,
Scottish Prisons Service
Working with the probation service
Many other prisons have attempted to calm prisoners
behaviour by allowing them contact with animals,
particularly cagebirds and fish that can be easily
cared for in a cell. Liz Ormerod is a veterinary
practitioner from Fleetwood in Lancashire and
chairwoman of SCAS. She has studied the effects of
what has become known as Pet Facilitated Therapy
through her work with a former senior probation officer
for the county, Mary Whyham.
Together they surveyed the policies in place at 156
penal institutions around the UK and maintain that in
those places where prisoners had contact with animals
there were a number of very significant benefits. These
included better relationships between the prisoners
and their guards, a reduction in violence, fewer
incidents of self-harm and suicides, a reduction in drug
taking, and improved self-esteem among the inmates.
If these effects are seen consistently in all
institutions that allow pet-keeping, then why is it the
case that less than one-in-three prisons surveyed have
such a policy? Liz Ormerod believes that there is
opposition from the public and within the prison
service to anything that smacks of pampering the
prisoners. That does seem strange when they are
allowed to have a television but are not allowed to keep
a bird or fish in their cell, she asserts.
The hard cell
There have been a number of other objections
basedon claims that bringing in animals would
provoke allergic responses in prisoners or staff, or
thatlarger animals brought in from outside the prison
could be serving as a drugs mule.
Security is certainly an issue because of the
continuing increase in the prison population.
Prisoners are being kept two or even three to a cell
in facilities that were only designed for one. In some
cases, prisoners are kept locked up for most of the
day because there are not enough staff available to
oversee educational and training programmes like that
at Polmont.
Even in those places which have introduced
policies on pet ownership or to allow animals to visit
the institution, there is no guarantee that such
privileges will be maintained. Mary Whyham points out
that the attitudes of the prison governor and senior
colleagues are crucial, and many schemes have
foundered after key staff moved on to be replaced by
those with different views.
04-06 Dogs in Prison.indd 5 19/10/2012 12:41
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Its a dogs life in prison
Yet Liz Ormerod insists that maintaining such
policies would make the working lives of prison staff
much easier. It builds a different, more cooperative
atmosphere. Both the prisoners and the prison officers
start to see each other as better people. A pet gives
both sides something to talk about and the guards will
often bring in little treats for the animals. So the anger
that many prisoners feel starts to go away.
One obvious aspect to looking after an animal is
the time that it takes, an asset that inmates possess in
greater quantities than they would wish. Liz maintains
that it also fulfils a deeply held need to nurture another
living being, especially among the genuine hard
cases. At one prison I talked to a man who has stayed
up solidly for 72 hours looking after a sick budgie.
Iwish I had that sort of commitment more often from
the clients that I had at my practice. But for some of
these men having a pet is the first time that they have
felt unconditional love.
Positivity in prison
So pet keeping can help to improve the prisoners
behaviour in the short term but the goal of the dog
training projects is to produce permanent changes.
Joan Dalton established Project Pooch when she was
vice principal of the school connected to the MacLaren
Correction Facility for Young People. Her job was to try
to help her students gain the credit points that would
allow them to gain the high school graduation
certificates needed by most US employers. She
estimates that around 500 students and 600 dogs
have passed through the scheme since its inception.
Students could gain credits in subjects such as
biology and civics through their involvement with the
dog training project but, according to the students
own reports, the most important thing that they learned
was patience, she explains.
They discovered that they could only train the dogs
once they had built up a good relationship with the
animal, and that the necessary changes in canine
behaviour would only come about through positive
reinforcement. Generally the animals chosen for the
training programme are those that the dog pound finds
most difficult to re-home and few offenders fail to
appreciate the parallels between their dogs plight and
their own.
Joan believes that the educational qualifications
and improved self-esteem that participants gain from
the scheme help them to make a new life once they
are released. Usually many offenders will go on to
become regular clients of the prison service as they go
through their lives, but study by psychologist Sandra
Merriam found a zero recidivism rate among graduates
of the scheme. Indeed, many former students with jobs
outside do return but only to help the Project POOCH
organisers at fund raising events to help them continue
their work.
Properly run not a panacea
Mary Whyham warns that dog training schemes are
unlikely to provide a panacea to the problem of youth
offenders. Moreover, a badly organised scheme with
the wrong choice of supervisors, trainers and dogs is
unlikely to produce the goods and may even do harm
by discrediting this work in the eyes of the prison
authorities.
Joan Dalton agrees that it is vital that the
schemesare properly organised and wonders
whether the eight-week training programmes
envisaged for the Polmont scheme will be enough for
every student and every dog. She points out that
under Project POOCH, some trainers and some
dogs have needed much longer periods of training
before they are ready to be released or re-homed.
But once both sides are considered ready, they will
have been equipped with the skills that they will need
to survive in their new roles either as a family pet or as
a free member of society.
In Oregon state we do have something like 8 per
cent unemployment but our students can compete
successfully in the job market because they have
acquired skills that can be useful in a lot of fields, such
as doggy day care centres and pet shops. One recent
student has just started a dog grooming business and
another has plans to train as a veterinary technician,
says Joan.
The important thing is that by creating a
relationship with their dogs that is based on respect,
they learn to respect themselves. They start to see
that they do have some value and will no longer think
of themselves as just some stupid criminal that
nobody wants. n
04-06 Dogs in Prison.indd 6 19/10/2012 12:41
For more information or to book your course
www.bsava.com
Learn@Lunch
webinars
These regular monthly lunchtime (12 pm) webinars are
FREE to BSAVA members just book your place through
the website in order to attend. The topics will be clinically
relevant, and particularly aimed at vets and nurses in
first opinion practice. There will be separate webinar
programmes for vets and for nurses.
This is a great MEMBER BENEFIT.
Coming soon
What to say to a grieving owner webinar for nurses,
14 November
Cascade update webinar for vets, 5 December
Dealing with nasty dogs webinar for nurses,
12 December
All prices are inclusive of VAT. Stock photography: Dreamstime.com. Alptraum; Alterfalter; Isselee
Surgery of the pelvis
4 December
Designed for general practitioners, offering
a clinically relevant approach to the
diagnosis and decision making
SPEAKER
Kevin Parsons
VENUE
Woodrow House, Gloucester
FEES
BSAVA Member: 227.00
Non BSAVA Member: 340.00
New, important
information on
feline viral disease
15 January
First talk in the Feline Mini-Modular
programme covering the major and
emerging viral infectious diseases of cats
SPEAKER
Andy Sparkes
VENUE
Hilton Stansted Airport
FEES
BSAVA Member: 233.00
Non BSAVA Member: 350.00
Infectious diseases
of the rabbit
20 November
A cutting-edge day course for veterinary
surgeons treating rabbits in practice
SPEAKER
Emma Keeble
VENUE
Woodrow House,
Gloucester
FEES
BSAVA Member:
227.00
Non Member:
340.00
07 CE Advert November.indd 7 19/10/2012 12:41
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Clinical conundrum
Describe the abnormalities in Figure 1
In the right eye no abnormalities were detected. In the
left eye there was a central stromal ulcer with
associated corneal oedema and peripheral corneal
neovascularisation. A periocular tenacious
mucopurulent discharge was also present.
Describe an appropriate ophthalmic
exam
Menace response. This was positive in both eyes,
indicating that vision was present bilaterally.
Dazzle and direct pupillary light reflexes. These
were also positive in both eyes, indicating function
of the neurological pathway from the retina to the
facial nerve (cranial nerve (CN)VII) and the
oculomotor nerve (CN III).
Schirmer tear test 1 (STT 1). In the right eye the
result was over 15mm/min, indicating adequate
levels of aqueous tear production. In the left eye
the STT reading was 0mm/min. This test should
be performed before any topical medications
are applied.
Fluorescein dye test. There was no dye uptake on
the right cornea but there was fluorescein uptake
at the site of the ulcer present on the left cornea
(Figure 2). This pattern of uptake on the left eye
suggests that the ulcer is mid-stromal.
Slit lamp examination. This instrument is useful to
assess the depth of the ulcer in the left eye, which
was confirmed to be mid-stromal.
Fundic examination. Examination of the right eye
fundus using indirect ophthalmoscopy revealed no
abnormalities but was not possible for the left eye
due to the corneal pathology.
Intraocular pressure measurements. IOP was
normal in the right eye (16 mmHg) but was not
measured in the left eye (due to the risk of further
damaging the cornea).
Andrew Lewin, an Intern at Willows
Veterinary Centre and Referral Service,
invites companion readers to consider a
case of unilateral ocular discomfort and
redness in a young cross-breed dog
Case presentation
An 18-month-old male cross-breed dog
presented with a 2-week history of left ocular
pain and redness. A general physical exam
revealed no other abnormalities. The dog had
been previously treated with systemic and
topical non-steroidal anti-inflammatory drugs
and topical ocular lubricant.
A
B
Figure 1: The right eye (A) and left eye (B) of an 18-month-old
male cross-breed dog at the time as observed of initial
presentation
08-11 CLINICAL CONUNDRUM.indd 8 19/10/2012 12:40
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9
What is the significance of the
abnormalities seen in Figure 3?
The diagnosis in this case based on the findings so far
was keratoconjunctivitis sicca (KCS) and ulcerative
keratitis in the left eye. A physical examination revealed
unilateral crusting of the nares on the left hand side.
This indicates that the KCS may be of neurogenic
origin as both the lacrimal gland and the lateral nasal
gland share a common innervation. Other clinical
signs which are occasionally observed with
neurogenic KCS include Horners syndrome, facial
paralysis and trigeminal nerve deficits, none of which
was present in this case.
What is the normal range for the STT
test and what is your interpretation of the
values obtained in this patient?
A STT test can be performed either with (known as
STT 1) or without (STT 2) a topical anaesthetic applied
to the cornea prior to placing the test strip in the lateral
half of the lower conjuctival sac. Performing the STT
without the aid of topical anaesthesia is preferred, as
this measures both basal and reflex tear production,
whereas only basal tear production can be measured
in the anaesthetised eye.
The normal value for STT 1 in the dog is over
15mm/min, as was found to be the case in the right
eye of this patient. It is necessary to measure the
production of tears for a full minute as it has been
shown that the value will not rise in a linear fashion
during this time. A value of 614mm/min indicates
mild to moderate KCS and a value of < 5mm/min
indicates severe KCS, as was detected in the left eye
of this patient.
It is important to remember that occasionally
qualitative tear deficiencies can be present which
may present with a normal STT value. Qualitative
tear deficiencies can be detected using a tear
break-up test, which is performed by applying a
drop of fluorescein into the eye and allowing the
patient to blink. The eyelids are then held open and
the corneal surface observed with the aid of a blue
A
B
Figure 2: The right eye (A) and left eye (B) after fluorescein
had been applied bilaterally at the time of presentation.
There is no uptake of dye in the right eye and is an obvious
corneal defect in the central left cornea. Observation of the
defect using fluorescein is one method which the clinician
can use to determine the depth of an ulcer
Figure 3: Nasal crusting observed on the left hand side
08-11 CLINICAL CONUNDRUM.indd 9 19/10/2012 12:40
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companion
Clinical conundrum
light source such as that found on a handheld slit
lamp. The time taken for the first dry spot to appear
is noted and compared against normal values.
Anormal tear break-up test time is 1525 seconds
and a value of 10seconds or less is indicative of
tear film instability.
Which primary conditions can
cause KCS?
Immune-mediated: this is the most common cause
of KCS in dogs.
Drug therapy: topical atropine and systemic
trimethoprim sulphonamides can both cause
reduced tear production.
Infectious conditions such as distemper virus.
Acinar hypoplasia is a congenital condition
occasionally seen in toy breeds such as Yorkshire
Terriers, which can often present unilaterally
leading to KCS.
Iatrogenic KCS can be created by removal of the
tear gland of the nictitans membrane.
Systemic conditions including hypothyroidism,
diabetes mellitus and hyperadrenocorticism can
lead to reduced tear production.
Neurogenic KCS: this can be caused by a loss of
parasympathetic innervations to the lacrimal gland
(CN VII) or a loss of sensory innervation to cornea
(CN V). Loss of parasympathetic innervation can
be either idiopathic or due to middle/inner ear
disease. Neoplasia involving the nerves innervating
the lacrimal gland can also be responsible for
causing the condition.
Which further investigations may be
useful in the management of this case?
Radiography (relatively insensitive), computed
tomography (CT) or magnetic resonance imaging
(MRI) can be used once a diagnosis of neurogenic
KCS has been reached, to try and determine an
underlying aetiology.
In this case CT was used to image the tympanic
bullae and surrounding soft tissue, the region of the
left facial nerve and retrobulbar spaces. No pathology
was detected, so a final diagnosis of idiopathic
neurogenic KCS was reached. MRI is arguably a more
sensitive method of detecting neuritis than CT, but
was not used in this case as CT was deemed
sufficient for ruling out neoplasia and middle ear
disease. There were also financial limitations with this
case which were partly responsible for the choice of
imaging modality.
Construct an initial treatment plan for the
ophthalmic problems
The treatment plan for this dog had to address both
the ulcerative keratitis and the underlying idiopathic
neurogenic KCS. Despite the ulcer being mid-stromal,
a medical approach was adopted given the marked
associated corneal neovascular response.
The ulcer was treated with systemic analgesics
(carprofen 4mg/kg q24h), broad-spectrum systemic
antibiotics (cefalexin 15mg/kg q12h) and topical
antibiotics (polymyxin B ointment applied four times
daily to both eyes)*. The neurogenic KCS was treated
with ocular lubricants (applied every 2 hours to both
eyes) and oral pilocarpine. Pilocarpine is a muscarinic
parasympathomimetic drug available in various
concentrations which was historically used for the
treatment of glaucoma.
Pilocarpine has a non-specific
parasympathomimetic effect, and so will not only
stimulate secretion from the lacrimal glands but will
also have systemic side effects. It is irritant when
applied topically so can be used diluted at 0.1% in this
way (based on anecdotal evidence) or used orally at
1% as was done in this case (1 drop/10kg q12h orally).
The oral dose can be increased until signs of toxicity
are observed (hypersalivation, vomiting, diarrhoea and
cardiac arrhythmias). In some cases the pilocarpine
treatment can be stopped altogether after around six
months but in others it will need to continue as a
lifelong therapy.
Other treatments which were considered in this
case were bandage contact lenses to temporarily
protect the ulcer from further erosion and parotid duct
transposition. In this case medical management was
deemed sufficient without the need for surgery.
Outcome
At a re-check appointment 9 days later, the right eye
was unchanged after therapy, with a good tear film
* Editors Note:
Readers are reminded
that the PROTECT
poster (available at
www.bsava.com) has
guidelines on emperic
selection of antibiotics
for use in cases of
corneal ulceration.
08-11 CLINICAL CONUNDRUM.indd 10 19/10/2012 12:41
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11
AVAILABLE FROM BSAVA
BSAVA Manual of Small Animal
Ophthalmology
2nd editon
Edited by: Simon Peterson-Jones and Sheila Crispin
This Manual provides a practcal, consultng room guide to
small animal ophthalmology, but with su cient detail to
satsfy those who wish to study this fascinatng specialty in
greater depth. Features:
Surgical principles
Chapters dedicated to exotc pets
High quality full-colour photographs throughout
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photographs that aid clinical diagnosis. All practtoners should own a copy...
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CONTRIBUTE A CLINICAL CONUNDRUM
If you have an unusual or interestng case that you would like to share with your
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and a short but comprehensive explanaton, in no more than 1500 words to
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ACKNOWLEDGEMENTS
Thanks to Mike Rhodes for his help in the preparaton
of this artcle and to Christne Heinrich for her kind
permission to use her photographs.
Figure 4: The right eye (A) and left eye (B) as observed 9 days
after the time of initial presentation to the referral service.
The right eye appears to be unchanged from the time of
initial presentation. The left eye has markedly improved in
appearance: the central corneal ulceration has resolved and
superficial neovascularisation is visible in this region
A
B
and no signs of ulceration. The central ulcer in the
lefteye had healed and there was superficial
neovascularisation and associated corneal opacity
in this region (Figure 4). The left eye was confirmed
to be visual with a positive menace test. Both eyes
were comfortable and STT confirmed a reading of
> 15mm/min bilaterally.
The dose of pilocarpine was increased gradually
until a side effect (hypersalivation) was observed. At
this point the dose was reduced and treatment was
continued while monitoring STT levels, which remained
within the normal range in both eyes. One month after
initial presentation the dog was re-examined and
was found to have made excellent progress, and the
dose of pilocarpine was gradually reduced while
monitoring STT levels.
Eventually the drug was discontinued and one year
later the dog is continuing to do well without treatment.
It has been recently suggested that approximately half
of dogs with neurogenic KCS will not require
permanent treatment as they may have a self-limiting
underlying disease process.
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How to approach the
patient with polyuria
and polydipsia
A
n animal that is drinking and
urinating more than normal can
be a diagnostic challenge. There
is a long list of possible
differential diagnoses (Figure 1) requiring
logical progression through the diagnostic
pathway. Investigation may very quickly
and simply give an answer (e.g. diabetes
mellitus) or may need extensive, and
possibly expensive, testing to achieve a
diagnosis (e.g. partial central diabetes
insipidus). Owner education is key, as until
a diagnosis is made and correct therapy is
instigated the problem is likely to be
frustrating for both the owner and their pet.
Healthy animals drink 2070ml/kg/day
and produce 2045ml/kg/day of urine.
Animals, especially cats, fed a wet diet
may need to drink very little to maintain
hydration, as wet diets can contain up to
80% water. Animals fed a dry diet will often
drink a large proportion of their daily water
requirement within an hour or two of eating,
which can create unusual drinking patterns
if diet or feeding times are changed.
In normal animals urine concentration
is controlled by antidiuretic hormone (ADH,
also known as arginine vasopressin). ADH
is produced in the hypothalamus and
stored in the posterior lobe of the pituitary.
It is released in response to changes in
serum osmolality and acts on the kidneys
to retain water by increasing tubular
permeability. Thirst is also important in
water balance but is stimulated at a higher
osmolality threshold than that needed for
ADH release.
PU/PD
Polyuria (PU) and polydipsia (PD) usually
exist concurrently, with determination as to
which is the primary problem being one of
the major diagnostic challenges. Polydipsia
is usually defined as water intake of
>100ml/kg/day and polyuria as urine
production >50ml/kg/day. A large number
of disease processes can cause PU/PD,
and most affect the way ADH is produced
or exerts its action within the kidney.
However, as always, there are some
exceptions, for example osmotic diuresis
secondary to diabetes mellitus or a poor
medullary concentrating gradient
secondary to hepatic insufficiency.
Investigation starts with a detailed
history to allow confirmation of the
presence of PU/PD and to rule out
misinterpretation of related clinical signs
such as dysuria or incontinence. Asking
the owner to measure water intake
definitively over a 24-hour period will help
confirm the presence of PU/PD.
At the outset of investigations,
collecting multiple urine samples to
measure specific gravity (SG) can be very
helpful (Figure 2) as wide variations in
normal SG are reported (results in healthy
dogs range between 1.006 and 1.040).
Serial urine samples with an SG <1.020 are
supportive of PU/PD, whereas samples
consistently >1.030 support normal
urine-concentrating ability.
Careful clinical examination may also
help provide clues as to the origin of the
PU/PD. Neutering status is important,
alerting the clinician to the possibility of
pyometra in the intact bitch for example.
Inthis condition E.coli toxins interfere with
the action of ADH within the kidney. Careful
examination of peripheral lymph nodes
helps to exclude lymphoma, and evaluation
of the anal sacs helps exclude anal sac
adenocarcinoma; both of which can cause
PU/PD through hypercalcaemia. Skin
changes such as bilaterally symmetrical
alopecia, thin skin and calcinosis cutis
suggest possible hyperadrenocortisim
(Figure 3).
Simon Tappin from DickWhite Referrals helps us
get to grips with this tricky presentation
Primary polydipsia (psychological/
behavioural)
Central diabetes insipidus
Nephrogenic diabetes insipidus
Diabetes mellitus/primary glucosuria
Hyperadrenocortcisim
Chronic renal failure
Hypercalcaemia
Infectous focus (e.g. pyometra / sepsis)
esp. with Escherichia coli
Hepatc insu ciency
Primary hyperaldosteronism
Pyelonephrits
Hyponatraemia
Hypokalaemia
Hyperadrenocortcism
Acromegaly
Very low protein diets
Hyperthyroidism
Erythrocytosis
Iatrogenic drugs
phenobarbital, potassium
bromide, glucocortcoids, diuretcs
(e.g. furosemide), lithium
Figure 1: Differential diagnoses for polyuria and
polydipsia in dogs and cats
Figure 2: Urinalysis and serial urine specific
gravity measurements are essential early in the
investigation of PU/PD
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Initial further investigations (Figure 4)
are aimed at excluding diseases that
interfere with the action of ADH within the
kidney (secondary nephrogenic diabetes
insipidus) and diseases which lead to
osmotic diuresis (e.g. renal failure and
chronic renal failure). Urinalysis (including
culture), haematology and full
biochemistry, including a bile acid
stimulation test are a good starting point,
before more focused investigations such
as adrenal function tests and imaging are
performed. If these investigations are
unremarkable, and renal concentrating
ability has not been proven by random
urine samples, investigations then focus
on investigating the presence of diabetes
insipidus (central or nephrogenic) or
primary (psychogenic polydipsia).
Diseases leading to osmotic
diuresis
Diabetes mellitus
Diabetes mellitus leads to elevated serum
glucose levels through the absolute or
relative deficiency of insulin. This elevation
in glucose quickly exceeds the renal
tubules ability to resorb glucose and leads
to glucosuria. The presence of glucose in
the urine leads to an osmotic effect,
causing excessive water loss, primary
polyuria and hypovolaemia. This leads to
the stimulation of thirst, increased water
intake and a secondary polydipsia.
Urinalysis and fasting glucose levels are
usually sufficient to diagnose diabetes;
however in cats, where stress-induced
hyperglycaemia is relatively common, the
measurement of fructosamine or
glycosylated haemoglobin can be helpful.
Glucosuria
Primary renal glucosuria is an uncommon
disease which is most commonly seen in
Norwegian Elkhounds and the Basenji. It
results from the congenital inability to
resorb glucose from the renal tubules,
leading to osmotic diuresis in the same
way as diabetes mellitus. These dogs have
glucosuria but normal serum glucose
levels. Some dogs and cats may also have
glucosuria as a component of Fanconi
syndrome. This is a tubular disorder, which
results in increased urine concentrations of
glucose, potassium, phosphate,
bicarbonate and amino acids due to
reduced tubular resorption.
Renal failure
Chronic renal failure (CRF) is caused by a
gradual reduction in the number of
functioning nephrons present within the
kidney. At compensation the remaining
nephrons increase their glomerular filtration
rate (GFR). This leads to an increased
amount of filtrate being presented to the
distal tubules and, as a result, less sodium
and urea are reabsorbed. This leads to
osmotic diuresis, which is worsened by a
reduced medullary concentrating gradient.
Animals with CRF usually have increased
serum urea, creatinine and phosphate
levels, as well as isosthenuric urine
(SG1.0081.012).
Figure 3: A Yorkshire terrier with
hyperadrenocorticisim with marked bilaterally
symmetrical alopecia
History and physical
examinaton
Laboratory
investgatons
Urine and blood
PU/PD
Abnormal?
Suspect:
Hyperadrenocortcism
Pyometra
Hyperthyroidism
Hypercalcaemia
Specialist tests:
Plasma osmolarity
Water deprivaton test
DDAVP trial
Increased BAS or Ammonia?
Suspect:
Liver disease
Portosystemic shunt
Hypercalcaemia?
Suspect:
Hyperparathyroidism
Hypercalcaemia of
malignancy
ACTH stmulaton
Exclude:
Addisons
Hyperadrenocortcism
Central diabetes insipidus
Primary polydipsia
Nephrogenic diabetes insipidus
Glucosuria?
Suspect:
Diabetes mellitus
Renal glucosuria
Normal if S.G.
>1.025 Dogs
>1.030 Cats
Azotaemia?
Suspect renal disease
Figure 4: Diagnostic pathways for the investigation of PU/PD
BAS = bile acid stimulation
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How to approach the
patient with polyuria and polydipsia
Acquired or secondary
nephrogenic diabetes insipidus
Many disorders interfere with the normal
interaction between ADH and its receptor
in the kidney or lead to reduced medullary
concentrating ability. These can appear
with marked PU/PD but the ADH sensory
and release mechanisms are present but
disease interferes with ADH action.
Pyelonephritis
Pyelonephritis leads to inflammation of
the renal pelvis, which affects the
concentrating ability of the renal medulla.
This leads to PU/PD and eventual renal
failure. Bacterial toxins especially those
from E.coli, compete with ADH binding
sites within the kidney, which leads to
further polyuria. Pyelonephritis may be
very difficult to diagnose, needing a
combination of techniques such as
abdominal ultrasonography, looking for
evidence of subtle changes within the
renal pelvis (Figure 5) and pyelocentesis to
collect culture samples. Insome cases this
may not be possible and is a sufficient
suspicion regarding pyelonephritis (e.g.
previous recurrent urinary tract infection)
then a trial treatment with a suitable
antibiotic (potentiated amoxicillin or a
fluoroquinolone) may be an appropriate
alternative. Ifthis improves clinical signs,
antibiotics should be continued for
46weeks.
Liver disease
Hepatic insufficiency and portosystemic
shunts both lead to PU/PD. The exact
mechanism is unclear; however, it is most
likely that reduced urea production leads to
a reduced medullary concentrating
gradient or that toxins alter the perception
of thirst. A bile acid stimulation test is the
best screening test of liver function.
Hyperadrenocorticism
Hyperadrenocorticism, or Cushings
syndrome, is a relatively common cause of
PU/PD in middle-aged to older dogs. Signs
may be classic and associated with
polyphagia, skin signs and a pot-bellied
appearance (see Figure 3); however in
their absence hyperadrenocorticism
cannot be excluded and should be
considered as a possible differential.
Haematology will often reveal evidence
of a stress leucogram, mild thrombocytosis
and erythrocytosis are less commonly
documented. Biochemistry may reveal
increased alkaline phosphatase (seen in
approx. 9095% of cases) and cholesterol
(seen in approx. 75% of cases). A urine
sample should be collected by
cystocentesis for culture, even if an active
sediment is not present, as 4050% of
dogs will have active urinary tract
infections at presentation.
An ACTH stimulation test is the most
commonly used screening test for
hyperadrenocorticism as it is least
affected by stress. The ACTH stimulation
test has a sensitivity of 85% in pituitary-
dependent and 65% in adrenal-dependent
disease (specificity of 8590%). A low
dose dexamethasone suppression test is a
more sensitive and reliable test (sensitivity
100% in adrenal-dependent and
9095% in adrenal-dependent
hyperadrenocorticism) however it can be
affected by stress and cannot detect
iatrogenic hyperadrenocorticism nor be
used for monitoring treatment. Once a
diagnosis is reached, further tests can
help discriminate between pituitary- and
adrenal-based disease.
Hypoadrenocorticism
Hypoadrenocorticism leads to the inability
to concentrate urine through the absence or
insufficient levels of aldosterone.
Mineralocorticoid deficiency leads to
chronic sodium wasting and loss of
medullary tonicity. There is also some
evidence to suggest that decreased
aldosterone reduce the sensitivity of the
ADH receptors, furthermore the
hypercalcaemia associated with
hypoadrenocorticisim may also contribute
to the PU/PD. Treatment with synthetic
mineralocorticoids typically corrects this,
although some dogs may need additional
dietary sodium chloride to correct their
PU/PD. Differentiating hypoadrenocorticisim
from renal failure can be difficult on
biochemistry and sodium:potassium ratios
alone, so an ACTH stimulation test is
needed for definitive diagnosis.
Hypercalcaemia
Increased serum calcium concentrations
inhibit the action of ADH in the kidney,
leading to primary polyuria and secondary
polydipsia, and can lead to renal failure.
Other clinical signs include weakness,
vomiting and dull mentation. The
differentials for hypercalcaemia can be
remembered with the help of the
mnemonic HARD IONS (Figure 6). The
most common cause of hypercalcaemia in
an older dog is malignancy (lymphoma
followed by anal sac adenocarcinoma and
multiple myeloma).
Hyperthyroidism
Hyperthyroidism is often associated with
PU/PD in both cats (common) and dogs
Figure 5: Ultrasound evaluation revealing mild
pyelectasia. In this dog this was caused by the
polyuria and there was no evidence of
pyelonephritis
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(very rare <10% of thyroid tumours are
active). The exact mechanism is unclear,
however increased renal blood flow
probably leads to decreased medullary
tonicity and impaired water resorption as a
result. It is also thought that some
hyperthyroid cats may have a component
of psychogenic polydipsia and many will
have a degree of concurrent CRF.
Palpation for goitre and TT4 evaluation are
therefore important in investigating PU/PD
in older cats.
Acromegaly
Acromegaly is an uncommon cause of
PU/PD, however excessive amounts of
growth hormone (GH) lead to increased
GFR which leads to polyuria. Increase GH
may also lead to a GH-induced
glomerulonephritis and carbohydrate
intolerance, which may eventually lead to
overt diabetes mellitus.
Erythrocytosis
Erythrocytosis has been shown to cause
PU/PD through altered thresholds for ADH
release. It is thought that increased blood
viscosity and volume lead to increased
atrial natriuretic peptide release, which
both inhibits ADH release and reduces its
activity within the kidney.
Hypokalaemia
Hypokalaemia is a very common
electrolyte abnormality and is thought to
cause PU/PD by making the terminal
nephron less responsive to ADH. PU/PD is
an uncommon sign of hypokalaemia, with
muscle weakness (often leading to neck
ventroflexion in cats due to their absence
of a nuchal ligament) and cardiac
dysfunction more common. Hypokalaemia
occurs due to decreased intake, increased
excretion or as a result of increased
translocation to the intracellular space.
Diabetes insipidus and primary
polydipsia
Once diseases that interfere with renal
function (i.e. osmotic diuresis and causes of
secondary nephrogenic diabetes insipidus)
are excluded, investigations focus on trying
to differentiate the cause of PU/PD from
central diabetes insipidus (CDI),
nephrogenic diabetes insipidus (NDI) and
primary polydipsia (PP). It needs to be
stressed that these diseases are rare and
causes of secondary nephrogenic diabetes
insipidus are far more common. Thus
testing for diabetes insipidus and primary
polydipsia should only be undertaken after
a thorough primary investigation and
exclusion of all other possibilities.
Measurement of plasma osmolality is
often helpful at this stage as it allows
assessment of whether the animal drinks a
lot because it urinates a lot (CDI) or if it
urinates a lot because it drinks a lot (PP).
Measurement of plasma osmolality can be
done using an osmolality meter or estimated
using the following equation: (plasma
osmolality = 2xNa + BUN + Glucose).
If the animal has PP then plasma
osmolality should be low as the serum
should be very dilute due to increased
drinking. Conversely, if the animal has
CDI the plasma osmolality should be
increased due to increased excretion of
water. Unfortunately there is some cross
over with this test and the results are often
not as clear cut as hoped (Figure 7);
however it is a cheap test and a useful part
of the initial assessment.
H Hyperparathyroidism (primary and
secondary)
A Addisons (hyperadrenocortcism)
R Renal failure (acute and chronic)
D Vitamin D toxicity
I Idiopathic (cats) or Infecton
(granulomatous disease, e.g. fungal)
O Osteolysis (rare but reported with
osteomyelits and hypertrophic
osteodystrophy)
N Neoplasia (lymphoma, multple
myeloma, anal sac carcinoma)
S Spurious (lab error, excessive
supplementaton, etc.)
Figure 6: Differential diagnoses for
hypercalcaemia
P
l
a
s
m
a

o
s
m
o
l
a
r
i
t
y
310 mOsm/L
290 mOsm/L
Normal
range
280 mOsm/L
CDI NDI PP Partal CDI
Figure 7: Plasma osmolality in different conditions causing PU/PD. Although there is some crossover
between conditions plasma osmolarity less than 280 mOsm/l is very suggestive of primary polydipsia
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How to approach the
patient with polyuria and polydipsia
Phase 1: Preparaton
1. Determine water intake in a 24-hour
period with free access to water
2. Three to ve days before the test
gradually decrease water intake to
100 ml/kg/day
3. Starve the animal for 12 hours before the
beginning of the test
Phase 2: Water deprivaton
1. Prior to startng test
a. Withdraw all food (12 hours
previously) and water
b. Empty bladder completely consider a
urinary catheter
c. Obtain exact body weight
d. Check urine SG
e. Check serum BUN and electrolytes
f. Check hydraton and CNS status
2. During test
a. Completely empty bladder every
60120 min
b. Check urine SG
c. Check exact body weight every 60 min
d. Check hydraton and CNS status at
each interval
3. End test if:
a. Urine SG >1.030
b. Dog appears clinically dehydrated or
unwell
c. Dog has lost 35% of body weight
4. At end of phase 2:
a. Collect serum for endogenous ADH
determinaton
b. Empty bladder and recheck urine SG
Phase 3: Response to exogenous ADH
1. Administer 25 IU i.m.
2. Contnue to withhold food and water
3. Empty bladder every 30 minutes for
12 hours
4. Recheck urine SG
5. Check hydraton and CNS status
Phase 4: End of Test
1. Introduce small amounts of water
(1020 ml/kg) every 30 minutes for
2 hours
2. Monitor patent for vomitng, hydraton
and CNS status
3. If patent is well 2 hours afer the end of
the test, return to ad lib water intake
Figure 8: Protocol for the modified water
deprivation test
Classically a water deprivation test is
needed to differentiate CDI from NDI and
PP. The water deprivation test (WDT) is a
long, time-consuming test which does
carry some risks to the patient if not
completed carefully. A full description of
how to perform a water deprivation test is
found in Figure 8. In a normal dog (or a
dog with PP) as water is withheld urine SG
will rise gradually as the kidneys work hard
to retain water. If ADH is not present (CDI)
or is unable to have an effect within the
kidney (NDI), there will be no increase in
urine concentration. Once the animal has
become 5% dehydrated synthetic ADH
(DDAVP) is administered by intramuscular
injection and the response measured. If
ADH is absent (CDI) then the urine SG
should increase quickly; however, if the
kidney is unable to respond to ADH (NDI)
then urine SG will stay constant (Figure 9).
An addition to the standard WDT is to
measure plasma osmolality and
endogenous ADH concentrations before
the administration of DDAVP. This can be
very helpful in eliciting whether ADH is
being produced and is especially useful for
the differentiation of partial CDI from CDI
(Figure 10).
An alternative to a WDT is to consider a
DDAVP trial. This relies on the fact that NDI
is very rare and CDI should respond well to
DDAVP, whereas additional ADH in an
animal with PP will make little impact on its
PU/PD. Suggested treatment at home is
using oral DDAVP (absorption of tablets
can be variable however) with an empirical
dose: for a 20kg dog, 0.1 mg three times a
day for about 7 days; for a 40kg dog,
0.2mg three times a day for about 7 days.
Animals with CDI will respond quickly to
this treatment and the response can be
substantiated using urine samples
collected at home by the owners. The dose
of DDAVP is then slowly tapered to reach
the lowest possible dose that controls the
animals clinical signs.
Nephrogenic diabetes insipidus
Nephrogenic diabetes insipidus describes
conditions where the kidneys do not
respond to ADH to produce concentrated
urine as expected. Normally the
hypothalamus produces ADH in response
to increased serum osmolality. When
released ADH acts in the collecting ducts
to increase permeability, thereby retaining
water and the the production of
concentrated urine.
As described above, acquired or
secondary conditions which interfere with
the way ADH works in the kidney are
common (e.g. endotoxins from E. coli,
drugs such as glucocorticoids and
metabolic conditions such as
hypercalcaemia and hypokalaemia)
however primary or congenital NDI is very
rare. Congenital NDI is caused by a
deficiency of ADH receptors and clinical
signs usually develop at a very young age.
Signs are severe with very marked PU/PD
(urine SG 1.0011.005). Diagnosis is made
after excluding causes of secondary NDI
and a WDT showing failure to concentrate
after administration of exogenous ADH.
The animal should always have free
access to water and will always be
markedly polyuric and polydipsic. Dietary
sodium and protein restriction will reduce
the amount of solute presented to the
kidney therefore reducing the amount to
excrete in the urine each day by about
2050%. The addition of thiazide diuretics
(hydrochlorothiazide 15 mg/kg orally
q12h) to dietary restrictions may further
reduce urine production by increasing fluid
uptake in the proximal tubules.
Central diabetes insipidus
CDI is caused either by the absolute
(complete) or relative (partial) deficiency of
ADH. Complete CDI leads to the complete
inability to produce concentrated urine,
whereas in partial CDI ADH is released in
subnormal amounts often only at higher
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U
r
i
n
e

s
p
e
c
i

c

g
r
a
v
i
t
y
Primary
polydipsia
Partal
CDI
CDI
NDI
Administraton
of DDAVP
Time
Figure 9: Expected results of the water deprivation test
Figure 10: Measurements of plasma osmolality and endogenous ADH at the end of the WDT can be
very helpful in diagnosing partial CDI as small, but inappropriate amounts of ADH are released in
response to increasing plasma osmolarity
P
l
a
s
m
a

A
D
H
Plasma osmolarity
Normal
CDI
NDI
Primary
polydipsia
Partal CDI
osmolality than expected. Pituitary or
intracranial neoplasia (e.g.
craniopharyngioma or meningioma) are
the most common causes of CDI. Thus,
once a diagnosis of CDI is made,
advanced imaging of the pituitary gland
is recommended. Severe head trauma
may lead to clinical signs, with
spontaneous resolution possible due to
regeneration of disrupted axons. If no
aetiology is evident then idiopathic
disease is suspected. This is most
common in younger animals; however,
they may develop lesions during the
course of their life which were not initially
evident during the primary investigations.
Treatment revolves around the ADH
analogue desmopressin (DDAVP,
1-deamino, 9-D-arginine vasopressin); this
provides antidiuretic activity for about
8hours. One drop (1.5 to 4 g) placed two
or three times daily in the conjunctival sac
sufficiently controls the polyuria in most
dogs with CDI. In the absence of neoplasia
the long-term prognosis is good, with many
animals remaining asymptomatic on
appropriate therapy.
Primary polydipsia
Primary polydipsia is largely thought to be
behavioural in origin and can be controlled
in most cases by gradual water restriction
to the high end of normal (6080ml/kg per
day). If this not successful then behavioural
modification (e.g. increased exercise,
changed environment or seeking a
veterinary behaviourists opinion) may help.
Conclusions
Although common presenting complaints,
both polyuria and polydipsia represent
significant challenges to the small animal
practitioner. With careful history taking
andexamination, followed by logical
investigations the cause should be
determined, allowing directed therapy
andrealistic expectation of outcome for
theowner.
Note: Some of the medications
mentioned in this article are not
authorised for use in dogs and
cats. Readers are reminded to
follow the Cascade when
prescribing medication.
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Diagnosing feline
nasopharyngeal
diseases
Suspected nasopharyngeal neoplasia, polyp,
fungal granuloma (nasal discharge, epistaxis,
nasal asymmetry, stertor).
In cats amenable to oral examination while
conscious, it may be possible to get a view of the
nasopharynx by grasping the tongue with your fingers
and extending it rostrally, using the projecting lingual
papillae to help you get a firm grip on the tongue. The
soft palate develops a V shape and a momentary
glimpse of the nasopharynx can be obtained. This may
allow sight of a grass blade or polyp in the caudal
nasopharynx (polyps are usually situated more
caudally than nasopharyngeal lymphoma or fungal
granulomas). If there is a large mass lesion in the
nasopharynx, it is also sometimes possible to see a
bulging of the soft palate.
Under general anaesthesia (see Box 1), the
nasopharyngeal region is palpated through the soft
palate. Normally, the soft palate gives on palpation,
but if a polyp, granuloma or neoplasm is present, it is
generally possible to appreciate the presence of a
mass lesion, which may then be sampled by fine
needle aspiration.
With the cat in dorsal recumbency, the soft palate
can then be retracted to allow visualization of any
foreign bodies or soft tissue masses. Further
evaluation is aided by simple adjunct tools such as a
laryngoscope (Figure 1), spay hook (Figure 2) or
forceps, and a dental mirror.
E
ffective feline practice is grounded in a
knowledge of the clinical approach to, and
management of, a wide variety of problems
likely to be seen in cats, while making the
veterinary clinic as cat-friendly as possible. Focussing
on gold-standard preventive healthcare and the
common areas encountered in the first opinion setting,
the BSAVA Manual of Feline Practice will be a best
practice guide. Where appropriate, guidelines will also
be given as to the best steps to take when there are
financial considerations.
While the Foundation Manuals are particularly
relevant to students and recently qualified vets, or
those returning to practice after a career break,
recommendations will be given that can be followed by
all vets seeing feline cases. As an added feature,
quick reference guides (QRGs) throughout the book
will highlight practical techniques and treatment in an
easy-to-follow step-by-step fashion, aided by clear
colour photographs.
These QRGs will include: tips for taking and
interpreting a thoracic radiograph; performing a
neurological examination; tips for performing dental
extractions; enucleation; managing diabetic
ketoacidosis; performing early neutering; skin scrapes
and skin cytology; performing bronchoalveolar lavage;
thoracocentesis; taking a liver biopsy; placing a chest
drain to name just a few.
Examining the nasopharynx in a cat
Nasopharyngeal examination may be required in cats
for a number of reasons:
Evaluation of stertor (most commonly caused by
nasopharyngeal polyp, neoplasia or stenosis)
Suspected nasopharyngeal foreign body
(e.g.acute onset sneezing/gagging, facial
discomfort, nasal discharge)
The BSAVA Foundation Manual on feline
practice will be published next year. Here,
one of the co-editors, Andrea Harvey, who
will also be speaking at BSAVA Congress in
April, gives us a taste of what is to come
BOX 1: ANAESTHETIC CONSIDERATIONS
General anaesthesia is almost always required for further
investgaton or for removal of a foreign body or polyp.
Cats with nasopharyngeal disease can be at high risk
of upper airway obstructon. This is usually due to the
presence of associated discharge. Stmulaton of the
nasopharynx will also ofen result in excessive mucus
and saliva secreton, in additon to tssue oedema/
infammaton. It is therefore prudent to ensure that
all necessary equipment is prepared prior to inducing
anaesthesia. This should include: sucton equipment;
swabs and coton buds to help remove secretons; a
laryngoscope; various sizes of endotracheal tubes; and
a dog urinary catheter in case of difculty intubatng.
The cat should be pre-oxygenated, and intubated with
an endotracheal tube that is as large as possible. Pulse
oximetry monitoring should be used throughout, and
sucton equipment kept to hand throughout inducton,
the procedure and recovery.
18-22 Publications.indd 18 19/10/2012 12:39
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19
Figure 1: This 6-year- old MN DSH cat was presented with an
acute history of sneezing and pawing at the face, after
having been outside in the owners garden. He had no nasal
discharge or stertor. These signs, plus their acute onset,
suggested a nasopharyngeal foreign body such as a blade of
grass. Allis tissue forceps were used to retract the soft
palate, and a laryngoscope used to assist evaluation. A blade
of grass was seen in the nasopharynx and removed intact
using forceps
Figure 2: This 1-year-old FN DSH cat
presented with a few weeks of
progressively worsening stertor. There
was no nasal discharge or sneezing.
Under anaesthesia, a firm bulging of
the soft palate was palpable. The soft
palate has been retracted rostrally
using a spay hook and a
nasopharyngeal polyp can be seen (the
red lesion just caudal to the tip of the
spay hook). This was successfully
removed by traction, using grasping
forceps. This photo is taken with the
cat in sternal recumbency, but the
author prefers to conduct the
procedure with the cat in dorsal
recumbency
Diagnostic imaging
Plain radiography, CT and MR imaging all provide a
measure of the extent of a lesion and its precise
anatomical location or the presence of a foreign body.
However, imaging does not negate the need for
direct visualization. Plain radiographs are the most
practical diagnostic imaging modality for general
practice, with the most useful views being an intraoral
dorsoventral view of the nasal cavity and a lateral view
of the skull and pharynx, with the patient extubated in
order to be able to assess the nasopharynx. In the
majority of cases, however, these are of limited value
in reaching a diagnosis, and extubating the patient
may not be desirable.
Advanced imaging is not usually required but may
be considered in some cases where a diagnosis has
not been possible using other methods; this should be
discussed first with a specialist to determine whether
or not it is likely to be of value before proceeding.
Retrograde rhinoscopy
If a flexible endoscope is available (either a small
gastroscope or a bronchoscope) then a very good
view of the nasopharyngeal region can be obtained
(Figure 3). The endoscope is fully retroflexed into a
Ushape and inserted into the mouth, hooking the free
end over the top of the soft palate. It is then rotated to
be in a midline position (look for the endoscopic light
pointing cranially through the soft palate to show that
you are in the correct position) and pulled rostrally.
This technique is of particular value when a foreign
body or nasopharyngeal mass is suspected but
cannot be visualized as described above. Referral may
be required.
Figure 3: View of the nasopharynx
obtained though retrograde
rhinoscopy. This was a 5-year-old MN
DSH cat that had been presented with
a chronic mucopurulent nasal
discharge and progressively
worsening stertor. There is a fungal
(cryptococcal) granuloma (arrowed)
occluding the posterior nares. The
soft palate is at the top of the photo;
its location can be determined by
pushing on the soft palate with a
finger during the procedure
18-22 Publications.indd 19 19/10/2012 12:39
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Diagnosing feline nasopharyngeal diseases
Indications
Nasal fush only:
Where a foreign body is suspected or
has been identifed and fushing is
required to attempt to dislodge it
Where a mass has been identifed or is
suspected, and nasal fushing is
successful in dislodging enough tissue
for histopathology (this can occur with
fungal granulomas and nasal lymphoma)
In chronic rhinitis, to fush out tenacious
secretions (this can be therapeutic).
Nasal fush and biopsy:
Where a soft tissue mass has been
identifed or is suspected, and has not
been dislodged with vigorous nasal
fushing
Where a cause (e.g. foreign body or
polyp) of the clinical signs has not yet
been identifed; fushing can be used to
collect samples for cytology, and nasal
biopsy samples obtained for
histopathology.
Equipment
Suitably sized mouth gag
Gauze swabs
Gauze bandage
Throat packs: these can be made by
rolling up a small piece of gauze swab
and tying a gauze bandage around it;
the swab can be packed into the throat,
whilst the bandage remains outside the
mouth to allow easy retrieval.
Alternatively, a small sponge with a tie
attached can be used
Laryngoscope
Suction equipment
Lidocaine
Allis tissue forceps and/or spay hook
Dental mirror
35 mm diameter tip (or smaller)
endoscope
Quick Reference Guide: Nasal fushing and biopsy
by Andrea Harvey and Richard Malik
Cotton buds
Small bowl of tap water
2 formalin pots
1 plain collection tube
1 or 2 EDTA collection tubes
0.9% saline
2 x 10 ml syringes and needle for
drawing up saline
Suitable nasal biopsy forceps e.g.
alligator forceps with sharp cupped tips,
otoscope biopsy forceps or endoscopic
GI biopsy forceps. The bigger the
forceps that can be inserted, the larger
the samples that can be retrieved.
parameters (PCV and platelets) should
be checked and found to be normal prior
to taking biopsies. The authors do not
routinely assess coagulation times
unless the cat has any other systemic
abnormalities (e.g. liver disease).
General anaesthesia is required and
anaesthetic considerations are
important (see Box 1). With nasal fush
biopsy, there is the additional concern
of even more risk of upper airway
obstruction and aspiration, because of
the nasal fush fuid and haemorrhage
from biopsy. In addition to having
suction equipment and gauze swabs
and cotton buds to hand, the pharynx
should be packed (see below) and
consideration given to using a cuffed
endotracheal tube.
Performing a nasal
fush
1
With the cat anaesthetized and with an
ET tube in place, the pharynx is packed
with gauze swabs or small pieces of sponge
attached to a tie.
Throat pack
Alligator forceps
Patient preparation
The nasopharynx should be evaluated
prior to performing nasal fush or biopsy.
Since nasal biopsy can cause signifcant
haemorrhage, haematological
18-22 Publications.indd 20 19/10/2012 12:39
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21
2
One of the authors (AH) prefers to
have the cat positioned in sternal
recumbency, with the head and neck
facing ventrally over the edge of the table,
to encourage fuid to drain out rostrally
afterfushing.
3
Two to four 10 ml syringes are flled with
sterile 0.9% NaCl that has been warmed
to 38C. The end of the syringe is
wedged into one nostril.
One hand is used to hold the syringe in
place and to occlude the contralateral
nostril, while injecting 10 ml saline as fast
as possible using the other hand.
A collection dish is held underneath the
cats head to collect any material that
drains from the nose or pharynx.
Unless a foreign body has been
dislodged and thus the cause already
identifed, fuid is then transferred to an
EDTA tube for cytological assessment.
The procedure is repeated for the other
side of the nose.
Routine bacterial culture of fush fuid is
rarely helpful, but in cases of chronic rhinitis
culture can sometimes be useful in directing
antibiotic therapy if a resistant infection is
identifed (culture of tissue collected by
biopsy is more helpful).
The other author (RM) prefers cats to be
positioned in dorsal recumbency. Firm tape
can be used to hold the cats head in
position against the table top using the
maxillary canine teeth as points of
anchorage (not shown here). Gauze tape
can be hooked around the mandibular
canine teeth to open the jaws (not show
here) or, if a third person is available, it is
ideal if they can hold the tongue (as shown
here) and endotracheal tube up and away
from the palate.
4
After fushing, the throat packs can be
removed and examined for any foreign
material, or dislodged tissue. Usually foreign
bodies and many mass lesions will be
dislodged within two or three attempts.
Portions of dislodged tissue can be:
Used to make impression smears for
cytological assessment
Placed in formalin for histopathology
Retained for fungal culture if fungal
infection is suspected on the basis of
gross appearance, or suggested by
cytology or histopathology.
5
Following the procedure the pharynx
should be examined, and any
remaining secretions or fuid suctioned out.
Performing nasal
biopsy
1
The anaesthetized cat, with ET tube in
place, is positioned in sternal
recumbency with new throat packs placed
(so that any blood resulting from biopsy is
not aspirated). Care must be taken not to
risk penetrating the cribriform plate:
forceps can be pre-measured from the
nares to the medial canthus of the eye
and a piece of tape used to mark the
forceps at this point. The forceps must not
be inserted beyond this. WARNING: The
tape must not be allowed to get wet and
slip during the procedure.
18-22 Publications.indd 21 19/10/2012 12:39
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Diagnosing feline nasopharyngeal diseases
ANDREA HARVEY AT
CONGRESS 47 APRIL 2013
Thursday
14.0514.50
Feline jaundice
15.0015.45
Feline pancreatts
Sunday
14.3515.20
Constpaton/Obstpaton
OUT IN SPRING 2013
Edited by Andrea
Harvey and Sverine
Tasker, the BSAVA
Manual of Feline
Practce: A Foundaton
Manual will be available
in Spring 2013.
Cat-friendly practce tps
Problem-oriented clinical approach
Common presentatons
Management optons
Practcal step-by-step guides
For more details and to register your interest
email administraton@bsava.com
2
0.10.2 ml of 1% lidocaine is instilled
into the nares via a cannula and a few
minutes allowed for this to take effect.
3
The forceps are inserted anterograde
into the ventral meatus. The forceps are
opened and then lodged up against any
area of resistance, before closing and
retracting them. The head should be
directed slightly ventrally, to encourage any
blood to fow cranially to the nostrils rather
than caudally into the pharynx. Gauze
swabs and cotton buds should be on hand
to help stop any haemorrhage, which
inevitably occurs.
reserved in a plain pot on a moistened
sterile gauze swab, for bacterial and
fungal culture.
Both sides of the nose should be
sampled, with at least six samples
collected from each.
Note: It is important to remember to
wash the forceps in water after each
sample has been placed in formalin
(using the forceps), prior to inserting
them into the nose again to avoid
formalin entering the nose.
Pre-measuring the forceps. This cat has a mouth gag
in place because retrograde rhinoscopy had just
been performed; a gag is not necessary for nasal
biopsy
5
Following the procedure, the throat
packs should be removed once
haemorrhage appears to have ceased.
The pharynx should then be carefully
examined and any remaining blood or
blood clots removed with swabs or cotton
buds, and any secretions suctioned, prior to
recovering the cat from anaesthesia.
The pharynx should be evaluated
continually for any ongoing haemorrhage
prior to extubation, and anaesthesia
shouldbe maintained until any
haemorrhage has ceased.
The cat should be monitored very closely
in the recovery period, ensuring that suction
equipment, laryngoscope, ET tubes and
intravenous anaesthetic agent are kept
close to hand until the cat is fully recovered.
Analgesia should be provided for at least
24 hours following biopsy.
Typical samples collected from nasal investgatons.
From lef to right: nasal ush uid in EDTA tube for
cytology; secretons from nasal ush on a gauze
swab for bacterial and fungal culture; tssue
samples from the lef and right sides of the nose in
formalin for histopathology
4
Tissue collected is placed in formalin
pots (labelled with the side collected
from). A small amount of tissue is also
18-22 Publications.indd 22 19/10/2012 12:39
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23
Congress 47 APRIL 2013
scientific
proceedings
veterinary
programme
47 April
The ICC / NIA Birmingham UK
www.bsava.com
47 April
scientific
proceedings
nursing programme
The ICC / NIA Birmingham UK
www.bsava.com
All the fun of the free
You know youll come away from Congress with more
knowledge and confidence thanks to the science, but
youll also come away with plenty of treats thanks to an
abundant treasure chest of freebies in the NIA
Exhibition heres your guide to Congress booty
Stay cool with your
free daily tub of
delicious ice cream
available from booths
in the NIA.
Sponsored by Petplan.
Smoothies are
one of the most
popular rewards
and a quick way
to get in one of
your five a day.
Sponsored by
Virbac.
Stay hydrated all day with free
bottles of water available at
the catering points in the NIA.
Sponsored by National
Veterinary Services.
Invaluable resources
to support your attendance at lectures
not only do you get the abstracts in the free
Proceedings book, members also get
access to all the lectures online after the
event. This means you can listen again, or
catch up on the ones you missed.
Help yourself to a cuppa
(tea or coffee) any time of
the day in the NIA you
might need that caffeine
to help you keep going.
Sponsored by Willows.
Early birds can also get
a hot drink in the morning
in the ICC & NIA.
Sponsored by VetPlus.
The first item youll pick up will
probably be your Congress bag from
the big blue container outside the NIA.
This will give you somewhere to put
all the rest of your goodies.
Sponsored by Royal Canin.
Not only does every delegate get a free
lunch bag each day (sponsored by
Norbrook Laboratories), this year you need
to look out for the equivalent of Willie
Wonkers golden ticket, with a winning
ticket in one of the packs the prize being
a trip to WSAVA Congress in South Africa
in 2014.
Your drinks voucher can be
exchanged for an alcoholic
or soft drink at the bar.
Sponsored by
Hills Pet Nutrition.
As well as all the BSAVA
treats, our Exhibitors
provide plenty of great
give-aways on their
stands and your
Exhibition Voucher
Booklet contains thousands of
pounds worth of benefits (almost 17k
worth of vouchers in 2012!).
Discounts
Special Offers
Competitions
The ICC / NIA Birmingham UK
www.bsava.com
47 April
exhibition
vouchers
Welcome drinks come and enjoy
complimentary canaps, wine, beer
and juice as we celebrate with our
exhibitors in the NIA on Thursday at 5.
Sponsored by VetPlus.
The sweet shop on the concourse
brought to you by Mrial will provide
you with a sugary treat to keep your
energy up over the four days.
23-25 Congress.indd 23 19/10/2012 12:39
Congress 47 APRIL 2013
Delegates at Congress 2013 will hear of research into
mental health, wellbeing and mentoring which should
help in avoiding the problems that can get the better
of us in practice
Best practice is
all in the mind
Important study
Rosie is studying for a PhD in the universitys College
of Medicine examining mental health and wellbeing
in veterinary students. This involves following a
complete annual cohort of graduates from each UK
school, looking at how they adapt to life in practice
and the factors affecting their psychological state and
its effect on their job satisfaction and performance.
So in Birmingham she will describe progress in this
project and other research supported by various
veterinary institutions including the BSAVAs own
charity, PetSavers.
The first months in practice are known to be
among the most stressful periods that new graduates
are likely to face in their career. This is reflected in the
numbers of inexperienced practitioners that hand in
their notice and even go looking for new jobs outside
the profession that they have worked so hard to join.
The turnover rate for new graduates can be quite
high and that is probably linked to a disparity between
their expectations and the reality of life in practice.
They are certainly not lacking in the technical skills
needed for their work, the problem appears to be
mainly due to failings in confidence and
communication.
The best possible start
While there may been some practice principals who
feel that being thrown into the deep end is the best
way for new graduates to develop the additional skills
that they will need to succeed, many others recognise
that young colleagues benefit from receiving
guidance from a senior colleague. In one of her three
presentations, Rosie will be looking at the concept of
monitoring and how it can help smooth the transition
from vet school to practice.
There are lot of practice owners and senior
veterinarians out there who support the idea of
mentoring but they dont know where to start with it or
they have struggled with it in the past, she explains.
So she will offer practical insights gained from her
investigations of mentoring systems employed both
within veterinary practice and in sister professions.
R
osie Allister from the University of Edinburgh
will be looking at the professions work in
tackling the mental illness issues that affect an
unacceptably high proportion of its members
in her talks at BSAVA Congress. She will explain how
researchers, like herself, are gathering the information
on the relative effectiveness of different interventions in
preventing depression and other mental
health problems and so allow
vetsto begin looking after
their own.
24
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23-25 Congress.indd 24 19/10/2012 12:39
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25
Congress 47 APRIL 2013
Learning from others
The corporate practices will often have more advanced
support systems for their junior staff than a smaller
practice. We can learn from the way that doctors are
trained and mentored at the beginning of their careers.
Of course, veterinary practice may be unable on
economic grounds to allow staff to spend any
extended period shadowing a senior colleague.
Vets should be looking at the strategies that work in
other areas and adapting them for their own
situations, she says.
This is important not only to help the new
graduate but also to improve the efficiency of the
whole business. To work effectively as a team,
you need everybody to be well and coping with their
job. As soon as one person begins to struggle, then
that can have knock-on effects on all of their
colleagues, she notes.
We arent all the same
One factor that makes it difficult for senior staff to
provide better help for their colleagues is that every
new graduate is different and so the support that they
need in their work may vary. Rosie is hoping to obtain
funding to develop a training programme for senior
vets in mentoring skills. This is intended to identify
what a new graduate needs to help them adapt to
practice life, and show how the practice can provide
them with the most appropriate support.
Although we often think of new graduates needing
special support, the problem of poor mental health
can affect vets at all stages of their career. In this, as in
most situations, prevention is much better than cure
and so those attending this stream on psychology in
practice will also hear from Brian Faulkner, managing
director of Frontfoot Consultancy and 2008 Petplan Vet
of the Year.
Brian will be presenting some ideas gained
from the developing field of positive psychology
to improve the way that colleagues deal with
problems. He will raise questions about the typical
mindsets of veterinary surgeons and whether their
attitudes help or hinder them in developing the
psychological resilience needed to achieve
success in a veterinary career.
Psychology in Practice
at Congress
In your Congress programme you will see various icons. This
one indicates that the talk includes electronic voting. By popular
demand, this will be available in more sessions in 2013 than
ever before including the Psychology in Practice stream with
Rosie and Brian.
Using personal keypads delegates can answer questions posed to the
whole audience. This helps establish common opinions and experiences
and it is all totally anonymous, so you can be as frank as you like.
Questions might be case-based in some instances, such as:
What do you think is the best test? Or you might be asked an
opinion-based question, like Do you agree with this statement?
The answers (always anonymous!) are presented on screen in
a graphical format that can be used as a basis for discussion
by the speaker.
This technology has been employed at Congress
for several years, and also in BSAVA CPD courses
across the country. If you havent attended one
before it really does help add to your
engagement in the talk and makes the whole
experience more interactive. For more
details about the programme visit
www.bsava.com, or email
congress@bsava.com if you
would like us to send you a
programme.
Electronic Voting
Thursday 4 April
8.309.15: Understanding and managing values,
beliefs and opinions as the basis of leadership.
Brian Faulkner
9.2510.10: What is emotonal intelligence and how
can we use it to delivery customer satsfacton?
Brian Faulkner
10.5511.40 Psychology of condence, achievement
and success in veterinary practce. Brian Faulkner
11.4512.30: Wellbeing in the vet profession: what do
we know and why does it mater? Rosie Allister
13.5014.40: New graduates: approaches to reducing
atriton and improving performance through
understanding wellbeing. Rosie Allister
14.4015.35: Mentoring in practce. Rosie Allister
23-25 Congress.indd 25 19/10/2012 12:39
26
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companion
C
alling all runners have you always wanted
to do the London Marathon but never got
around to applying for a place? Or perhaps
youve been disappointed in the ballot and
missed out. We can help you and you can really
helpPetSavers.
By choosing to be the 2013 PetSavers Marathon
runner you could not only achieve a personal
ambition, but also contribute to the wellbeing of pets
throughout the world. Your sponsorship will be used
to fund vital research in one of the designated
PetSavers grants areas.
What to do
Get in touch today tell us why you want to do the run
and how much you think you can raise. Applications
need to be in by 30 November and the minimum
sponsorship you would be expected to achieve is in
the region of 2000. We will help with lots of publicity
and ideas to make sure you can reach your target.
What we will do
The successful runner will hear from us before
Christmas and we will provide lots of help with
fundraising. Youll even get a PetSavers running
vest or T-shirt to inspire your training. Email
info@petsavers.org.uk or call Gemma on
01452726723.
Getting a spot on the start line for the
London Marathon can be almost as difficult
as running it we have a place on offer
areyou up for the challenge?
Marathon place
could be yours
P
etSavers heated pads are ideal for keeping your
small pets warm this winter. The pads run on a low
voltage and can be left on constantly, even
underneath an animals favourite blanket. They
aresafe, robust and easy to clean. The pad surface can
beeasily wiped clean and be rolled up for storage when
notin use.
If you work in a practice, the heated pads are ideal for
minimising perioperative hypothermia, or just to keep them
warm in hospital. PetSavers pads are much cheaper than an
incubator and less hassle than hot water bottles. The plug-in
lead can be passed easily through the bars of a cage.
Heated pads are available to buy from the website at
www.petsavers.org.uk for just 40.00 (including VAT).
Feeling
warm
all over
26-27 PetSavers.indd 26 19/10/2012 13:18
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27

PETSAVERS FUNDING
To nd out more about how PetSavers funds
essental research that ultmately helps vets
save pets please visit www.petsavers.org.uk
or email info@petsavers.org.uk if you would
like to nd out how you can support this
important work.
Funding for
study of urinalysis
Rachel Burrow of the University of Liverpool tells us
about her recently funded Clinical Research Project
entitled Comparison of non-validated in-house method
of urinalysis with the reference laboratory method
A
nalysis of urine is a commonly
performed and relatively simple
test that can help to investigate
diseases of the urinary system
and also many other body systems of both
dogs and cats.
Traditionally, urine was submitted to a
commercial laboratory where it would be
centrifuged to separate the cells and other
particles from the liquid part of the sample
by a standardised technique. Both parts of
the sample would then undergo various
tests and the results obtained would be
compared with well established standard
(normal) values.
In-house tests
Many veterinary practices now have
greater in-house laboratory facilities,
including small bench-top centrifuges, and
are able to prepare urine samples
themselves. This is usually more cost-
effective and allows results to be obtained
much more quickly, which is of great
benefit to owners and their pets.
The technique is not standardised,
however, and it is not known if the results
obtained in a commercial laboratory are
directly comparable to those obtained
in-house. Also, there are no established
normal values for urine analysed in-house.
Difference from commercial labs
There are differences between
commercial laboratories and veterinary
practices in the ways that the urine
samples are prepared that may affect
theresults.
For example, commercial laboratories
use larger volumes of urine which are
centrifuged for longer times at lower
speeds. This may cause less damage to
the fragile cells present within the sample
compared to in-house methods, which
spin a lower volume of urine at a higher
speed for a shorter period of time.
It is possible that analysis of the same
urine sample from one patient using these
two methods of urinalysis could give
different results, leading the veterinary
surgeon to make different management
decisions for that particular patient.
Aims of the study
We will compare the results obtained
when urine samples from the same
patients are analysed using these two
different methods. The results will make
veterinary surgeons aware of potential
limitations of in-house bench-top
centrifuges for preparation of urine for
urinalysis, and help vets interpret
in-house test results.
Leaving a gift to
PetSavers can help us
achieve our ultimate
aim of improving the
health of pets and will
support the
diagnosis
treatment of
thousands
of pets
across
theUK
L
eaving a legacy in your will is a
very special way to support the
future of animal health. When
PetSavers ultimately receives
your gift we may be able to recognise
your contribution by naming a
research project in your name. For
example, Jane Bailey, who cared
deeply about animals, made a
residuary bequest to PetSavers. We
were able to say thank you by naming
two of our projects after herthe Jane
Bailey Lymphoma Research Projects.
If you would like further information
about leaving a gift in your will to
PetSavers, you can download
our booklet online at
www.petsavers.org.uk or email
info@petsavers.org.uk.
If you would like to discuss leaving a
gift to PetSavers, please call 01452
726723 and Gemma, our PetSavers
Co-ordinator, will get in touch.
Leaving
a legacy
PetSavers A division of the Britsh Small Animal Veterinary Associaton, Woodrow House, 1 Telford Way,
Waterwells Business Park, Quedgeley, Gloucester GL2 2AB www.PetSavers.org.uk www.facebook.com/UK.PetSavers www.twiter.com/@PetSavers_UK info@PetSavers.org.ukTel: 01452 726723Fax: 01452 726701 Registered Charity No. 1024811
Remembering
PetSavers
in your will
26-27 PetSavers.indd 27 19/10/2012 12:38
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What every practitioner
should know about
hereditary diseases
H
ereditary diseases are presented to us
regularly in practice but it is not always
straightforward to identify the specific
disease or know how to test for it. What help
is available to practitioners and, more importantly, is it
possible to start reducing the incidence of these
diseases in purebred animals? A searchable database
of laboratories offering genetic (DNA) tests for
hereditary diseases in dogs and cats worldwide has
been launched by the WSAVA Hereditary Disease
Committee (HDC). It contains contact information
about the laboratories performing these tests; and
outlines the specific tests available and the breeds
likely to be affected. It is searchable by laboratory,
testor breed.
Specific information about the genetic test,
including the mutation, gene and chromosome
involved, is also provided when available, as are
linksto or citations for available research, with
references to the Online Mendelian Inheritance in
Animals (OMIA) and Online Inheritance in Man (OMIM)
numbers if appropriate.
In due course, the HDC hopes to link its database
to the Associate Database of Hereditary Diseases and
Genetic Predispositions on the Veterinary Information
Network (VIN) to offer more specific clinical information
to clinicians and WSAVA Members.
Professor Dr Urs Giger, Chairman of the HDC,
comments: Theres a strong sense of urgency and
understanding that international collaboration is
needed and global solutions required in tackling
hereditary diseases. The veterinary clinician must
also play a key role in the enhancement of the genetic
health in purebred dogs. We hope the launch of our
database is a big step forward in our goal of
providing tools to practitioners to facilitate the
diagnosis, treatment and control of these diseases.
It currently contains details on around 50 testing
laboratories, representing over 130 disease mutations
in nearly 200 dog and 40 cat breeds. We would
welcome updates, revisions and additions. Please
send any comments or questions to the committee
coordinator at wsavagenetics@gmail.com.
The database can be accessed at www.wsava.
org/HereditaryDefects.htm.
The WSAVA Hereditary Disease
Committee has launched a new
web tool to provide clinically
relevant information on
hereditary diseases and genetic
predispositions in dogs and cats
Dr Urs Giger
2829 WSAVA NEWS .indd 28 19/10/2012 12:36
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The CSCs key goal is to ensure our annual
WorldCongress, the flagship of our organization,
meets a consistently excellent standard. Committee
Chair, Dr Nicola Neumann, explains more
COMMITTEE FOCUS
Congress Steering
Committee
I
share the same passion of many of my
colleagues about our world family of
veterinarians and hope to see us
generously sharing our experiences and
knowledge in a way that is beneficial to
less developed veterinary communities
who are trying to step up the ladder. I
come from Ireland, a small country with
only 2,000 vets, and was amazed at the
sense of pride and achievement that
rippled among us when we hosted our first
WSAVA World Congress in 2008.
The Congress Steering Committee
(CSC) was formed early in 2010 with a
specific brief to look at the future
development of our annual World Congress
to ensure that it meets our aspirations in
terms of leadership, scientific content,
organisation and branding. One of its first
recommendations was to appoint a
Professional Congress Organiser (PCO) to
take on the day-to-day development and
management of five World Congresses
under the direction of the WSAVA Executive
Board. Following a detailed tender process
Kenes Group, a company with a long track
record in delivering global medical
conferences, was appointed to this role.
The CSC has worked closely with
Kenes and the board-appointed Congress
Liaison Officer and our key achievements
over the last two years include:
Developing a new set of World
Congress Standard Operating
Procedures (SOP) the regulations
which govern how Congress should be
organised, how it should run and how it
should feel;
Developing and implementing a new
selection process for the World
Congresses in 2015, 2016 and beyond.
The changes will be highly beneficial to
WSAVA member organisations around the
world but the processes are new so, as
always when things change, our main
challenge is to help our members
understand the new system.
Our next priorities include monitoring
the progress of our World Congresses
under the new management of the Kenes
Dr Nicola Neumann,
MVB MRCVS MACVSc
Cat Medicine,
Graduate Diploma
Business Management
WHO SITS ON THE CSC?
Chairperson Nicola Neumann (Ireland),
neumann@eircom.net
Adriana Lopez Quintana (Uruguay),
alopezquintana@gmail.com
Luis Tello (Chile), luistello@banfeld.net
Gregg Takashima (USA),
gregg.takashima@comcast.net
Jerzy Gawor (Poland), jgawor@pp.com.pl
Renee Hoynck (The Netherlands),
rchhoynckvp@gmail.com
Kaywalee Chatdarong (Thailand),
ckaywale@yahoo.com
Umesh Karkare (India), fsai@gmail.com
Kevin Stevens (South Africa),
kvet@eastcoast.co.za
group and setting up annual review
processes for all aspects of the World
Congress. We hope to encourage a high
number of excellent bids for World
Congress 2017 and will take this as a sign
that member organisations are starting to
see the benefits of the changes weve
been making.
The opportunity now exists for more
countries than ever to host a World
Congress because the CSC and Kenes
undertake the planning and the work that
was previously the entire responsibility of
the host association. We look forward to
receiving bids from all regions of the world!
Full details on the membership of the
CSC Committee, together with information
on the new World Congress SOP and the
bidding process are available at
www.wsava.org/Protocol.htm.
2829 WSAVA NEWS .indd 29 19/10/2012 12:36
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companion
Aimee Llewellyn was born in Seattle,
Washington, and grew up on the family farm of
mixed arable crops and beef cattle in Silverton,
Oregon. Her father is an aeronautical electrical
engineer for Boeing, and her mother trained as
a classical pianist. Aimee received a BSci
(hons) from the University of Hertfordshire, in
Environmental Science with a focus on
biochemistry in 2003. She has worked at the
Royal Botanic Gardens, Kew, as a taxonomist
and illustrator, and as a Senior Scientific
Assistant and then Research Scientist post-doc
(non-PhD) for Rothamsted Research. Aimee
now works at the Kennel Club as the Genetics
and Health Information Manager
Aimee
Llewellyn
the companion interview
Q
You grew up on a farm, so did you ever
consider a veterinary career?
A
I think many children who love animals dream of
growing up and becoming veterinarians, and I
was no exception. I envy vets being more
hands-on and creating that connection with animals,
but I fell in love with research especially applied
research.
What attracted you to studying genetics?
I have always been interested in biology. The
genomics and other -omics technological
development within my lifetime has been behind my
career choices. I think my practical farm-girl mind
was the driving force towards choosing areas that also
have an application aspect, as well as theoretical.
What is your particular area of interest?
Improvement through scientific understanding. I began
my career focused on crop improvement, and now
hope to contribute to the improvement of dog health
and welfare.
Tell us about your early career.
My previous work was mainly plant science-based,
with focuses on metabolomics, genomics, and crop
improvement. This work gave me good experience in
all aspects of research from experimental design
through bench-top lab work to publication. I also
spent a fascinating year at the Royal Botanic
Gardens, Kew, where I undertook a project
developing and illustrating a taxonomic key, and
doing field work in Sri Lanka.
What attracted you to the position within the KC?
I was ready to undertake a role where my experiences
as a research scientist could be used to benefit
something I care about in a more direct way. I also felt
that my personal interests in animals, especially dogs,
was being neglected and that by combining my
professional experience and my love of dogs I would
be putting my specialist skills to good use.
Youve been at the KC for almost a year, tell us your
observations.
I came to the KC with the assumptions, like many
people, that the organizations purpose was mainly
about registering pedigree dogs. I had no idea how
30-31 Interview November.indd 30 19/10/2012 12:36
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if you really
want to do
something,
take a leap of
faith and try
many aspects of all, not just pedigree,
dogs lives the KC is involved with. While
many of the health resources, such as
Health Test Results Finder, are necessarily
limited to registered dogs, there are still
many tools that can be utilized by pedigree
and non-pedigree owners. I also had no
idea how much money the KC Charitable
Trust invests in research.
Tell us about your perception of the UK
vet profession.
I have found the UK vet profession to be
very professional and welcoming to me as
a newcomer into their world. I have found
many to be particularly engaged in, and
supportive of, clinical research,
which is fantastic, as they are the people
the dog owners usually come to first with
their concerns!
What challenges do you face in your role
with the KC?
My greatest challenge is to continue
developing good relationships and links
between all of the individual groups
interested in canine health veterinary
scientists, researchers, dog breeders, the
public, welfare groups, and other
interested parties. With cooperative and
focused effort, real steps in canine health
and improvement can be made.
What are your aims in the next year?
I hope to expand the resources and tools
available to dog breeders and the public to
help them make informed, positive choices.
To do this, these tools must be based on
good science, and developed with the help
of the vet and research communities.
The KCs work with breeders is well
known, tell us about what it offers the
vet profession.
The KCs unique perspective is being a
good source of breed-specific health
information. The tools we currently have
online can provide vets with research-
developed breeding advice such as our
inbreeding coefficient calculator, and up-to-
date breed specific recommendations on
DNA testing. The KC Charitable Trust also
provides funding for a spectrum of research
projects, and we have launched the
International Canine Health Awards this
year providing grants of up to 40,000
available to vets at all stages of their career.
What single thing would improve the
quality of your life?
A house with a garden! Living in London
means I am a little short of private green
space, making dog ownership rather
challenging I am currently borrowing a
lot of friends dogs.
What is the most important lesson life
has taught you?
Leap. If you really want to do something,
take a leap of faith and try. It is amazing
what can be managed if you are a little
risky now and then.
If you could go back and give some
mentoring advice to the younger you,
what would that be?
Be more confident in your abilities, and
dont be afraid to ask for help. Most people,
given the chance, are happy to share their
knowledge; you just have to ask.
What, for you, have been the most
exciting developments in science in
recent years?
Whole genome sequencing. To be able to
see the genetic blueprints of any living
thing in a reasonable amount of time, and
an achievable cost will significantly
change the way we target health care
and advice. For dogs, this could mean the
effective elimination of so many inherited
diseases, and a better understanding of
genetic diversity.
Do you have any professional heroes?
I am possibly cheating with this answer,
but I have three: Dian Fossey, who literally
gave her life for her work studying gorillas
in Rwanda; Barbara McClintock, who
revolutionised cytogenetics; and Mary
Kingsley, a 19th-century scientific writer
and explorer whose stories of adventure
kept me awake at night as a child.
Will you be at Congress next year? If so,
what would you like delegates to come
and talk to you about?
I would love to invite vets and vet
researchers to talk to me about what
the Kennel Club can do to better provide
them with information and access to
breed-specific and general canine health
information. If they already use the
web-based information, or the Vet Practice
Manual, Id like to know how that is
working for them, and how it might be
improved. My goal is to be a point of
contact for reliable, up to date,
easy-access information.
You can meet
Aimee Llewellyn on
the Kennel Clubs stand
at BSAVA Congress
47 April 2013.
30-31 Interview November.indd 31 19/10/2012 12:36
For more information or to order
www.bsava.com
BSAVA reserves the right to alter prices where necessary without prior notice.
companion offerof the month
Exclusive offer for companion readers
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Edited by Molly Varga,
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The number of exotic and wildlife cases presented at the
veterinary practice has increased significantly in the past
10 years, with increasing expectations regarding level of
care. This new Manual aims to provide veterinary nurses
with a greater understanding of the nursing requirements of
these species, enabling them to modify and apply their skills
to these cases.
BSAVA Member offer
BSAVA Manual of Canine and Feline
Musculoskeletal
Disorders
Covers conditions of bone, tendon and muscle and provides a
ready reference for the practitioner faced with a dog or cat
showing lameness, stiffness or joint pain:
Arthritis in-depth
Chapters on individual joints
Common surgical procedures on joints
Step-by-step Operative Techniques
WHAT THEY SAY
...a great tool for anyone interested in the diagnosis and
treatment of musculoskeletal disorders... VETERINARY
AND COMPARATIVE ORTHOPEDICS AND
TRAUMATOLOGY
Out now!
BSAVA
Pocketbook
for Vets
Edited by
Sheldon Middleton
The BSAVA Pocketbook for Vets provides the new graduate
(and possibly the not so new) with a precise and quick
guide to the important drugs, tests and procedures most
commonly encountered in small animal practice. The
Pocketbook pulls together information from the BSAVA
Small Animal Formulary, BSAVA manuals and other sources,
and is a quick glance reference that can be carried in a
scrub top pocket for ease of use when consulting or during
ward rounds. Notes pages are provided throughout.
BSAVA Publications
COMMUNICATING VETERINARY KNOWLEDGE
Extra 30% discount off member price
BSAVA Manual of Canine and Feline
Nephrology and Urology
2nd edition
Chronic kidney disease in-depth
Cystoscopy and lithotripsy
Management of glomerulonephritis
Offer is available to BSAVA members only. Ends 30 November
2012. Free P&P on telephone orders for UK and Eire delivery
online rates of P&P apply for overseas orders.
WHAT THEY SAY
...partcularly helpful for general
practtoners and veterinary students
seeking a good overview of the current
state of knowledge
CANADIAN VETERINARY JOURNAL
BSAVA Member Price:
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companion offer: 49.0034.30
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BSAVA Member Price: 45.00
Price to non-members: 68.00
32 Publications Advert November.indd 32 19/10/2012 12:36
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33
WHOS WHO ON SURREY AND SUSSEX COMMITTEE
Chair: Olive OLeary
Secretary: Muna Roberts
Treasurer: Louise Smith
PetSavers Rep: Alissa Cooper
Commitee Members: Gerry Polton, Julian Hoad and Wolfgang Dohne
Focus on...
BSAVA Surrey and
Sussex Region
Next CPD Course
Wednesday 6 February 2013 (Evening meetng)
Tips, tricks and pitfalls in rigid and flexible endoscopy
Speaker: Philip Lhermete
The Holiday Inn, Guildford, Surrey
MEMBERS: dont forget to bring a valid BSAVA membership card to the meeting!
I
n January 2013, BSAVA will have a number of small
changes to the structure of their 12 regions
throughout the United Kingdom; part of this change
includes the amalgamation of the current Surrey and
Sussex and Kent regions to form one region to be
known as South East.
It is hoped that by merging these two regions, we
can continue to provide the high level and variety of
CPD that our members have come to expect from both
of these very successful regions in a way that is even
more relevant to the geographical demographics in
this area.
In order for this to be really successful, we need
your input! If you have any suggestions for speakers,
topics or venues that you would like to see us use, then
please get in touch by emailing Ben Dales on
b.dales@bsava.com.
We are currently ironing out some of the logistics
involved with the merger and once this is complete we
will have a full programme of exciting and varied CPD,
so please look out for your e-alerts and companion
inserts. Just as a personal reminder, please can you
make sure that your details particularly your email
address are always up to date in our database.
Youcan achieve this very easily just by registering on
our website at www.bsava.com or emailing
administration@bsava.com.
Come meet the President
We will be holding an informal social evening on
28November 2012, giving delegates the chance to
come and catch up with colleagues, network and
meet with the BSAVA President Mark Johnston. This
event will be free of charge for BSAVA Members so
please email surreyandsussexregion@bsava.com
for further information.
A Regional Merger
The BSAVA Surrey and Sussex
Region is merging with Kent to
create the new South East region
Combined dentistry success
Surrey and Sussex BSAVA recently held a superb
dentistry meeting in conjunction with the BVDA.
Thirteen delegates attended this weekend course
held at a local 6th form college. We had the
science block to ourselvesapart from the giant
snail living in one of the classrooms, presumably
the teachers pet!
Lisa Millela, John Robinson and Rachel Perry
provided truly fascinating and practical lectures.
We had over four hours of practicals each day,
focusing on charting, de-scaling and polishing,
dental radiography and extractions.
Thanks to our sponsors Veterinary Concepts
each delegate was able to take radiographs and
view their efforts digitally. Lets just say that some
were better than others! It was brilliant to have the
opportunity to take real radiographs on cadavers
and a new experience for many of the delegates.
Sunday was extraction day. We had practicals
on both simple and surgical extractions. Delegates
found it really useful being able to practice
different methods of extractions and the tutors
were generous with their guidance and practical
advice. All attendees seemed to thoroughly enjoy
the weekend and its amazing how quickly it went.
Hopefully we will be running additional practical
dentistry meetings in the future. The weekend
meeting was co-sponsored by Pfizer.
33 Focus On.indd 33 19/10/2012 12:35
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companion
CPD diary
EVENING WEBINAR
Tuesday 12 November
Old bugs and new bugs:
what do I need to know
about infectious disease in cats?
Speaker: Samantha Taylor
Online
Details from administration@bsava.com
EVENING WEBINAR
Tuesday 20 November
Crusty canine and
festering feline
Speaker: Natalie Barnard
Online
Details from administration@bsava.com
December 2012
November 2012
EVENING MEETING
SOUTH WEST REGION
Wednesday 14 November
Clinical pathology
Speaker: Kathleen Tennant
Canalside, Huntworth, Bridgwater,
Somerset TA7 0AJ
Details from southwestregion@bsava.com
DAY MEETING
Tuesday 6 November
Crusty canines and festering
felines
Speaker: Natalie Barnard
Crabwall Manor, Chester
Details from administration@bsava.com
EVENING MEETING
NORTHERN IRELAND REGION
Thursday 1 November
Wound management
Speaker: Georgie Hollis
VSSCo, Lisburn BT28 2SA
Details from nirelandregion@bsava.com
EVENING MEETING KENT REGION
Wednesday 7 November
Dentistry in rabbits and rodents
Speaker: Cedric Tutt
Best Western Russell Hotel, 136 Boxley Road,
Maidstone ME14 2AE
Details from kentregion@bsava.com
EVENING MEETING
SOUTH WALES REGION
Wednesday 7 November
Nasal disease
Speakers: Nic Hayward and Kit Sturgess
The International Legacy Hotel,
Cardiff CF15 7LD
Details from southwalesregion@bsava.com
EVENING MEETING
MIDLAND REGION
Thursday 8 November
Interpretation of abdominal
ultrasound images
Speaker: Andrew Parry
Wolverhampton Medical Institute,
New Cross Hospital, Wolverhampton,
West Midlands WV10 0QP
Details from midlandregion@bsava.com
EVENING MEETING
SOUTHERN REGION
Thursday 22 November
Chronic vomiting and diarrhoea in
cats: a practical approach to
investigation and treatment
Speaker: Martha Cannon
Beechdown, Beechdown Park,
Winchester Road, Basingstoke RG22 4ES
Details from southernregion@bsava.com
EVENING MEETING
SCOTTISH REGION
Thursday 22 November
Keep calm and carry on: seizure
management in dogs
Speaker: Annette Wessman
Glasgow University Vet School
Details from scottishregion@bsava.com
DAY MEETING
SOUTH WEST REGION
Thursday 22 November
Medical and surgical management
of canine lower urinary tract
disease
Speakers: Ian Battersby and Ronan Doyle
Alveston House Hotel, Alveston, Thornbury,
Bristol BS35 2LA
Details from southwestregion@bsava.com
DAY MEETING
SOUTH WEST REGION
Friday 23 November
Medical and surgical management
of canine lower urinary tract
disease
Speakers: Ian Battersby and Ronan Doyle
Kingsley Village, A30, Penhale, Fraddon,
Cornwall TR9 6NA
Details from southwestregion@bsava.com
DAY MEETING
EAST ANGLIA REGION
Sunday 11 November
Whats new in oncology?
Speaker: Gerry Polton
The Cambridge Belfry, Cambourne, Cambridge
CB23 6BW
Details from eastanglia.region@bsava.com
DAY MEETING
Tuesday 20 November
Common and emerging infectious
diseases in the pet rabbit: an
up-to-date review
Speaker: Emma Keeble
BSAVA Headquarters, Woodrow House,
Gloucester GL2 2AB
Details from administration@bsava.com
EVENING MEETING
NORTH EAST REGION
Wednesday 7 November
Inappetent cats
Speaker: Roger Wilkinson
IDEXX Laboratories Wetherby,
Grange House, Sandbeck Way, Wetherby,
West Yorkshire LS22 7DN
Details from northeastregion@bsava.com
EVENING MEETING
NORTH WEST REGION
Wednesday 7 November
Pain
Speaker: Matt Gurney
Holiday Inn, Haydock
Details from northwestregion@bsava.com
DAY MEETING
BSAVA EDUCATION
Tuesday 4 December
Decision making for the hips and
pelvis
Speaker: Kevin Parsons
BSAVA Headquarters, Woodrow House,
Gloucester GL2 2AB
Details from administration@bsava.com
34-35 CPD Diary.indd 34 19/10/2012 12:35
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January 2013
February 2013
OTHER UPCOMING BSAVA CPD COURSES
See www.bsava.com for further details
Surrey and Sussex Region
Wednesday 6 February
Tips, tricks and pitalls in rigid and fexible
endoscopy
BSAVA Educaton
Thursday 7 February
Should I give it steroids? Problems in
small animal gastroenterology
Southern Region
Sunday 10 February
How to solve common problems in small
furries, including anaesthesia and post
op care
BSAVA Educaton
Tuesday 19 February
Practcal approach to the diagnostc and
management issues in cats with kidney
disease
EXCLUSIVE FOR MEMBERS
Extra 10% discount on all BSAVA
publicatons for members atending any
BSAVA CPD event.
All dates were correct at tme of going to print; however, we
would suggest that you contact the organisers for confrmaton.
EVENING MEETING
SOUTH WALES REGION
Wednesday 6 December
Liver disease
Speaker: Kate Murphy
Shepherds Veterinary Hospital,
Bridgend CF31 2BF
Details from southwalesregion@bsava.com
EVENING MEETING
KENT REGION
Thursday 6 December
Christmas Referrals Fair
Not just skin deep: Cutaneous
manifestations of systemic disease
Speaker: Jane Coatesworth
Best Western Russell Hotel, 136 Boxley Road,
Maidstone, ME14 2AE
Details from kentregion@bsava.com
EVENING MEETING
NORTHERN IRELAND REGION
Thursday 6 December
Transfusion medicine:
why, when and how
Speaker: Patricia Ibarrola
VSSCo, Lisburn BT28 2SA
Details from nirelandregion@bsava.com
EVENING WEBINAR
Thursday 6 December
Common and emerging
infectious diseases in the pet
rabbit: an up-to-date review
Speaker: Emma Keeble
Online
Details from administration@bsava.com
DAY MEETING
NORTH WEST REGION
Sunday 9 December
Cardiology day
Speakers: Simon Swift and Sonja Fonfara
Swallow Hotel, Preston New Road, Preston,
Lancashire PR5 0UL
Details from northwestregion@bsava.com
DAY MEETING
NORTH EAST REGION
Sunday 9 December
Behavioural or medical? Aristotle
solves the clinical conundrum
Speaker: Samantha Lindley
Novotel Newcastle Airport, Ponteland Road,
Kenton, Newcastle Upon Tyne NE3 3HZ
Details from northeastregion@bsava.com
EVENING WEBINAR
Tuesday 11 December
Decision making for the
hips and pelvis
Speaker: Kevin Parsons
Online
Details from administration@bsava.com
EVENING MEETING
WEST MIDLANDS REGION
Thursday 3 January
Cruciate surgery
Speaker: Eithne J. Comerford
Wolverhampton Medical Institute, New Cross
Hospital, Wolverhampton WV10 0QP
Details from westmidlands@bsava.com
DAY MEETING
Tuesday 15 January
Feline medicine: haematological
disease
Speaker: Andy Sparkes
Hilton, Stansted Airport, Essex CM24 1SF
Details from administration@bsava.com
EVENING MEETING
SOUTHERN REGION
Wednesday 23 January
A practical approach to
ophthalmological emergencies
in small animals
Speaker: Robert Lowe
Potters Heron Hotel, Romsey Hampshire
Details from southernregion@bsava.com
DAY MEETING
NORTH EAST REGION
Sunday 27 January
Commonly encountered
conditions of rabbits and small
furries
Speaker: Anna Meredith
The Pavilions, Great Yorkshire Showground,
Railway Road, Harrogate,
North Yorkshire HG2 8NZ
Details from northeastregion@bsava.com
DAY MEETING SCOTTISH REGION
Sunday 27 January
Gastrointestinal disease:
approach, supportive care and
imaging for vets
Speaker: Alison Ridyard
Edinburgh
Details from scottishregion@bsava.com
DAY MEETING SCOTTISH REGION
Sunday 27 January
Oncology for nurses
Speaker: Katy Calder
Edinburgh
Details from scottishregion@bsava.com
EVENING MEETING
MIDLAND REGION
Wednesday 5 December
Evidence-based management of
renal failure
Speaker: Hattie Syme
Yew Lodge Hotel, 33 Packington Hill, Kegworth,
Derby DE74 2DF
Details from midlandregion@bsava.com
EVENING MEETING
WEST MIDLAND REGION
Tuesday 5 February
Reptiles: handling and
husbandry hands on with
lizards, snakes and chelonians
Speaker: Sarah Pellet
Animal Care Department, Solihull College,
Blossomfield Road, Solihull B91 1SB
Details from westmidlands@bsava.com
DAY MEETING
Tuesday 5 February
Feeding back to health: clinical
nutrition in general practice
Speaker: Isuru Gajanayake and Rachel Lumbis
Telford Golf and Spa Hotel
Details from administration@bsava.com
AFTERNOON/EVENING MEETING
METROPOLITAN REGION
Tuesday 5 February
Approach to backyard poultry
Speaker: Steve Smith
The Oxford Belfry, Milton Common, Thame,
Oxfordshire OX9 2JW
Details from metropolitanregion@bsava.com
EVENING MEETING
NORTH EAST REGION
Wednesday 6 February
Murmurs
Speaker: Sue Roberts
IDEXX Laboratories Wetherby,
Grange House, Sandbeck Way, Wetherby,
West Yorkshire LS22 7DN
Details from northeastregion@bsava.com
34-35 CPD Diary.indd 35 19/10/2012 12:35
With a fresh approach, BSAVA Congress 2013 offers something for
everyone; vets, nurses, practice managers, new graduates, experienced
principals, specialists, general practitioners, and everyone in between.
With such a diverse programme and creative delivery, no other
veterinary conference offers so much for the whole of your team.
Reasons to attend
Why not get all your CPD in one place? Did you know that by
joining us in Birmingham in April 2013 and choosing from the many
lectures, workshops and podcasts that are available you could fulfill your
entire CPD requirement for the year!
Over 300 lectures catering to all levels and abilities of veterinary practice
staff with a lifecycle approach, making them relevant to your career stage
A creative approach to practical, hands-on sessions
A management programme that has been expanded to three days making
it ideal for vets, vet nurses and practice managers
BSAVA Lecture 2013 with Richard Dawkins
A commercial exhibition that features over 250exhibitors, providing
everything that is needed for all aspects of a successful small animal practice
The ICC / NIA
Birmingham UK
www.bsava.com/congress
Register online now
47 April 2013
The Congress for
the whole team
Early Bird
Deadline
31 January
2013
36 OBC Nov - Congress Ad.indd 36 19/10/2012 12:34