Companion August 2014 Low Res

The essential publication for BSAVA members
companion
AUGUST 2014
How To
Deal with
thermal burns
P18
Legislation map
Animal law in the UK
P4
A captivating
message
Wildlife work
P14
Lameness and
haematuria in
an Australian
Cattle Dog
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companion AUGUST 2014
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BSAVA 2014
Log on to www.bsava.com to access
the JSAP archive online.
EJCAP ONLINE
To access the latest
issue of EJCAP visit
www.fecava.org/EJCAP.
Find FECAVA on Facebook!
3 BSAVA News
Latest from your Association
47 Legislation map
Animal welfare laws in the UK
89 Movement of dogs in and out of
Ireland
Paula Boyden explains
1013 Clinical Conundrum
Forelimb lameness and haematuria
1417 A captivating message
Wildlife Vets International
1822 How To
Deal with thermal burns
2425 Decision making in wound
closure
John Williams explains
2627 PetSavers and ear disease
Sue Paterson reports
2829 WSAVA News
World Small Animal Veterinary
Association
3031 The companion interview
Steve Broomfield
33 Regional CPD
Local knowledge close to home
3435 CPD Diary
Whats on in your area
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 (print): 2041-2487
ISSN (online): 2041-2495
Editorial Board
Editor Simon Tappin MA VetMB CertSAM DipECVIM-CA
MRCVS
Past President Michael Day BSc BVMS(Hons) PhD DSc
DiplECVP FASM FRCPath FRCVS
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
Features Editorial Team
Andrew Fullerton BVSc (Hons) MRCVS
Design and Production
BSAVA Headquarters, Woodrow House
No part of this publication may be reproduced
in any form without written permission of the
publisher. Views expressed within this
publication do not necessarily represent those
of the Editor or the British Small Animal
Veterinary Association.
For future issues, unsolicited features,
particularly Clinical Conundrums, are
welcomed and guidelines for authors are
available on request; while the publishers will
take every care of material received no
responsibility can be accepted for any loss or
damage incurred.
BSAVA is committed to reducing the
environmental impact of its publications
wherever possible and companion is printed
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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 .
Additional stock photography:
www.dreamstime.com
Nicole Hrustyk
www.dollarphotoclub.com
annette shaff; mysontuna; Quasarphoto
T
he objective of this PetSavers-
funded study was to assess the
prevalence of gastrointestinal
toxicity in dogs receiving
chemotherapy with vincristine and
cyclophosphamide and the efficacy of
maropitant in reducing these events.
Dogs receiving chemotherapy with
cyclophosphamide or vincristine were
randomized to either receive maropitant or
not in the period immediately after
treatment and for four days afterwards.
Owners completed a diary of adverse
events following treatment.
Adverse events occurred in 69% of
dogs in the vincristine group. Most of
these adverse events were mild and
included: lethargy (62%), appetite loss
(43%), diarrhoea (34%) and vomiting
(24%). Adverse events occurred in 81% of
dogs treated with cyclophosphamide.
Most of these adverse events were mild
and included: lethargy (62%), diarrhoea
(36%), appetite loss (36%) and vomiting
(21%). There was no difference in total
clinical score, or in vomiting, diarrhoea,
appetite loss or lethargy score between
dogs treated with maropitant and non-
treated dogs in either the vincristine or
cyclophosphamide groups.
ALSO IN THIS MONTHS ISSUE
The eect of season and track conditon
on injury rate in racing greyhounds
Intra-artcular mepivacaine reduces
interventonal analgesia requirements
during arthroscopic surgery in dogs
Investgaton of the use of ne needle
aspiraton techniques in UK veterinary
practce
In vitro comparison of output uid
temperatures for room temperature and
pre-warmed uids
Venous air embolism detected on
computed tomography of small animals
Whats in JSAP this month?
Gastrointestinal toxicity after
vincristine or cyclophosphamide
administered with or without
maropitant in dogs
Chemotherapy-related side effects are
frequent but usually mild in dogs receiving
vincristine or cyclophosphamide. The
authors conclude that prophylactic
administration of maropitant does not
reduce the frequency of adverse events
and maropitant should be administered
only as required for individual cases.
Adapted from Mason et al. JSAP 2014; 55: 391398.
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M
y first volunteer role was on the
PetSavers Management Committee.
I liked the idea of raising money to
find out more about animal diseases
with the eventual hope of providing better
treatments. It was really interesting to learn more
about the great work that PetSavers had done
and the vital studies that had been funded.
The PetSavers Management Committee
discusses new ways of raising money and
raising the awareness of PetSavers. We have
a stand at Congress and are able to talk to lots
of people about getting involved in this
important work.
I am now also on my local BSAVA Regional
Committee as PetSavers representative. I raise
awareness of PetSavers locally and also help to
organize local CPD events for the members of
BSAVA in my area.
I find discussing ways of raising money for a
cause I believe in really very rewarding. I have
met lots of new and interesting people and of
course I got to go to BSAVA Congress. I would
say to other members that it is good to get
involved in positive things that can shape the
profession for the future.
Get to know
your BSAVA
colleagues
Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know
Volunteer
voice
Alison
Liversey
Find out how you can get involved as a
BSAVA volunteer, email Carole Haile
c.haile@bsava.com.
Ketamine and tramadol
classification changes
T
he Home Office has announced changes to the classification of
ketamine and tramadol through the introduction of The Misuse of Drugs
Act Amendment Order 2014, which came into effect on 10 June 2014.
This means ketamine is now reclassified as a Class B drug under the
Misuse of Drugs Act 1971, but remains a Schedule 4 controlled drug under the
Misuse of Drugs Regulations 2001. Although Schedule 4 drugs are not subject
to safe custody requirements, ketamine is a substance of abuse and so the
Royal College of Veterinary Surgeons (RCVS) advises that it should be stored in
the Controlled Drugs cabinet and its use recorded in an informal Register.
Tramadol is now classified as a Class C drug under the 1971 Act and as a
Schedule 3 controlled drug under the Misuse of Drugs Regulations 2001,
which means that it is subject to regulations on documentation, prescription
writing and supply on prescription, labelling and record keeping as well as
destruction of the drugs only in presence of an authorized person. Tramadol is
also being inserted into Schedule 1 to the Misuse of Drugs (Safe Custody)
Regulations 1973, which means it is exempted from the safe custody
requirements. Full details and a summary of the legal requirements can be
found in the news section at www.bsava.com.
Take the lead for PetSavers
A
reminder to all BSAVA members that PetSavers, the charitable division
of the BSAVA, will be holding its first ever charity dog walk on Sunday
26 October at the Bathurst Estate in Cirencester from
10am. Dogs and their owners will have the choice of
participating in either a three mile or slightly more
challenging six mile walk through the picturesque estate.
After collecting their medal and goody bag on completion
of the walk participants will be able to enjoy refreshments
on what the charity hopes will be a perfect autumn day.
Tickets for Walk your dog for PetSavers 2014 Sunday
26 October are available at 10.00 per dog entry.
Please visit www.petsavers.org.uk for more information.
Keep calm and Ceilidh
B
SAVA Scottish Congress takes
place from 2931 August, at
the Heriot-Watt in Edinburgh. So
far, 2014 is fast shaping up to
be our most successful Scottish
Congress to date with over 150
veterinary professionals already signed
up to join us in Edinburgh and Exhibition
spaces are completely packed.
There is still time for you to register
for 13 hours of CPD delivered through
morning lectures and afternoon
seminars. You will also be able to enjoy
an extensive trade exhibition, interactive
sessions, case reports, Friday Exhibitor
led CPD and social activities, and of
course the fabulous gala dinner at The
Dalmahoy, with Ceilidh dancing into the
early hours.
Further information is available at
www.bsava.com/scottishcongress
or by emailing scottishcongress@
bsava.com. With weekend prices
starting at just 209 for vets and 165
for nurses this is the year to get your
CPD in the Highlands.
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BSAVA 2014
The Veterinary Surgeons Act 1966 applies throughout the United Kingdom (England,
Wales, Scotland and Northern Ireland). Animal welfare is covered by similar acts in each
of the four administratons:
The Animal Welfare Act 2006 applies in England and Wales
The Animal Health and Welfare (Scotland) Act 2006
The Welfare of Animals Act (Northern Ireland) 2011.
All these Acts introduce a duty of care on the person responsible for the animal
to ensure the welfare needs of the animal are met as well as making it an oence to
cause unnecessary suering. Veterinary surgeons and veterinary nurses will ofen be
responsible for an animal on a temporary basis and should therefore consider their
responsibilites under these Acts.
Five welfare needs are detailed in the Animal Welfare Acts:
The need for a suitable environment
The need for a suitable diet
The need to be able to exhibit normal behaviour paterns
The need it has to be housed with, or apart from, other animals
The need to be protected from pain, suering, injury and disease.
Dew claw removal
The Animal Welfare Acts also prohibit certain procedures and mutlatons.
The removal of dew claws is considered to be an act of veterinary surgery and
therefore can, as a general rule, only be carried out by a veterinary surgeon.
However, Schedule 3 to the Veterinary Surgeons Act 1966 allows anyone of or
over the age of 18 to amputate the dew claws of a dog before its eyes are open.
The Animal Welfare Acts allow removal of dew claws as a permited procedure,
however they do not dene a dew claw. The RCVS provides some guidance on this in
its supportng guidance to the Code of Professional Conduct (27.8-27.13) and
states that:
27.12 The removal of the rst digit of the hind limb (true dew claws) is justed in most circumstances
27.13 The removal of the rst digit of the fore limb is justed only if, in the veterinary surgeons professional opinion,
the partcular anatomy/appearance of the digits invites possible damage.
However, it concludes that Legislaton has not dened dew claws and, ultmately, it is for the courts to decide the
meaning of dew claws applying to any specic legislaton.
The RCVS guidance also states that The removal of the whole or part of a dogs tail amounts to the practce of
veterinary surgery and therefore can, as a general rule, only be carried out by a veterinary surgeon (27.42).
UK
Legislation map
BSAVAs Head of Scientific Policy, Dr Sally Everitt, looks at
companion animal health and welfare legislation in the UK
T
here is a wide range of legislation that can
apply to companion animals including that
relating to the operation of pet shops (Pet
Animals Act 1951); animal boarding
establishments (Animal Boarding Establishments
Act 1963) and dog breeding (The Breeding of
Dogs Acts 1973 and 1991 and Breeding and Sale
of Dogs (Welfare) Act 1999), as well as legislation
that applies to all animals, such as the animal
welfare legislation.
As veterinary surgeons we are not expected to
be experts in the law but some legislation does
affect the work that we do. The situation is made
more complicated as responsibility for animal health
and welfare is now devolved to the four
administrations, leading to variations between the
regulations in England, Wales, Scotland and
Northern Ireland. We also need to be aware of
regulations in Europe both because of the effect that
it can have on regulations in the UK and because of
the increasing movement of companion animals
within Europe. This isnt a comprehensive review of
all the legislation but rather it aims to point out some
of the legislation that is relevant to veterinary
practice. Full details of all the legislation in the UK
can be accessed at www.legislation.gov.uk.
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Microchipping: The Scot sh Government has recently completed a consultaton into compulsory
microchipping and other measures to promote responsible dog ownership. However, there are currently no
plans to introduce compulsory microchipping in Scotland.
Tail docking: The Animal Health and Welfare (Scotland) Act 2006 prohibits the mutlaton of animals and there
are no exemptons in any regulatons for the non-therapeutc docking of dogs tails. It is also an oence to take
a dog from Scotland for the purpose of having its tail docked. However, following research recently published in
the Veterinary Record the Scot sh Government may review this positon.
Dog control: Secton 10 of the Control of Dogs (Scotland) Act 2010 amends the Dangerous Dogs Act 1991 so
that it becomes a criminal oence to allow any dog to be dangerously out of control in any place. The deniton
of dangerously out of control is slightly dierent from that in place in England and Wales and contains the
provision for a Dog Control Notce to be served where a dogs behaviour gives rise to alarm, or
apprehensiveness on the part of any individual, and the individuals alarm or apprehensiveness is, in all circumstances,
reasonable. The apprehensiveness may be as to (any or all of) (a) the individuals own safety, (b) the safety of some other
person, or (c) the safety of an animal other than the dog in queston.
Microchipping: Compulsory microchipping will be
introduced in Wales from 1st March 2015. It is likely that the
regulatons will be similar to those in England.
Tail docking: As in England, tail docking is banned under the
Animal Welfare Act with exemptons for certain working dogs
under the Docking of Working Dogs Tails (Wales) Regulatons
2007. However, the details of exempton are slightly dierent
[see box on page 7].
Electronic collars: In 2010 the Welsh Assembly introduced
legislaton to prohibit the use of electronic collars in dogs and
cats with the Animal Welfare (Electronic Collars) (Wales)
regulatons. An oence under these regulatons carries a
maximum period of imprisonment of 51 weeks, a ne, or both.
Microchipping: The compulsory microchipping of dogs will be required from 6th April 2016. The
legislaton relatng to this has not been nalized but is likely to include requirements for training of those who
implant microchips as well as a legal requirement to report adverse reactons and microchip failures.
Veterinary surgeons and veterinary nurses working under the directon of a veterinary surgeon are likely to be
exempt from the requirement to complete an approved training course.
Tail docking: The Animal Welfare Act 2006 banned tail docking in England other than for medical reasons and
with exemptons for certain types of working dog under the Docking of Working Dogs Tails (England)
Regulatons 2007. In partcular, the legislaton provides:
That any veterinary surgeon who docks a tail must certfy that s/he has seen specied evidence that the
dog is likely to work in specied areas and that the dog is of a specied type
The dog must be no older than ve days when docked and will also need to be microchipped before it is
three months old.
Dangerous dogs: Secton 1 of the Dangerous Dogs Act 1991 makes it illegal to own certain
breeds of dog (Pit Bull Terrier, Japanese Tosa, Dogo Argentno, Fila Braziliero) unless they are
registered on the Index of Exempted Dogs. The Dangerous Dogs (Amendment) Act 1997 gave
the courts discreton in sentencing, such that they were not always required to order that the
dog be destroyed where an owner was found to have kept a dog in breach of the legislaton.
Secton 3 of the Dangerous Dogs Act applies to all breeds of dog and makes it an oence if the dog
is dangerously out of control, which is dened as any occasion on which there are grounds for
reasonable apprehension that it will injure any person. Recent amendments have extended the act
to cover private property as well as atacks or potental atacks on assistance dogs.
Scotland
England
Wales
STOP PRESS: At the tme of going to press the Natonal Assembly for Wales is nalizing
the details of The Animal Welfare (Identcaton of Dogs) (Wales) Regulatons 2014 and
The Animal Welfare (Breeding of Dogs) (Wales) Reglatons 2014. Once the nal details
are released we will make the informaton available on the BSAVA website.
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BSAVA 2014
The Animal Health and Welfare Act 2013 replaces a plethora of Acts relatng to animal health and welfare. The Act
unites all animal welfare policy under the auspices of the Minister for Agriculture, not just that relatng to farm animals.
Veterinary practce in the Republic of Ireland is regulated by the Veterinary Council of Ireland established under the
Veterinary Practce Act 2005 and amended by The Veterinary Practce (Amendment) Act in July 2012.
For the purposes of pet travel it is important to remember that the Republic of Ireland is a European Member
State more details of movements between the UK and ROI are included in the report by Paula Boyden that
follows this artcle.
Republic of Ireland
Microchipping: The licensing and
microchipping of dogs are both compulsory in
Northern Ireland. It is an oence to own an unlicensed
dog, unless the dog is:
A puppy under six months old and kept by the person who
was also the keeper of the bitch that gave birth to the puppy
An assistance dog used by a disabled person
A dog kept, and on oer for sale, in a licensed pet shop
A police dog
A dog kept under a block licence, on the premises to which
the block licence relates.
Tail docking: The Welfare of Animals Act
(Northern Ireland) 2011 banned docking
with exemptons for certain types of
working dog and where docking is
performed as part of medical treatment or in an
emergency to save the dogs life.
Dog breeding: The Welfare of Animals (Dog
Breeding Establishments and Miscellaneous
Amendments) Regulatons (NI) 2013 set out
minimum standards for breeding
establishments, which are dened as any establishment
breeding, supplying or advertsing three or more liters of
puppies in any 12 month period, although there are exemptons
for hunt clubs and charites.
Puppies from a licensed establishment must be a
minimum age of 8 weeks before being transferred to a
new owner and must have been microchipped by
8 weeks of age.
Bitches in a licensed establishment should
not be mated untl they are over 12 months of
age, or afer 8 years, except with a veterinary
certcate. A bitch should not give birth to more
than three liters in any period of three years and
shall not be bred in any consecutve heat period.
Northern Ireland
Legislation map
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There is no EU-wide legislaton on the welfare of pets, so animal welfare regulatons vary between Member States.
However, the EU is currently undertaking a study about the welfare of dogs and cats in a commercial environment in
order to establish whether an EU-wide legal framework is necessary. This study is intended to report at the end of 2014.
The European Commission in proposing a single, comprehensive EU Animal Health Regulaton. These regulatons
will cover companion animals and their owners as well as producton animals.
The movement of companion animals is covered by a range of legislaton depending on species and the type of
movement. Dogs, cats and ferrets travelling with their owner are currently covered by the Pet Travel Scheme, Regulaton
(EC) no 998/2003 which will be replaced by EU Regulaton (576/2013) which comes into eect on 29th December 2014.
Any commercial movement which includes all movements that involve a transfer of ownership are covered by the
Balai Directve 92/65/EEC.
Pet travel requirements
For pets travelling to and from other EU Member States and approved non-EU countries, they must:
Be positvely idented by means of a microchip
Have an up-to-date vaccinaton against rabies
Be issued with an EU pet passport by an o cial veterinarian
Wait 21 days afer rabies vaccinaton before travelling
Travel into the UK on an approved route
Dogs must be treated by a vet for tapeworm between 24 and 120 hours (one to ve days) before arrival into the UK
and the pet passport signed accordingly. No treatment is required for dogs entering from Finland, Ireland or Malta.
There are no requirements for pets travelling directly between the UK and either the Channel Islands or the
Isle of Man.
Commercially traded dogs and cats will need to meet all the requirements of the pet travel scheme but in
additon must come from a holding or business registered with the EU Member State of origin and be
accompanied by a certcate in accordance with current requirements.
Full details of import requirements are available from the Animal Health and Veterinary Laboratories
Agency website www.defra.gov.uk/ahvla-en/imports-exports/.
Where an animal does not appear to meet the import requirements, veterinary surgeons should
contact their Local Authority (ofen the Trading Standards or Environmental Health departments).
Contact details for local authorites (including a post code checker) can be found on the Trading
Standards Insttute website.
TAIL DOCKING: SO WHICH DOGS CAN BE DOCKED?
In England, Wales and Northern Ireland legislaton species the types of
working dogs which may be docked. The types of evidence that the
veterinary surgeon will require to see before docking, and the wording
of the docking certcate, should be checked before undertaking any tail
docking. The tming of docking and microchipping may also be specied.
England: dogs involved in law enforcement; actvites of the armed
forces; emergency rescue; lawful pest control or the lawful shootng of
animals. Types of dog: hunt, point, retrieve breeds of any type; Spaniels
of any type or Terriers of any type. Combinatons of breeds are
permited to be docked.
Wales: dogs involved in law enforcement; actvites of the armed
forces; emergency rescue; lawful pest control or the lawful shootng of
animals. The breeds which may be docked are specied and no
combinatons of breeds are allowed to be docked. The certcate
which must be completed by both veterinary surgeon and client
requires the client to specify the breed of the dog and its dam, and the
veterinary surgeon must be satsed that the dog and its dam are of
the stated breed.
Northern Ireland: dogs involved in law enforcement; lawful pest
control or the lawful shootng of animals. The breeds specied are listed
as: Spaniels of any breed or combinaton of breeds, Terriers of any breed
or combinaton of breeds. Any breed commonly used for huntng, or any
combinaton of such breeds. Any breed commonly used for pointng, or
any combinaton of such breeds. Any breed commonly used for
retrieving, or any combinaton of such breeds.
Europe
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Movement
of dogs
in and out of Ireland
F
or the purposes of this article, movement
refers to the movement of dogs from the
Republic of Ireland (ROI) to Great Britain (GB).
Northern Ireland is part of the UK and will be
discussed later.
The movement of dogs, cats and ferrets across
Europe is governed by two key pieces of legislation:
Regulation (EC) no 998/2003 provides for the
non-commercial movement of dogs, cats and
ferrets
The Balai Directive 92/65/EEC provides for the
commercial movement of dogs and cats
(among others)
These rules have been in place since 1 January
2012, when the UK harmonized with EU rules for both
the non-commercial and commercial movement of
pet animals.
In order to move across Europe all dogs (cats and
ferrets) must comply with the veterinary preparations
required for travel under the EU pet travel scheme:
microchip, vaccinate, 21 day wait, pet passport.
Article 3 of Regulation (EC) no 998/2003 states:
For the purposes of this Regulation:
(a) Pet animals means animals of the species listed
in Annex I which are accompanying their owners
or a natural person responsible for such animals
on behalf of the owner during their movement and
are not intended to be sold or transferred to
another owner;
Therefore the only animals that are permitted to
travel under Regulation (EC) no 998/2003 are dogs,
cats and ferrets which are accompanying their owners
or a natural person responsible for such animals on
behalf of the owner during their movement.
Paula Boyden, Veterinary Director of
the Dogs Trust, describes the rules
regarding travelling with dogs between
Ireland and the UK
This means that dogs being moved for the purpose
of change of ownership, including those for rescue/
rehoming, must comply with the Balai directive, as it is
considered an economic activity. Therefore, dogs for
rehoming need to comply with both the veterinary
preparations required for travel under the EU pet travel
scheme (as above) plus:
Travel from a holding or business registered with
the EU member state of origin
Be accompanied by a fit and healthy to travel
certificate issued by a vet authorized by the
competent authority confirming that a clinical
examination was carried out no more than 24 hours
before travel (this will change to 48 hours from
29 December 2014)
AHVLA must be notified of the movement and the
pets will be subject to a risk-based inspection
regime at the place of destination. This means the
pets must remain at their point of destination in the
UK for at least 48 hours in order to facilitate
inspection visits by AHVLA
In addition, movement must also comply with
Council Regulation 1/2005 (Welfare of Animals
During Transport).
Owners moving their pets from the ROI into GB
have not experienced any change on the ground
because no systematic border compliance checks are
carried out prior to entry to Great Britain. This was
agreed by both ROI and GB in recognition of the
negligible rabies risk associated with the movement of
pets between the countries, because they are both
free of rabies. Equally, no treatment is required against
the tapeworm Echinococcus multilocularis, due to
equivalent (negative) disease status.
We are reminded that although border compliance
checks do not routinely take place, this does not mean
08-09 Movement of Dogs.indd 8 17/07/2014 15:21
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that the rules do not apply. In fact, Trading Standards
(who are responsible for enforcing the EU rules within
Great Britain) have the power to detain and seize pet
animals that are found to be non-compliant during the
course of their inland investigations.
Whilst the legislation has not changed per se,
there does appear to be a change in implementation
of the rules in respect of commercial movements into
GB. This includes dogs for rescue/rehoming. This may
be due in part to concerns expressed in Europe that
the commercial aspect of this movement could lead to
an unfair trade advantage between the UK and
Ireland. The impact is a reduction in the movement of
dogs for rescue/rehoming; many organizations do not
have the resources, financial or otherwise, to hold
dogs for 3 weeks.
Movement from the Republic of Ireland
(ROI) to Northern Ireland (NI)
Whilst there is a requirement in legislation for pets
moving between the Republic of Ireland and Northern
Ireland to comply with the EU pet travel Regulation, the
authorities in both jurisdictions enforce these
requirements on the basis of risk. The risk of rabies is
considered negligible on the island of Ireland from
dogs moving from north to south and vice versa; there
are therefore no border checks on animals moving
from the Republic of Ireland to Northern Ireland.
New Regulation
A new EU Regulation (576/2013) comes into effect on
29 December 2014 and replaces Regulation (EC) no
998/2003. It introduces a number of changes
designed to strengthen enforcement regimes across
the EU, increase levels of compliance and improve the
security and traceability of the pet passport.
From 29 December 2014 all dogs, cats and ferrets
prepared for travel will be issued with a new style
pet passport. This passport will include improved
security features most notably laminated strips
to cover the pets details (including the microchip
number) and each rabies vaccination entry. This
will help prevent anyone tampering with this
information once it has been completed by a vet.
The vet issuing the pet passport will also need to
fill in their details on a new issuing of the
passport page and must make sure that all their
contact details are included when they certify
vaccinations. It is worth noting that any passport
issued before the 29 December 2014 will remain
valid for the lifetime of the pet, or until the
treatment spaces are filled.
Any vet issuing a passport will need to keep a
record of the information entered into the passport
relating to: the microchip (number, location and
date of reading/application); the details of the pet
(name, species, breed, sex, colour, date of birth,
distinguishing features); the owners contact details
and the pet passport number. This information will
need to be retained for at least three years.
A new 12 week minimum age of vaccination will be
introduced by the new Regulation to create
consistency across the EU and aid compliance
checking. Currently, there is no minimum age of
vaccination; rather the vaccine must be
administered in accordance with its marketing
authorization in the country in which it is
administered. This means that in some countries
the rabies vaccine is licensed to be given to
puppies from an unvaccinated dam at 4 weeks,
which could lead to legitimate movement at
8 weeks of age.
Owners travelling with more than
five pets will need to travel under
the rules laid down by the Balai
Directive unless the animals are
aged over six months and are
travelling to attend a show/
competition/training event or
training for such an event. They will
need to present written evidence of
their registration.
The new Regulation
will also require all EU
countries to carry out
some documentary
and identity checks on
pet movements within
the EU.
08-09 Movement of Dogs.indd 9 17/07/2014 15:21
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BSAVA 2014
Clinical conundrum
Case presentation
An 8-year-old female neutered Australian Cattle Dog presented with
a 4-month history of lethargy, inappetance, right forelimb lameness,
and a 6-month history of stranguria and haematuria. The dog had
received a 2-week course of non-steroidal anti-inflammatory drugs
(NSAIDs), which had produced no clinical improvement in the
lameness but had reduced the degree of stranguria. Radiographs
obtained prior to referral revealed an area of bony lysis of the right
antebrachium. In addition, a lateral abdominal radiograph revealed
multiple large radiopaque cystouroliths. The dog had recently
moved to the United Kingdom from Arizona in the United States of
America, was currently vaccinated (leptospirosis, infectious
hepatitis, distemper, parvovirus and parainfluenza) and wormed
every 3 months with a praziquantel, pyrantel and febantel
combination. No other significant medical history was reported.
Chiara Giannasi, Resident in
Internal Medicine at Dick White
Referrals, invites companion
readers to consider a case of right
forelimb lameness and haematuria
in an Australian Cattle Dog
Physical examination
The dog was alert, in good body condition and 8/10
lame on the right forelimb. There was a firm
circumferential diffuse bony swelling over the right
carpus, which was painful on palpation (Figure 1). The
bladder was small with multiple large uroliths palpable
within the bladder. The remainder of the examination
was unremarkable. On admission to the hospital,
stranguria and haematuria were both evident (Figure 2).
Create a problem list based on the dogs
history and physical examination findings
1. Lethargy
2. Inappetance
3. Stranguria
4. Haematuria
5. Cystouroliths
6. Painful bony swelling with lysis of the right
antebrachium
Lethargy and inappetance were most likely due to
the pain induced by the right forelimb lameness and
the presence of cystouroliths causing the urinary tract
signs (stranguria and haematuria).
Pain and the lameness associated with the lytic
forelimb swelling were considered the main presenting
sign and investigations were centered on this problem.
Figure 1: On physical
examination the dog was
lame on the right
forelimb and a bony
swelling was palpable
over the right carpus Figure 2: Haematuria present on admission
1013 Clinical Conundrum.indd 10 18/07/2014 13:33
BSAVA 2014
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of the nature of the cystouroliths; however, it is
important to remember that the presence of urinary
crystals does not always correlate to the origin of
cystouroliths present.
Repeat radiographs of both forelimbs were
performed under general anaesthesia as it had been
6 weeks since the initial images were obtained and
both the lameness and swelling had progressed in
that period.
What is your interpretation of the
forelimb radiographs (Figures 3 and 4)?
There is an extensive permeative osteolytic lesion
involving the mid to distal portion of the right radius, as
well as the distal portion of the ulna. The accessory
and radial carpal bones also show evidence of
osteolysis. The lesions have resulted in marked cortical
thinning of the affected bones. A well-defined
periosteal reaction and mild soft tissue swelling are
visible surrounding the right radius. The radiocarpal
joint also appears moderately swollen. The left limb
n Calcium oxalate
n Struvite
n Cystne
n Calcium phosphate
n Silica
Table 1: Compositions of radiopaque uroliths
A cystotomy was planned to remove the cystouroliths
after these evaluations. The composition of radiopaque
cystouroliths are listed in Table 1 with calcium oxalate
and struvite uroliths being the most common types
seen in dogs.
List the possible differential diagnoses
for a painful lytic bony lesion in the right
antebrachium
n Neoplastic
Primary: osteosarcoma, haemangiosarcoma,
chrondrosarcoma, fibroscarcoma, plasma cell
tumour (plasmacytoma, multiple myeloma),
lymphoma
Metastatic disease
n Infectious
Bacterial or fungal osteomyelitis
n Metabolic (unlikely at a single site)
Hyperparathyroidism (primary and secondary
renal)
Hypovitaminosis D (rickets)
n Ischaemic injury
n Trauma
What investigations would you perform
and why?
A complete blood count and biochemistry were
performed to screen for any systemic abnormalities,
and specifically to evaluate for pancytopenia,
circulating atypical lymphocytes, hypercalcaemia
and hyperglobulinaemia. The results were
unremarkable. Urinalysis and culture performed on a
voided sample confirmed the presence of marked
haematuria. No crystals, renal casts or active
sediment was identified on cytology; urine culture
was also negative. Urinalysis revealed alkaline urine
(pH 8.0), which is more likely to favour the formation
of struvite and oxalate uroliths. There was no
evidence of crystalluria to assist in the identification Figure 3: Dorsoventral radiographs of both antebrachia
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BSAVA 2014
Clinical conundrum
appears normal. The radiographs reveal worsening of
the bone lysis in comparison with that seen previously,
with the main differential diagnoses being fungal
osteomyelitis and primary neoplasia.
What further investigations should be
performed and why?
Inflated thoracic radiographs under general
anaesthesia were obtained to assess for obvious
pulmonary pathology, including metastatic disease
and lymphadenopathy or pulmonary infiltration
associated with systemic fungal disease; these were
within normal limits.
A bone biopsy sample was taken from the distal
radius to determine the underlying cause for the
radiographic changes. A Jamshidi needle was
inserted into the radius, via a lateral approach,
approximately 3 cm above the carpus and advanced
perpendicular to its long axis allowing collection of
the biopsy specimen. Due to the cortical thinning,
iatrogenic fracture was identified as a potential
procedural risk and had been carefully discussed
with the owner.
Figure 4: Lateral radiographs of both antebrachia
Histology identified a fungal infection with
extensive pyogranulomatous inflammation, leading
to extensive bony lysis. The large size of the fungal
organism and the presence of multiple endospores
were suggestive of Coccidioides immitis (a fungal
organism present in southwestern USA, including
Arizona). Samples were submitted for fungal culture
at the Health Protection Agency, which confirmed
infection with Coccidioides immitis. Material
submitted for culture must be handled very carefully,
especially when a tissue invasive fungal organism is
suspected. Serological testing is also possible for
Coccidioides immitis, although it was not performed
in this case.
Given the swelling of the radiocarpal joint, joint
fluid was retrieved via arthrocentesis for cytology in
order to identify any underlying infection or
inflammation. Cytology revealed low grade
neutrophilic inflammation but no evidence of fungus.
Does coccidioidomycosis in this dog
pose any threat to the human and
companion animal populations in the
United Kingdom?
Coccidioides immitis is only found in specific areas of
the world that have the appropriate climate and
environment for the fungus to grow. These conditions
are not found in the United Kingdom Coccidioides
species require very arid soils and prolonged hot, dry
summer months for fungal growth.
Direct transmission between infected patients
(both human and veterinary species) has not been
reported, and Coccidioides immitis is not generally
regarded as zoonotic. However, inoculated infection
has the potential to occur in humans if sharps injuries
are sustained during the aspiration of affected tissues,
surgery or post-mortem examination of infected
veterinary patients. Hence, sedation or anaesthesia, as
well as protective clothing, should always be used
when obtaining tissue samples if an invasive fungus
such as Coccidioides immitis is suspected.
How would you manage this patient
based on your diagnosis?
Given that the lameness was the initial presenting
complaint from the owner and was causing the dog
marked discomfort, we elected to treat the
BSAVA 2014
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coccidioidomycosis prior to considering further
evaluation of the cystouroliths. Cystotomy was
planned due to the number and unknown origin of
the cystouroliths.
Therapy of coccidioidomycosis includes the use
of azoles or amphotericin B. Treatment for a
minimum of 46 months beyond clinical cure with a
marked reduction or resolution of positive
serological findings is recommended. With
disseminated disease, treatment can be prolonged
(often >1 year) and in some cases lifelong therapy is
required. Relapse occurs commonly and it is
unknown whether previous infection provides
lifelong immunity as in humans.
Azoles inhibit ergosterol synthesis, resulting in cell
membrane permeability and inhibition of fungal cell
growth. Itraconazole was used in this case and is
preferred for animals with bony involvement; it may
also be effective in cases that fail to respond to
fluconazole. Other potential azoles that could be used
include ketoconazole and fluconazole. Ketoconazole
is no longer the drug of choice due to adverse effects
and lower activity. Fluconazole may be preferable for
cases with central nervous system involvement.
Periodic monitoring of liver enzymes is recommended
with azole antifungal therapy due to the possible
hepatotoxicity (suggested after 46 weeks of therapy
and then every 34 months). Amphotericin B was
avoided in this case due to the expense, narrow
therapeutic window and level of supportive care
required to avoid nephrotoxicity and other associated
adverse effects. Treatment with amphotericin B should
be reserved for severe disease that does not respond
to traditional azole therapy. All azole drugs are
potentially teratogenic, so should be avoided during
pregnancy. Specific advice should also be given to
clients, with care being taken to warn women of child
bearing age about the handling precautions as the
use of these drugs is associated with an increased
risk of birth defects.
The dog commenced therapy with itraconazole
at a rate of 5 mg/kg p.o. q12h. Analgesia was provided
with meloxicam at a rate of 0.1 mg/kg p.o. q24h and
tramadol at 3 mg/kg p.o q8h. This improved the
lameness but the pain on palpation remained;
the dogs stranguria resolved with the introduction of
the meloxicam.
COCCIDIOIDOMYCOSIS: PATHOPHYSIOLOGY
The alkaline sandy soil of the southwestern USA, western Mexico and Central and
South America is the normal habitat for Coccidioides fungal species, which grow
as vegetatve mycelia during rainfall. As a result of this geographical distributon,
coccidioidomycosis is ofen referred to as Rif Valley Fever.
The mycelia germinate and form arthrospores with soil drying, becoming airborne
under appropriate weather conditons. In dogs and cats the major route of infecton
is via inhalaton. Cutaneous contaminaton via a penetratng wound occurs less
commonly. Within the body it transforms in to the parasitc form, the spherule, and
undergoes division later rupturing at maturity. The severity and extent of the disease
depends on the immunocompetence of the host, and can range from a mild pulmonic
form to fatal multsystemic disseminaton. Two species of Coccidioides have been
identfed, Coccidioides posadasii and Coccidioides immits (isolated in this case), both
of which have similar manifestatons and drug susceptbilites. Pulmonary infecton
occurs via the bronchioles and alveoli, through the peribronchial tssues, to the
associated lymph nodes. Disseminated disease extends beyond the tracheobronchial
and mediastnal lymph nodes to the axial and appendicular skeleton and overlying
skin (most commonly), central nervous system, abdominal viscera, pericardium,
myocardium and prostate gland.
What are the long term concerns in
this case?
There is a risk of forelimb fracture in this dog due to the
bone lysis and cortical weakness. Stabilization of the
leg may be difficult if a fracture occurs due to the large
area of bone destruction, therefore warranting
amputation of the limb; these risks were further
discussed with the owner.
Given the presence of cystouroliths, urethral
obstruction was a concern; however, the dogs urinary
tract signs were long standing and only large uroliths
were present on the radiographs. The owner was
warned regarding signs of obstruction.
Outcome
The dog was discharged after 2 days of hospitalization
and appeared comfortable on the prescribed
analgesics. A repeat appointment was made for 2
weeks time for reassessment. Cystotomy to remove
the uroliths was planned for this time, with follow up
limb radiographs and assessment of liver enzymes
planned following 6 weeks of treatment. Unfortunately,
the dog did not return for reassessment and was lost
to follow up, having returned to the USA. n
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BSAVA 2014
Vets restoring wildlife
is a captivating message
A
ndrew Greenwood works for Wildlife Vets
International (WVI) and sees the direct effects
of human intervention and environmental
mismanagement on animal species up close.
As a vastly experienced avian specialist with the
International Zoo Veterinary Group (IZVG) he advises
important captive breeding and species reintroduction
programmes alongside regular zoo work from the
wildlife practices head office in Yorkshire.
Conservation, he admits, can be a hard sell
when trying to raise funds even to veterinary
surgeons. Practices have a huge base of people
who care about animals, says Andrew. The only
problem is that it is much easier to sell the idea of
welfare than conservation.
Yet if estimates of the rate of species loss are
what the World Wildlife Fund suspects, then at the
very least 200 species are pushed into extinction
every year. By conservative estimates, since WVI
became a registered charity in May 2005 around
1,800 species have become extinct, and the figure
could potentially be 10 or even 100 times more.
Life on the edge
The WVI often operates with species that have been
pushed to the brink. For instance, amur leopards in the
Russian Far East number less than 50 in the wild. A
combination of logging, deer hunting and opportunistic
poaching following the collapse of the Soviet Union
stretched cat numbers dangerously thin. Thanks to
WVIs work with an international team there may be
hope. An intensive captive breeding and reintroduction
programme is underway.
As you would expect, demand for expertise far
outstrips supply and the organizations portfolio is
Species conservation is one of the least well
understood, complex and important activities
affecting animal biodiversity today. Linked as
it is with social and environmental effects on
wildlife, it rarely makes headlines in the way
that floods in the Somerset Levels or a
government scandal does, but those
involved would like to get your attention.
Robin Fearon reports
Main image: John
Lewis auscultating
the thorax of a
sedated tiger
14-17 Wildlife Vets International.indd 14 18/07/2014 13:50
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extensive. Tiger projects in Bangladesh, Sumatra and
Russia are coupled with Painted Dog Conservation in
Zimbabwe, primates in Vietnam, vultures and other
rare bird species in India and Mauritius.
Since 1994 Andrew has flown each year to the
Indian Ocean islands to provide veterinary expertise
to restoration projects for reptile species and birds
such as the Mauritius kestrel, the echo parakeet and
pink pigeon.
Partner organization the Mauritian Wildlife
Foundation is probably the most successful
endangered species restoration outfit in the world,
says Andrew. Four of the last known surviving kestrels
in the area have been saved and the population has
been restored to more than 500. The echo parakeet
and pink pigeon were down to about 20 birds each
and have now recovered to similar numbers.
There are some complex disease situations
associated with these species, says Andrew, adding
that if it were not for captive falconry birds, pet parrots
and racing pigeons those problems would be
multiplied. Thankfully, we are working with problems
that are well presented in captivity. It does not mean
necessarily they are easier to manage in the wild, but
we know about them.
The problem and the solution
The biggest problem for island birds has been human
intervention and the introduction of cats and rats.
Logging to grow cash crops like sugar cane is another.
If nest sites go, food resources disappear and then
predators pick off the rest, it is unsustainable, says
Andrew. We are not at the stage with any of those
species where they can be left unmanaged.
Restoration work begins by taking a proportion
of the population into captive breeding
programmes. Gradually young birds are
reintroduced to the wild under careful supervision:
nest sites are monitored, predators controlled and
food provided where necessary.
Most of the parakeets have now been taught to use
nest boxes provided by wildlife biologists. All boxes
have access hatches and can be reached using a
ladder, making the job of monitoring eggs or chicks
much easier. Put up boxes for wild birds and they
wont use them, but if you release birds that have been
bred in nest boxes, they recognize them and start
using them, says Andrew. They then either partner
up with a wild bird or other birds copy them. It is a soft
release process and it is successful.
The way that the Mauritius Wildlife Foundation
works is typical of successful species reintroduction
programmes the world over. Essentially, breeding
programmes are moved into the wild. They work with
wild birds as if they were captive, says Andrew. They
increase the number of clutches, rescue eggs and
chicks so they maximize output from wild birds.
Captive-wild breeding speeds up the recovery
process in small populations, though it is expensive
and requires long-term work, especially in mammal
reintroduction programmes such as that of the Amur
leopard. Yet it offers hope for species that may
already be extinct in the wild and it provides the
perfect reason to maintain viable habitat and
supportive eco-systems. The Mauritian government
recognizes this and has created a huge forest
reserve for pink pigeons so they have a place to live
once reintroduced.
WVI provides crucial advisory and veterinary
support to each project, plus specialist medicine and
pathology services, as well as links to an academic
research base at universities including Glasgow, East
Anglia, Reading and Kents Durrell Institute of
Conservation and Ecology.
Its reports form the basis of ongoing field work.
The guy in the field is at the tip of a pyramid and the
base is all the specialists and researchers working
behind the scenes, says Andrew.
Repeated requests for help where there was a
veterinary or disease problem were what led the vets
at the IZVG to set up WVI in the first place. The
practice, set up in 1976, found itself in the privileged
position where it could allow clinicians leave to go
overseas for weeks or sometimes months at a time to
help out; time that other zoo and wildlife organizations
could not afford.
Painted Dog Conservation
WVIs foundation in 2005 led well-known vet Steve
Leonard to throw his weight behind the charity and
sign up as patron. He reasoned that a lot of the small
conservation projects he had encountered during BBC
Steve Leonard examines a dog as part of a distemper and rabies vaccination program to
help protect African painted dogs against these diseases
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Vets restoring wildlife
is a captivating message
Wildlife filming could really benefit from the charitys
skills. One Painted Dog Conservation in Zimbabwe
has become a headline WVI project.
Steve has been out to Zimbabwe twice setting up
vaccination clinics around the Hwange National Park.
Painted dogs are badly affected by distemper from
domestic dogs so teams were sent out to rural villages
to ring vaccinate an area around Hwange and create a
protective barrier.
Using donated vaccines and veterinary drugs the
project was able to set up field treatment centres,
administering vaccines and performing castrations. In
a five day period we managed to vaccinate around
750 dogs, Steve recalls. We saw a lot of
transmissible venereal tumours and we would ideally
like to offer more neutering clinics.
Painted dogs are suffering pointedly from the same
combination of human intervention and complex
disease issues that typify endangered species
everywhere. Part of WVIs response is to provide
vaccination resources, train local vets and
conservationists on how to dart wild dogs, take
biological samples for analysis and create disease
protocols. That training tells them how to maximize
their interaction with the dogs, says Steve.
The vets role
Public understanding of conservation problems is
generally good, thinks Steve; what is not understood is
the role vets have to play. People just assume that
vets are at the heart of a lot of this, when quite often
they are not, he says. There are a lot of small
endangered species projects all over the world where
they cannot afford veterinary expertise.
Modern conservation has to involve sustainable
development and support for local communities or it
cannot work. All the time we are learning and that is
where vets have a role to play, in terms of monitoring
these animals and understanding the stresses.
Britains veterinary community could realize its
passion for conservation and wildlife by supporting the
work of wildlife veterinary organizations, says Steve.
Vets, nurses and receptionists are all passionate
about these things. We want to tell them this is an
organization they can get behind, who will take their
support and do amazing things with it.
Olivia Walter, WVI development manager, says all
her efforts are now being targeted towards the
profession. All of our projects are long term, she
says. We dont do emergency veterinary care for an
animal that has been caught in a snare or injured in a
road accident. It is much more at a population level,
looking at diseases and training vets, working with
scientists and creating strategies.
Involving the profession and industry
A core of around 10 practices has signed up to raise
funds and promote the WVIs conservation message.
Olivia has high hopes that message will filter down to
the general public. We would like to get more
practices on board, raising funds for us and
increasing awareness of what we do among their
clients, she says. We are a small organization so
these things happen organically.
Board level talks have led to profitable links with
the veterinary industry and MSD Animal Health is one
of several companies to provide equipment and
financial support. The company already supports the
efforts of the Afyah Serengeti project and Mission
Rabies in India to vaccinate domestic dogs and
prevent disease. It also provides vaccine to WVI for
Painted Dog Conservation and Steve Leonard.
Ken Elliott is marketing manager for MSDs
companion animal business and an advocate of
conservation projects. WVI has got tremendous
potential, he says. What they are doing is just the tip
of the iceberg. The limiting factor is funding. They are
not able to advertise on TV, but what they can do is
work with the British veterinary profession to make their
name and win support.
Community clinic
with partners
Painted Dog
Conservation,
Zimbabwean
Veterinary
Department and
WVI vets Steve
and Tom
WVI vet Andrew Greenwood releases a male flycatcher.
Within the first breeding season 4 chicks were fledged
BSAVA 2014
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One of the WVI projects I am most interested in at
the minute is with big cats in southeast Asia and the
idea they could be changing their behaviour because
of distemper virus contracted from domestic dogs.
There are quite a few cases where tigers have raided
villages for food and the villagers have responded by
clubbing them to death.
But it is work in the Russian Far East by vet John
Lewis that somehow typifies both the fragility of
conservation efforts and the core of WVIs work, says
Ken. Work with the Amur leopard is critical, he says.
And it could go either way.
Big cat conservation
It is not untypical for John Lewis to be at his desk on a
Sunday afternoon after touching down from Azerbaijan.
On this particular Sunday, lengthy project reports and
disease data litter the space, and his recent preliminary
talks about a restoration project involving the Persian
leopard in the Caucasus have gone well. It was very
positive, he says. They have money, which is
extraordinary. The only condition with any of these
projects is that although there is a lot of impetus to get
involved now, it needs to go on for 20 years.
Big cat projects are Johns preserve. Logistically
demanding because the field work is extensive, in the
case of the Amur leopard it involves months of hiking,
camping, tracking and capture, with no guarantee of a
result. Some years I have spent two months out there
and we have caught nothing. It is difficult to predict.
Distemper, probably from domestic dogs, has
killed at least two tigers in Russia and it may be a
growing problem. We aim to create veterinary
services in these areas using people who are
experienced in wildlife medicine and conservation,
because that is what is needed, says John.
He oversees the Amurs captive breeding and
reintroduction programme. Zoo animals are bred
and relocated to the Russian Far East to be raised
under the correct climate and conditions, exposed
to the same environmental and disease factors as
wild leopards.
Zoo animals must be extremely healthy otherwise
there is a risk of reintroducing disease to the wild
population. Johns reports create a picture of health for
the entire Amur leopard population as well as
indigenous prey species. There is little point in
releasing animals where they will go hungry or die from
infectious disease.
Historically, there have been no big cat
reintroductions, only translocations or release onto
reserves. The nearest conservationists have got is
reintroduction of the Iberian lynx, a much smaller
species. It is early days but it looks as though the
lynxs reintroduction from captivity has brought the
wild population up from around 120 to 300 over a
10-year period.
Amur leopard reintroduction will be done carefully,
stage by stage. Even once the animals are reared and
ready for release they must be tracked, monitored and
their health status and population dynamics analysed.
You must have milestones, says John. If we dont do
it then the leopard is doomed.
Measuring impact
Judging success is the hard part. Reintroduction of the
Arabian oryx into Oman in the 1960s involved zoos
and countries across the globe. Thirty years later
Oman relaxed controls on poaching and the species
disappeared. It is a stark lesson.
Fortunately, in former Amur leopard habitats where
prey numbers crashed following the fall of the Soviet
Union, deer numbers have been restored through
good management in national parks. John believes
they can now go back and try to create a larger
population.
There is no path except constant vigilance and
patience ahead. Will it take 50 or even 100 years to
reintroduce the Amur leopard, John ponders. It is
difficult to say. If we do make the effort, it is
expensive, long-winded and it might just work, he
concludes. To myself and many other people, to give
up is entirely unacceptable. The truth is that I will be
dead long before we know whether the Amur leopard
project has worked. n
WVI vet Johanna Storm cleans up a blood stained black
necked ibis before fixing the broken bones

W
V
I
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How to deal with
a patient with
thermal burns
Immediate first aid
Since the skin is very slow to cool, it is
possible for the burning process to
continue for some time after removal of
the patient from the heat source. Thus,
the first treatment consideration should
be to stop the burning process. The
recommendation is that the burned
areas should be cooled with running tap
water (15C/59F) for 2030 minutes.
The use of wet compress towels is not as
effective at reducing burn depth.
Similarly, iced water is also not
recommended as this can rapidly
decrease the patients core body
temperature, causing vasoconstriction,
thereby contributing to increased wound
depth and reducing circulation to the
immediate area. Owners should be
advised to avoid hypothermia during
transport, by wrapping the patient in
clean, dry sheets or blankets. The
patients temperature should be carefully
monitored to ensure hypothermia does
not occur; if the patients temperature
drops below 38C active warming will be
required to prevent any further drop.
Infection control considerations
Burns patients are at high risk of sepsis,
therefore, it is recommended that all
personnel wear examination gloves
when handling the patient and strict
aseptic technique (including sterile
gloves, sterile swabs, etc.) must be
used when performing any invasive
procedure (e.g. placing catheters or
collecting blood).
Louise ODwyer, Clinical Director of the
PetMedics Veterinary Hospital, helps us
approach the patient with thermal burns
Pain management
A multimodal analgesic protocol is
recommended for the management of
pain. In the acute phase of burn injuries,
intravenous opioids should be the
primary method of analgesia. The degree
of pain associated with burn wounds is
incredibly varied, and the use of pain
scoring systems, such as the Glasgow
Composite Measure Pain Score, is highly
recommended. Pure opioid agonists such
as methadone (0.10.25 mg/kg i.v.
q26h) or morphine (0.10.5 mg/kg s.q.
q26h) are recommended for veterinary
patients with moderate to severe pain.
Ketamine is reported to be useful for the
treatment of somatic pain and can be
used in conjunction with opioids as a
constant rate infusion at 0.150.6 mg/kg/
hr. Lidocaine may provide additional
analgesia and may also have free radical
scavenging properties. Lidocaine is used
at a rate of 1.53 mg/kg/hr, but should be
used with caution in feline patients. If
using a constant rate infusion, a loading
dose equal to the hourly rate should
initially be administered. Each patient
should be evaluated individually for
optimal analgesia, again using a pain
scoring system to ensure that ongoing
analgesia is adequate.
Primary survey
As with any emergency patient, on initial
presentation the burns patient will require a
primary survey in order determine the
extent of the injury and to commence
treatment as required. Priorities include
ensuring the patient has a patent airway,
and assessing the requirement for
ventilatory support, followed by fluid
therapy to treat hypovolaemic shock.
Oxygen (100%) should be administered to
any patient suspected to have smoke
inhalation injury to accelerate the
elimination of carbon monoxide. Intubation
T
hankfully thermal burns are an
uncommon presentation in small
animal practice; however, dealing
with these injuries can be
challenging. This article provides a review
and logical approach to the assessment
and management of a patient with
thermal burns.
Extent of burns
In human medicine thermal burns
historically have been classified according
to the extent (expressed as a percentage)
of the body surface involved and the depth
of injury to the skin. The most common
scale used for humans is the rule of nines,
whereby the adult human body is divided
into areas corresponding to 9% of the total
body surface area, or multiples of 9%. For
example, individual thoracic limbs
comprise approximately 9% of the total
body surface area; each lower limb, 18%;
the head and neck, 9%; the chest and
abdomen, 18%; the back, 18%; and the
perineum, 1%. The modern burn
classification system also classifies burns
according to their depth as superficial,
superficial partial-thickness, deep
partial-thickness or full thickness.
In veterinary patients there is often
difficulty in assessing the depth of the
injury at initial presentation, and serial
examinations over the first 24 hours are
usually required to determine the extent of
the injury. For some local burn wounds the
injury may not be immediately evident to
the owner, with the patient being presented
2448 hours post-injury.
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or emergency tracheostomy may be
required if the airway oedema is severe. In
the event of orotracheal injury, endotracheal
tubes should be carefully secured, as
progressive oedema may make emergency
re-intubation more demanding.
In patients injured during house fires,
the effects of smoke inhalation will be
evident on the upper respiratory tract within
the first 24 hours and occur as a result of
direct thermal injury. The adherence of
irritants to the upper respiratory tract results
in the release of inflammatory mediators
and reactive oxygen species (by-products
of respiration, which can cause damage to
cell DNA), increased vascular permeability
and oedema formation. This oedema can
progress to airway obstruction and
bronchospasm that generally peaks at
around 24 hours post-injury, and
subsequently resolves over the following
days. Haemorrhage, mucosal congestion,
ulceration and laryngospasm may also
occur within the first 24 hours. Additional
complications occur due to the adherence
of soot to the respiratory mucosa, which
allows other irritants to bind to the mucosa.
Vascular access can be complex in the
hypovolemic, burnt patient. Ideally, short
peripheral catheters should be placed in
non-burnt areas. Burnt areas may be used
in the first 24 hours; however, dressing the
catheters may be complex in these
locations, and the sites also become
rapidly colonized with bacteria, thus
catheters need to be removed within
2448 hours. Intraosseous catheters are
an alternative for patients where vascular
access is difficult, but this technique can
be difficult in adults . Where burns over a
large surface area have been sustained,
central catheters may be the most suitable
option, as these patients may require
parenteral nutrition or central venous
pressure monitoring. However, the use of
central catheters should be avoided
whenever possible due to the risks
associated with hypercoagulability in
patients with extensive burns.
Fluid therapy
Fluid resuscitation is a vitally important
step in the treatment of severely burnt
patients. The aim of fluid resuscitation is
to maintain organ perfusion and avoid
tissue ischemia using the least amount of
fluid required. In most burns cases, there
is little change in intravascular volume or
haemodynamics for the first 12 hours
following the injury, but a delay in fluid
resuscitation beyond 2 hours of the burn
injury reportedly results in complications
in resuscitation and an increase in
mortality. In patients with severe burns,
after 12 hours there is generally a period
of haemodynamic instability (for 2448
hours) despite fluid resuscitation. During
this period neither preload nor cardiac
output can be normalized using fluid
resuscitation until 24 hours after the
injury. Severely burnt patients that also
have concurrent inhalation injuries,
commonly have a marked increase in
haemodynamic instability, with a 3050%
increase in initial fluid requirements being
seen when compared with patients with
burn injuries alone.
In human medicine the consensus
formula (formerly referred to as the
Parkland formula) has become the most
widely used resuscitation guideline and is
used to calculate the volume of crystalloids
required within the first 24 hours following
severe burn injury. The formula
recommends the administration of isotonic
crystalloids at a rate of 4 ml/kg per
Figure 1: Nasal oxygen catheter placed in a bulldog. Oxygen saturation monitoring is also being
performed using a pulse oximeter
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How to deal with
a patient with thermal burns
percentage of total body surface area
affected in the first 24 hours, with half of
this volume being administered over the
first 8 hours after presentation. The
remaining fluid is administered over the
following 16 hours. However, recent studies
have found that average fluid volumes
administered to burns patients significantly
surpass the formula predictions, frequently
exceeding 67 ml/kg per percentage of
total body surface area affected.
The use of both natural (e.g. albumin)
and synthetic (e.g. hydroxyethyl starches)
colloids in the resuscitation of burns
patients is controversial. This concern is
due to the potential for leakage of proteins
and large molecules through
compromised capillary membranes. The
current recommendation is to wait at least
812 hours post-injury before utilizing
colloids. The use of colloids may increase
colloid osmotic pressure (COP), which has
been reported to reduce oedema
formation in non-burnt tissue (but not in
the burn wound itself).
Secondary survey
Following initial stabilization of the patient,
a secondary survey should be performed
to identify any concurrent injuries. Patients
should be assessed for neurological
injuries secondary to trauma, hypoxaemia
and carbon monoxide poisoning; ideally
this should be performed once the patient
is normovolaemic. The airways and thorax
require auscultation for stridor, crackles or
wheezes, and the adequacy of ventilation
should be assessed, ideally via blood gas
analysis. The face, oral cavity and pharynx
should be examined for the presence of
burns or debris that may suggest inhalation
injury has occurred.
The eyes should be assessed for
conjunctivitis, particulate material and
corneal ulceration. Corneal ulcers
commonly occur secondary to thermal
injury or abrasion by particulate material,
so fluorescein staining should always be
performed. Topical anaesthetics such as
proxymetacaine should be used to
facilitate examination behind the third
eyelids for foreign material, and the eyes
should be copiously flushed with sterile
saline. Baseline radiographs ideally should
be obtained to assess for any changes as
a result of smoke inhalation or traumatic
injury. It should be remembered that
thoracic radiographs may be normal
initially, although bronchial markings may
be present.
The development of pulmonary
infiltrates or lobar consolidation may
suggest pneumonia. Arterial blood gas
evaluation is useful to determine
parameters related to ventilation,
oxygenation and perfusion. However, it
should be remembered that both the
partial pressure of oxygen (pO
2
) and
oxygen saturation (SpO
2
) can be
misleading in the presence of carbon
monoxide inhalation. In this situation pulse
oximetry will misread carboxyhaemoglobin
as oxyhaemoglobin; co-oximetry should be
performed, if available, to determine
carboxyhaemoglobin levels as co-
oximeters will directly measure
carboxyhaemoglobin and oxyhaemoglobin.
Baseline complete blood count, serum
biochemistry panel and urinalysis should
be performed on admission. If
myoglobinuria is noted, this may indicate a
need for higher fluid rates to avoid renal
tubular damage. Coagulation testing is
recommended, as burnt patients may
suffer from hyper- or hypocoagulable
states. The abdomen should be assessed
for compartment syndrome (increased
intra-abdominal pressure due to underlying
disease processes), gastric distension and
other traumatic injuries.
Carbon monoxide toxicity
Carbon monoxide is the most commonly
inhaled agent producing complications in
smoke inhalation patients. The severity of
the injury secondary to carbon monoxide
toxicity is directly dependent on the
concentration of inhaled carbon monoxide,
the duration of exposure and the
underlying health status of the patient.
Carbon monoxide is rapidly absorbed
across the alveolar membrane, binding to
haemoglobin with an affinity 200 to 250
times greater than that of oxygen. This
binding of carbon monoxide prevents the
binding of oxygen to haemoglobin
molecules, resulting in a functional
anaemia. Additional detrimental effects of
carbon monoxide toxicity include induction
of lipid peroxidation, direct cellular
Figure 2: Partial-thickness burn, involving loss
of the epidermis and part of the dermis, due to
a wet burn
Figure 3: The patient in Figure 2
demonstrated a good recovery from the
injury with no scarring
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damage, reperfusion injury and central
nervous system demyelination. The
administration of supplemental oxygen
improves oxygen saturation and decreases
the half-life of carboxyhaemoglobin
(CO-Hgb). The elimination half-life of
carbon monoxide is 5 hours at 21% oxygen
or 1 hour at 100% oxygen. Oxygen may be
delivered by a variety of routes (e.g. face
mask, nasal cannula, oxygen hood, oxygen
cage or via intubation), depending on the
severity of the respiratory compromise and
patient tolerance of the technique (Figure
1). Nasopharyngeal burns may hinder
oxygen supplementation via nasal cannula.
Monitoring
Severe burns patients may require
continuous ECG, direct blood pressure
measurement, pulse oximetry, frequent
arterial blood gases, electrolytes and
lactate (to assess and monitor perfusion),
biochemical profiles (to monitor liver and
kidney parameters) and complete blood
counts (to assess for infection, anaemia,
low platelets, etc.), as well as coagulation
profiles and a closed urine collection
system with a urinary catheter placed
aseptically (i.e. using sterile gloves and
sterile technique). Urinary catheterization
may be useful to allow urine output to be
measured, as this is commonly used in
patients with severe burn injuries to guide
fluid therapy and resuscitation.
Figure 4: Full-thickness burn due to a dry burn (contact with a
radiator pipe)
Figure 5: Extensive full-thickness burns in a German Shepherd Dog
involved in a house fire
An aseptic peripheral intravenous
catheter should be placed as the first
choice in burns patients. Another option, in
severe cases, would be the placement of a
central venous catheter; however, this is
often associated with a high incidence of
thrombosis and infection in these patients.
Serial central venous pressure (CVP)
measurements can also be performed
when a central venous catheter is placed,
and can be used to guide fluid therapy,
allowing assessment of volume status and
right-sided cardiac function. When CVP
cannot be used, lactate can help guide
therapy, as lactate values increase as
anaerobic metabolism increases, and, as it
is a marker of perfusion, will decrease as
perfusion increases. Once no longer
required, central lines should be removed
as early as possible.
Wound management
As mentioned, one of the priorities in burnt
patients is to minimize contamination of
the damaged skin. It is vital that the
handling of these patients, including for
wound management, is performed
correctly on every occasion. Hands
should be thoroughly washed, using an
appropriate antimicrobial detergent, and
examination gloves worn, particularly
when dealing with superficial burns and
partial-thickness superficial burns
(Figures 2 and 3). If the patient has
sustained deep partial-thickness or
full-thickness burns then sterile gloves
should be worn (Figures 4 and 5).
The underlying cause of the injury will
determine the initial type of wound
management required. Burns arising due
to scalds from hot liquids (wet burns) or
contact with a heat source (dry burns)
generally result in minimal contamination,
and therefore require standard lavage
procedures. Chemical burns (e.g. from
caustic liquids) may require very extensive
lavage, to remove the contaminant.
A standard flush can be set up using a
litre of warmed lactated Ringers solution
(LRS), a fluid administration set and a
stopcock with a 35 or 50 ml syringe and
an 18 G needle attached, or alternatively a
litre of warmed LRS, an administration set
and an 18 G needle and be placed into a
fluid pressure bag and then the bag
inflated. This allows for the optimal
pressure (~8 psi) to be used to irrigate the
wound. With burns wounds, since they are
generally not heavily contaminated with
organic matter, the volume of fluid is
required to reduce bacterial contamination
of the wound surface. Following lavage,
the wound requires debridement. This
procedure may need to wait until the
patient has been stabilized, as it is likely
that sedation or general anaesthesia will
be required. So interim dressings may be
applied (see below).
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How to deal with
a patient with thermal burns
The eschar, the blackened, dead layer
of skin seen following a burn, should be
removed via debridement (Figure 6) and
this can be carried out using a variety of
techniques: surgical debridement or
application of debridement dressings (e.g.
wet-to-dry dressings) are commonly
performed techniques. Following
debridement, open wound management
will generally be performed before the
wound is closed surgically, if this is
possible. Research has indicated that an
earlier and more aggressive surgical
approach to debridement results in
attenuation of the hypermetabolic response
and reduced infection rates. The increased
permeability of the burn eschar causes
excessive fluid, protein, immunoglobulin
and electrolyte loss. In addition, the eschar
promotes bacterial growth. Escharectomy
is the best means of preventing bacterial
infections and sepsis, and exposes a
viable bed of tissue for skin grafting or
permanent wound closure; this is generally
carried out as part of the surgical
debridement process.
The most common topical agents used
in the UK for the treatment of burn wounds
include silver sulfadiazine and honey. Silver
sulfadiazine (SSD), a water-soluble cream
synthesized from silver nitrate and sodium
sulfadiazine, has long been considered the
gold standard in topical burn treatment.
Silver sulfadiazine has a broad
antimicrobial spectrum and fair to good
eschar penetration with minimal adverse
side effects in people. Recently, sustained
silver-releasing products have been
developed that combine a silver agent with
a carrier dressing (e.g. a foam dressing).
Such products can be applied to partial-
thickness burns and can remain in place
for 37 days. This eliminates manipulation
of the burn site and the pain associated
with dressing changes. Care should be
taken not to use silver sulfadiazine in
patients with kidney or liver failure, as it has
been shown to cause a transient
leucopenia in human burns patients, which
resolves with discontinuation. It is
recommended to change to another topical
medication if the white blood count begins
to fall.
Honey has been used for the
treatment of wounds for many years due
to its antimicrobial properties, but limited
information is available regarding its utility
in burn wounds. Antimicrobial properties
arise due to its low pH, high osmolarity
and the production of hydrogen peroxide.
Honey acts by providing a physical
barrier to invading organisms and also
provides a moist environment for wound
healing. The use of honey in open wound
management has demonstrated an
improved healing rate, reduced
contracture, reduction in over-granulation,
improved wound strength and a more
sterile environment when compared with
SSD. Medical grade manuka honey is the
authors topical treatment of choice for
burn wounds.
Figure 6: Full-thickness
burn as a result of
contact with a heat mat.
The blackened eschar is
clearly visible
Nutritional support
considerations
Nutritional support is an important
consideration for the burns patient. Burn
patients experience increased muscle
catabolism and a negative nitrogen
balance, resulting in the loss of lean body
mass and often severe muscle wasting, so
nutritional support should be addressed as
early as possible, ideally within 2448
hours post-injury. Enteral nutrition is
recommended over parenteral nutrition as
it helps maintain gut motility, decreases
plasma endotoxin and inflammatory
mediators, preserves first pass nutrient
delivery to the liver and decreases
intestinal ischemia and reperfusion injury.
Parenteral nutrition is only recommended
as a consideration in patients that do not
tolerate enteral nutrition due to vomiting,
oral ulceration, prolonged ileus or during
the perioperative period. Even in these
situations, enteral nutrition may be
provided via oesophagostomy or
gastrostomy tubes.
Conclusion
Burn patients can be very challenging,
from initial management through to their
longer term nursing care, because of the
complexity of the multifactorial effects on
the major body systems. Despite these
challenges, they are highly rewarding as
they allow us to put all our knowledge into
action. Almost every aspect of the patients
management needs to be considered from
fluid therapy, analgesia, nutrition and
wound management, through to respiratory
and cardiovascular considerations.
Although demanding from initial
presentation to recovery, with good nursing
and appropriate treatment these cases
should have a rewarding outcome.
References are available online and in
e-companion
MORE ONLINE
18-22 How To.indd 22 21/07/2014 11:00
For more information or to book your course
www.bsava.com/cpd
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 access the event. The topics will
be clinically relevant, and particularly aimed at those in
first opinion practice. There are separate webinar
programmes for vets and for nurses
This is a valuable MEMBER BENEFIT
Coming soon
22 October Nursing the hospitalized seizure
patient for nurses
19 November Anal surgery for vets
26 November Otitis for nurses
Book online at www.bsava.com
BSAVA and
Affiliate Group
webinars
16 September
Making sense of
breathing systems
BSAVA with AVA
18 September
Chronic pain: 20 myths
and misconceptions
BSAVA with BVRSMA
FEES (PER WEBINAR)
BSAVA Member: 20.00 inc. VAT
Non BSAVA Member: 30.00 inc. VAT
All prices are inclusive of VAT.
Making the
complicated
straightforward
Surgery for common hind limb
orthopaedic joint conditions
7 October
This one day course will focus on
evidence-based decision making,
current controversies and how to deal
with problems in the most common
hind limb joint conditions
SPEAKER
Richard Meeson
VENUE
Oulton Hall, Leeds
FEES
Interactive
endocrinology
7 October
Using case examples we will discuss
aetiology, clinical signs, and the rationale
behind laboratory testing and diagnostic
imaging. Personal keypads will allow
delegates to vote anonymously in decision
making processes as we work through
clinical cases
SPEAKER
Nick Bexfield
VENUE
Woodrow House, Gloucester
FEES
23 CE Advert August.indd 23 21/07/2014 11:01
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BSAVA 2014
Decision making in
wound closure
W
ound closure and
reconstruction should aim to
return the patient to normal
function as soon as possible.
To achieve this aim, the key questions that
must be addressed are when and how a
particular wound should be closed. To
answer these, the veterinary surgeon must
take into account a number of factors:
The overall condition of the patient
How the wound was caused
The degree of trauma at the site of the
wound.
Failure to take such factors into
account may lead to local wound
complications and dehiscence and, with
severe trauma, the consequences to the
patient could be catastrophic.
Timing of wound closure
The four options for closing a wound
(Figure 1) are:

John Williams, editor of
the BSAVA Manual of
Canine and Feline
Wound Management
and Reconstruction,
takes companion
readers through the
considerations for
wound closure
Closure opton Wound classifcaton Wound management
Primary closure Clean wound Immediate closure without tension. May
require an appropriate fap or grafing
technique
Delayed primary
closure
Clean-contaminated or
contaminated wounds, or where
there is questonable tssue viability
or oedema, or skin tension is likely if
primary closure is atempted
Lavage and debridement of open wound.
Appropriate dressing used. Closure
performed 23 days afer wounding. May
technique
Secondary
closure
Contaminated or dirty wounds Lavage and debridement of open
wound. Appropriate dressing used. Closure
performed 57 days afer wounding. May
technique
Second
intenton
healing
Wound unsuitable for surgical
closure technique: extensive
contaminaton and devitalizaton.
Do not consider over a joint surface
as it may lead to joint contracture
Lavage and debridement of open wound.
Appropriate dressing used. Allowed to
heal by granulaton, contracton and
epithelializaton
Figure 1: Closure options for traumatic wounds
Figure 2: Thin hairless skin of a chronically
managed wound on a cats leg
Primary closure
Delayed primary closure (closed after
4872 hours, before granulation tissue
develops)
Secondary closure (closed after
granulation tissue develops, 57 days)
Second intention healing (contraction
and epithelialization).
The degree of contamination and of
tissue viability play a major role in the
decision-making process. To be able to
close a traumatic wound primarily it must
be possible to convert it from a
contaminated to a clean-contaminated
wound, and there can be no evidence of
tissue necrosis or foreign debris.
It is also important not to manage an
open wound for an excessive period of
time. The role of open wound management
is to create an environment that will allow
wound closure and return to normal
function. There is no merit in dressing a
wound for months on end with no clear
plan as to how to reconstruct the wound.
Such action frequently leads to contracture
or formation of exuberant granulation
tissue with tissue that is covered by thin
friable epithelium (Figure 2) and may
prove to be more expensive than early
surgical reconstruction.
Early wound construction and closure
should be considered:
If vital tissues are exposed
Where reconstruction of the tissue is
required for structural support
(e.g. footpads)
Where wounds are located over the
flexor surface of a joint and prolonged
open wound management may lead to
contracture
For open wounds over tendons, as scar
tissue may form which will prevent the
normal gliding action of tendons
2425 Publications.indd 24 21/07/2014 13:12
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Figure 3: Simple interrupted sutures placed
35 mm from wound edges and spaced at
intervals of about 5 mm
For orofacial wounds, where the
vascular supply is particularly rich and
early return to function is often a
requirement (e.g. eyelids).
Basic closure techniques
Once the decision has been made to close
a wound, the surgeon needs to decide on
the optimal and simplest method of closing
that wound. As with all surgery, wound
reconstruction relies heavily on the basic
tenets that were put forward by Halsted:
Gentle tissue handling
Accurate haemostasis
Preservation of local blood supply
Aseptic technique
Close tissues without tension
Careful approximation of tissues
Ensure no dead space.
Primary closure
The cardinal rule of wound reconstruction
is to avoid excessive wound tension.
Wounds with an adequate amount of
elastic surrounding skin can be closed
using direct skin mobilization. Appositional
suturing techniques should be used to
minimize tension on the wound (Figure 3).
Delayed primary closure
Wound contraction is seen in healing
open wounds in 59 days and results in a
centripetal reduction in the size of the
wound. The process of wound
contraction stops when the wound
margins contact each other or when
tension from the skin adjacent to the
wound is equal to, or greater than, the
contractile forces generated by
myofibroblasts within the granulation
tissue. By definition, delayed primary
closure is performed prior to the
appearance of granulation tissue within
the wound.
It is essential that when delayed
primary closure, secondary closure or
second intention healing is chosen, the
wound undergoes adequate debridement
and open wound management, since
wound contraction is facilitated by:
A moist wound bed
Adequate debridement
Control of wound infection.
Inadequate debridement is the most
common reason for delayed healing and
persistent wound infection. Wound
contraction is delayed by:
SURGICAL MINI-SERIES
BSAVA Manual of Canine and Feline
Wound Management and Reconstructon
Decision-making in wound closure is just one of the topics discussed in the
BSAVA Manual of Canine and Feline Wound Management and Reconstructon.
The Manual places emphasis on practcal decision-making, underpinned by an
understanding of the biological wound healing process.
Practcal decision-making
Advanced faps, grafs and microsurgery
Step-by Step Operatve Techniques
Case examples
Member price: 49.00
Non-member price: 75.00
e-Book also available
OTHER TITLES IN THE SURGICAL MINI-SERIES
Fracture Repair and
Management
Member price: 35.00
Head, Neck and
Thoracic Surgery
Member price: 45.00
Dentstry
Member price: 45.00
Wound infection
Desiccation
Exposed bone
Exuberant granulation tissue.
The normal process of wound
contraction can be facilitated by:
Pre-suturing lesions prior to excision
Placement of tension sutures
Using skin-stretching devices across
open wounds.
Secondary closure
This is done following open wound
treatment that extends beyond 5 days,
allowing complete debridement and
management of an infected wound before
closure. By definition, secondary closure is
performed after the appearance of
granulation tissue in the wound.
Second intention healing
This is defined as wound healing by
granulation, contraction and re-
epithelization. Second intention healing is
generally reserved for wounds located in
areas with abundant skin or for smaller
wounds located on the extremities.
All gures accompanying this artcle have been reproduced from
the BSAVA Manual of Canine and Feline Wound Management
and Reconstructon, 2nd editon.
Figure 3 was drawn by S.J Elmhurst BA Hons
(www.livingart.org.uk) and is printed with her permission.
SPECIAL OFFER
2425 Publications.indd 25 21/07/2014 13:12
Sue Paterson talks ear disease
PetSavers is
all ears
26
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BSAVA 2014
Celebratng 40 YEARS of improving the health of pets
A
ntibiotic resistance has become a very
real problem for veterinary surgeons in
both primary care practice and referral
practice. The treatment of ear disease has
become especially challenging with the emergence
of increasing numbers of multiply resistant
pathogens such as meticillin resistant
Staphylococcus pseudintermedius (MRSP),
Pseudomonas spp. and Enterococcus faecalis.
Whilst the management of otitis involves much more
than purely treating infection, without the ability to
treat infection appropriately other therapeutic
measures become irrelevant.
It is not long ago that veterinary surgeons seized
upon any new paper on the use of third line
antibiotics such as ticarcillin, amikacin or ceftazidime
to treat multiply resistant otic isolates. More recently
with the new guidelines on antibiotic usage urging
caution and justification when using such drugs, they
are used less frequently. However, without viable
alternatives to such topical therapy vets are
frequently faced with the difficult dilemma of having
to use an off licence third line antibiotic or
compromise the wellbeing of the animal.
There is no doubt that increasing numbers of
animals undergo radical ear surgery because their
infections cannot be managed medically. Antiseptics
offer an alternative to antibiotics but there is scant
evidence of their efficacy in a clinical situation. There
have been many excellent papers looking at the in vitro
activity of different antibacterial agents (Farca 1991,
Lloyd 2000, Cole 2003, Reme 2006, Cole 2007,
Swinney 2008, Guardabassi 2010, Steen 2012, Mason
2013) but no in vivo work.
It is well recognized that both antibiotics and
antiseptics work differently in vitro compared with
in vivo. Organic debris, pus and wax can affect a
products antibacterial action. Chlorhexidine is
described as being one of the few antibacterial
products that is active in the presence of blood or
organic material but this information is mostly based
on in vitro human studies.
To the authors knowledge there have been no
in vivo studies undertaken in the dog. The aim of
our application to PetSavers for funding was
therefore to allow us to look at the activity of a range
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of different antibacterial agents in vivo using cases
in our clinic.
Our aim was to assess the ability of different ear
cleaners to treat both routinely identified bacterial
and yeast infections and also the more resistant
pathogens often seen in chronic otitis cases in the
presence of purulent exudate, mucus and wax. In
addition to assessing the ability of topical
antiseptics to kill pathogens, our study has also
looked at the changing pH within the ear after the
addition of an ear cleaner.
There is a wealth of information in the literature
about the way that pH affects antibiotic activity.
Aminoglycoside and fluoroquinolone antibiotics work
best in a neutral or slightly alkaline environment.
However, despite advice about appropriate periods
of time taken between application of an acidic based
product to an ear and subsequent topical antibiotic
administration, there are no studies that actually
measure the changes in pH within the ear after
application of a cleaner.
What has been interesting and exciting about our
study is that it has given us essential information
about the potential use of antibacterial agents, in the
form of antiseptics, as therapy in cases of otitis
externa in the dog. Many of the results have revealed
marked differences between previously reported in
vitro data and our in vivo data. The study reinforces
the fact that although in vitro work is undoubtedly
useful, in vivo studies in clinical cases provide
information that can be used by veterinary surgeons
in practice to help in their management of cases
without in some instances having to resort to
antibiotic therapy.
PetSavers funding has provided a grant to finance
work that has been driven by a need to find alternative
therapies for difficult clinical cases. The results have
motivated us to go on to look at other topical products
to provide clinicians with more choice in therapy.
P
etSavers is set to host its first ever
sponsored dog walk through the beautiful grounds of Cirencester
Park, Bathurst estate, by kind permission of the 9th Earl of
Bathurst and the Countess Bathurst.
In recent years PetSavers fundraisers have taken part in the Virgin
London Marathon and the Bath Half Marathon now, as we celebrate
our 40th anniversary, we have decided to take charge and host our
very own event.
Thanks to kind donations over the years PetSavers has been able to
fund a huge number of important studies however, your help is still
needed so that we can continue to support clinical research and training
programmes that are vital if we are to understand more about the
illnesses and diseases suffered by companion animals. So Walk your
dog for PetSavers 2014 provides the opportunity to raise both the
necessary funds and increase awareness of PetSavers.
Chair of the PetSavers Management Committee, Pedro Martn
Bartolom, says the support PetSavers gets from its volunteers and
fundraisers is truly extraordinary. PetSavers is diversifying its
fundraising activities across the UK to reach as many people from this
loyal and involved group as possible. I am sure that the charity dog
walk will be another success for PetSavers and a very rewarding event
for all those taking part.
The Bathurst Estate and Cirencester Park, designed in the 18th
century Lord Allen Bathurst and his friend, the poet Alexander Pope, will
provide what we hope to be the perfect Autumnal setting for what will no
doubt be a great day. The PetSavers team has mapped out two of the
most scenic routes the estate has to offer, one 3 miles long and the other
slightly more challenging at 6 miles long, with highlights including
The Popes Seat and Badger Roundabout.
We would love you to join us on this special day. For more information
and to register for the walk visit www.petsavers.org.uk.
Walk your
dog for
PetSavers
2014
References are available online and in e-companion.
MORE ONLINE
26-27 PetSavers Ear Disease.indd 27 21/07/2014 13:16
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BSAVA 2014
T
he WSAVAs One Health Committee has
launched its second three-year programme of
work, which aims to highlight the role of small
companion animals in One Health. Plans for
the project were discussed during a two-day meeting
at Duke Medical Center in Durham, North Carolina
from 910 June 2014.
During the meeting, One Health Committee
Chairman Professor Michael Day, from the University
of Bristol, UK, gave a public lecture entitled Cats,
Dogs and Humans: One Medicine, One Health to take
the WSAVAs One Health message directly to the
human medical community at Duke. Delegates then
planned a three-year programme of work, visited the
WSAVA One Health Committee launches
Phase II Project
BSAVA Senior Vice-President
Professor Michael Day reports
on the latest developments
with the One Health initiative
comparative oncology research laboratories and met
with representatives of the North Carolina One Health
Collaborative and the US One Health Commission.
One of three focus areas for the One Health
Committee is comparative and translational clinical
research, explains Professor Day. Holding this
meeting at one of the major global human health
centres was an important step forward in engaging
with the human medical community which remains
one of the greatest One Health challenges. We need to
take every opportunity to promote the benefits to
human medicine of investigating shared spontaneously
arising diseases in dogs.
Later this year, the One Health Committee will host
a full-day programme on rabies control in Africa at the
WSAVA World Congress. The fourth annual WSAVA
Global One Health Award will also be presented at
World Congress.
The work of the One Health Committee is made
possible through the generous sponsorship of a
consortium of seven industry sponsors, co-ordinated
through the WSAVA Foundation, the WSAVAs
charitable Trust. n
28-29 WSAVA August 2014.indd 28 21/07/2014 13:22
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START PLANNING FOR WSAVA 2015
WSAVA invites you to join them at the 40th World Small
Animal Veterinary Associaton Congress (WSAVA 2015),
being held in excitng Bangkok, Thailand 1518 May
2015. WSAVA 2015 promises to harness the expertse
of the worlds foremost veterinarians for a stmulatng
exchange of knowledge and experiences. For full details
visit www.wsava2015.com.
Update
from the
WSAVA President
O
ne of the most rewarding aspects of being involved
with the WSAVA is knowing that, by working
together, we are daily making a real and significant
difference to the health and welfare of companion
animals around the world.
I particularly applaud the work of the WSAVAs Global Pain
Council on the publication of its ground-breaking Global Pain
Treatise, which has now been published in the Journal of Small
Animal Practice (JSAP). No animal should have to suffer pain and
this publication marks a step forward towards our goal of creating
a pain-free environment globally for companion animals.
The Global Pain Treatise is the culmination of a huge amount
of work from Karol Mathews and her team, and I congratulate
them all. An aspect of it of which we are especially proud is that it
provides alternatives in circumstances when recommended
drugs are unavailable. It is a sad reflection on the state of global
veterinary medicine that, because of restrictive local laws, not all
veterinarians have access to opiates or to ketamine or to many
other pain-saving drugs. With this in mind, the global digital
edition of our journal, Clinicians Brief, will now attempt to list
alternative drugs. It will not be easy as we are not aware of the
availability of a global database. One of our major tasks for the
next two years is to work with the leadership of the World
Veterinary Association to develop a list of all recommended
drugs, for all conditions. We hope our member associations can
use this to lobby their governments or industry for access.
Meanwhile, our thoughts are turning to World Congress
a huge amount of planning and careful preparation has taken
place to ensure that it will be an inspirational showcase for cutting
edge thinking on all aspects of veterinary care for companion
animals. We look forward to seeing many of you there. n
Professor Colin Burrows
highlights one of the WSAVAs
flagship initiatives to raise global
standards of veterinary care
Dont forget your
running
shoes!
Packing for World Congress?
Bring your running shoes so you
can join us for the WSAVA
Foundations second fun run
T
his unique event takes place on Thursday 18
September and will raise vital funds for the
African Small Companion Animal Network
(AFSCAN), an initiative launched by the
WSAVA Foundation to advance standards of veterinary
care across Africa. More than 300 runners are
expected to take part in the 5 km run which will follow
a scenic route along the Cape Town sea front. You
dont have to run though, as a 3 km walk will take place
at the same time.
Participants are asked to make a donation to the
WSAVA Foundation and will receive a commemorative
T-shirt, a water bottle and a tasty breakfast package
to enjoy at the finish line. The fastest 15 men and
15 women finishers will receive a special medal.
WSAVA thanks Hills Pet Nutrition and Zoetis for
supporting this event.
Sign up today and help AFSCAN transform
veterinary care across Africa you can register by
emailing reg_wsava2014@kenes.com.
For full details of the scientific programme at
WSAVA World Congress and to register, visit
www.wsava2014.com. n
28-29 WSAVA August 2014.indd 29 21/07/2014 13:22
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BSAVA 2014
Steve
Broomfeld
the companion interview
Steve Broomfield is manager of the Blue Cross
hospital In Victoria, central London and knows
what it is like to sit in the hot seat after taking his
place in the infamous black chair in which
contestants are grilled by John Humphreys,
presenter of BBC televisions popular quiz show,
Mastermind. Steve was born in London but
grew up in Cambridge, attending the local
grammar school and the technical college that
is now part of Anglia Ruskin University. He is
married with two daughters, one is a
physiotherapist and the other is reading for a
Masters in human osteo-archaeology at
Edinburgh University.
Q
How did you get into the animal
welfare area, and what were you
doing before your current job?
A
After school I worked for a local
newspaper but Ive been with the
Blue Cross since 1980. I ran
rehoming centres from 1980 to 2001, then
became a regional manager based at the
head office in Burford, Oxfordshire, and
came to the hospital in Victoria in 2006.
What are your responsibilities there?
As hospital manager I am responsible for
all aspects of the administration and
management of the facilities. We have
around 80 staff vets, nurses,
receptionists, etc and undertake about
30,000 consultations a year. We also
undertake around 10,000 investigative
procedures and another 7,000-8,000
surgical procedures, all for people who
cannot afford private veterinary fees. We
deal with a lot of unemployed people,
obviously, but also street-dwellers and a
large number of owners with mental and
physical health issues. We do everything
from first opinion and prophylactic
treatment through to orthopaedic surgery.
We also do a lot of education work and
have various community outreach
services such as an ambulance collection
service, mobile clinic and community
veterinary nurses. We also have two other
London hospitals at Hammersmith and at
Merton, and another in Grimsby, plus
several smaller welfare clinics round the
country. We are a 24-hour service and
cover most of south and east London,
working in conjunction with other charities
at all levels. Any animals that are
abandoned by their owners are
transferred to our rehoming centres.
What do you enjoy most about your job?
Oddly, pretty well all of it. They are great
people to work with, theres an excellent
atmosphere and I feel I am doing a
worthwhile job. Strangely, I even enjoy my
commute to work from near Southampton,
by bike and train to Victoria, via Waterloo.
That gives me exercise on the bike and an
hour on the train to read the paper or an
improving book (such as the novels of
Patrick Hamilton!).
And the flipside of that what is your
biggest bugbear?
Other cyclists in London. Cycling with your
phone clamped to your ear isnt clever, and
red lights apply to you, too.
How are charity clinics coping with the
effects of the current economic climate?
Im lucky in that we are a national charity
with a national fundraising set-up. Our
workload has definitely increased but our
supporters are loyal and generous.
How do you see the relationship
between the charity clinics and private
vet practices and can this be improved
for their mutual benefit?
By and large we get on well. We obviously
30-31 Interview Aug.indd 30 21/07/2014 13:24
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take referrals from them if owners fall on
hard times, and there are some areas
where we can offer expertise. Likewise,
there are areas where we call on private
practice for assistance. Overall, and after
more than 30 years in the charity sector,
Id say it works pretty well. There is also an
interchange of staff, so best practice can
flow both ways.
You were on Mastermind this year have
you a longstanding interest in quizzes?
I used to be in a pub quiz team about 25
years ago, but I just like quizzes and have
ever since I can remember. I was on
Fifteen to One back in the 1990s (eight
times, somehow I just kept on winning!)
and also on Brain of Britain on Radio 4.
What made you decide to enter
Mastermind this year and had you
applied in the past?
To be honest, Ive spent years and years
shouting the answers at hapless
contestants so I thought it was time to put
my money where my mouth is, so to
speak. I also worked out that the key to
success is a narrow subject where the
questions have to be fairly limited in
scope, if that makes sense.
Could you say a little about what
happened in the selection process?
I applied online, submitting no fewer
than four specialist subjects. This was
followed by an interview at the BBC
building in Portland Place, in which I was
given 20 general knowledge questions.
I wasnt told the answers, but must have
done well enough. That was followed by
some horse-trading to get three subjects
(first round, semi-final and final) which I
and the producers both liked. Obviously
they need to avoid too many similar
subjects, and they also need sensible
subjects that they can find decent
questions about.
You reached the semi-final where you
answered question on the novels of
Patrick Hamilton. What happened up to
that point?
In my first round my subject was the Battle
of Balaklava (the Charge of the Light
Brigade, etc). I scored 30 points with one
pass, and unfortunately another chap who
did Father Ted got 30 and no passes.
However, I was a high-scoring runner-up
(the highest, I think) so I think I did pretty
well. From memory only about three people
in the whole series managed scores of 30
or above.
So who was Patrick Hamilton?
He was an English novelist/playwright of
the 1920s50s who wrote a total of 13
novels. I like his work very much and,
unlike say Charles Dickens, his output was
manageable to read. From the first round to
the recording of the semi-final I had three
months, so I read all his novels in
chronological order, which is an odd
experience. Hamilton died young he was
allegedly managing three bottles of whisky
a day, and his last novel Unknown
Assailant was written in 1955 and shows
the effects on his creativity. He died in the
early 60s and is now sadly neglected. He
has been described as a modern Dickens.
If anyone wants to try, Id recommend
either Hangover Square or The Slaves of
Solitude as a starter.
Viewers might have noticed that at one
point that you looked to one side when
told that you had given a wrong answer.
What was the story about this?
It was extremely annoying. The question
was about his first novel, Monday Morning.
The central character, Anthony Forster,
writes a poem which he then throws off the
west pier at Brighton when he splits up with
his girlfriend. The question was simple
what was the poem called? I said
Relinquishment, but the answer given
was De Dichio, which made me pull a
face. The director told me afterwards that
they had checked when they saw my
reaction, but were right. Unfortunately the
book is out of print (I had to get it via
inter-library loan and it is rare enough that
I wasnt allowed to take it from the library),
so I cant check. According to Amazon, the
book is due for reprint in May 2015
I know what will be the first thing I will do
when I get a copy!
What does it feel like to sit in the chair?
What thoughts went through your mind,
and on balance did you enjoy the
experience?
Sitting in the chair with only John
Humphreys visible in the bright lights will
have one of two effects fight or flight.
Watching some contestants it is obvious
flight is a possibility, but for me I found it
concentrated the mind. I loved it, and may
well try again in a year or two it is allowed,
you know, and I even had a phone call from
the BBC asking me to apply again.
John Humphreys has a reputation for
being a rather grumpy individual how
did you get on with him and the rest of
the production team?
Avuncular, I think would be the word. He
is on a tight schedule in the first round
he films seven programmes, four in an
afternoon and three in the evening. As
a result its all a bit fast-moving, so there
is no time to stop and chat, and no
group photos.
Are there any particular memories or
anecdotes about the experience that you
want to share?
Its filmed in Salford, and my wife and
I were put up for the night in an adjacent
Holiday Inn. Unfortunately, on both
occasions I was on the 12th Floor as a
claustrophobic, using the lift wasnt an
option have you ever seen the
stairwells in those places? Also I have
since had several comments from fellow
commuters on the train and one or two
of the guards! Its nice to be even
slightly famous.

B
B
C

K
a
r
e
n

W
r
i
g
h
t
sitting in the chair will
have one of two effects
fight or flight
30-31 Interview Aug.indd 31 21/07/2014 13:24
BSAVA MANUAL OF CANINE AND FELINE
Wound Management
and Reconstruction
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Thoracic Surgery
Soft tissue surgery of the
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If you dont have the
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www.bsava.com/publications
BSAVA reserves the right to alter prices where necessary without prior notice.
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COMMUNICATING VETERINARY KNOWLEDGE
Dentistry
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An extremely useful reference
for the recognition and
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examined by veterinary
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Surgery
sewn up
Repair those gaps in your library
with our essential surgery manuals
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Guides the surgeon through
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32 Publications Advert August 2014.indd 32 21/07/2014 13:25
Local
News from BSAVA Regions
knowledge
BSAVA 2014
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33
Important change
to West Midlands
September
meeting
We have changed the venue for
Complaints, Catastrophes and the
College with Stuart Ellis of the VDS from
the Wolverhampton Medical Centre to the
Three Pears at Worcester. We made this
change to the venue because BSAVA
members told us that The Three Pears is
much preferred and it is right at
junction 6 of the M5.
Wed also like you to remember that
evening CPD in the West Midlands is free
to BSAVA vet and VN members, and
costs only 20 for non-members. Book
via the BSAVA website and why not
bring along your work colleagues?
We are really looking forward to the
full day CPD event in the Autumn.
Veterinary examination, handling and
husbandry of reptiles, small mammals
and cage birds will be a hands-on
course with the animals at Solihull
College, with excellent and enthusiastic
speakers Sarah Pellett and Nathalie
Wissink-Argilaga. This is on Saturday
4 October. The cost is 120 for members
and 199 for others and it will be suitable
for vets and nurses.
Finally a call for new committee
members. We do currently have a full
and active committee that works well
in the West Midlands, but some
current members may be off to new
ventures next year and we are open to
new volunteers to join us now to
prepare for a more active role in 2015.
Email c.haile@bsava.com if you are
interested in volunteering.
Find out more about regional CPD near
you at www.bsava.com.
Packed house for wounds meeting
Common orthopaedic problems
An afternoon meeting with Andy Moores, RCVS recognized Specialist in Small Animal
Surgery (Orthopaedics) and European Specialist in Small Animal Surgery, proved
highly enlightening to those who came to explore common orthopaedic problems of
the shoulder, elbow and stifle.
Andys clinical interests encompass all aspects of musculoskeletal disease and
traumatology, and during the meeting Andy talked us through the mysteries of
orthopaedic problems of the shoulder joint, elbow dysplasia and other elbow
conditions, IOHC, humeral condylar fractures and cruciate disease. We enjoyed a
very informative and entertaining lecture, which was not only practical, but also highly
interactive. The meeting was kindly sponsored by Zoetis Limited.
Reptiles: work smart and stay safe
Southern meeting for nurses
We are delighted to welcome Matthew
Rendle, Senior Clinical Nurse at London
Zoo, Zoological Society of London.
Matthew started his veterinary nursing
career at The Park Veterinary Centre in
Watford in 1989. He has experience in the
nursing care of many species, from ants to
elephants (and most things inbetween). In
2012 he was promoted to Senior Clinical
Veterinary Nurse for London Zoo. Matthew
regularly lectures to veterinary nursing and
veterinary surgeon undergraduates at the
RVC as part of their core modules.
Matthew also lectures on herpetology
extensively in Europe and America. He is a
keen herpetologist, and this takes up most
of his spare time.
This evening meeting will be held on
9 September at the new Bursledon
Community Centre in Southampton.
Registration will start at 7.30pm, the talk
will be from 8pm to 10pm. BSAVA
members can attend for free, prices for
non BSAVA members are 15 for veterinary
nurses and 25 for veterinary surgeons.
Refreshments will be served.
North East delegates were enthralled by the
wound management evening at Chantry
Vets in Wakefield on 3 June, supported by
Zoetis Limited, including BSAVA President
Katie McConnell who was visiting the
region. The packed house were there to
benefit from the expertise of Louise
ODwyer, Clinical Director at Petmedics in
Manchester. Louise had attendees on the
edge of their seats with her pictures of
gunshot and stab wounds, de-gloving
injuries and third-degree burns. She went
through the protocol from the moment the
owner phones the practice, through
emergency treatment and long-term
management, especially how to use
different kinds of dressings at different
stages of healing, with lots of case histories.
The evening was aimed at nurses, but
there were lots of vets too, and all want
Louise to come back for another talk. Her
plea for the night please vets, teach your
nurses to use thoracic auscultation.
Louise offered lots of fascinating hints
and tips and anecdotes and all the
delegates said they will be changing their
wound management protocol in some way
as a result of her talk. The committee want
to thank to Chantry Vets for the use their
meeting room, and Bronson Sheppard from
Zoetis for organizing sponsorship and
coming along.
33 Regions.indd 33 21/07/2014 13:28
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BSAVA 2014
CPD diary
DAY MEETING
EAST ANGLIA REGION
Sunday 21 September
Interactive decision-making when
treating eyes
Speakers: Christine Heinrich and
David Gould
The Animal Health Trust, Newmarket
Details from eastanglia.region@bsava.com
AFFILIATE WEBINAR
BSAVA & AVA
Tuesday 16 September
20:0021:00
Making sense of breathing
systems
Speaker: Susannah Taylor
Online
Details from courses@bsava.com
AFFILIATE WEBINAR
BSAVA & BVRSMA
Thursday 18 September
20:0021:00
Chronic pain: 20 myths and
misconceptions
Speaker: Gwen Covey Crump
Online
AFFILIATE WEBINAR
BSAVA & BVBA
Tuesday 5 August
19:0020:00
Rabbit behaviour: welfare and
handling in a clinical environment
Speaker: Anne McBride
Online
LUNCHTIME WEBINAR
Wednesday 24 September
13:0014:00
Behaviour and fireworks
Speaker: Daniel Mills
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 20 August
13:0014:00
Analgesia and pain assessment
Speaker: Jackie Brearley
Online
LUNCHTIME WEBINAR
Wednesday 13 August
13:0014:00
Hypercalcemia in the cat
Speaker: Natalie Finch
Online
August
September
DAY MEETING
IN CONJUNCTION WITH BVOA
Tuesday 2 September
Scared of orthopaedics? Building
confidence and skills in practice
Speaker: Peter Attenburrow
Oulton Hall, Leeds
DAY MEETING
IN CONJUNCTION WITH VCS
Getting the most from cardiac
diagnostics
Speaker: Mike Martin
DAY MEETING
SOUTH WEST REGION
Defusing the veterinary stress
time bomb
Speaker: Jenny Guyat
Exeter Court Hotel, Exeter
Details from southwest.region@bsava.com
WEEKEND MEETING
SOUTH EAST REGION
JOINT MEETING WITH BVDA
Saturday 20 and
Sunday 21 September
Practical dentistry:
extractions and radiography
Speakers: John Robinson, Matthew Oxford
Details from southeast.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Defusing the veterinary stress
time bomb
Speaker: Jenny Guyat
Hilton Bristol, Bradley Stoke
Details from southwest.region@bsava.com
DAY MEETING
Handy tips on nursing small exotic
mammals
Speaker: Wendy Bament
Venue: Twycross Zoo
EVENING MEETING
NORTHERN IRELAND REGION
Inside the ear
Speaker: Sue Paterson
Venue: TBC Londonderry
Details from nireland.region@bsava.com
EVENING MEETING
CYMRU/WALES REGION
Pain management:
an update
Speaker: Matt Gurney
Welshpool Livestock Market
Details from cymru.wales.region@bsava.com
DAY MEETING
METROPOLITAN REGION
Friday 5 September
Emergency surgery
Speakers: Dan Brockman and
Lindsay Kellett-Gregory
Venue: Holiday Inn, Elstree, London
Details from metropolitan.region@bsava.com
EVENING MEETING
SOUTHERN REGION
Tuesday 9 September
Reptiles: work smart and
stay safe
Speaker: Matthew Rendle
The NEW Community Centre Bursledon,
Southampton
Details from southern.region@bsava.com
EVENING MEETING
WEST MIDLANDS REGION
Complaints, catastrophes and
the college
Speaker: Stuart Ellis
The Three Pears, Worcester
Details from westmidlands.region@bsava.com
LUNCHTIME WEBINAR
13:0014:00
Different diagnosis of
haematuria
Speaker: Rob Foale
Online
34-35 CPD Diary.indd 34 21/07/2014 13:58
BSAVA 2014
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DAY MEETING
Tuesday 7 October
Interactive endocrinology
Speaker: Nick Bexfield
EXCLUSIVE FOR MEMBERS
Extra 5 discount on all
BSAVA publicatons for members
atending any BSAVA CPD event.
All dates were correct at tme of going to print; however, we
suggest that you contact the organizers for confrmaton.
LUNCHTIME WEBINAR
Wednesday 15 October
13:0014:00
PUO
Speaker: Nat Whitley
Online
LUNCHTIME WEBINAR
13:0014:00
Nursing the hospitalized
seizure patient
Speaker: Laurent Garosi
Online
October
OTHER UPCOMING BSAVA CPD COURSES
See www.bsava.com for further details
South West Region
Fracture planning in practce:
interactve case discussions
Northern Ireland Region
Thursday 23 October
Rabbits
North East Region
Sunday 26 October
Neurolocalizaton: how to stop worrying
and love the neuro exam!
Scotsh Region
Sunday 26 October
Orthopaedics
DAY MEETING
NORTH EAST REGION
Sunday 28 September
Its all about sex!
Speaker: Gary England
Blackwell Grange Hotel, Darlington
Details from northeast.region@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
The PUB Clinical Club: oncology
Speaker: Shirley Van Lelyveld
The Royal Oak, Ockbrook
Details from eastmidlands.region@bsava.com
DAY MEETING
IN CONJUNCTION WITH BrAVO
Wednesday 1 October
Advanced ophthalmology: just
above basics and problem cases
Speaker: Jim Carter
Venue: Chilworth Manor, Southampton
EVENING MEETING
CYMRU/WALES REGION
Wednesday 1 October
What happens after they come
through the doors of the
Animal Health Trust?
Speaker: Mayank Seth
Venue: Glyndwr University, Wrexham
DAY MEETING
WEST MIDLANDS REGION
Saturday 4 October
Veterinary examination, handling
and husbandry of reptiles,
small mammals and cage birds:
a hands-on day with the animals
Speakers: Sarah Pellett and
Nathalie Wissink-Argilaga
Animal Care Department, Solihull College
Details from westmidlands.region@bsava.com
DAY MEETING
Wednesday 8 October
Controversies in canine
cardiology: data or dogma?
Dispelling myths in canine
cardiology
Speaker: Virginia Luis Fuentes
DAY MEETING
EAST ANGLIA REGION
Sunday 19 October
The art and science of internal
medicine: developing a
logical approach
Speakers: Ian Battersby and Rob Foale
The Cambridge Belfry, Cambridge
Details from eastanglia.region@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Tuesday 21 October
The PUB Clinical Club: Dos and
donts of cytology
Speaker: Emma Scurrell
The Royal Oak, Ockbrook
Details from eastmidlands.region@bsava.com
AFTERNOON MEETING
SOUTHERN REGION
The colourful consultation
Speaker: Brian Faulkner
Holiday Inn, Basingstoke
Details from southern.region@bsava.com
DAY MEETING
Thursday 9 October
Controversies in feline cardiology:
navigating the nightmare of feline
heart disease
Speaker: Virginia Luis Fuentes
EVENING MEETING
SOUTH EAST REGION
Practical blood transfusions with
an update on Alabama Rot
Speaker: David Walker
Leatherhead Golf Club, Surrey
Details from southeast.region@bsava.com
DAY MEETING
Thursday 9 October
BSAVA Dispensing Course
Speakers: Fred Nind, Phil Sketchley,
Sally Everitt, Mike Jessop, Pam Mosedale,
John Millward, Mike Stanford
Aldwark Frimley Hall, Surrey
DAY MEETING
METROPOLITAN REGION
Sunday 5 October
Chronic feline gastrointestinal,
pancreatic and hepatic disorders
Speaker: Martha Cannon
De Vere Denham Grove Hotel,
Buckinghamshire
Details from metropolitan.region@bsava.com
DAY MEETING
Tuesday 7 October
Making the complicated
straightforward: surgery for
common hind limb orthopaedic
joint conditions
Speaker: Richard Meeson
Venue: Oulton Hall, Leeds
EVENING MEETING
CYMRU/WALES REGION
Tuesday 7 October
Part 1 of a 2 part series
Wound reconstruction from
the simple to the complex:
a practical guide
Speaker: Stephen J Baines
Venue: Brynamlwg Clubhouse, Aberystwyth
34-35 CPD Diary.indd 35 21/07/2014 13:58
Full your potential
BSAVA Dispensing
Course
Avoid dispensing disasters
Understand the legislation
Cope with the prescribing cascade
Dispose of medicine waste safely
Be aware of adverse reactions and be pharmacovigilant
Use antibiotics responsibly
Impress the Inspectors
For Veterinary Surgeons and Veterinary Nurses
Next event:
9 October 2014
Frimley Hall Lime, Camberley, Surrey
This course meets the RCVS Practice Standards Veterinary hospital pharmacy course requirements,
is AMTRA accredited and carries 41 AMTRA CPD points
From webinars at home and evening meetings in your region,
to postgraduate certicates in medicine, surgery, emergency care and
ophthalmology BSAVA CPD can offer you accessible education that
gives you new skills, and more condence. We are run by the profession
for the profession we understand your needs.
Visit us online at www.bsava.com/cpd to nd out more about courses
that will help you full your potential.
36 OBC.indd 1 21/07/2014 13:35

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