The essential publication for BSAVA members

Clinical Conundrum
Consider the case of an
anorexic bearded dragon
P8
How To
Provide effective oxygen
supplementation
P12
companion
SEPTEMBER 2009
Kitten Training
The benefits of kitten
classes to the practice
P20
Where does
the profession
stand on waste
regulations?
companion
2 | companion
3 Association News
Introducing the Petsavers
Management Committee
47 What A Waste
The rules on the disposal of
healthcare waste. John
Bonner reports
811 Clinical Conundrum
Consider the case of an
anorexic bearded dragon
1215 How To
Provide effective oxygen
supplementation
1618 GrapeVINe
From the Veterinary
Information Network
19 Petsavers
Latest fundraising news
2021 Kitten Classes
Kersti Seksel outlines the
benefits of kitten clubs
2224 WSAVA News
The World Small Animal
Veterinary Association
2526 The companion Interview
Elizabeth Simpson
27 CPD Diary
Whats on in your area
companion is produced by BSAVA exclusively for its members.
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BEST
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T
he NEW edition of the BSAVA
Manual of Canine and Feline
Behavioural Medicine will be published
soon and will be an essential update for
members practice library shelves. Building
on the success of the first edition, published
in 2002, the Editors have again brought
together a host of international experts on
behavioural medicine of dogs and cats. This
new edition is designed to be even more
practical and user-friendly, with the
following considerations discussed for a
range of behavioural presentations:
Evaluation of the patient, including any
possible underlying disease
Evaluation of client attitudes, beliefs and
behaviour
Risk evaluation
Behavioural biology of the condition
Acute management protocols
Long-term treatment strategies
Prognosis
Follow-up
Preventive measures.
ISSN 2041-2487
The Manual will include history-taking
forms and questionnaires, together with a
CD containing a series of useful client
handouts that can be printed out, and to
which you will be able to add your
practice details.
Members will soon be able to order
the new edition online at www.bsava.com
or from our Membership and Customer
Service Team (telephone 01452 726700,
fax 01452 726701, email administration@
bsava.com).
Member price 49. Members
get great savings (typically 30% or
more) on BSAVA Manuals, as well
as further discounts on selected titles
at participating BSAVA events.
A new edition of the
BSAVA Manual of Canine
and Feline Behavioural
Medicine is due out next
month, edited by Debra
Horwitz and Daniel Mills

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ASSOCIATION NEWS
INTRODUCING THE
PETSAVERS
MANAGEMENT
COMMITTEE
Petsavers was established in the early
Seventies (originally called the CSTF) by a
group of veterinary surgeons who recognised
a need to fund high quality research into
conditions which affect small animals. This is
how the Management Committee works to
improve the knowledge and treatment of
SA diseases whilst maintaining the highest
ethical and scientific standards
Jo Arthur
Jo is Chair of
Petsavers Grant
Awarding
Committee
(GAC). Her role
is to provide
information about how the
GAC has awarded the funds
raised by Management
Committee. Jo has raised a lot
of money for Petsavers by
participating in six London 10K
runs since 2004.
Sarah Collins
Sarah is a
qualified
veterinary nurse
working at
Langford
Veterinary
Services. She was invited to join
the management committee to
provide a nurses input as this
group have always been great
supporters of the charity,
helping to explain the work of
the charity to pet owners.
Sarah has served on the
committee for the last year, and
has recently taken over the job
of putting together the Bulletin.
Mark
Pertwee
Mark is Chair
of the
Management
Committee,
having
previously acted as a regional
Petsavers representative. He
has raised money for the
charity with his various
climbing expeditions and often
represents Petsavers at
events. Mark works in
practice in Worthing.
Ed Hall
As Senior Vice
President, Ed
sits on
Petsavers
Management
Committee as
the BSAVA Officer. The
Officer is there to provide
their wider experience of the
Association and to help
identify where there are
opportunities to work with
other committees or
organisations.
Want to get more
involved with BSAVA?
For details about
volunteering email Carole
Haile (c.haile@bsava.com)
or call 01452 726717.
Whos who on PMC
O
ver the last 35 years
Petsavers has funded
many groundbreaking
and important research
projects into diseases such as
diabetes, arthritis and neoplasia.
In order to qualify for an award
a research project must show
that it will be of benefit to small
animal clinicians and must not
involve the use of experimental
animals. In addition, Petsavers
has funded various three year
clinical training scholarships at
vet schools throughout the UK.
Subjects have included,
oncology, orthopaedics,
medicine, anaesthesia and
critical care, dermatology and
neurology. Frequently the
recipients have gone on to
become leading specialists in
their field.
The Petsavers Management
Committee is made up of
volunteer veterinary surgeons
and nurses, plus a full time
fundraiser. The role of the
committee is to find ways to
raise awareness of Petsavers
amongst the profession and the
public. This is achieved through
events like the London 10K run,
competitions and the sale of
Petsavers branded products
such as heated pads, pet
carriers, collars and cards.
Petsavers also provides support
to individuals who wish to raise
money for the charity through
their own personal fundraising
projects. The committee is
constantly looking for new ways
in which to raise the profile of
the charity. For more informa-
tion visit www.petsavers.org.uk
or email info@petsavers.org.uk
to find out how you can get
involved and download copies of
the Petsavers Bulletin. n
Simone Der
Weduwen
Simone
discovered
Petsavers
through her role
as Secretary in
the North West region, where
she organised raffles and other
fundraising activities. She has
also run the 10k and the
London Marathon on behalf of
Petsavers and says she enjoys
being involved in raising
awareness of this veterinary
charity, which doesnt just help
individual pets during their
lifetime but improves the
welfare of our pet population
for many generations to come.
Michelle Stead
Michelle is Chair
of Southern
Region as well as
volunteering
with Petsavers.
She is involved
with the selection of our annual
charity Christmas cards, works
on our stands at events such as
Discover Dogs, and generally
pitches in wherever she can
with her invaluable support.
Darren Peart
Darren worked
in small animal
practice after
graduation
before working
in industry as an
advisor then product manager
and Field Sales Manager. He now
works for Intervet/Schering-
Plough Animal Health and brings
his commercial and veterinary
experience to his involvement
with Petsavers fundraising.
Ruth Corkhill
Ruth has worked
in practice in
Birmingham and
has an interest in
breeding. She is
also Petsavers
regional representative for the
Midlands. She joined Petsavers
Management Committee to
help reinforce the influence of
practitioners on the fundraising
strategy for the charity.
4 | companion
REGULATIONS
WHAT A WASTE
Four years on from the introduction of new rules on the
disposal of healthcare waste and everyone involved in the
process knows exactly what is expected of them yes?
Well, not exactly, says Mike Jessop, Past President and
BSAVAs in-house expert on what we used to call clinical
waste. He tells John Bonner that despite all the work
BSAVA and the Goat Vet Society did in helping BVA
produce guidelines, the veterinary profession still needs
clarification on key details of the regulations or it may
soon find itself in a mess
T
his is the kind of case that keeps
Mike Jessop awake at night
Clients bring in their 60kg
Rottweiler to his practice in South Wales for
surgery on its knee. Somehow, the wound
becomes infected with the MRSA bacterium.
Despite the best efforts of the clinical team,
they are unable to control the infection and
the animal has to be euthanased.
Due to the national authoritys strict
interpretation of the waste disposal
legislation, the cadaver is classified as
hazardous waste. It is taken to a transfer
station where it is mixed with other
4 | companion
companion | 5
REGULATIONS
dangerous materials before being taken
away to a specialised hazardous waste
incineration plant. The practice then has to
present the already distraught clients with a
bill of 720 to simply cover the cost of
disposing of the dogs remains. Can we
have his ashes back?, ask the clients. No?
Well in that case can we at least go and see
his last resting place? The vet looks down
and shuffles his feet in embarrassment...
Fighting your corner
Mike had the misfortune of being the BSAVA
officer who was assigned responsibility for
drafting the Associations response in the
consultation process on the Hazardous
Waste Regulations (England & Wales) 2005.
As such he became embroiled in dealing
with legislation that is extremely
complicated, onerously detailed and not just
a little bit soporific although it also has
enormous implications for the way that
small animal practitioners run their
businesses.
Before these rules were introduced, life
was much simpler for practitioners. All
animal parts, swabs, soiled dressings, etc
were dropped into yellow clinical waste
bags and taken off with any cadavers for
incineration at the nearest pet
crematorium. Now, the crematoria need to
obtain a special licence to incinerate
material other than animal carcases.
Meanwhile, the practice waste has to be
sorted into a bewildering array of different
receptacles, depending on whether they are
classified as hazardous or non-hazardous,
and the intended means of disposal.
Regulation regulation regulation
Those categories are based on the European
Waste Framework Directive which controls
the disposal of all forms of hazardous waste,
either by burial or
incineration. The 2005
regulations implement the
directive in England and
Wales, with similar
regulations already
introduced in Scotland and
soon to be in Northern Ireland.
Two other documents are also
important in determining how practices
should deal with what now must be called
healthcare waste. These are the
Department of Health guidelines produced
in 2006 (see www.dh.gov.uk) and the Special
Waste Regulations 1996, which attempt to
define which chemical and biological
materials should be classed as hazardous.
This includes a key definition of infectious
waste as any substances containing viable
microorganisms or their toxins which are
known or reliably believed to cause disease
in man or other living organisms.
While that wording seeks to minimise
the risks to the public from cadavers of
animals that have died from diseases caused
by zoonotic pathogens, it could also be
interpreted to mean many other materials.
That might include a disposable towel
handled by someone who carries MRSA on
their hands, Mike points out.
As with much EU legislation, the
interpretation of the legislation is crucial.
The Commission attempts to draft
reasonable rules covering a wide range of
industrial sectors and the differing national
requirements of 27 member states. There
can also be further variation in the way that
the rules are applied, as in Scotland where
different terminology is used to define
waste and the responsible authority is the
Scottish Environmental Protection Agency,
rather than the Environment Agency for
England and Wales. Further down the
process, it is possible for different
interpretations of the rules to emerge at a
local level, according to the whims of
individual inspectors.
6 | companion
REGULATIONS
Counting the cost
So far, there have been no known examples
of the nightmare scenario that Mike
suggests and there is an understandable
view among some senior members of the
profession that sleeping dogs should
remain undisturbed. However, he believes
that the profession needs clearer guidance
on what exactly constitutes hazardous
waste, or its members may find
themselves at the mercy of the specialist
waste contractors.
Currently, an animal that dies or is
euthanased at the practice is sent for
incineration and any bedding is classed as
offensive waste and put in the yellow and
black tiger bags for deep landfill. That
would cost me 2.60 for a 7kg bag. But if
everything is treated as hazardous waste
the costs for disposal at one of the few sites
licensed to dispose of those materials rises
to about 1.85 a kilo. On top of that, the
practice would have to pay a consignment
fee for every item handed over to the
contractor, together with a fee to the
Environment Agency. The costs of disposing
of the carcase could easily run into
hundreds of pounds.
When Mike has raised this issue with
the Environment Agency, its staff have made
reassuring noises about the small number of
animal carcases likely to fall into this
category, though he reckons that in a typical
small animal practice there could, with
pedantic interpretation of the definitions,
be at least one or two cases a month of
animals dying or being euthanased with an
infection that is potentially transmissible to
humans. If there are about 4500 practices in
the country each seeing two cases then
around 100,000 pet owners a year could
have a further reason to lament the loss of
their animal.
These rules could have a particularly
dramatic effect on the work of animal
welfare groups, Mike warns. The charity
clinics see a disproportionate number of
infectious diseases because their clientele
have a traditionally poor uptake of
vaccination. So an RSPCA clinic may produce
four to five cases per vet per month.
What is waste?
Cadavers, of course, are not the only items
produced by a veterinary practice which
might be classified as hazardous waste.
Clear guidance on the disposal of
medicines has been produced by the
BSAVA and is available online under the
ADVICE section of www.bsava.com. There
is less certainty, though, about the rules on
other waste materials such as sharps and
the waste chemicals produced in the
practice laboratory.
Sharps are a particularly contentious
issue, with the Scottish authority advising
those practices north of the border to
separate off special (i.e. hazardous) and non
special waste items. But the Environment
Agency appears to regard all sharps as
potentially hazardous and would like them
to be subject to the more stringent disposal
process. The Department of Health is
taking a similar line, and applying the
precautionary principle to the much greater
volumes of these materials produced by the
National Health Service.
This indifference to the costs of
disposing of the highest category materials
could be a consequence of the sort of
economies of scale that an organisation of
the NHSs size should be able to negotiate
with waste disposal contractors. However,
Mike speculates that there may be another
explanation, in the lack of accountability
often displayed by such a financial
behemoth. I suspect that they may not
realise why they are paying this bill until the
Audit Office comes along in five years time
and asks what is all this for?
Implications
As small businesses, veterinary practitioners
tend to be much more concerned about
wasting money than the public sector seems
to be. Yet the need to control costs is not
the only reason why Mike is worried about
how the term hazardous waste will be
defined. If the process is taken to its illogical
conclusion, practices could be required to
apply for a licence to transport its
hazardous materials from a branch
premises for storage at the main site. Mike
has queried this with his local Environment
Agency and been told that strictly speaking
the carriage of small quantities of waste
material that is not the carriers own waste
should require a waste carriers licence.
However, given that the waste is
transported to the main collection centre by
an employee or the owner of the
establishment, the agency would not pursue
any licensing requirements at this time.
Though it is reassuring, the Welsh
Environmental Agencys response does not
provide guarantees that inspectors at other
offices may not come up with a different
opinion, or that the local view may not
change with time.
If the agency finds that a practice has
infringed the regulations, the penalties can
be severe. If your waste bag splits open at
the land fill site and spills some theatre
waste, the practice owner is legally
responsible and may pay a fine of currently
up to 5,000 plus costs. Serious breaches of
the rules which may endanger life, such as a
needle stick injury, carry the possibility of an
unlimited fine or imprisonment, he warns.
companion | 7
REGULATIONS
To ensure that the practice does not
fall foul of the law, staff must carefully
follow the rules as they are currently
understood. This means that we should be
segregating waste according to the
instructions given in the BVA good practice
guide produced in conjunction with BSAVA
and the Goat Vet Society, and ensure that
the practice has a contract with a properly
licensed and approved waste disposal
company. It is also important for the
responsible person at the practice to fill in
all the paper work every time that a
consignment of waste is handed over for
disposal. That person may be the practice
manager or the senior nurse but it is the
practice owner who is ultimately
responsible and they must ensure that they
know what is happening and have
established the necessary practice
protocols and policies, he says.
Going forward
Meanwhile, Mike insists that the BVA (as
the professions lead organisation on this
issue) should be pressing the Environment
Agency to reconsider the status of animal
cadavers under the rules and to clarify its
position on the other areas where there is
still confusion.
These problems over the disposal of
pet animals have arisen only in the UK
because the other EU member states have
taken a different route in implementing the
legislation. Everywhere else in Europe,
dead pets are treated the same as fallen
livestock and disposed of under the
relevant animal waste legislation. Under
those rules, it is permitted in Britain to
send a sheep or cow with a transmissible
spongiform encephalopathy to be
incinerated at the nearest facility, usually
one of the networks of pet crematoria.
So despite the complexity of the
broader legislation there is a relatively
straightforward solution to the issues
which Mike has raised. That is for the
Environment Agency to recognise that a
dead dog or cat is not a uniquely dangerous
item that needs to be treated as
significantly more dangerous than human or
farm animal remains.
At the moment there is this bizarre
situation in which a human dying of MRSA
or some other infection such as salmonella
can be buried in a public cemetery or
cremated at the local crematorium, with
the family receiving the ashes back.
However, if a dog dies of those same
diseases, it has to be treated as hazardous
waste. What we are calling for is a simple
change, for the cadavers of domestic pets
to be removed from the hazardous waste
regulations or to allow existing pet
crematoria to handle these supposedly
hazardous carcases as they were previously
allowed to do. n
8 | companion
CLINICAL CONUNDRUM
CLINICAL
CONUNDRUM
Livia Benato, RCVS Trust Senior Clinical Training Scholar in
Rabbit and Exotic Medicine at the Royal (Dick) School of
Veterinary Studies, invites companion readers to consider
the case of an axorexic bearded dragon
Case Presentation
A 1
1
/2-year-old male bearded dragon (Pogona vitticeps) weighing 430 grams
was presented because it was anorexic, thin and reluctant to move. The
animal had been purchased from a local pet shop one year before and was
housed alone in a glass vivarium. The vivarium was furnished with a branch
for climbing; a heat lamp was installed on the top of the tank, and fine sand
used as substrate. The vivarium also contained a UV lamp that had not been
changed for a year. The bearded dragon was misted once daily and fed with
variably sized crickets and vegetables dusted with a calcium and
multivitamin supplement. Water was provided by means of a small bowl on
the bottom of the tank. No monitoring of temperature and humidity was
possible inside the vivarium. The owner reported that in the previous
4 weeks the dragon had become anorexic and had stopped passing faeces,
spending most of the time in the same position. On clinical examination the
bearded dragon appeared dehydrated, with sunken eyes, and was lethargic.
The oral cavity and teeth were in good condition. The skin appeared dry and
relatively inelastic, with evidence of incomplete shedding. An elongated soft
mass was palpable in the middle of the coelomic cavity. No other
abnormalities were detected.
Identify problems from the
clinical history and physical
examination
Sub-optimal husbandry
Lack of monitoring temperature
and humidity
The UV light had not been changed
during the previous 612 months
and may not be working correctly
The water bowl was too small
Fine sand is a poor choice of
substrate as it has been associated
with intestinal impaction
Vitamincalcium supplement
provided by dusting only
Anorexia
Lethargy
Dehydration (dry skin, sunken eyes)
Elongated mid-abdominal mass
No faecal output during the preceding
4 weeks
Consider the differentials for the
problems: can they be prioritised
based on the information so far?
Anorexia is a non-specific clinical sign
that can be associated with a variety of
disorders, such as systemic infection,
gastrointestinal disease, metabolic
bone disease, renal disease, liver
disease, stomatitis, pneumonia and
electrolyte disorders.
Lethargy is also a non-specific sign and
can occur in hypoglycaemia,
hypocalcaemia, hypothermia and
metabolic bone disease.
Differentials for the abdominal mass
would include gastrointestinal
obstruction, abscess, uroliths and
neoplasia.
Dehydration may have developed due to
the poor husbandry, or water intake
may have decreased secondary to
another disease process.
8 | companion
companion | 9
CLINICAL CONUNDRUM
Faecal output may have been reduced
due to parasitic disease, gastrointestinal
impaction/obstruction, uroliths or
neoplasia.
What would be your first steps in
investigation?
To evaluate for the presence of
intestinal parasites, the cloaca was
swabbed and the sample spread on a
glass slide. A small amount of warm
saline solution was added and a smear
made and examined microscopically.
No parasites were found (if more
material had been available, faecal
flotation and/or concentration would
have been more sensitive).
A blood sample (0.5 ml) was taken
from the ventral coccygeal vein and a
blood smear made. The remaining
blood was placed in a lithium heparin
microcontainer and submitted for
haematological and biochemical
evaluation to assess: renal and hepatic
parameters; serum calcium (ionised);
the degree of dehydration; inflammation
(infectious/non infectious). All results
were within the laboratorys normal
reference ranges for this species apart
from haematocrit which was at the very
top end of the normal range. No toxic
changes were detected in any cell line.
A radiographic examination was
performed to evaluate the mass and to
assess the possibility of gastrointestinal
obstruction. Cotton wool was placed
around the patients head to apply slight
pressure over the eyes and stimulate
the immobilising vago-vagal reflex.
The patient was taped onto the
radiographic cassette with micropore
non-adherent tape. A dark and quiet
environment contributed further to its
immobilisation. Lateral and dorsoventral
full body exposures were taken.
Interpret the radiographic
findings and make a diagnosis
The radiographs showed a mass in the
caudal coelomic cavity that is consistent
with an intestinal impaction (arrowed in
Figure 1). No other radiographic
abnormalities were detected and skeletal
density was considered adequate.
A diagnosis of intestinal impaction
associated with dehydration and sub-
optimal husbandry was made. The nature of
the impaction could not be determined
from the tests conducted thus far.
How would you treat this case?
The treatment plan had a number of
aims: to address the underlying causes,
such as sub-optimal husbandry; to
correct the dehydration; and to resolve
the intestinal impaction by a surgical or
medical approach.
Figure 1: A horizontal beam lateral view radiograph of the bearded dragon
10 | companion
CLINICAL CONUNDRUM
CLINICAL CONUNDRUM
Figure 3: Cat with
simple closed urinary
collection system
Husbandry: The bearded dragon was
hospitalised and placed in a vivarium with
newspaper as substrate. Newspaper was
chosen as it is both digestible and non-toxic
should it be ingested. A heat lamp and a
UV-B lamp were placed on the top of the
cage at a maximum distance of 20 cm from
the patient. The average temperature was
maintained between 30C and 32C with a
top temperature of 40C under the basking
light. The relative humidity was maintained
at 3050%. Temperature and humidity were
monitored using a thermometer and
hygrometer placed inside the cage. A
shallow water bowl was also provided.
Rehydration: Options for rehydration
therapy comprised:
Bathing in shallow warm water (reptiles
can absorb water from the cloaca, the
warm environment stimulates their
metabolism and the patient can drink
the bathing water)
Subcutaneous fluid administration
Oral gavage of an electrolyte solution.
In this case a bath in shallow warm
water helped to rehydrate the bearded
dragon while minimising stress associated
with excessive handling. The bath was
repeated three times daily.
In addition, a bolus of 10 ml of
Hartmanns solution (2% of body weight)
was given subcutaneously into the dorsal
area and 13 ml of electrolyte solution
(3% of body weight) was given orally via
crop tube. This fluid supplementation
totalled 5% of body weight and was
repeated twice within the next 24 hours.
Electrolyte solution was preferred over
assisted feeding during the first 24 hours of
hospitalisation to avoid metabolic
imbalance, common in anorexic reptiles.
The use of oral electrolyte solution also
rehydrates the gastrointestinal contents and
aids avoidance of refeeding syndrome in
which rapid administration of calories may
provoke a life-threatening metabolic
imbalance. From the second day of
hospitalisation, the electrolyte solution was
replaced with Critical Care Formula for
Reptiles (VetArk) at the same quantity
three times daily.
Resolution of intestinal impaction:
In this case, because the intestinal impaction
was thought to be due to dehydration
rather than an intestinal foreign body it was
decided to start with medical treatment and
rehydration, rather than performing
surgery. An enema using 5 ml of warm
sterile saline solution was given gently three
times daily in order to rehydrate the
intestinal mass causing the impaction and to
stimulate intestinal motility.
Outcome
On the fourth day of hospitalisation, the
bearded dragon passed a significant amount
of faeces and a dry mass of urates (Figure 3).
During the following 2 days some
mealworms were left in the cage and the
bearded dragon resumed eating and started
to become more active. On clinical
examination the bearded dragon appeared
relaxed and the coelomic cavity was not
tense when palpated. No masses were
found. The treatment was discontinued and
the patient was discharged.
What advice would you give to
the owner regarding prevention?
At home, the owner was advised to
improve their husbandry and management
of the bearded dragon. The fine sand
substrate was replaced with newspaper that
was changed on a regular basis. A UV-B
lamp was added to the cage, and the
bearded dragon was bathed daily. It was
recommended that a variety of vegetables
and invertebrates be fed, and to offer
vitamin and mineral supplemented gut-
loaded crickets rather than supplying the
supplement by dusting alone. Figure 2: Warm water bathing to encourage rehydration
companion | 11
CLINICAL CONUNDRUM
Figure 3: Dry urates passed by the bearded dragon on day 4 of hospitalisation
At follow-up 1 and 4 weeks post
hospitalisation, the client reported that the
bearded dragon was very active, was eating
well and was taking different types of
invertebrates and vegetables daily. The
owner had changed the substrate to artificial
grass that was cleaned and washed regularly
and a shallow water bowl, big enough for the
bearded dragon to bathe in, had been
provided. The owner had not weighed the
reptile, even though it had been advised.
Discussion
The bearded dragon is a desert lizard native
to Australia. It is a very popular pet,
particularly amongst beginner
herpetologists. However, in captivity this
species frequently suffers from disease
problems that are directly due to poor
husbandry and management.
Gastrointestinal impaction can occur
for several reasons, such as stress,
inappropriate feeding, inadequate
temperature and humidity in the vivarium
and, frequently, the accidental ingestion
of substrate.
Obtaining a thorough and accurate
history is an important part of the reptilian
clinical examination, as many medical
problems are related to the experience of
the owner and the quality of the
management and feeding. In this case the
owner was not an experienced
herpetologist and was not fully informed
about the management and feeding of
Reptile husbandry and
health a practical
approach
The BSAVA Manual of Reptiles, 2nd edition is
edited by Simon Girling and Paul Raiti and
features a host of international expert contributors.
Correct husbandry is the starting point of the
Manual and is emphasised throughout as of prime
importance. Details of clinical examination and
procedures including anaesthesia and surgery
follow. Disorders are then discussed on a system basis, with separate
chapters devoted to parasitology and infectious diseases. Useful
appendices include a drug formulary, a table of differentials for presenting
signs, and a protocol for handling venomous snakes and lizards.
Full-colour photos and useful tables complement the text throughout.
Member price: 59 (89 to non-members)
Available from www.bsava.com or ring 01452 726700
bearded dragons. Sunken eyes are a
common clinical sign of dehydration in
bearded dragons and might have been
detected by a more experienced owner.
Lethargy, anorexia and weakness are
common clinical signs in animals with
intestinal impaction. In this case the
intestinal impaction was secondary to
dehydration and accumulation of dry urates
in the caudal part of the intestinal tract, but
ingestion of inappropriate substrate might
also have been implicated.
This case illustrates that incorrect
husbandry in reptiles can rapidly lead to
life-threatening conditions that are entirely
preventable. Simple supportive care, by
providing appropriate temperature, lighting
and humidity, are frequently all that is
required, in combination with long-term
changes in the home environment and diet
to prevent further disease.
12 | companion
HOW TO
PROVIDE EFFECTIVE
OXYGEN SUPPLEMENTATION
HOW TO
Karen Humm of the RVC
discusses the pros and cons
of methods of oxygen
supplementation
Direct from a cylinder using oxygen
tubing
Breathing system attached to an
anaesthetic machine
Piped source:
Using oxygen tubing
Using a breathing system.
Humidification
Irrespective of the method of
administration, oxygen is supplied in
cylinders or tanks of dry gas or produced as
a dry gas from an oxygen generator.
Administration of dry oxygen at high rates
can lead to increased viscosity of respiratory
secretions, impaired muco-ciliary clearance,
mucosal desiccation and an increased risk of
respiratory tract infection. Therefore if
oxygen is to be administered for longer than
an hour or so, it should be humidified. This
is particularly important in patients with
nasal or tracheal catheters or those
undergoing mechanical ventilation as the
administered oxygen bypasses the upper
airway, the natural site of humidification in
an animal. Humidification is achieved simply
by allowing oxygen to bubble through sterile
water. Bubble humidifiers are cheap
(Flexicare Medical Ltd.) and will fit onto flow
meters designed for piped oxygen (Figure 1).
If a humidifier is not available, regular
nebulisation can be performed but this
requires intensive nursing care and
expensive equipment. Alternatively, some
commercially available oxygen cages have an
integral humidification system.
Short term methods of oxygen
supplementation
When a patient in respiratory distress
presents to the practice, a quick but
thorough physical examination should be
performed (focused on the patients
respiratory, cardiovascular and neurological
systems) and initial stabilisation performed.
During this period oxygen is generally
supplemented non-invasively. However, the
requirement for a member of staff to stay
with the patient constantly means that this
is usually a short term option and facilities
for administering oxygen on a longer term
basis may need to be organised.
R
espiratory distress is triggered by
hypoxia, hypercapnia or a marked
increased in the work of breathing.
Hypoxia is by far the most common of
these causes and generally patients with
hypercapnia or a marked increase in the
work of breathing have concurrent hypoxia.
Therefore oxygen supplementation is of key
importance in managing any patient with
respiratory distress. If there is uncertainty
as to whether a patient is in respiratory
distress, supplemental oxygen should be
administered while they are evaluated.
Oxygen supplementation
methods
Oxygen makes up approximately 21% of the
gaseous component of room air. Various
methods of increasing this percentage are
available, each with its own advantages and
disadvantages. For both short and long term
options the percentage inspired oxygen
achieved will be affected by the size of the
patient, their respiratory rate and the flow
rate of oxygen used. Rough guides for flow
rates are given below but they only act as a
starting point and adjustments may need to
be made on a patient by patient basis.
Oxygen source
The source of oxygen for patients in
respiratory distress will vary between
practices depending on their facilities.
However most practices will use one (or
more) of 4 options:
Figure 1: Bubble humidifier
companion | 13
HOW TO
1) Mask supplementation
Using a mask to provide oxygen to a patient
is simple and effective. An oxygen flow rate
of one (for cats and small dogs) to ten (for
giant breeds) litres/minute should be used.
Whilst a high percentage of inspired oxygen
(8090%) can be achieved in anaesthetised
dogs using a tight fitting mask, the majority
of conscious dyspnoeic patients will not
tolerate a tight fitting mask and therefore
the actual percentage of inspired oxygen in
clinical patients is closer to 3555%. Calmer
patients will tolerate a mask gently held
over the muzzle allowing free movement,
but many patients, particularly cats, will not
allow a mask near their head. Struggling
with a patient to administer oxygen is
counterproductive as their oxygen demand
will be increased by the stress and increased
muscular activity. Collapsed or weak
patients are ideal candidates for mask
oxygen supplementation as they do not
move (although unconscious patients need
intubation to protect their airway from the
risk of aspiration) (see Figure 2). Care
should be taken as a tight fitting mask can
easily lead to hyperthermia and inadvertent
use of lower oxygen flow rates than the
patients minute volume re-breathing will
result in hypercapnia.
2) Flow-by
Flow-by supplementation is not an efficient
means of oxygen supplementation (Figure
3). The conscious patient is likely to receive
an inspired oxygen percentage of
considerably less than the maximum, 40%,
achievable by this method. However,
flow-by is usually ready within seconds, is
non-invasive and is less stressful than mask
supplementation. Flow rates of 210 litres/
minute should be used and the oxygen
outlet should be held as close to the
patients nose (or mouth if they are panting)
as possible without causing distress.
Sometimes a patient will tolerate flow-by
when tubing is directed to the side of their
mouth rather than in front of it.
3) Tracheal oxygen supplementation
If a patient is showing signs of severe
respiratory distress secondary to upper
respiratory tract obstruction (increased
inspiratory effort and marked inspiratory
noise audible without a stethoscope) a
catheter can be placed percutaneously
into the trachea. A brief clip and clean of
the overlying skin is required and a large
bore, 14 or 16 Gauge, catheter is inserted
into the space between the tracheal rings
4 and 5 or 5 and 6. Once the stylet is
within the trachea the catheter is
advanced into the tracheal lumen in the
direction of the carina and the stylet
removed. Oxygen is then administered in
a flow-by fashion directed at the catheter.
This technique is only useful in dogs over
approximately 10 kg who have a
sufficiently large tracheal lumen to allow
catheter placement. Invasive tracheal
oxygen can be difficult to maintain and
so is really only suitable for short term
oxygen supplementation.
Figure 2: Oxygen delivered by mask is most suitable for
weaker patients
Figure 3: Oxygen flow-by
14 | companion
HOW TO
PROVIDE EFFECTIVE
OXYGEN SUPPLEMENTATION
Longer term oxygen
supplementation
Following an initial physical examination and
emergency stabilisation (e.g. furosemide
administration or thoracocentesis) it is
often beneficial to allow a patient to calm in
a kennel prior to further manipulation.
Oxygen supplementation is continued
with flow by or mask supplementation
whilst preparations for delivery of
oxygen supplementation in the longer
term are made.
1) Nasal catheters
Oxygen can be supplied direct into the
respiratory tract via nasal catheters in
both dogs and cats. Feeding tubes are
commonly used as catheters with a
5 French catheter being suitable for a
cat and an 8 or 10 French for most dogs.
Before placement the catheter should be
pre-measured against the animal from the
nostril to the lateral canthus of the eye.
A few drops of 0.5% proxymetacaine or
2% lidocaine should be administered into
the nostril 10 minutes prior to placement
of the catheter. The patient is gently
restrained with their nose pointing dorsally
and the catheter is advanced into the
ventral meatus. Pushing the nasal planum
dorsally while aiming the catheter ventro-
medially can aid correct placement. The
catheter should be gently but rapidly
advanced as patients often move and
sneeze during this part of the procedure.
If the catheter is not in the ventral meatus
it will not advance the pre-measured
distance as the dorsal and middle meatuses
end at the ethmoid turbinates rather
than in the nasopharynx. Once the catheter
is in the correct position it should be fixed
in place with sutures or tissue glue
attached to butterfly wings of tape round
the catheter. The catheter should loop
round the alar cartilage with fixation
close to the nasal orifice to prevent
dislodgement (Figure 4). The catheter
is then looped dorsally between the eyes
(which may decrease the chance of the
patient removing it) or onto the lateral
aspect of the head to be secured just
below the ear.
The procedure should be abandoned if
an animal becomes distressed as this may
lead to marked worsening of their hypoxia.
The procedure is also contraindicated in
coagulopathic animals. Once in-situ
catheters can be displaced by determined
patients, so a buster collar may be required
which again can be stressful. However, if a
patient will tolerate placement and
maintenance of a nasal oxygen catheter
they can provide a consistent inspired
oxygen percentage of 4050% with an
oxygen flow rate of 50100 ml/kg/min.
The placement of a second nasal catheter
can increase this percentage further to
6070%. Unfortunately, if a patient
consistently pants then the mixing of air in
the pharynx leads to a decrease in the
percentage inspired oxygen.
2) Nasal prongs/cannulas
Prongs designed for oxygen
supplementation in humans can be used for
dogs. They come in 2 sizes (paediatric and
adult Flexicare Medical Ltd). The prongs
advance approximately 1 cm into the nostril
and will provide a percentage inspired
oxygen of around 40%. They are minimally
invasive but are therefore easily displaced
by an intolerant patient. Administration of
proxymetacaine or lidocaine into each
nostril approximately 10 minutes before
placing the prongs can be useful as can
taping the prong tubing together (but not to
the dog) over the dorsal aspect of the
muzzle (Figure 5). As with a nasal catheter
this method is less efficacious in the
panting patient.
Figure 4: Nasal catheter looped around alar cartilage and
fixed in place using bandage butterflys
Figure 5: Nasal prongs in situ
companion | 15
HOW TO
Approaches to respiratory
distress
The BSAVA Manual of Canine and Feline
Emergency and Critical Care, 2nd edition is edited
by Lesley King and Amanda Boag, with
contributions by experts from the UK, North
America and Europe. The Manual provides a
practical resource for what remains one of the
most important areas of veterinary medicine.
Chapter 7 covers the general approach to
dyspnoea including emergency stabilisation
through oxygen supplementation.
Member price: 56 (85 to non-members)
Available from www.bsava.com or ring 01452 726700
3) Tracheal catheter
Some texts describe administering oxygen
via a tracheal catheter on a longer term
basis, particularly for patients with facial or
upper airway injury. A standard intravenous
catheter can be used or a long stay catheter
of increased length placed as described
above. In the authors hands this is not an
effective method for longer term
supplementation as the catheter is difficult
to secure and prevent from kinking.
4) Buster collar oxygen hood
Oxygen can be administered into an
enclosed buster collar (either practice-
made or commercially produced (Kruuse
UK Ltd)). Practice-made collars should have
a small gap left at the top of the collar to
allow venting of humid air and carbon
dioxide. Despite this vent hole, many dogs
and some cats become hyperthermic,
particularly in hot conditions. Placement of
the collar may be poorly tolerated, however
most dogs and cats do settle if left in a
kennel. A high flow rate should be used
initially to fill the collar with oxygen and
then a rate of approximately 1 litre/min is
suitable for a medium size dog and should
result in a percentage inspired oxygen of
approximately 40%.
5) Oxygen cage
Collapsible (Figure 6) or lightweight oxygen
cages are commercially available in various
sizes (e.g. J.A.K. Marketing Ltd or Kruuse
UK Ltd). They have adaptors for breathing
systems and are simple to use. Models vary
in presence of means of thermoregulatory
or humidity control. Some practices also
have permanent fixed oxygen cages
although again they are rarely temperature
or humidity controlled. As the cages are
completely sealed hyperthermia can rapidly
develop, particularly in dogs. It is of note
that once a cage is opened the level of
oxygen within it rapidly drops to room
level. This can mean that if a patient is
frequently being handled their inspired
oxygen fraction is barely increased.
An oxygen cage can be made in the
practice when required by placing cling-film
over the front of a cage although the gaps
present and the large volume of the cage
relative to the patient within it, mean that
even with very high flow rates the
percentage of oxygen is often barely
increased.
6) Endotracheal intubation and
ventilation
It is very rare that an animal in respiratory
distress requires anaesthetising and
intubation allowing provision of 100%
oxygen. This most commonly occurs in
patients with upper respiratory tract
obstruction when intubation allows
by-passing of the obstruction such as in cases
of laryngeal paralysis. Judging when
intubation is required can be difficult. Less
invasive oxygen supplementation techniques
in conjunction with stabilisation should be
attempted first and the patients response
assessed. If a patient still has marked
respiratory distress despite treatment then
intubation and ventilation may be required. If
the cause of respiratory distress is not upper
respiratory tract in origin the prognosis for
patients that require intubation and
ventilation is unfortunately very poor.
Oxygen toxicity
Exposure of the lungs to an inspired oxygen
fraction greater than 60% for greater than
approximately 2472 hours can lead to
oxygen toxicity. This causes damage to the
alveoli potentially worsening any lung
disease present. Ideally therefore oxygen
supplementation should be kept below 60%
for longer term supplementation. As most
methods of oxygen supplementation in the
practice situation do not achieve an inspired
percentage greater than 60% this is
generally a theoretical concern.
Figure 6: Commercially available
collapsible oxygen kennel
16 | companion
VIN
L. Dean Baird, DVM, Mountain Empire Large Animal Hospital, Johnson City, TN
This posting concerns a 3y F(I) Chihuahua that has had a heart murmur for the duration of the time that the owner
has had the dog (approx. 1 yr). Recently, she has had a cough. Otherwise, the dog has apparently been healthy
(I have done echocardiography only; I am not her regular DVM). She weighs 3.5lb. She has a loud holosystolic V/VI
murmur that is loudest over the heart base. I do not believe that the murmur is present during diastole. Chest rads
(which I have not seen, have reportedly shown some evidence of LV enlargement).
ECG: HR 150-169, sinus arrhythmia, very tall R waves. Echo results (numerically): LVId 2.3, LVDs .9, VSd .5, VSs .9,
LVWd .35, LVWs .9, LA:Ao 2.5:1, FS 56-62
On B-mode the LV and LA appeared enlarged, R side did not appear enlarged. There was no colour-flow evidence of a
septal defect. Mitral valve structure did not appear distorted, EPSS was 0.2 cm. I could not see evidence of pulmonic
or aortic stenosis. However, this seemed unusual, to me, about the aortic valve area: On the right parasternal short
axis view, I could not see the hyperechoic line that is formed between the left coronary cusp and the noncoronary
cusps of the aortic valve. Also, on the right parasternal long-axis left ventricular outflow view, the aortic valve cusp
that is visible opposite the left coronary cusp appears to barely move away from the wall of the aorta/LVOT. I do not
know if these concerns are important. I am not a cardiologist AND HAVE MADE THAT CLEAR to the owner AND,
further, have recommended referral to one.
I do not think that they are going to go for referral. So,
1) Based on the information that I have provided, what do you think are the most likely rule-outs (I would have
thought, perhaps, MV degeneration, even at this young age, except that the valves do not look diseased).
2) Other than a PDA and, perhaps, pulmonic stenosis, is there any other congenital disease that has any chance of
surgical repair, currently?
Mark D. Kittleson, DVM, PhD, Diplomate ACVIM (Cardiology),
VIN Consultant, University of California, Davis
So this less than 2 kg dog has the LV the size of a 5 kg dog and what appears to be a very large left atrium. That
could explain the very tall R waves on the ECG but the only congenital cardiac disease where we see an R wave in
lead 2 that is out of all proportion to LV size is in PDA. So how tall was the R wave in lead 2? So far the breed, the tall
R wave and the hyperdynamic, volume overloaded left heart make me think PDA is first on the list and then PDA and
then PDA. I cant remember if you have color flow Doppler or not. If you do and theres no continuous turbulence on
the main PA then its probably not a PDA. If you dont have color flow Doppler, go back and listen to the murmur with
your stethoscope head in the left armpit to see if its continuous there or not. How about the femoral pulse? Bounding
or normal? Can you get the chest rads to look at and post here? Things get a lot easier if theres a ductal aneurysm
present on the DV. Obviously all of this is critical since a PDA can be fixed.
L. Dean Baird
I am at home so I have limited information. Without looking at the tracing, I cannot tell about the R wave size in lead
2. I need to either get the rads that were done (I have not seen them) or repeat them if I can get the dog back in.
Also, I can do color flow on the MPA and re-auscult. But, it was the auscultation that has led me away from PDA; it
was loud but not continuous (3 other DVMs agreed). Nonetheless, if I can get her back, I will re-auscult. Because, as
you stated, this is the one thing that we can do something about and, the owners probably would.
GrapeVINe
The Veterinary Information Network brings together veterinary professionals from across
the globe to share their experience and expertise. At vin.com users get instant access to
vast amounts of up-to-date veterinary information from colleagues, many of whom have
specialised knowledge and skills. In this regular feature, VIN shares with companion
readers a small animal discussion that has recently taken place in their forums
Discussion: Chihuahua with congenital or acquired disease?
LVId: Left
Ventricular
Internal
dimension
diastole
LVDs: Left
Ventricular
Dimension
systole
VSd:
Intraventicular
Septum diastole
VSs:
Intraventricular
septum systole
LVWd: Left
Venticular free
wall diastole
LVWs: Left
Ventricular free
wall systole
LA:Ao: Ratio of
Left Atrial to
Aortic diameter
FS: Fractional
shortening
companion | 17
VIN
What is the left side view for PDA you referred to?
Information in my text pretty much limited to left cranial
long axis view, and left base long axis view. We were
basically taught left apical, on the other end, and left
parasternal long and short.
Mark Kittleson
Peter, It is essentially a left cranial view but with the
transducer almost on the sternum pointed almost directly up
at the spine. Its the left cranial view of the main pulmonary
artery and pulmonic valve but a little more extreme. It helps
a lot if you have color flow Doppler to get you into the right
region, at least.
Mark Rishniw
Its a relatively specialized view that most people without
appropriate guidance (by a teacher) and echo experience
wont be able to get, unfortunately.
Dave Hoch DVM, Gainesville, FL
I was curious, wouldnt a 3yr old with a PDA present for right
sided failure as blood reverses through the ductus? Present
with lethargy, inappetance, ascities, differential cyanosis,
etc? I just havent seen any 3yr olds with the condition
either fixed prior to that age or euthanized on presentation
from CHF. Are the owners pursuing correction? If not the
little one is just going to go into CHF.
Mark Rishniw, BVSc, MS, DACVIM (Cardiology), VIN Consultant, Ithaca, NY

>>> But, it was the auscultation that has led me away from PDA; it was loud but not continuous (3 other DVMs
agreed). <<< Depends how far forward you listened. At the cardiac apex, a PDA will often sound like a mitral
murmur.

L. Dean Baird
I now have this information:

1) The original DVM repeated rads and sent them to me with the dog (I am not posting them but I can). I see a
prominent density on the vd view that is consistent with a ductal aneurism (should have gotten the rads sooner).
2) The R-wave amplitude on lead 2 is 4.1 mv.
3) Re-auscultation very high on the left cranial chest (actually above the thoracic inlet) does reveal a continuous
murmur, with the systolic portion louder than diastolic.
4) I cannot visualize a defect on echo, but can see marked turbulence in the pulmonary artery with color-flow.
5) Bounding femoral pulse is present.

I did not have much trouble imaging the area of the pulmonary artery but cannot visualize the defect, as I stated. Is
this rare? Should I be able to image it?
Mark Rishniw
Visualizing the ductus from the right side is virtually impossible you can see where the turbulent flow is coming
from in some cases, but you need a special left-sided view to visualize the PDA in its entirety. However, you have a
diagnosis! Well done!
L. Dean Baird
I dont know how often you folks get after-posting follow-up; this is a happy one. I have not seen a copy of the
referral letter/medical report but the original clinician for this pet called me and reported that this dog successfully
had surgery to repair a PDA at VMRCVM. The cardiologist involved apparently felt that this case was an unusual
presentation for PDA (makes me feel a little better). Other than a residual murmur, they expect her to do well
(second-hand information). The main reason that I am posting is to point out how vital VIN is for general
practitioners like myself. My ability to converse with you about this case on-line allowed us to focus our diagnostics in
a way to get this correctly diagnosed. This is something that you, in cardiology (and the other folders, as well), have
done consistently. Thank you!
Peter Martin, Flemington Veterinary Hospital, Statesboro, GA
Image
reproduced
from BSAVA
Manual
of Canine and
Feline Thoracic
Imaging
LPS echocardiogram in a dog with a PDA,
optimized for visualization of the ductus. The 2D
image on the left demonstrates the appearance of
the ductus itself at its connection with the main
pulmonary artery (MPA). The aorta (Ao) and right
ventricular outflow tract (RVOT) are also shown.
The colour Doppler image on the right was
acquired simultaneously and turbulent flow is
evident within the ductus. ( J. Dukes-McEwan)
18 | companion
VIN
All content published courtesy of VIN with permission granted by each quoted VIN Member.
For more details about the Veterinary Information Network visit vin.com. As VIN is a global veterinary discussion forum not all diets,
drugs or equipment referred to in this feature will be available in the UK, nor do all drug choices necessarily conform to the
prescribing rules of the Cascade. Discussions may appear in an edited form.
This thread appears in an edited form.
To read the full thread and access the links mentioned visit http://www.vin.com/Link.plx?ID=68604
GrapeVINe
Mark Kittleson
Hi Dave, this dogs PDA has already been closed. Right heart failure definitely not. Reversal of flow? That is about
the age a dog with a wide open (grade 6) ductus often shows up. Thats the type that has pulmonary hypertension
from birth and no murmur. In all of the others reversal of flow at that age is really rare (dont remember seeing one).
Those dogs, if they do show up, show up in heart failure. And weve seen dogs where the PDA has been missed show
up much later than that. I dont know the record but my bet is that its 12 or 13 years of age. I know weve seen an
8-year-old this year.
>>> Present with lethargy, inappetance, ascities, differential cyanosis, etc? <<<Again, a grade 6 PDA will show up
with differential cyanosis and polycythemia but they do not usually go into right heart failure.
William Herndon, Carlsbad, CA
Dave, I have rarely seen dogs with left to right PDAs present with ascites...but I can count the number of cases on
one hand.
Dave Hoch
Thanks for the input. I believe I was taught that with L to R PDA they show up with the continuous murmur, with
varying clinical signs. But as the dog ages, the right side of the heart hypertrophies eventually leading to right to left
shunting. Is that wrong?
William Herndon
>>> I believe I was taught that with L to R PDA they show up with the continuous murmur, with varying clinical
signs <<< Yes
>>> But as the dog ages, the right side of the heart hypertrophies eventually leading to right to left shunting. <<<
Progressive pulmonary vascular disease from chronic left to right shunting resulting in shunt reversal would be a very
rare finding in an older dog.
Mark Rishniw
>>> I believe I was taught that with L to R PDA they show up with the continuous murmur, with varying clinical
signs <<< True. Always, the signs are of left-sided CHF, since the left heart diastolic pressures are increased to the
point of CHF.
>>> But as the dog ages, the right side of the heart hypertrophies eventually leading to right to left shunting. Is that
wrong? <<< Yes. The right heart never sees the overload (just the PA, PV and left heart), so its completely oblivious
to the problem. I have yet to see reactive pulmonary hypertension in a PDA dog that has resulted in right-heart
changes (they generally either get fixed, or die of left-sided failure way before then).
Mark Kittleson
>>> But as the dog ages, the right side of the heart hypertrophies eventually leading to right to left shunting. Is that
wrong? <<< Unfortunately, yes, and on several levels. Take a look at www.vin.com/Link.plx?ID=71596 to read about
the pathophysiology of all of this and get back to us with questions.
Dave Hoch
Thanks guys. I learned all this (my instructors would have good laugh at my expense) but must be experiencing early
onset dementia or a dyslexic moment :)
companion | 19
PETSAVERS
Improving the health of the nations pets
RUNNING THE LONDON
10K FOR PETSAVERS
PETS WE LOVE
PHOTO COMPETITION
PETSAVERS
Jo Arthur describes how
fundraising can mean a
fun day out
T
he London 10K this July was the
sixth that Ive taken part in to raise
money for Petsavers and in my
opinion the atmosphere was better than
ever. Around 25,000 runners gave it their
best for their chosen charity. Every time I
take part in a run for charity Im always
struck how such events reflect the best in
people not just those who run, but all
those who donate sponsorship.
Reasons to run
The number of supporters lining the streets
seemed significantly larger than in previous
years, all shouting encouragement and
clapping us on. Was this because times are
hard for many people at the moment, and
charity events are an opportunity to feel
good about ourselves and those who cant
afford to donate sponsorship can at least
get out on the street and cheer runners on?
Getting going
The race officially starts at 9.35am the
elite runners start first to the cheers and
clapping of all the other runners and stirring
music played over loudspeakers. The rest of
us have to wait our turn, the last in line not
reaching the start line until nearly 10.30am.
The weather was kind to us a mixture
of sunny warm spells and overcast not like
the baking heat of one year, when Mark
Johnston remarked that if we had been
greyhounds or racehorses we wouldnt have
been allowed to run. I was grateful for the
clement weather, as my training had not
gone well due to factors that no doubt
affected many of the Petsavers runners
during the weeks leading up to the run
too much work and even mornings and
evenings being too hot to run. I was also
grateful for the support provided by
Michelle Stead, on Management Committee,
who cheered us on in two directions from
Cleopatras needle.
T
he theme of this years Petsavers
photography competition is Pets
We Love. It is open to all amateur
photographers in the UK and judged in
two categories (Adults: over 16; Junior:
under 16). Remember, this is a great
opportunity for you to develop your own
budding snapper skills, but also
to encourage your clients
and introduce them to the
work of Petsavers and
we will provide you with
flyers and posters to
All worth it
Many thanks to everyone who ran the
London 10K for Petsavers this year, and all
those who ran in previous years. Its still not
too late to get involved if you would like
to show your support for the Petsavers 10K
team and contribute to funding Petsavers
Clinical Research Projects and Training
Programmes, retrospective sponsorship is
very welcome; just go to www.justgiving.
com/petsavers to donate.
promote the competition in your practice.
Photography vouchers will be awarded
to the top three photos from each
category 1st prize receives 250 worth,
2nd prize 150 and 3rd 100. The
competition closes on 28 January 2010.
Full details can be found at www.
petsavers.org.uk. If you would like
more flyers like the one
enclosed in this months
companion, or a poster,
please email your request to
info@petsavers.org.uk.
20 | companion
PUBLICATIONS
KITTEN CLASSES
how they help clients,
pets and practice
Dr Kersti Seksel is the
principal of a referral only
specialist practice for animal
behaviour in Sydney and
Melbourne in Australia and
an author of the new
BSAVA Behaviour manual
(see page 2). Here she
outlines the benefits of
kitten clubs, having been
involved with the popular
Kitten Kindy

organisation
in Australia
O
nce upon a time it was thought
that training a dog before it was
6 months of age was neither
possible nor was it of benefit to the puppy
or the owner. Now this is known to be
incorrect. Puppy training classes were
developed almost 20 years ago and are now
considered the norm. Veterinary practices
around the world have recognised the
benefits and conduct the classes on a
regular basis. This has benefited many of the
6 million dogs in the UK.
Unfortunately, although cats are
thought to be one of the most popular pets
in Britain, most of the 7.7 million cats in the
country have never benefited from training.
In Australia, training schemes such as Kitten
Kindy

are available. The very idea of

training cats is a foreign concept to most
people, and so is the idea of holding kitten
socialisation and training classes. Yet Kitten
Kindy

is one of the training programmes

that has proved just as a successful as its
canine predecessors like Puppy Preschool

,
working as a practice builder and delivering
many benefits to owners, kittens and the
veterinary practice.
What does it involve?
Kitten Kindy

is a socialisation and
education programme designed to help
owners and kittens start off on the right
track. Like similar training schemes it looks
to help prevent behaviour problems, and
educate owners on all aspects of raising a
kitten and then living with a cat in the
family. The aim is also to establish a close
bond between the cat, the owner and the
veterinary practice. It is another valuable
service that veterinarians should offer their
patients and clients.
Kitten Kindy

in particular is designed
for kittens under twelve weeks of age to
help them develop into manageable and
social adult cats. Ideally kittens involved in
such training should be no more than
14 weeks old when they complete the
course to avoid the potential for fighting.
Classes like these allow kittens to
explore, interact, play with toys and
develop confidence. The classes teach
20 | companion
companion | 21
PUBLICATIONS
owners about normal feline behaviour and
how to play and interact with their kittens
appropriately, and helps them to prevent
or at least deal with many problem
behaviours. The success of the programme
depends on the support of all personnel
within the practice.
Why do the classes?
Put simply, it is a great practice builder and
lots of fun. The specific objectives of kitten
training will differ with the individual
practice but generally include education of
owners about health care, feline behaviour,
appropriate play, early identification of any
problem behaviours, and advice on
management and socially responsible pet
ownership.
What do you need to run a
class?
You need a secure area of the hospital so
that exploring kittens cannot escape. It
needs to be relatively large as it is
transformed into a kitten gymnasium and
needs to provide space for the kittens to
explore as well as for the owners to be
seated comfortably.
You should have:
a variety of scratching posts vertical
and horizontal
empty cardboard boxes
a variety of toys such as:
tunnels air conditioning tubing,
ready-made cat tunnels
cat tracks
balls / fluffy toys on elastic or fishing
rods
cat baskets
litter trays
an indoor garden.
Structure
Kittens are obviously not small puppies.
Although the basic principles of training are
similar, classes cant be conducted the same
way as puppy classes. The structure of the
classes should suit the individual practice
and you should aim to recruit the kittens at
the time of their first visit, if not before,
through advertising. Provide owners with
written material on kitten care that
emphasises the importance of training to
their kitten.
Classes are best run over a 23 week
period and each class lasts about 1 hour
each week. The first class is best run
kitten-free so that the owners can listen
without being distracted by kittens.
Kittens should be aged between
812 weeks when they start class. Only
three to six kittens should attend each class
with their owners. Owners of cats older
than 14 weeks are encouraged to attend
without their cat so that they too can learn
about feline behaviour.
Two people are usually necessary to
conduct the class as that allows for better
observation of the kittens and more
effective control of the class. The whole
family should be encouraged to attend and
get involved. All kittens attending class
must have started their vaccination and
worming programme.
What do you teach?
With patience and time, kittens can be
trained to come when called and sit, walk
on a harness and give high-fives. Some
kittens respond well to food and praise
while others are more motivated by a game.
However, the main aim is really to help
owners understand their cats and why cats
do what they do.
Kittens need to learn in a safe non-
threatening environment. The key is always
to reward appropriate behaviour. This can
be done using small tasty treats such as
dehydrated liver, barbecue chicken, cheese,
minced meat, or Vegemite. It helps to start
training when the kitten is most responsive,
for example just before a meal. Each
training sessions should be short no more
than two or three minutes at any one time
but get owners to repeat often at home.
During classes behavioural and medical
issues can be discussed. Behaviour topics
such as litter tray management (how often
to change litter trays, how to clean them,
where to place them), appropriate games,
scratching posts etc should be covered.
Flea control, nutrition and dental care can
also be addressed.
Owners should be taught how to teach
kittens to accept being handled and
restrained. Giving owners a practical
demonstration on how to hold kittens, clip
nails and how to medicate using rewards
are important. Showing owners how to
groom and brush their kitten, and bath
them if necessary can also be useful.
Questions from owners are always
encouraged. Homework sheets can be
handed out at the end of each class that
reinforce advice given in the class.
What can this bring to the
practice?
The classes help develop a strong bond
between the client and the veterinary staff.
They allow the opportunity to educate the
owner that the veterinary hospital is more
than a place for sick animals and annual
heath checks. The kittens develop
confidence and the owners learn that cats
are trainable! Plus its fun!
22 | companion
TOWARDS STANDARDS IN
VETERINARY PRACTICE
Gastrointestinal
Standardization
Group
The WSAVA
Gastrointestinal
Standardization
Group was formed to
develop a world-wide
standard for the
histological evaluation
and diagnosis of gastrointestinal tract
diseases. Without a uniform standard, it has
been difficult to compare and contrast
results reported in retrospective and
prospective clinical trials. With the support
of the WSAVA, the Group has been
developing a standardized histological
evaluation system for companion animal
gastroenterological disorders.
Standardization will yield several benefits
including uniformity in the diagnosis of
disease, staging of disease, and the
subsequent development of controlled
clinical trials for the treatment of canine and
feline gastrointestinal disorders.
A look at the
achievements and future
plans of the WSAVA
Standardization Projects
The Groups efforts have been
presented at various conferences, including
the WSAVA Congress in Dublin, the
ACVIM Forum and the ECVIM Congress.
The Group presented its report at a Full
Plenary Session at the ACVIM Forum on
June 7, 2008 in San Antonio, leading to an
ACVIM Consensus Statement. These
Statements are designed to provide
veterinarians with guidelines regarding the
pathophysiology, diagnosis, or treatment of
animal diseases. The foundation of the
Consensus Statement is evidence-based
medicine, but if such evidence is conflicting
or lacking, the appointed panels provide
interpretive recommendations on the basis
of their collective expertise. A more formal
version of the Consensus Statement has
been submitted for publication in JVIM.
Future projects for the GSG include:
Developing a standard for jejunal and
ileal pathology
Standards for surgical biopsy of the GI
tract
Diagnosis and staging of gastrointestinal
lymphoma, especially well-differentiated
feline lymphoma
Biopsy standards for the diagnosis of
intestinal lymphangiectasia
Investigating the relationship between
histopathological and clinical findings.
Key publications from the GSG
Day MJ, Bilzer T, Mansell J, Wilcock B, et al. Histopathological standards for the
diagnosis of gastrointestinal inflammation in endoscopic biopsy samples from
the dog and cat: a report from the World Small Animal Veterinary Association
Gastrointestinal Standardization Group. Journal of Comparative Pathology
2008; 138: S1S43
Willard M, Mansell J, Fosgate G, et al. Effect of sample quality upon the
sensitivity of endoscopic biopsy for detecting gastric and duodenal lesions in
dogs and cats. Journal of Veterinary Internal Medicine 2008; 22: 10841090
ACVIM Consensus Statement on Guidelines for Histopathological Assessment
of Intestinal Inflammation in the Dog and Cat. Submitted to the Journal of
Veterinary Internal Medicine
An atlas of the Groups work WSAVA Standards for Clinical and Histological
Diagnosis of Canine and Feline Gastrointestinal Diseases is projected for
publication in 2010
companion | 23
WSAVA NEWS
communication system that allows voice and
visual conferencing on the study material.
The system is cost-effective and allows
sharing of high quality images and excellent
internet-based voice communication. The
images can be manipulated by any member
participating in the conference. The project
was presented at the ACVIM 2009 Forum in
Montreal, Canada.
Looking to the future, the Group is
exploring opportunities to prospectively
gather more comprehensive case-specific
information to be able to correlate disease
classification, therapeutic protocol and
outcome, thereby allowing better disease
prognostication.
Please visit the GI Standardization
page of the WSAVA website
(www.wsava.org) for more
information, including standardized
forms for collecting and reporting
information obtained during
gastrointestinal endoscopy.
The WSAVA and WSAVA
Gastrointestinal Standardization
Group would like to extend its
sincere appreciation to Hills Pet
Nutrition for their generous
sponsorship of this initiative.
Please visit the Liver Standardization
page of the WSAVA website for more
information.
The Groups work has been made
possible through the generous
sponsorship of Hills Pet Nutrition.
Please visit the Renal Standardization
page of the WSAVA website for more
information about the Groups
activities.
The WSAVA and WSAVA Renal
Standardization Group would like to
extend its sincere appreciation to
Bayer Animal Health and Hills Pet
Nutrition for their generous
sponsorship of this initiative.
Renal
Standardization
Group
The purpose of this
initiative is to employ
the three diagnostic
modalities used in
human nephro-
pathology (light,
electron, and
immunofluorescent microscopy) to
accurately characterize glomerular disease
in proteinuric dogs, and to relate these
findings to clinicopathological presentation
and outcome. The projects long-term goal
is to better understand and evaluate, and
thus optimize, the medical management of
dogs with proteinuric renal disorders.
To accomplish this, two diagnostic renal
pathology centres (DRPCs) Texas A&M
University and Utrecht University
purchased Aperio, a slide digitizing system
and software. The equipment has been
installed and configured, and is functioning
beyond initial expectation. This system
allows samples to be submitted to the
DRPC for processing and then digital
capture of the entire stained section(s) on
each microscopic slide. The scanned slides
then can be examined by any of the
committee members anywhere in the world
through a computer. Electron microscopic
and immunofluorescent microscopy images
can be (and are being) digitally added to the
database for viewing as well. The group of
participating renal pathologists has
expanded to include a number of additional
group members from the USA and Europe.
In addition, the group has developed an
extensive electronic relational medial
database for collecting clinical information
on the patients for which biopsy samples
are submitted. The goal is to develop a
comprehensive and unbiased dataset, in
which individual lesions can be quantified
and manipulated statistically to identify
logical and clinically useful combinations of
clinical and pathological findings, which are
needed to develop a classification system
for proteinuric dogs.
The Group has successfully begun using a
Liver
Standardization
Group
This Groups
activities have
culminated in
worldwide
standardization for
histological evaluation
of liver tissues for
liver diseases of dogs and cats, including
unified nomenclature, well-defined
histological diagnostic criteria, and precise
definition of chronicity stages and grades of
diseases. Additionally, recommendations
surrounding the requirements for tissue
staining techniques and size of tissue
specimens have been put forward for the
different diseases. Descriptions of all
relevant liver diseases of dogs and cats,
together with typical slides, have been made
available as a reference for all veterinarians
through the publication of the WSAVAs
first textbook, WSAVA Standards for Clinical
and Histopathological Diagnosis of Canine and
Feline Liver Diseases, available from Elsevier.
The Group has presented extensively at
various veterinary conferences around the
world, including the recent ACVIM 2009
Forum in Montreal, Canada.
Helping to make the work
possible
Integral to the adoption of WSAVAs
standardization projects is the peer-review
provided by the WSAVA Scientific Advisory
Committee (SAC). Chaired by Prof Michael
Day, the SAC also provides crucial
assistance in the planning of the various
Congress scientific programs, assessing
nominations and recommending WSAVA
Award winners, and suggesting responses
to the requests for input on scientific
matters that are often received by the
WSAVA Executive Board.
Another critical factor in the success of
the WSAVA Standardization Projects has
been that a number of industry leaders in
small animal veterinary medicine, including
Bayer Animal Health, Hills Pet Nutrition,
and Intervet/Schering-Plough Animal
Health, have recognized the benefits to
global companion animal health. It is
through their generous support that these
initiatives have become a reality.
24 | companion
WSAVA NEWS
WSAVA NEWS WSAVA NEWS
A FRESH LOOK
AT VACCINES
The VGG is entering a new
phase of activity
VGG group: left-right: Drs Ron Schultz, Marion Horzinek and Michael Day
T
he first phase of the work of the
WSAVA Vaccination Guidelines
Group (VGG) is now complete, and
led to the production of international
guidelines for vets that were published in
the Journal of Small Animal Practice (volume
48 issue 9, September 2007, pages 528541)
and are also available
on the WSAVA
website. The
guidelines were
formally presented at
the 2007 Sydney
Congress and, since
that time, members
of the VGG have
spoken widely on
them in the USA,
UK, elsewhere in Europe and in Australia.
The VGG has now been reconvened for
a second phase of activity following
agreement of sponsorship from Intervet/
Schering-Plough Animal Health. This
sponsorship will permit a further one-year
cycle of activity with three face-to-face
meetings. The first of these meetings
was held from 13 February 2009. Under
the leadership of the new VGG chair,
Professor Michael Day, the second phase
of the VGG will:
Update the 2007 guidelines
Survey WSAVA member associations to
collect and analyse feedback on the
VGG guidelines
Prepare a new set of guidelines for pet
owners and breeders
Present a discussion paper on key issues
in teaching of veterinary immunology
and vaccinology.
To access the 2007 guidelines and
find out more about the VGG, visit
www.wsava.org/SAC.htm
The members of the VGG and the
WSAVA would like to thank Intervet/
Schering-Plough Animal Health for
their kind generosity in sponsoring the
activities of the VGG.
companion | 25
THE companion INTERVIEW
ELIZABETH
SIMPSON
Elizabeth Simpson was born and grew up near
Croydon, Surrey. Although her school didnt
encourage academic ambition, her father, who
worked in the City, helped her to choose science
subjects at A-level to allow her to pursue veterinary
medicine. Elizabeth applied to the veterinary
schools in London, Bristol and Cambridge, being
rejected by the first on the grounds that they had
already accepted their female for the next years
intake (1957), but was offered a place at each of the
other two schools. Elizabeth chose Cambridge,
where she was the only female student in her year,
though she says she was never made to feel an
outsider by either fellow students or teachers
You spent only a brief time in
practice after qualifying in
1963. What attracted you to an
academic career?
A strong curiosity to find out
more about the underlying
pathophysiology of disease, an
interest awakened in me during my
undergraduate exposure to cutting edge
physiology and pathology in Cambridge
and subsequently, during my clinical
training, to morbid anatomy and
histopathology under the guidance of
Dr Arthur Jennings at the Cambridge
veterinary school. During the two years
I spent in practice I was often frustrated
at not being able to explore disease
diagnosis beyond an examination of
biopsies histologically and carrying out
postmortems when appropriate.
After returning from Canada in 1966,
you worked at Cambridge before taking
a post at the National Institute for
Medical Research in London in 69.
What was your first project there?
My research work in Cambridge was
focused on tumour rejection responses in
mice and dogs, and I obtained an MRC
project grant for this. But I was also
teaching pathology to clinical veterinary
students as a University Demonstrator
(i.e. junior lecturer), and I helped to run the
postmortem and diagnostic pathology
service of the veterinary school, under
Dr Jennings guidance. I moved to the NIMR
following an invitation by Sir Peter
Medawar, who was then the Director, to
spend some of my time providing pathology
advice to the experimental animal division,
but with the rest free to follow my research
interests which by then had converged on
the role of various lymphocyte
subpopulations in graft rejection responses,
a topic under intense scrutiny at the NIMR
by a number of scientists, including the
Director, at that time.
How difficult was it to build a scientific
career at a time when it was still very
much a male-dominated world?
I found little or no evidence of sexism in
attitudes towards me as a student, vet or
scientist, either in Cambridge or in London.
In contrast, in Canada I had experienced
substantial discrimination in the profession,
and in order to work as a vet I had had to
start my own practice in Fredericton, New
Brunswick, where my then husband had
registered for a PhD in geology at the
university. When we moved to Ottawa, I
likewise had difficulty in being accepted for
veterinary posts (how would you, as a
woman, do a postmortem on a cow?
they seemed not to have heard of the block
and tackle), so I moved into a virology
research lab.
At the NIMR and the various other
MRC research institutes where I worked
as a research scientist, I was respected
and well mentored by senior scientists
such as Peter Medawar and Avrion
Mitchison, and I also spent a very
productive time at NIH in the US in the
1970s (and as a summer visitor to the
Jackson labs in Maine from 1976). I was
working in a very exciting area of cellular
immunology, where conceptual and
practical advances were being made rapidly
on the international scene. In a sense, there
was no time to be sexist, you just got on
with what you personally thought was
important, and were judged on what you
did, whether male or female.
Q
A
26 | companion
THE companion INTERVIEW
You have built a formidable reputation
as a cellular immunologist what
specifically have been your interests in
this area?
At a fairly early stage in my research career
I became fascinated in trying to fully
understand a simple graft rejection system,
with respect to both the genetics
controlling rejection by the recipient and
the exact molecules that were being
recognised as foreign in the graft.
The simple graft I chose was the skin of
males transplanted to females of the same
inbred strain. The rejection target molecules
were therefore encoded by a histocompati-
bility gene or genes on the Y chromosome
(HY). These grafts were rejected by females
of some inbred strains (e.g. rats, mice), but
not others, so there were immune response
(IR) genes of the recipient strain that also
needed to be identified.
Another feature of the system I chose
to study was the relatively slow rejection
time, implying that the targets were weak
transplantation antigens; in this way they
resembled the tumour antigens that I had
originally wished to study but with which I
became frustrated, due to the difficulty of
getting to grips with their molecular nature.
So, for me, these grafts expressing weak
transplantation antigens were a proxy for
tumours, and I hoped that by studying
them I would throw light on how better
to tackle treatment of tumours in all
species humans are, after all, to vets,
just another species!
My work in this area resulted in
identification of both the IR genes
controlling responsiveness and the HY gene
products that were the target of the
response. It also showed that these graft
rejection responses were effected by
T lymphocytes, which recognised peptide
fragments of the weak transplantation
antigen presented in a specialised peptide
binding groove of a self cell surface
molecule, the so-called MHC restricted
responses (as described for viruses in 1974
by Zinkernagel and Doherty Doherty is
also a vet who were awarded the Nobel
prize for their discovery). MHC restriction
turns out to be a fundamental property of
all adaptive immune responses to viruses
and other pathogens, as well as transplants,
tumours and the autoantigens responsible
for autoimmune disease. This understanding
is fundamental for devising rational
treatments such as vaccination and
immunosuppression.
What have been the applications of
your research?
We now understand a great deal about
adaptive immune responses to tumours
induced by viruses and they can be tackled
by vaccination approaches, e.g. papillomas in
many species, certain leukaemias and
lymphomas, although we need to
understand better the normal regulatory
responses that can limit effector function.
Autoimmune disease is common in humans
and is increasingly recognised in other
species. Immunosuppression can be
effective in treatment but has undesirable
side effects, so better targeted approaches
are being studied.
The research I have done is of a
fundamental nature and therefore has
application across a broad field, both
clinically and experimentally. It has not been
directed primarily towards addressing a
specific clinical question. But clinical
questions cannot be effectively solved in the
absence of an underlying knowledge, and
that, by the very nature of scientific
advance, is an ever-changing scene. We
move from hypothesis to hypothesis,
disproving one before proposing another
that better fits the observations. Vets are
uniquely trained as observers of the whole
animal, and in a very strong position to
follow their observations and their scientific
curiosity to open up new avenues for
research and further knowledge.
What do you consider to be your
most important professional
achievement so far?
Having had a very satisfying research
career, contributing to the training of
other scientists, and seeing my interests
in science and medicine taken forward
by them and their colleagues. Also
important to me is my role, in the past and
present, in contributing to the selection
process for fellowships, both human and
veterinary, awarded to young clinicians
for going into research.
Who has been the most inspiring
influence on your professional career?
Sir Peter Medawar, the British zoologist.
Medawars work on graft rejection and the
discovery of acquired immunological
tolerance, for which he was awarded a
Nobel prize, was fundamental to the
practice of tissue and organ transplantation.
What is the most significant lesson you
have learned so far in life?
The importance of keeping an open mind
about all matters.
If you were given unlimited political
power, what would you do with it?
Reject it immediately.
If you could change one thing about
your appearance or personality, what
would it be?
To become a little more tolerant!
What is your most important
possession?
My family, if I can be said to own them!
THE companion INTERVIEW
Since retiring from the Medical Research Councils Clinical Research
Centre in Harrow Elizabeth has acted as consultant to various
research charities (including the Wellcome Trust) who fund
fellowships for young scientists (human and veterinary clinicians)
at the beginning of their research careers. She is also an advisor to
laboratory research groups, at Imperial College and elsewhere.
CPD DIARY
companion | 27
CPD
DIARY
9
September
Wednesday
Orthopaedics: the diagnosis
and management of carpal
and tarsal problems
Speaker Hamish Denny
The University of Bristol, Langford
House, Langford, North Somerset
BS40 5DU. South West Region
Details from Kate Rew,
kate@linhayvet.co.uk
EVENING
MEETING
23
September
Wednesday
Management of dermatophytes
Speaker Anita Patel
The Russell Hotel, 136 Boxley Road,
Maidstone, Kent ME14 2AE. Kent Region
Details from Hannah Perrin,
hannah@burnhamhousevets.com
EVENING
MEETING
12
October
Monday
Thoracic radiology
Speaker Nic Hayward
The University of Exeter, Queens
Margaret Rooms, Streatham Campus,
Northcote House, Exeter EX4 4QJ.
South West Region
Details from Kate Rew,
kate@linhayvet.co.uk
EVENING
MEETING
10
September
Thursday
Preparing for bonfire night
special. Drugs used to treat
behaviour/phobias
Speaker Danny Mills
The Acorn House Veterinary Surgery,
Linnet Way, Brickhill, Bedford
MK41 7HN. East Anglia Region
Details from Graham Bilbrough,
graham-bilbrough@idexx.com
EVENING
MEETING
10
September
Thursday
Practical haematology:
detective work for nurses
Speaker Kostas Papasouliotis
BSAVA, Woodrow House, 1 Telford
Way, Waterwells Business Park,
Quedgeley GL2 2AB.
Organised by BSAVA
Details from the Membership and
Customer Service Team, 01452 726700,
administration@bsava.com
DAY
MEETING
13
September
Sunday
Considering behaviour in
veterinary medicine
Speaker Sarah Heath
The Pavilions of Harrogate, Great
Yorkshire Showground, Harrogate
HG2 8QZ. North East Region
Details from Karen Goff, 01924 275249,
northeastregion@bsava.com
DAY
MEETING
15
September
Tuesday
Endoscopy
Speaker P.J. Noble
The Swallow Hotel, Preston New Road,
Preston PR5 0UL. North West Region
Details from Simone der Weduwen,
01254 885248, beestenhof@
ntlworld.com
EVENING
MEETING
22
September
Tuesday
Oncology I
Speaker Rob Foale
BSAVA, Woodrow House, 1 Telford Way,
Waterwells Business Park, Quedgeley
GL2 2AB. Organised by BSAVA
Details from the Membership and
Customer Service Team, 01452 726700,
administration@bsava.com
DAY
MEETING
24
September
Thursday
GIT I
Speaker Penny Watson
The Thorpe Park Hotel and Spa,
1150 Century Way, Thorpe Park, Leeds
LS15 8ZB. Organised by BSAVA
Details from the Membership and
Customer Service Team, 01452 726700,
administration@bsava.com
DAY
MEETING
14
October
Wednesday
Dispensing law
Speaker John Hird
The Holiday Inn Haydock, Lodge Lane,
Newton Le Willows WA12 0JG.
North West Region
Details from Simone der Weduwen,
01254 885248, beestenhof@
ntlworld.com
EVENING
MEETING
7
October
Wednesday
Rational use of practical
diagnostic imaging in common
small animal emergencies
Speakers Chris Lamb and Monica Merlo
The Packfords Hotel, 16 Snakes Lane
West, Woodford Green, Essex IG8 0BS.
Metropolitan Region
Details from Alison van Gelderen, 0772
0755000, allivetuk@yahoo.co.uk
DAY
MEETING
10
September
Thursday
ECGs for dummies like me
Speaker Geoff Culshaw
The L.A Lecture Theatre R(D)SVS,
Edinburgh. Scottish Region
Details from Claire Robertson,
07792 251003, claireadriennelamb@
hotmail.com
EVENING
MEETING
9
September
Wednesday
Haematology Road Show
Speakers Guillermo Couto and Michael Day
Day meeting at the Daventry Hotel,
Sedgemoor Way, Daventry,
Northamptonshire NN11 0SG.
Organised by BSAVA
Details from the Membership and
Customer Service Team, 01452 726700,
administration@bsava.com
11
September
Friday
Haematology Road Show
Speakers Guillermo Couto and Michael Day
Day meeting at Mottram Hall, Wilmslow
Road, Mottram St Andrew, Cheshire
SK10 4QT. Organised by BSAVA
Details from the Membership and
Customer Service Team, 01452 726700,
administration@bsava.com
14
September
Monday
Haematology Road Show
Speakers Guillermo Couto and Michael Day
Day meeting at the Marriott Hotel,
Kingfisher Way, Hinchingbrooke
Business Park, Huntingdon PE29 6FL.
Organised by BSAVA
Details from the Membership and
Customer Service Team, 01452 726700,
administration@bsava.com
16
September
Wednesday
Haematology Road Show
Speakers Guillermo Couto and Michael Day
Day meeting at the De Vere Hotel,
Hook Heath Road, Gorse Hill, Woking
GU22 0QH. Organised by BSAVA
Details from the Membership and
Customer Service Team, 01452 726700,
administration@bsava.com
British Small Animal Veterinary Association
Woodrow House, 1 Telford Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB
Tel: 01452 726700 Fax: 01452 726701
Email: administration@bsava.com
Web: www.bsava.com
For more information
or to order visit www.bsava.com,
email administration@bsava.com
or call 01452 726700
BSAVA CPD Road Shows
Keeping you ahead...
The veterinary profession is full of great
practitioners and the BSAVA can help you
stay at the forefront of your career through
our extensive CPD programme. Over the
coming months BSAVA is holding three
Road Shows, bringing more choice and
international specialists to your doorstep.
A series of 1-day courses which will deliver the very
best CPD, at a convenient location and at a cost that is
great value for money.
BSAVA CPD Road Shows Well see you there!
Haematology in
practice all you
need to know
Guillermo Couto &
Michael Day
09 September Daventry
Hotel, Northamptonshire
11 September Mottram Hall,
Cheshire
14 September Marriott
Hotel, Huntingdon
16 September Gorse Hill,
Woking
Feline infectious
diseases
Michael Lappin &
Danille Gunn-Moore
16 October Chilworth
Manor, Southampton
18 October Hilton Hotel,
Dunkeld
19 October Mottram Hall,
Cheshire
21 October Miskin Manor,
Nr Cardiff
Orthopaedics
Mike Conzemius &
John Innes
4 November Radisson
Hotel, Belfast
11 November Bellhouse
Hotel, Beaconseld
Mike Conzemius &
Michael Guillard
6 November Thistle Hotel,
Brands Hatch
9 November Novotel Hotel,
Newcastle
Road Show Fees
Members price
191.83 inc. VAT
Non-members price
287.74 inc. VAT
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