companion

JULY 2014

The essential publication for BSAVA members

Zoo animal,
wildlife or pet?
Welfare issues
explored

Clinical Conundrum How To… Clinical Abstracts

Pelvic limb weakness Read a capnography Hidden gems of
trace Congress
P10 P14 P22
 3 BSAVA News
Latest from your Association
What’s in JSAP this month?
4–8 Not reigning cats and dogs
Non-traditional pets Risk factors for postoperative
complications following bilateral
closed anal sacculectomy
9 Client information sheets
Useful resources for the practice

10–13 Clinical Conundrum

Pelvic limb weakness
Tim Charlesworth from dogs were over-represented within this
study population.
14–18 How To…
Read a capnography trace
Eastcott Referrals reports on The paper concludes that anal
the complication rate for sacculectomy is a safe procedure with a
20–21 Scottish Congress bilateral closed anal relatively high rate of short-term but
What speakers say self-limiting, minor postoperative
sacculectomy in the dog, in a complications. Smaller (<15 kg) dogs are
22–25 Clinical Abstracts
Hidden gems of Congress
study aimed at evaluating more likely to experience postoperative
potential risk factors for the complications but the risk of permanent
faecal incontinence is low.
26–27 PetSavers & oncology
Jane Dobson reports
development of postoperative Adapted from Charlesworth T. JSAP 2014; 55: 350–354
complications and identifying
ALSO IN THIS MONTH’S ISSUE
28–29 WSAVA News
World Small Animal Veterinary
breed groups at risk of
Radiographic and MRI characteristics of
requiring anal sacculectomy
■
Association

A
30–31 The companion interview
retrospective review was carried
Martin Alder
out of the medical records of
dogs undergoing bilateral closed
33 Regional CPD
Local knowledge close to home anal sacculectomy between 2003
and 2013. Sixty-two dogs were included in
34–35 CPD Diary the study of which 32.3% developed mild
What’s on in your area and self-limiting complications, including
14.5% of dogs that experienced
postoperative defecatory complications.
No dog developed permanent faecal
incontinence. Dogs less than 15 kg
bodyweight were more likely to develop
postoperative complications. Dogs in
which gel was used to distend the anal sac
were more likely to have postoperative
complications than those where gel was
not used. Previous abscess formation,
recurrent disease and pretreatment with
Additional stock photography:
antibiotics had no significant effect on
www.dreamstime.com
© Dave Bredeson; © Isselee; © Rixie; © Winai Tepsuttinun postoperative complication rates. Cavalier
King Charles Spaniels and Labrador-type
lumbar disseminated idiopathic spinal
hyperostosis and spondylosis deformans
in dogs
Prevalence of dermatophytes and
■
other superficial fungal organisms in
asymptomatic guinea pigs
Diagnostic value of MRI in dogs with
■
inflammatory nasal disease
■ Comparison of bacterial cultures from
urine and cystoscopically obtained lower
urinary tract biopsies in dogs
■ Evaluation of toxicities from combined
metronomic and maximal tolerated
dose chemotherapy in dogs with
osteosarcoma
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!

companion is published monthly by the British Editorial Board No part of this publication may be reproduced
in any form without written permission of the
Small Animal Veterinary Association, Woodrow publisher. Views expressed within this
House, 1 Telford Way, Waterwells Business Park, Editor – Simon Tappin MA VetMB CertSAM DipECVIM-CA publication do not necessarily represent those
Quedgeley, Gloucester GL2 2AB. This magazine MRCVS of the Editor or the British Small Animal
is a member-only benefit. Veterinary schools Veterinary Association.
interested in receiving Past President – Michael Day BSc BVMS(Hons) PhD DSc For future issues, unsolicited features,
companion should DiplECVP FASM FRCPath FRCVS particularly Clinical Conundrums, are
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bsava.com. We welcome available on request; while the publishers will
all comments and ideas ■ CPD Editorial Team take every care of material received no
for future articles. Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS responsibility can be accepted for any loss or
Tony Ryan MVB CertSAS DipECVS MRCVS damage incurred.
Tel: 01452 726700 Lucy McMahon BVetMed (Hons) DipACVIM MRCVS BSAVA is committed to reducing the
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■ Features Editorial Team on paper made from sustainable resources
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ISSN (print): 2041-2487 ■ Design and Production Members can access the online archive of
ISSN (online): 2041-2495 BSAVA Headquarters, Woodrow House companion at www.bsava.com .

2 | companion JULY 2014 | © BSAVA 2014

Pet travel
consultation Volunteer
B voice
SAVA invites members to
participate in a consultation
on pet travel. The current
pet travel regulations

Get BSAVA
(EU 998/2003 and its amendments)
will be replaced by a new
Regulation (EU 576/2013) on the
non-commercial movement of pet
animals which will come into effect
publications
on the move Get to know

on 29 December. While the
fundaments of the Pet Travel
Scheme remain the same there will
be some changes, including:
■ A new format passport with
laminated strips to reduce
tampering and space for more
details of the issuing and
certifying veterinary surgeon to
improve traceability
Y
ou can now get the latest your BSAVA
companion issue on your
mobile or tablet via the new colleagues
BSAVA e-companion app. As
well as the convenience of reading and
storing each issue on your device,
additional functionality and content is
provided such as image hotspots, active Barbara-
weblinks and related material from other
Ann Innes

A
■ A minimum age of 12 weeks for BSAVA publications.
vaccination The app is available for Android and
iPad. The Android version will work on friend and ex-colleague suggested I join
■ A requirement for veterinary
tablets and phones with a screen size of BSAVA Scottish Region. Having attended
practices to keep pet passport
4.5" or larger. A version compatible with Congress in Birmingham and Scottish
information for at least three
the iPhone is under development. The Congress on a regular basis, the chance to be
years
e-companion app includes all the 2014 involved in selecting lecture topics and organizing CPD
■ Increased requirements for
issues – the archive of back issues will events appealed to me. Since then I’ve been the
documentary and identity
be added shortly. Scottish Region’s Congress Coordinator, and also a
checks in all EU Member States
Don’t forget, you can also access member of BSAVA Education Committee.
■ New rules for those travelling
the latest articles in the Journal of Small As the Scottish Region’s Congress Coordinator I
with more than five pets.
Animal Practice via an app provided by am responsible for liaising with the venue, staff at Head
our publisher, Wiley. The app gives you Office and the rest of the committee to make sure we
Defra will be carrying out a
access to the latest papers, put on a great event every year.
consultation to gather views on
bookmarking and article sharing I’m also involved in helping produce CPD in the
the implementation of these
features, dynamic figures, tables and Scottish Region throughout the year in my role on the
regulations from both veterinary
references, and the ability to browse regional committee. I produce meeting previews and
practices and members of the
content before downloading an issue or reviews for companion and help coordinate our
public. At the time of going to
article for offline use. The app is advertising. My interest in CPD extends to my role on
press the details of this
available for Apple devices; a version for the Education Committee too, where I take part in
consultation were not available
Android devices is under development. discussions on BSAVA’s national education programme.
but will be posted on the
For further information on how to I’ve met some great people since volunteering with
Consultation page of the BSAVA
download and activate the apps visit the BSAVA, who are all very supportive and encouraging.
website, along with our own
My apps page in the myBSAVA section I’ve also increased my range of skills. I would never
questionnaire. ■
of the website (login required). ■ have thought that I had the ability to help organize and
run a large event like Scottish Congress. There’s a real
sense of achievement when it all goes well and both

Seeking new volunteers

delegates and exhibitors are happy.
As a Veterinary Nurse member, I like having access

in Northern Ireland
to the BSAVA Pocketbook for Veterinary Nurses and to

B
the BSAVA Small Animal Formulary, plus, without the
significant member discount on CPD I would never
SAVA is recruiting members to form a new Regional Committee to help
have had the opportunity to complete the Veterinary
shape the future of the profession in Northern Ireland. After a successful
Nursing Merit Award in Anaesthesia and Analgesia.
Congress weekend in May, four members of the Northern Ireland
I’d encourage anyone to get involved as a BSAVA
Regional Committee held their Annual Regional Meeting where they
volunteer. You will meet a great bunch of people and
decided not to stand for re-election.
learn a lot from them. ■
BSAVA wishes to thank the former committee members for all their hard
work in the region over the years. Thanks also to VetNI for their ongoing
contribution as our congress organizer. Find out how you can get involved as a
Email Carole Haile – c.haile@bsava.com – to find out more about BSAVA volunteer, email Carole Haile –
volunteering as a Regional Officer in Northern Ireland. ■ c.haile@bsava.com.

© BSAVA 2014
| companion JULY 2014 | 3
Not reigning
cats and dogs
BSAVA is working with stakeholders in
the pet industry on an initiative aimed at
improving the quality of care provided by
owners of ‘non-traditional’ companion animals.
There are plans to offer guidance to veterinary
professionals who have step in to deal with
health problems often caused by ignorance or
inexperience. John Bonner reports
G
enerations of selective breeding were
needed to produce the rounded heads
and juvenile appearance of many popular
dog breeds. However, the same effect can
be achieved over a few months in lizards by simply
failing to provide them with a satisfactory diet.
Changes in skull shape caused by softening of
the bones are an important clinical sign in reptiles
affected by metabolic bone disease. This condition is
only one of many seen by veterinary practitioners
dealing with the hugely increased numbers of
non-traditional pets. That their owners are unable to
recognize or prevent diseases caused by poor
management is not due to lethargy or callousness
– more that they don’t understand their animal’s basic
biological needs.
Call for a ban
Concern among veterinary surgeons about the
incidence of easily preventable diseases in what
are often called ‘exotic’ pets is nothing new.
4 | companion JULY 2014 | © BSAVA 2014
However, there has been a renewed intensity to the
debate over recent months since Neil Forbes and
Martin Whitehead, two practitioners with a strong
interest in these non-traditional pets, published a letter
in the veterinary press calling for regulations to ban all
but a few reptile species from being kept as pets.
That drew a swift response from colleagues keen
to protect the interests of those experienced reptile
keepers who not only look after their animals well but
have also made substantial contributions to our
understanding of their biology. Hampshire-based
practitioner Peter Scott wrote that “demonising exotic
pets and exotic pet owners is simply dishonest:
welfare problems exist across all species.”
Yet, as RSPCA chief veterinary officer James
Yeates points out, welfare issue in other species
doesn’t justify inaction over the problems in
reptiles and other non-traditional pets.
Moreover, there is good reason for treating
this group as a special case because of the
increased risk of poor welfare due to ignorance
of their physiology and behaviour.
“Generally, people would say it is important for
animals to be kept in conditions as close to their
natural environment as possible. That is difficult to
achieve in an ordinary home as you will typically
need ultraviolet light, a massive temperature
gradient, good humidity control, suitable vegetation,
water, etc. That requires huge resources and the
people providing all that can’t really be called pet
owners, they are really running a private zoological
collection” he says.
 Discussing reptiles as if they are a homogenous
group is unhelpful, Dr Yeates goes on, due to the
huge variation in the habits and needs of different
species. Hence there is limited knowledge of the
requirements of most species not only in the
pet-keeping population but also among those
veterinary practitioners who may be asked to deal
with the resulting health problems. So he supports
Forbes and Whitehead’s proposal for a positive list of
those species that can be kept in captivity with
reasonable confidence. That would be preferable to
a negative list of banned species, which he says
would be less effective, more difficult to administer
and lacks the necessary precautionary approach to
novel pet species.
Positive lists the answer?
Andover-based practitioner John Chitty is, like
Martin Whitehead, a member of the BSAVA Scientific
Committee’s Exotic Species Subcommittee. He also
favours a positive list of commonly kept and
reasonably well studied species such as corn
snakes and bearded dragons, but cautions that
there are many animals already in private hands that
would not be included on the list. “If we went down
that route we would have a major headache in
deciding what to do with those animals,”
he warns.
However, Martin Whitehead feels that
legislators can take encouragement from
the examples of positive list legislation
already in force in Belgium, the
Netherlands and Australia.
“The Belgian and Dutch
rules only cover mammalian species but they have
been reasonably successful and the same principles
could be applied to other groups,” he says.
Perhaps understandably, the pet trade is
unenthusiastic about the prospect of rules being
introduced to prevent pet shops from selling a wide
range of the species currently available. This would be
unfair to owners who are able to keep those animals in
captivity with acceptable morbidity and mortality
levels, it says. Given that fundamental disagreement,
the sector trade association, the Pet Industry
Federation (PIF), deserves great credit for inviting
various veterinary bodies and animal welfare
organizations to a meeting on exotic animal welfare at
London Zoo earlier this year.
Profession and trade working together
Inevitably, there was still some evidence of the
mutual distrust that historically has coloured the
relationship between the veterinary profession and
the pet trade, but the meeting produced more
progress than either side may have expected. In
particular, the PIF’s educational arm, the Pet Charity
(formerly the Pet Care Trust), proposed setting up
four working groups to investigate the key issues
and the BSAVA has agreed to nominate
representatives for each one.
© BSAVA 2014
| companion JULY 2014 | 5
Not reigning cats and dogs
The first group will address the terminology used
by each of the main stakeholders to ensure that they
are all speaking a common language. That is
essential because people may even disagree about
what constitutes an exotic pet. So, for example,
should the raptors used in falconry or rare
psittacines kept in private breeding colonies be
regarded as pets?
For the moment, the working groups will focus
solely on reptiles. One will try to gather accurate data
on the numbers of reptiles kept in Britain, while another
will analyze the supply chain for reptilian pets in the
UK and make recommendations on the sourcing,
transport and sale of these animals. Finally, another
group will investigate the available data on the welfare
of reptilian pets with the aim of producing information
sheets for new owners that can be endorsed by
each of the contributing organizations.
The last group is, therefore, addressing the issue
which all sides agree is crucial to improving the welfare
6 | companion JULY 2014 | © BSAVA 2014
of captive reptiles – better education for prospective
owners. Often they not only know very little about their
responsibilities to the animal but also make the
decision to buy one on the spur of the moment.
Accurate, authoritative and clear information needs to
be available at the point of sale while better training is
necessary for the staff working in pet shops.
Gaining greater understanding
The veterinary profession also needs to know more
about these species – currently, only a small
percentage of practitioners have an active interest in
these species, but that may change over the next few
years. Michael ‘Stan’ Stanford of the British Veterinary
Zoological Society points out that a more
comprehensive understanding of common reptiles will
now be included on the Royal College’s list of Day 1
competencies required of new veterinary graduates.
Yet improved education is not a panacea for the
problems experienced by reptiles in captivity. “It will
certainly help but it isn’t a complete solution, I feel that
there will also have to be legislation and proper
enforcement,” said Martin Whitehead. He would favour
a licensing system like that proposed by the German
Veterinary Association’s Exotic Animals Group that
requires would-be owners of the more unusual pet
species to undertake suitable training before being
allowed to take their animal home.
 Mr Whitehead acknowledges that in the current
political climate in the UK it is probably very unlikely
that the government would introduce legislation to
control the trade in, and ownership of, reptiles.
Indeed, a Defra official at the PIF meeting did warn
that there is little appetite in government for
introducing potentially costly bureaucracy. He
suggested that it should be the industry that takes
responsibility for improving health and welfare by
setting up a system of self-regulation.
However, as Michael Stanford points out, decisions
on animal welfare issues are often made in Brussels
not Whitehall. “That is why it is important for the
relevant veterinary organizations – the BVA, BSAVA
and BVZS – to reach a consensus on the right way
forward and take their views to Europe.” They could
then lend their weight to the efforts of the Federation of
Veterinarians in Europe, which has urged the
Commission to prepare regulations for a positive list of
approved species that would be similar to, but more
comprehensive than, the Belgian and Dutch system.
Drafting such rules would be complicated by
issues such as those raised by John Chitty on the care
of existing pets. But in the meantime, the Commission
could consider much simpler regulations that would
not only protect welfare but would also have the
potential capacity to control disease and protect
endangered species.
Regulations banning the import of wild caught
birds were introduced in 2007 to limit the risks of
importing avian influenza but they have had broader
benefits. John Chitty points out that the regulations
have been effective in encouraging captive breeding
of many parrot species and has taken some of the
pressure off wild populations. He believes that similar
rules banning imports of wild caught reptiles and
amphibians could have equally positive effects –
although he says that there would need to be
exemptions for conservation purposes, to allow
public zoos and private collections the
new genetic material needed to
avoid inbreeding.
Regulations and licensing
The pet trade is unenthusiastic about a ban on
importing wild caught animals. It points out that a
growing proportion of currently
imported animals are effectively
ranched in their native countries and that
this provides an economic incentive for
preserving key habitats. Instead, the PIF
is proposing a system of licensing for
commercial importers and a regulatory
distinction between general pet stores
and those with specialist knowledge of
exotic species.
Any changes in the legislation covering
the welfare of reptiles and other exotic
species in captivity will, of course, take
some time to reach the statute books. But in
the meantime, this new spirit of cooperation
between the pet trade, veterinary and welfare
organizations could produce much more
immediate improvements in welfare.
“These care sheets are an excellent idea
and could bring results in helping people to
understand the needs of their pet. If the sheets
carry the logos of each of the supporting
organizations that will mean that they do have
some authority,” notes John Chitty.
Michael Stanford is also encouraged by the
willingness of very different organizations to work
together in finding solutions to the challenges facing
inexperienced owners. “Until very recently, it would
have been quite a challenge to get the RSPCA to talk
to the main importer of reptiles in the UK. Now they are
doing exactly that – so that’s really something.” ■
Turn the page to find out
how you can contribute to our
consultation on non-traditional
companion animals.
© BSAVA 2014
| companion JULY 2014 | 7
 Non-traditional
companion animals
consultation
T
here is currently a great deal of discussion Not just reptiles
going on in Europe about whether there As an Association with a focus on education and
should be restrictions on keeping certain science, we have a role in ensuring that
“exotic” and wild caught animals as pets. The veterinary surgeons and veterinary nurses in
Federation of Veterinarians of Europe (FVE) has practice have access to the resources they need
produced a statement calling for the establishment of to treat a wide range of small animals. Although
“suitability” lists. the article on the previous pages focuses on
In the UK there are already some restrictions problems with reptiles we are interested in a wide
through the Convention on International Trade in range of animals, including:
Endangered Species (CITES) and the Dangerous Wild
Animals Act (DWA); however, these are focused on ■ Tortoises/terrapins
conservation and human safety rather than animal ■ Snakes
health and welfare. ■ Other reptiles
BSAVA has set up a subcommittee (which reports ■ Backyard poultry
through the Scientific Committee) to look at some of ■ Cage/aviary birds
the issues surrounding “exotic pets”. The first problem ■ Reptiles
they encountered was in the definition of “exotic”, ■ Fish/amphibia
which is why they have chosen the term “non- ■ Rabbits and guinea pigs
traditional” to distinguish those species which are ■ Hamsters and gerbils
starting to be kept and where there may be the ■ Rats and mice
greatest problems in ensuring that their health and ■ Ferrets
welfare needs are met. ■ Other small mammals

Participate in the consultation

In order to develop our support in this area further
we would like to know your experience and views
on treating these animals – please take a few
minutes to complete our online survey or send your
comments to Sally Everitt, Head of Scientific Policy –
s.everitt@bsava.com. ■

AVAILABLE FROM BSAVA

BSAVA Manual of
Exotic Pets
5th edition: A Foundation Manual
Edited by Anna Meredith and Cathy Johnson-Delaney

This Manual covers the range of exotic pets, from small mammals, through birds, reptiles and
amphibians, to invertebrates. Commoner pets, such as rabbits, rodents and budgies, are
included and the ever-increasing range of non-traditional pets encountered by the veterinary
surgeon in practice is reflected in coverage of groups such as marsupials, ratites and crocodilians.
■ Biology, husbandry, handling ■ Anaesthesia and analgesia Member price: £49
and restraint ■ Common surgical Non-member price: £79
■ Diagnostic approach to procedures
common conditions ■ Euthanasia Buy online at
■ Supportive care ■ Drug formulary www.bsava.com

8 | companion JULY 2014 | © BSAVA 2014

Client information
leaflets
Are you making the
PRESCRIBING CASCADE
The cascade provides a legal mechanism
most of these exclusive allowing veterinary surgeons to use their

resources for BSAVA

clinical judgement to prescribe a suitable
medicine where no authorized veterinary

members?
medicine exists. A medicine prescribed
in accordance with the cascade may be

V
eterinary surgeons should
provide information to their
clients about the safe use of
drugs that they prescribe and
dispense for patients under their care.
For drugs authorized for use in dogs
and/or cats this information is usually
supplied to veterinary surgeons by the
pharmaceutical company and this should
then be passed on to clients.
For drugs that are not authorized for
the particular use in the particular
species (i.e. prescribed under the
cascade) there is still a responsibility to
provide clients with information, but the
leaflets that accompany these drugs may
not be adequate (e.g. they may have
been written for the treatment of human
patients or for the treatment of a different
condition). Thus, the BSAVA has
provided, as a service to its members, a
series of Client Information Leaflets (CILs)
that can be used to help practitioners
fulfil their obligations.
administered by the prescribing veterinary
surgeon or by a person acting under their
direction. Responsibility for the prescription
and use of the medicine remains with the
prescribing veterinary surgeon.
If there is no medicine authorized in the
UK for a specific condition, the veterinary
surgeon responsible for treating the
animal may, in particular in order to avoid
unacceptable suffering, treat the animal in
accordance with the following sequence:
1. A veterinary medicine authorized in the UK
for use in another animal species or for a
different condition in the same species.
2. If there is no such medicine, use either:
a. A medicine authorized in the UK for
human use
b. A veterinary medicine from another
Member State or country outside
the EU in accordance with an import
certificate from the Veterinary
Medicines Directorate.
3. If there is no such medicine, a medicine
prepared extemporaneously by a veterinary
surgeon, pharmacist or a person holding an
appropriate manufacturer’s authorization.
Further details on the prescribing cascade are
available in the online BSAVA Guide to the Use
of Veterinary Medicines.
The information provided in these CILs
is not intended to be exhaustive or to
cover every possible use of a particular
drug. In particular, the use of these drugs
in small mammals, birds or other ‘exotic’
pets has not been considered. The
information is provided for use with canine
and feline patients only. Practitioners
should exercise care to check that the
information provided in the leaflets is
suitable for their patient.
These information leaflets do not
absolve veterinary surgeons from
providing information specific to the
individual patient or client but will help
provide generic information on the safe
use of a drug. The responsibility for the
safe and appropriate use of drugs
remains with prescribing veterinary
surgeons. Leaflets for additional drugs
will be available later on in the year –
keep an eye on the BSAVA website for
further details. ■

CILs AVAILABLE
The following CILs are available to download in either a PDF or JPG format from the BSAVA website (www.bsava.com). These leaflets can be integrated with
practice management software – instructions are available online.
■ Allopurinol ■ Colchicine ■ Fludrocortisone ■ Mitotane ■ Salbutamol
■ Amiodarone ■ Cyclophoshamide ■ Gabapentin ■ Morphine ■ Sotalol
■ Amitriptyline ■ Darbepoetin ■ Hydroxycarbamide ■ Omeprazole ■ Sucralfate
■ Amlodipine ■ Diazepam ■ Itraconazole ■ Ondansetron ■ Sulfasalazine
■ Aspirin ■ Diazoxide ■ Ketoconazole ■ Pentoxifylline ■ Tramadol
■ Atenolol ■ Digoxin ■ Lactulose ■ Phenoxybenzamine ■ Ursodeoxycholic acid
■ Azathioprine ■ Diphenoxylate ■ Levetiracetam ■ Piroxicam ■ Vitamin K1
■ Budesonide ■ Erythromycin ■ Melphalan ■ Pregabalin
■ Busulfan ■ Erythropoietin ■ Methotrexate ■ Propranolol
■ Chlorambucil ■ Famotidine ■ Metronidazole ■ Pyridostigmine
■ Chlorphenamine ■ Fentanyl patches ■ Misoprostol ■ Ranitidine

Members can download the BSAVA Client Information Leaflets from www.bsava.com/resources/clientinformationleaflets or can access all member content
in one place by using the BSAVA knowledge vault (www.bsava.com/myBSAVA/BSAVAknowledgevault).

© BSAVA 2014
| companion JULY 2014 | 9
Clinical conundrum

Create a problem list based on

Andrew Parry and Stephen the dog’s history and clinical
Kalff of Willows Referral Service examination
invite companion readers to ■■ Exercise-induced pelvic limb weakness

consider a case of pelvic and lameness:

–■ Progressive hip and lumbar spinal
limb weakness discomfort on manipulation
■■ Previous third digit interphalangeal
arthrodesis of the left pelvic limb
■■ Marked thickening of the adjacent
Case presentation fourth proximal interphalangeal joint of
An 8-year-old male Whippet was admitted for investigation of progressive the left pelvic limb
intermittent pelvic limb lameness of 6 months’ duration. Clinical signs were ■■ Historical polyuria/polydipsia and
characterized by episodes of pelvic limb lameness and generalized discomfort proteinuria
after vigorous exercise. Stiffness after periods of recumbency was not
reported and the dog was very willing to exercise. The clinical signs reportedly
resolved following rest. During questioning, the owner was unsure whether the What differential diagnoses
left or right pelvic limb was more severely affected. should be considered at this
Six weeks prior to referral, the dog developed polydipsia and polyuria. stage?
Urinalysis demonstrated proteinuria. A 6-week course of antibiotics was
■■ Progressive hip and lumbar spinal
prescribed, which led to the resolution of the polydipsia and polyuria.
discomfort could denote:
At presentation the dog was bright, alert and in good body condition
–■ Musculoskeletal disease including
(body condition score 5/9). Thoracic auscultation and abdominal palpation
revealed no significant abnormalities. Mild left pelvic limb lameness and specific joint disease (e.g. hip
mild right thigh muscle atrophy were evident. Pain was elicited upon osteoarthritis and degenerative
manipulation of both hips. Digit three of the left pelvic limb was slightly lumbosacral disease)
–■ Inflammatory disease (e.g.
misshapen; however, neither instability nor discomfort was apparent upon
manipulation of this digit. immune-mediated polyarthritis,
The proximal interphalangeal joint of the adjacent fourth digit was also infectious disease)
–■ Vascular disease
markedly thickened. Again, neither discomfort nor instability was detected
–■ Neoplasia
during palpation. The orthopaedic examination was otherwise
■■ The left pelvic limb phalangeal lesions
unremarkable. The dog was admitted for observations. Over the course of
the day, following several examinations, the dog exhibited progressively appear historic and not of current
more pain upon manipulation of the hips, and marked bilateral pelvic limb clinical significance, with neither
lameness became evident (Figure 1). Mild discomfort also became apparent instability nor discomfort noted on
on lumbar spinal palpation. examination. Dogs with lameness
Previous history included a seroma 7 months previously over the proximal secondary to digital pathologies often
interphalangeal joint of the third digit of the left pelvic limb. This joint had have a history of avoidance of, or
been arthrodesed several years before, for treatment of chronic exacerbation of lameness when
interphalangeal joint instability. walking on, rough/hard surfaces
Radiographs performed by the referring veterinary surgeon revealed ■■ Polyuria/polydipsia:
migration of the arthrodesis implants (Kirschner wires). The implants were –■ Primary polydipsia (e.g. fever,
removed around the same time as the onset of the dog’s current clinical signs; psychogenic, neurological)
the seroma resolved following this surgery. There was no other significant –■ Primary polyuria due to osmotic
medical history. diuresis (e.g. diabetes mellitus,
diuretics), renal insensitivity to

10 | companion JULY 2014 | © BSAVA 2014

 antidiuretic hormone (ADH) (e.g.
primary nephrogenic diabetes
insipidus, secondary nephrogenic
diabetes insipidus for example
secondary to steroids, renal failure
or urinary tract infection,
hyperadrenocorticism or
hypercalcaemia) or ADH deficiency
(e.g. central diabetes insipidus)
■■ Proteinuria:
–■ Pre-renal: Bence Jones proteins,
haemoglobinuria, myoglobinuria
–■ Renal: glomerular disease (e.g.
glomerulonephritis, amyloidosis),
tubular disease (e.g. Fanconi
syndrome), physiological causes
(e.g. seizures, strenuous exercise)
–■ Post-renal: cystitis, urolithiasis,
bladder neoplasia, genital tract
disease, trauma, haemorrhage

What initial investigations would Figure 1: The patient is shifting weight from both pelvic limbs. Note the hunched appearance and
the position of the thoracic limbs in relation to the body
you consider?
1. Polyuria/polydipsia and 2. Progressive hip and lumbar spinal Parameter Result Reference
proteinuria: Complete blood count discomfort: range
and biochemistry as well as urinalysis ■■ Radiographs of the pelvic limbs
Albumin 21.4 g/l 25–40 g/l
including culture and sensitivity and lumbar spine are useful to
testing are indicated to evaluate for assess for musculoskeletal disease Urea 11.7 mmol/l 2.5–6.7 mmol/l
concomitant diseases that may cause but will give limited or no Phosphate 1.02 mmol/l 0.8–1.6 mmol/l
polyuria and polydipsia, as well as information on non-orthopaedic
Table 1: Complete blood count and serum
assess the severity of the proteinuria. disease. Arthrocentesis to assess biochemical analysis (results not shown were
Results are shown in Tables 1 and 2. for arthropathies is also indicated. considered normal)
Urogenital ultrasonography to assess ■■ Computed tomography (CT) was used
renal architecture is also valuable. in this case. The rationale was that it
Parameter Result
allows visualization of both abdominal
What problems are associated and musculoskeletal components. As Specific gravity 1.026
with measuring the urine protein: the CT scanner is a multi-detector unit, pH 6.5
creatinine ratio in the presence of the procedure can be performed very
Protein +++
haematuria? quickly with excellent contrast
Microscopic haematuria reportedly does resolution compared with radiography. Blood ++++
not change significantly the urine protein: The use of a contrast agent also allows Urine protein: 8.4
creatinine (UPC) ratio. Macroscopic evaluation of the urinary tract creatinine ratio
haematuria, however, will cause an (essentially an intravenous urogram)
Sediment examination Moderate haematuria
increase in the UPC ratio (associated with and regions of inflammation or
serum protein) and so should be neoplasia, as well as quick evaluation Bacterial culture Negative
interpreted with caution. of the vascular components. Table 2: Urinalysis (cystocentesis sample)

© BSAVA 2014
| companion JULY 2014 | 11
 Clinical conundrum
A thrombosis (AT) was the radiological
B
Figure 2: CT images of the caudal abdomen
and pelvis of the dog. Images are optimized
for assessment of the soft tissues. A contrast
agent has been administered. (A) Dorsal
multi-planar reformatted (MPR) CT image.
Note the large non-contrast-enhancing
filling defect (thrombus) within the terminal
aorta. (B) Transverse CT image. The mural
filling defect is clearly visible within the
aorta
12 | companion JULY 2014 | © BSAVA 2014
CT revealed a large, occlusive
filling defect within the terminal aorta,
extending caudally from 2 cm caudal to
the left renal artery (Figure 2). It
occluded both external iliac arteries,
and the continuation of the aorta,
including both internal iliac arteries.
Both deep circumflex iliac arteries were
moderately to markedly enlarged,
suggesting chronic adaptation of the
collateral circulation.
A cause of the clinical signs. Aortic
B Bilateral renal changes on imaging
Figure 3: Ultrasound images of the descending
aorta caudal to the left renal artery. (A) The
mural filling defect is visualized as a rounded,
heterogeneously hyperechoic lesion within the
lumen of the aorta. (B) On colour Doppler
interrogation, no flow is identified around
the thrombus
Both femoral arteries had contrast-
enhanced blood within them,
consistent with the physical
examination findings of good quality
femoral pulses. Both kidneys were
mildly irregular in outline with loss of
their corticomedullary distinction and
moderate bilateral pyelectasia.
Together these changes suggested
bilateral chronic nephropathy.
■■ An ultrasound examination (Figure 3)
confirmed the CT findings. On colour
Doppler interrogation, there was
absence of flow detected within the
external and internal iliac arteries. Both
deep circumflex iliac arteries were
enlarged with increased flow on colour
Doppler interrogation.
What is the significance of the
findings?
From the list of differential diagnoses
above, based on the imaging findings, it
was clear that a vascular incident was the
diagnosis. Vascular claudication of the
pelvic limbs was the likely explanation for
the clinical signs.
What is the likely aetiology for
the aortic thromboembolism in
this case?
The presence of hypoalbuminaemia,
proteinuria and elevated on UPC ratio is
suggestive of a protein-losing nephropathy.
This was confirmed on urinalysis. Urine
culture and sediment examination were not
suggestive of a urinary tract infection.
indicated the likelihood of a nephropathy.
Differential diagnoses to consider in
this case should include
glomerulonephritis, which may be primary
or secondary (immune complex
deposition), amyloidosis, proximal tubular
defects, leptospirosis and other less
common causes of glomerular disease.
The presence of microscopic haematuria
was suspected to be iatrogenic in origin
(e.g. secondary to cystocentesis).
In dogs, AT is infrequently recognized
and often has a more chronic insidious
onset than that seen in cats. Around half of
dogs will present with chronic bilateral
pelvic limb dysfunction secondary to a
mural thrombus within the distal aorta, and,
in contrast to cats, dogs will not usually
have an underlying cardiac disease.
Interestingly, up to 55% of dogs
presenting with AT will have palpable
femoral pulses and very few will have
cold cyanotic extremities. Presumably
this is due to the chronic progressive
occlusion of the terminal aorta and iliac
arteries, allowing compensation by the
collateral supply. Hence, exercise-
induced clinical signs are likely explained
by vascular claudication.
Causes of thrombosis can be broadly
categorized using Virchow’s triad:
■■ Alterations in normal blood flow
Endothelial injury
■■
■■ Hypercoagulability
It is unlikely that alteration (stasis) in
normal blood flow plays a large part in the
aetiology of AT in the dog. In the cat
underlying cardiac insufficiency is often a
causative factor, causing aortic
thromboembolism, as opposed to a mural
aortic thrombus as seen in the dog.
Whilst endothelial injury (e.g.
secondary to hypertension) has been
reported as a causative factor of AT in
dogs, there was no evidence of such a
finding in this patient. Most dogs
presenting with AT have hypercoagulability
or hypofibrinolysis (e.g. protein-losing
nephropathy (PLN), hyperadrenocorticism,
diabetes mellitus or hypothyroidism). Loss
of antithrombin secondary to PLN has
been well established in both dogs and
humans. Measurement of antithrombin was
not performed in this case.
Assessment of a hypercoagulable state
(e.g. thromboelastography) was not
available at the time of presentation.
Measuring coagulation time in
hypercoagulable patients is often
unrewarding, as times are shortened rather
than elongated and therefore prone to error
in interpretation.
Further information about the nature of
the protein-losing nephropathy could be
gained from renal biopsy and was
discussed with the dog’s owners. However,
in this case the owners felt that any
potential benefit the procedure would give
(possible therapeutic avenues) was
outweighed by the potential complications.
How would you treat this dog?
Treatment should focus on:
■■ Restoring pelvic limb function
■■ Reducing renal protein loss
■■ Treatment of the cause of the bilateral
nephropathy. Symptomatic treatment
for proteinuria will include angiotensin
converting enzyme (ACE) inhibitors
(see below)
The principal goal of therapy is to
restore pelvic limb function. Possible
thrombolytic therapies include
thrombectomy, thrombolysis,
anticoagulation and antiplatelet therapies.
Success has been reported with
thrombectomy and the use of thrombolytic
drugs (e.g. tissue plasminogen activator,
tPA). However, it should be remembered
that the use of acute-acting protocols on
longstanding, chronic disease can
sometimes have unfavourable outcomes.
A risk of using tPA is the possibility of
creating showers of thromboemboli, which
can cause deterioration of the clinical signs
by occluding of smaller more peripheral
vessels. Dogs with AT will usually present
as ambulatory. Therefore case selection for
therapy with tPA is perhaps best reserved
for those animals with more severe clinical
presentations.
Warfarin has been used in dogs with
AT with some success, especially if used in
combination with antiplatelet drugs such as
aspirin or clopidogrel. Careful monitoring
and dose control is required with the use of
such drugs.
The patient was treated with broad-
spectrum antibiosis (to treat for possible
renal infection, pending results of urine
culture and sensitivity testing), aspirin (as
an antiplatelet therapy), omeprazole (to
protect against potential gastrointestinal
irritation secondary to aspirin
administration) and benazepril (to help
reduce renal protein loss). The dog was
also fed a protein-restricted diet. The
rationale for the latter point was that
protein-restricted diets have been shown to
reduce proteinuria in cases of familial
nephropathy and experimentally-induced
proteinuria.
Outcome
Two weeks later the patient had improved
exercise tolerance. A repeat ultrasound
examination showed subjectively increased
flow around the edges of the thrombus
within the distal aorta, as demonstrated on
colour flow Doppler. Nine months after
diagnosis, the patient has gained weight
and remains well.
Acknowledgements
Special thanks to Isuru Gajanayake and
Julien Bazelle for their help in the
production of this case presentation.
© BSAVA 2014
| companion JULY 2014 | 13
How to read a
capnography trace
Karen Walsh from Willows
Veterinary Centre and Referral
Service helps us make sense
of these complex wave forms
C
apnography is a useful aid when monitoring
patients under general anaesthesia. It is
relatively simple to perform and provides
very useful information about the
cardiorespiratory function of the patient whilst requiring
minimal intervention. It has been long established that
the combination of pulse oximetry and capnography
can help to prevent avoidable anaesthesia mistakes in
human patients. This has led to capnography being a
minimal monitoring requirement for all people
undergoing general anaesthesia by the many
anaesthesia regulatory bodies throughout the world.
Definitions
■■ Capnometry refers to the measurement and
display of CO2 in numerical form only. A
capnometer is a device that performs such a
function, displaying end-tidal and sometimes
inspired CO2.
■■ Capnography is the measurement and display
of CO2 including end-tidal and inspired values
as well as a real-time CO2 waveform. A
capnograph therefore is a device that
measures CO2 and displays a waveform
(Figure 1).
■■ Hypocapnia is the term used to describe low
partial pressure of carbon dioxide
(< 35 mmHg). Persistent hypocapnia can lead
to cerebral vasoconstriction and hypoxia.
■■ Hypercapnia is the term used to describe
excessive partial pressure of carbon dioxide
(> 45 mmHg). Persistent hypercapnia can lead
to respiratory acidosis, cerebral vasodilation,
arrhythmias and, at very high levels, narcosis.
14 | companion JULY 2014 | © BSAVA 2014
Figure 1: Typical capnography trace (displayed in yellow) on a
multi-parameter monitor during anaesthesia
There are generally two types of sampling
analyser used in clinical practice: sidestream and
mainstream. Sidestream analysers remove a sample of
gas from the anaesthetic breathing system using a
pump, which is transferred to the sensor located in the
monitor. The gas removed from the breathing system
will contain anaesthetic gas which will need to be
either returned to the breathing system or removed in
the scavenging system. Mainstream analysers do not
remove a gas sample and the sensor is inserted
directly between the patient breathing system and the
endotracheal tube.
Capnography provides three pieces of information:
1. End-tidal carbon dioxide (ETCO2) value
2. The capnography trace
3. The difference between arterial and end-tidal
values ((a–ET)PCO2) – which can be used to give
an indication of alveolar dead space. This is not
commonly assessed in small animal patients as it
is uncommon to take arterial blood samples and it
will not be covered further in this article.
End-tidal carbon dioxide
ETCO2 is defined as the carbon dioxide level at the
very end of expiration, which is taken to be
equivalent to the arterial CO2 concentration, although
in reality it is usually 2–5 mmHg lower than actual
arterial blood levels. Normal values are considered to
be 35–45 mmHg. Long-term elevations in ETCO2 are
of concern as they will lead to respiratory acidosis with
45 mmHg
subsequent arrhythmias, myocardial depression and,
C D
if very high, narcosis. However, in the healthy patient, a
small increase above normal (50 mmHg) for a limited
amount of time may be helpful to maintain blood
PaCO2
pressure via the release of catecholamines.
ETCO2 monitoring has been developed because it B
E
allows a breath-to-breath estimation of the arterial
carbon dioxide levels. The ETCO2 will depend on: A

■■ Production of carbon dioxide in the tissues Time

(metabolism)
■■ Movement of carbon dioxide from tissues to the Expiration Inspiration
lungs (blood flow)
Figure 2: Phases of the capnograph. A = baseline,
■■ Movement of carbon dioxide from the blood vessel
representing the beginning of expiration (dead space gas),
into the alveolus and then out of the body (diffusion this should be zero; B = sharp upstroke, representing the
and breathing) mixing of dead space gas and alveolar gas; C = change to
alveolar gas; C–D = the alveolar plateau, increasing towards
ETCO2 levels can be affected at each of these the end point; D = end-tidal carbon dioxide value; E = end of
inspiratory phase, showing a rapid decrease in CO2
points, which should be taken into consideration
when interpreting the waveform and values indicated
on the machine.

The capnograph trace

Capnography is the graphical display of the changes
in carbon dioxide partial pressure over time (with each
breath). Evaluating this graph may help to explain
unusual end-tidal measurements. It is important to look
at the following in order to troubleshoot any problems
that may occur:

■■ Height: The height of the trace is related to ETCO2.

Most displays will have a guide showing a set level
of carbon dioxide
■■ Frequency and rhythm: The frequency will show
the number of breaths over time and there will
Figure 3: Note the less stylized capnograph curve but all the
usually be a digital display of this. The rhythm of same features can be distinguished
breathing can also be assessed at this time
■■ Baseline: The trace should return to the baseline
Effects of respiration
between each breath. If the trace does not reach
ETCO2 monitoring can be used to evaluate a
zero, this indicates that there is some re-breathing
patient’s ability to ventilate spontaneously. The rate,
of carbon dioxide. This article will look at the
frequency and depth of respiration can be evaluated
potential causes and remedies for this later using capnography.
■■ Shape: The shape of the trace can give some
important information about the interaction ■■ ETCO2 may decrease if the patient hyperventilates,
between alveolar ventilation, pulmonary blood flow or the ventilator frequency is set too high. The
and the rate of CO2 production. waveform under these circumstances should be

© BSAVA 2014
| companion JULY 2014 | 15
 How to read a
capnography trace
normal in shape but the end-tidal value will be
high or low.
■■ ETCO2 may increase due to hypoventilation, upper
airway obstruction and re-breathing. To distinguish
the cause, the waveform should be evaluated.
A normal waveform is seen with uncomplicated
hypoventilation, whereas an abnormal waveform
will be seen with upper airway obstruction (shark
fin, Figure 9). The baseline will be elevated in a
patient that is re-breathing and there may be a
value for inspired CO2.
Effects of metabolism
ETCO2 can give an indication of a patient’s
metabolism.
■■ An increase in ETCO2 can be interpreted as an
increase in metabolism if the patient is being
ventilated, as this helps to rule out changes in
ventilation as the cause of the increase. Increased
ETCO2 may occur with elevated temperature,
shivering, convulsions, administration of
adrenaline, blood or bicarbonate, release of a
tourniquet, insufflation of the peritoneal cavity with
CO2 and malignant hyperthermia (increased
ETCO2 occurs before an increase in temperature).
■■ ETCO2 falls with decreased temperature,
increased muscle relaxation and increased
depth of anaesthesia.
Effects of circulation
■■ ETCO2 will decrease if there is impaired
circulation to the lungs (e.g. hypotension,
peripheral vasoconstriction), as well as impaired
circulation through the lungs (e.g. embolism,
surgical manipulation).
■■ Gas emboli due to CO2 may increase or decrease
the ETCO2, but this is only likely to occur during
laparoscopy or thoracoscopy.
■■ ETCO2 can be used to monitor CPR and may be a
predictor of outcome in the dog. One paper
showed an increased likelihood of survival if
ETCO2 was >20 mmHg during CPR.
Sampling problems
As with all automated monitoring equipment, some
16 | companion JULY 2014 | © BSAVA 2014
understanding of the factors that can affect the
accuracy of the reading is important. The accurate
measurement of ETCO2 depends on several factors:
1. Ensuring there is no leak in the system. It is
important to use cuffed endotracheal tubes that
have been inflated until there is no leak. The degree
of accuracy can be estimated by assessing the
capnography trace: if there is a good fit between
the trachea and the ET tube there should be a
plateau at the top of the trace if a positive pressure
breath is applied. An underestimation of CO2 will
usually occur if there is a leak in the system.
2. High fresh gas flows that are required for non-re-
breathing systems can dilute CO2 levels when
using a sidestream sampling system. This is most
commonly observed in small patients such as cats.
3. Removal of water vapour from the gas sample.
Water vapour will be present in a gas sample from
the respiratory tract and can cause an apparent
increase. If water vapour reaches the measuring
cell it can interfere with performance, so care must
be taken to monitor the level of water in the water
trap. Water vapour can also occlude the sampling
tube, preventing the gas from reaching the
analyser, resulting in a falsely low or totally absent
capnograph.
Interpreting capnograph traces
As discussed above, the absolute value of ETCO2 is an
important piece of information when monitoring
anaesthesia. However, the capnograph trace allows
the observer to gain additional information regarding
the cardiorespiratory function of the patient and
provides a visual aid to interpreting the ETCO2 value.
Variations on normal
The normal capnograph trace (Figure 2) is based on a
ventilated adult human and has well defined phases. In
veterinary anaesthesia there are many more variations
of normal, as a large majority of patients will be
breathing spontaneously and sampling is affected by
the high fresh gas flow used in small patients breathing
via non-rebreathing systems. One such example is
shown in Figure 4. In addition, cardiac oscillations may
be seen superimposed on the inspiratory portion of the
trace (Figure 5).

PaCO2
Time
Figure 4: Spontaneous breathing: the plateau may be less
defined
PaCO2
Time
Figure 5: Cardiac oscillations, thought to be due to
contraction and relaxation of the heart and intrathoracic
great vessels on the lungs. Factors influencing the presence
of these oscillations are negative intrathoracic pressure, low
respiratory rate and small tidal volumes
Abnormal capnograph traces
As with any piece of monitoring equipment,
capnography is only one piece of the puzzle and
cannot be taken in isolation. When an abnormal trace
is detected, the first step should always be to observe
the patient and check the connections to the breathing
system. Figure 6 shows a sudden fall to baseline of the
capnograph trace. This could be encountered when
the patient becomes disconnected from the
capnograph sensor or could be due to cardiac arrest.
Observation of the patient will allow the two to be
distinguished.
Hyperventilation will lead to hypocapnia over
time, which is shown as a slow decrease in the
plateau and ETCO2 value (Figure 7). Causes of
hyperventilation include inadequate depth of
anaesthesia, pain and overventilation. Circulatory
PaCO2
Time
Figure 6: Sudden fall to baseline. Equipment causes include
disconnection and capnograph zeroing. Physiological causes
are apnoea and cardiac arrest
causes include impaired peripheral circulation
(decreased movement of CO2 from the tissues to the
lungs; decreased CO2 delivery through the lungs).
Hypothermia is also a relatively common cause of
decreased ETCO2 but may occur over a longer
period of time. There are several possible equipment-
related causes of hypocapnia, including sample
tubing leak (sidestream analysers), inadequate seal
around the ET tube and low sampling rates in
sidestream analysers, which may be accompanied
by an increase in inspired CO2.
A slow increase in ETCO2 over time is commonly
associated with hypoventilation under general
anaesthesia (Figure 8). Metabolic causes of this type
of pattern are seen less frequently but should be
considered if hypoventilation has been ruled out.
These include hyperthermia, absorption of CO2
during laparoscopy, shivering and increased
muscular activity.
PaCO2
Time
Figure 7: Slow decrease of plateau and end-tidal carbon
dioxide value
© BSAVA 2014
| companion JULY 2014 | 17
 How to read a
capnography trace
PaCO2
Time
Figure 8: Slow increase of plateau and end-tidal carbon
dioxide value
With airway obstruction, the prolonged expiratory
phase results in a change to the expiratory upstroke
which is commonly described as a ‘shark fin’ on the
capnograph trace (Figure 9). If it is a patient problem
the first line is to check for kinks in the ET tube and
breathing system and then to suction the airway or
change the ET tube. If true bronchospasm is
suspected, bronchodilators such as terbutaline may
be indicated.
A capnograph trace that does not return to the
baseline (Figure 10) indicates re-breathing of expired
CO2. Likely causes of this include inadequate fresh
gas flow and exhausted absorbent. If the patient is
connected to a non-re-breathing system, the fresh gas
flow should be checked and increased if necessary;
higher fresh gas flow may be required with high
respiratory rates. If attached to a re-breathing system,
the dead space and CO2 absorbent should be looked
at and the unidirectional valves checked.
PaCO2
Time
Figure 9: Shark fin trace, indicating airway obstruction
18 | companion JULY 2014 | © BSAVA 2014
PaCO2
Time
Figure 10: Trace not returning to the baseline, indicating
re-breathing of expired gases
Conclusion
The examples shown in this article are some of the
most common that will be encountered during
anaesthesia and illustrate that capnography is a very
useful tool in the monitoring of anaesthetized small
animal patients. A more in-depth look at capnography
can be found at www.capnography.com. ■
AVAILABLE FROM BSAVA
BSAVA Manual of
Anaesthesia and Analgesia
2nd edition
Edited by Chris Seymour and
Tanya Duke-Novakovski
The administration of safe and reliable
anaesthesia is important for all veterinary
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traumatic or surgical, is one of the most important ethical
responsibilities. This Manual covers these topics in depth.
■■ Pain assessment and management
■■ Anaesthetic equipment and patient monitoring
■■ Pharmacology and specific patient management
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■■ Local and regional anaesthesia
“The authors and editors have done an outstanding job”
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Member price: £55
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 BSAVA and Affiliate Cardiac diagnostics
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What to do when it all goes 18 September
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practitioner, essentials of ECGs and what’s
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This day is particularly aimed at those be clinically relevant, and particularly aimed at those in
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 Scottish Congress · 29–31 AUGUST 2014

What Scottish Congress

speakers say...
BSAVA Scottish Congress takes place on 29–31 August
at Edinburgh Conference Centre. Some of our speakers
talk about their careers and Congress talks

D
elegates at BSAVA’s Scottish Congress are always assured a warm celtic
welcome and with an ever-expanding programme of scientific lectures,
extensive trade exhibition and sizzling social events, Scottish Congress
really is one of the most pleasurable weekends of CPD in the veterinary
calendar. We asked our morning lecture speakers a few questions about their
areas of expertise and what they will be covering at Scottish Congress…

knowledge unparalleled at that time. He these conditions is simply not available to

Norman W. Johnston
What is it about dentistry that fascinates
you most?
I have always been interested in problems
of the oral cavity since it became obvious
in my first job that dental surgery in
animals was primitive compared to
humans. Normally veterinary medicine
and surgery shadows advances in human
medicine/surgery. For some reason
veterinary dentistry did not do this until
advances in equipment and knowledge
happened in the 1980s. At that time my
own interest in further education in the
field was starting and I was able to take
advantage of the exponential increase in
knowledge worldwide.
Oral comfort is vital to general well-
being. Humans suffering oral pain will
usually seek professional help rapidly.
Animals tend to be stoical and hide their
discomfort well. Training the profession to
recognize the signs of dental and oral
pathology and, more importantly, to know
when and how to intervene remains a work
in progress given the almost total lack of
dental training in most vet schools.
Who has been the biggest influence on
your career?
In my specialty the biggest influence has
been Dr Robert Wiggs from Dallas, Texas.
Dr Wiggs is the author of one of the
standard textbooks in veterinary dentistry
and was also my mentor. He was a
wonderfully patient teacher with a depth of
was also undergoing intensive treatment
for cancer when I worked with him, and
clearly in a lot of pain. Despite this he
always made time to help his students
learn. Sadly he passed away in 2005.
What will be covered in your lectures at
Scottish Congress?
■■ Difficult extractions & oral surgery
Techniques and principles of oral surgery
with particular reference to the extraction of
teeth via mucogingival flaps will be
described. We will also cover the
equipment necessary for efficient
extraction of teeth, along with discussing
potential complications.
■■ Common dental problems & how to deal
with them
A number of dental conditions commonly
presented to the small animal practitioner
will be described. The various
presentations of dental trauma and the
best practice approach to them will be
discussed. Other common conditions,
such as periodontal disease,
developmental and bite abnormalities, will
also be described.
■■ Dental radiology: a practice ‘must have’
Dental radiography is indicated in the vast
majority of dental and oral conditions, and
so the techniques and principles of dental
radiography in small animal practice will
be described in this lecture. Without
dental radiographs the diagnosis,
prognosis and treatment plan for most of
the clinician. To obtain diagnostic dental
radiographs quickly and easily should be
within the reach of all practices.
Sophie Adamantos
What fascinates you most about
emergency medicine?
I love the fact that you can sometimes
make a massive life-changing difference in
a small amount of time and the animal gets
better. I enjoy having to make rapid
decisions and thinking through the
evidence that guides that decision. It’s
dynamic and mostly its fun.
Emergency medicine is practised by
every vet. It is also an area that scares
some vets and has a really limited evidence
base. My hope is that we will be able to use
data generated from SAVSNET and
VetCompass to identify key areas for
research in emergency medicine and
create a evidence base from which to work.
Who has been the biggest influence on
your career?
I don’t know who will be more embarrassed
by this as he probably doesn’t know – but
Dan Holden has been the biggest
influence on my career. When I started my
first internship in anaesthesia I knew
nothing about emergency and critical care.
Dan ran the ICU at the University of Bristol
and I worked with him as part of the
anaesthesia service. He opened my eyes
to ECC and I went from there.

20 | companion JULY 2014 | © BSAVA 2014

What do you consider your greatest
achievement career-wise?
Becoming the first RCVS Recognised
Specialist in Emergency and Critical Care.
What will be covered in your lectures?
■■ ECCfor vets: electrolyte abnormalities –
case-based
This lecture will use clinical cases to
discuss common electrolyte abnormalities
encountered in dogs and cats, the
approach to their investigation and key
points for management.
■■ Fluid therapy in a world without colloids
Hydroxyethyl starches have recently
been removed from human medical
practice. This lecture will discuss how
these changes impact on veterinary
practice and how to change your fluid
therapy in order to manage conditions
that previously would have been treated
using artificial colloids.
■■ Angiostrongylus
Angiostrongylus vasorum is of increasing
importance in canine practice. It is likely
that this parasite is now countrywide and
coming to a practice near you soon!
Learn how to recognize the clinical signs
and syndromes that can be associated
with this parasite, and understand its life
cycle and the impact of the environment
on possible infection.
■■ ECC for nurses: triage (interactive)
This lecture will use clinical cases to take
you through the triage process.
Delegates will learn how to perform triage
on cats and dogs presenting as
emergencies and how to be aware of
life-threatening abnormalities identifiable
on physical examination and their likely
cause. Strategies for the management of
common life-threatening abnormalities
will also be covered.
■■ CPR
CPR is performed uncommonly in small
animal general practice; however,
anaesthesia arrests are probably the most
reversible cause of cardiopulmonary
arrest, and the most likely to occur in
practice. Being prepared and working as a
team are key for successful management.
In this lecture, delegates will learn about
the identification of cardiopulmonary arrest
and the common causes. After the lecture,
delegates will have an understanding of
basic cardiopulmonary resuscitation and
the importance of this for a successful
outcome, and will be aware of how to
organize a team for CPR.
■■ Tube care
Feeding tubes and chest drains are
increasingly used in small animal practice,
and having a good understanding of their
indications and applications is important
in order to use them correctly. This lecture
will show delegates how to understand
when a feeding tube is indicated in a case
and which one to select, along with being
aware of how to place naso-oesophageal
and oesophageal feeding tubes. Tube
care will also be covered, including when
to be worried about them and when to
remove them.
Hayley Walters
What is your particular area of interest
as a VN in practice?
My main area of interest is welfare. Animals
all over the world get a rough deal, I think.
It doesn’t matter whether they are a bear
sitting in a tiny cage on a bile farm in
China, a dog living free on the streets in
Bosnia or a pet cat living in a luxury
apartment in Scotland, they will all be
experiencing their own individual welfare
problems. The more research we do to
learn about an animal’s needs, the more
we can do to improve its welfare.
Being concerned about an animal’s
welfare comes naturally to most vet nurses,
but sometimes things get overlooked when
we are busy in theatre, or running blood
tests, or cleaning, or dealing with clients, or
the hundreds of other things we do on a
daily basis. The dog that has been barking
in the kennel all day becomes a nuisance
and we forget to stop and think what it
might be trying to tell us. Is it frightened? Is
it hungry? Is it lonely? Is it in pain? Or is it
just desperate for the toilet? By looking at
an animal’s body language and behaviour,
rather than just its presenting condition and
hospital sheet, we can improve its welfare
and experience whilst it is under our care.
What will be covered in your lectures?
■■ Welfare vs ethics
This lecture will cover what animal welfare
actually is (it’s not hugging bunnies!) and
will aim to show the difference between
welfare and ethics (this will be an
interactive session using real-life case
studies), whilst showing how to improve
patient welfare within the veterinary
practice as a veterinary nurse.
AND THERE’S MORE…
Along with these morning lectures, there will
also be a number of afternoon seminars with
Iain A. Grant, Jenny Helm, Samantha Woods,
Brigitte Lord and Stephanie Lalor.
For full details of the programme and prices
visit www.bsava.com/scottishcongress
where you can download a registration
form or register online. Follow us on Twitter
(@BSAVACONGRESS) for the latest news and
updates, or email scottishcongress@bsava.com
for further information.
© BSAVA 2014
| companion JULY 2014 | 21
 Congress · 9–12 APRIL 2015
You could be a
Congress
speaker
Clinical Abstracts are the scientific gems of
the Congress programme, and submissions
are invited from all areas of the profession.
Winners of the 2014 awards share their
experience, from submission to selection…
W
hat sort of person would put themselves
through the ordeal of allowing both their
friends and enemies to closely examine
and criticize the quality of their work?
People like you, perhaps, as the BSAVA scientific
programme offers an opportunity for anyone in the
veterinary profession to show what they can do.
Presenters of the Clinical Abstract sessions are given a
15-minute slot to describe the sort of project that could
be carried out in pretty well every veterinary practice
around the country.
Clinical Abstracts are one of the hidden gems of
BSAVA Congress, one that many who have been
attending the event for years may have never
witnessed. The sessions are held in small rooms where
the audience numbers rarely rise above 20 or so, but
their value should not be measured in terms of
Professor
Michael Day and
Wendy Barnett
22 | companion JULY 2014 | © BSAVA 2014
© DollarPhotoClub.com | © razihusin
numbers alone, as the format plays a crucial role both
in the progress of veterinary science and in the career
development of the speakers.
GPs, VNs and PMs
“The Clinical Abstracts are a part of the programme
that allows veterinary surgeons, nurses or practice
managers to announce the preliminary results of a new
study, describe interesting cases or discuss new
techniques in a relatively relaxed and informal
environment,” says Nick Bexfield, vice chairman of the
Congress Scientific Committee and one of those
responsible for selecting the Clinical Abstracts.
Although it is a longstanding feature of BSAVA
Congress, like the rest of the scientific programme the
Clinical Abstract stream is constantly evolving. There
was a major change in 2013 when VNs and practice
managers were invited to give presentations for the
first time. A particular highlight was the paper by
Wendy Barnett, who holds an advanced surgical VN
qualification and is executive director of the Pet Blood
Bank UK in Loughborough. Her paper was on the
prevalence of dog erythrocyte antigen 1.1 in the
population of dogs donating blood for the national
service. For this she was awarded a prize at this year’s
meeting in Birmingham for the best paper in the
haematology category.
This was the first study where Wendy has
appeared as the first author, although she has made
contributions to previous publications. She expressed
her thanks to her co-author Rachel Dean of the nearby
University of Nottingham veterinary school, whose
expertise in evidence-based medicine has helped
direct the research she is conducting with her
colleague Jennie Walton.
 Congress · 9–12 APRIL 2015

“We realized that we had accumulated

information on a sufficiently large population of donor
dogs to provide meaningful results, and so we were
looking at the numbers in each breed that carry this
particular antigen. This is important clinically
because it is dangerous for a DEA-negative dog to
receive more than one infusion of DEA-positive
blood. But it is also important for us to be able to
make efficient use of all the donated blood that we
receive,” she explains.

Abstracts win prizes

Overall, there are six categories of Clinical Abstract
prizes awarded – for the best presentation by a VN/
practice manager, a practitioner, an intern or new
graduate, an intern/resident in medicine, an intern/
resident in surgery and a poster presentation.
Although this form of presentation is a particularly
useful part of the training process for young clinicians,
Abstract sessions are not their exclusive province.
A practitioner in Derby, Nick, who is also a part-time
lecturer at the Nottingham school noted that his boss
there, the head of the medicine division Professor
Malcolm Cobb, presented two papers this year in the
cardiology Clinical Abstract stream.
But the majority of presentations will be from
younger colleagues because the disciplines of
preparing and delivering a short presentation are an
essential part of their training. This year, Mickey Tivers,
now based at Cave Veterinary Specialists in Somerset,
received the surgery residents’ Clinical Abstract award
for a study that formed part of his PhD undertaken at
the Royal Veterinary College on the changes that
occur in the livers of dogs following procedures to
attenuate congenital portosystemic shunts.
“I was looking at various markers of liver
regeneration using quantitative PCR technology to
analyse gene expression. It was mainly a lab-based
study that formed a chapter in my thesis but it was
one of the important ones because it does have
implications for the clinical treatment of these
animals,” he explains.
Mickey had given a number of presentations
during his PhD work and had all the necessary
information and slides to hand, and so he says there
wasn’t a great deal of extra work involved in
preparing the talk. “But it was an extremely valuable Professor
opportunity to present the work and gain some extra Michael Day and
experience of public speaking before quite a broad Mickey Tivers
audience of practitioners and academics. It is good
to be able to discuss your work with the wider
veterinary community.”
A less daunting option
By coincidence, the winner this year of the medical
residents’ award, Nele Van den Steen, is now a
colleague of Mickey’s at Cave Veterinary Specialists.
At the time of her presentation on the prognostic
indicators in oral melanoma in dogs, the Ghent
graduate was studying for a master’s degree having
completed an internship in the oncology department
of the Animal Health Trust, near Newmarket.
“As a resident you are sometimes required to give
a presentation at an international meeting,” Nele
observes. “This has usually been one of the big
oncology conferences where the audience will all be
specialists and the atmosphere can be a little
daunting. What was nice about the BSAVA session
was that it was a small mixed audience and they were
all very friendly.”
Her abstract involved a retrospective descriptive
account of 168 cases of which 95 were included in the
survival analysis. “I was working with Sue Murphy and

© BSAVA 2014
| companion JULY 2014 | 23
 Congress · 9–12 APRIL 2015
You could be a Congress speaker
Davide Berlato at the Animal Health Trust. We were
able to make some interesting observations that hadn’t
been reported before about breed prevalence.
Compared with Kennel Club registration data there
appeared to be an excess of retrievers and
Newfoundlands, and also in Golden Retrievers, the
prognosis was worse than in other breeds.”
Working towards qualifications
Anna Tauro from Fitzpatrick Referrals in Godalming
won the practitioners’ Clinical Abstract prize –
sponsored by companion – at Congress 2014 for a
presentation she gave last year on polymyositis in
Hungarian Vizslas. Her presentation perhaps
involved a little more preparation than Mickey or
Nele’s as it was not part of a larger study towards an
academic qualification. It described a project
involving retrospective analysis of clinical records
from 334 cases of this newly recognized and still
rather mysterious condition. Much of her work
involved trying to fill in the inevitable gaps in the data
from cases going back more than a decade.
Anna’s work has made a key contribution
towards an international effort, which it is hoped will
Professor Michael Day, Anna Tauro and companion editor Simon Tappin
24 | companion JULY 2014 | © BSAVA 2014
eventually identify the causative genes. So
presenting her Abstract was an ideal opportunity to
bring this condition to the attention of a wider
audience. “Our main goal was to describe this
emerging and diagnostically challenging disorder,
and inform first opinion veterinarians how to
recognize, investigate and treat it. We also hoped to
raise much-needed awareness about this condition
and to encourage colleagues, owners and breeders
to participate to a scheme to collect, store and
analyse the DNA of affected families and their
relatives,” she explains.
While Anna’s decision to submit an Abstract for
presentation in the neurology session was part of her
personal quest to understand an important new
disease, most of the other applicants had more
modest goals in using the experience as a step up the
professional ladder.
Because it’s worth it
For those like Anna, Wendy, Mickey and Nele* who
go on to win the section prizes there is the reward of
a £300 cheque to pay for further CPD activities or to
buy books. Those who are not lucky enough to
catch the judge’s eye will at least have had the costs
of their attendance at the current meeting paid – for
the whole meeting in the case of those speakers
who are already BSAVA members and for the day of
their presentation for those that are not.
There were 20 Clinical Abstract sessions in
different clinical disciplines in 2014, including three
entirely new streams devoted to the subjects of feline
practice, canine practice and working in practice.
Prospective Clinical Abstract presenters are asked to
submit a written summary of their presentation of no
more than 350 words online by 20 October. Full
details are available on the BSAVA website. n
ADDITIONAL AWARDS
*Two further awards were made this year to Joana Gonçalves
Aguiar for the best Clinical Abstract by an intern/graduate
and to Xavier Navarro for the best Clinical Abstract poster.

Clinical Abstract guide
at a glance
B
SAVA would encourage members
attending Congress to add some
Clinical Abstracts into their
programme diary – and indeed, to
consider submitting a Clinical Abstract no
matter what aspect of the profession they
are working in. Plus, if you don’t want to
present your Abstract then you might want
to consider a poster presentation.
You have plenty of time for
preparation and planning – the opening
date is 15 September and the deadline is
20 October. Details and full guidelines
can be found online in the Congress
section of the website. Here’s what you
need to know…
Oral presentations
If a Clinical Abstract is accepted for oral
presentation then you will be invited to
present the Clinical Abstract during a short
12-minute presentation (plus three minutes
for questions and the change-over) on one
of the days during Congress. Presenters
who exceed the 12-minute time limit will be
asked to leave the podium and will not be
asked to speak in any capacity at
Congress for the following three years.
n The Abstract must be submitted by the
presenting author – registration cannot
be transferred to another individual.
n The author’s name and address must
NOT be included in the main text of
the Abstract. The assessment process
is anonymous and the Abstract
reviewers and authors are blinded to
each other’s identity.
Congress · 9–12 APRIL 2015
n Abstracts must be written in UK English
and using SI units.
n Do NOT include references in the
abstract.
n The oral or poster presentation at
Congress must concentrate on the data
in the abstract.
n Specific advertizing of products by
presenters must not occur.
n Please note that the use of
copyrighted images or information is
not permitted in any BSAVA
presentation or lecture notes, unless
permission for their use has been
granted by the copyright owner.
n Please use Arial size 10 font.
n The format of the Abstract is flexible,
but should contain information on
the aim of the work, methods, results
and conclusions. A statement that
says “the results will be discussed”
is not acceptable.
n Single case reports are more likely to
be accepted as poster presentations.
n Abstracts are not edited after
approval. Therefore, you are
advised to check your abstract very
carefully before submission, since it
will be printed exactly as submitted.
Once the Abstract is submitted,
changes to the Abstract will not be
accepted. During the Abstract
submission process, you will need
to list all co-authors for your
Abstract. Please note that, after an
Abstract has undergone review, we
cannot accept any changes in
authorship.
Poster presentations
Some Clinical Abstracts, such as those
that require large data tables or multiple
figures, or single case reports, or where
the presenting author is not confident of
their oral presentation skills in spoken
English, are more suitable for poster
presentations. The standards for
acceptance of Clinical Abstracts for
poster presentations are the same as
those for oral presentations.
Poster
The poster (size A0 – 1.189m x 0.841m)
must contain the title, authors, affiliations,
abstract (Clinical Abstract), introduction,
objectives, materials and methods,
results, discussion, conclusions and
references, and any conflicts of interest
where these exist. The figures, tables,
etc. must be presented within the
dimensions given, and the poster must
be written in UK English.
If your Clinical Abstract is accepted,
the presenting author must be in
attendance during the allocated times to
answer questions from delegates.
The poster presentation will be on
Saturday 11 April 2015 at the ICC. You
will be responsible for displaying your
poster from 16.00 on Thursday 9 April
2015 and removing your poster after the
presentation reception at 16.50 on
Saturday 11 April 2015.
A prize is awarded for the best
poster. All poster presenters are eligible
for this prize.
© BSAVA 2014
| companion JULY 2014 | 25
 Celebrating 40 YEARS of improving the health of pets
PetSavers and O
oncology
Cancer is estimated to affect
one in four dogs and is one of
the major causes of death in
insured dogs and elderly cats.
Jane Dobson explains how
PetSavers has played a key
role in the development of
veterinary oncology
26 | companion JULY 2014 | © BSAVA 2014
ver the past 25 years, advances in
veterinary medicine, particularly in
diagnostics (imaging, cytology and
immunohistochemistry), along with higher
expectations of the pet-owning public, have resulted
in an increased rate of cancer diagnosis in companion
animals. The attitude and approach of both the
pet-owning public and the veterinary profession to the
diagnosis and treatment of cancer in cats and dogs
has also changed, with the demand for both basic
and specialist treatment of animals with cancer
continually increasing.
For all these reasons, veterinary oncology has
become an important discipline within companion
animal medicine, with an ever-increasing demand for
oncological expertize in advisory, referral, teaching
and research capacities. As a result, a need has
developed for postgraduate education to a specialist
level in this field. Not only must a veterinary
oncologist have good clinical knowledge and
acumen, they must also have a good understanding
of the pathological process of cancer and, in order to
contribute to the advancement of the subject, they
must also have experience of research techniques
and study design.
PetSavers steps in
PetSavers recognized this need and supported the
development of veterinary oncology in the UK and
Europe by funding four successive Senior Clinical
Training Scholarships in Veterinary Oncology at
the Department of Veterinary Medicine, University
of Cambridge.
These training programmes were very
successful both in terms of training present-day
veterinary oncology specialists – Dr Joanna Morris,
Professor Laura Blackwood, Dr Anneliese Stell and
Frances Taylor – and of clinical research output.
As part of the clinical training programme, scholars
are required to engage in clinical research and publish
their work in peer-reviewed journals. To this end
PetSavers has supported advances in the diagnosis,
management and prognosis of canine leukaemias and
lymphomas (Morris & Blackwood), canine mammary
gland tumours and canine nasal tumours (Morris),
canine oral melanomas (Blackwood, Stell), the
development of topical photodynamic therapy for
treatment of feline nasal planum carcinomas (Stell) and
canine mast cell tumours (Taylor).
Encouraging expertise
Morris, Blackwood and Stell all went on to complete
PhD research training programmes, and have
developed independent research programmes. In
addition, they also currently hold prominent positions
in veterinary oncology at three of the UK’s leading
Veterinary Schools – Dr Joanna Morris is at the
University of Glasgow, Professor Laura Blackwood
works at the University of Liverpool and Dr Anneliese
Stell is at the Royal Veterinary College. All are
internationally recognized as specialists in their field,
are regularly invited to speak at national and
international meetings, and contribute to key text
books on their specialty.
In 2004 veterinary oncology became recognized
as a subspecialty by the European College of
Veterinary Internal Medicine, and in acknowledgement
of their contribution to advancing the field of veterinary
oncology in Europe, Drs Morris and Blackwood were
awarded de facto Diplomate status. Dr Blackwood is
currently chair of the ECVIM Medical Oncology
Education Committee. Frances Taylor successfully
passed the European Board examination to become a
European Diplomate and thus Europrean specialist in
Veterinary Oncology in 2012.
The most recent PetSavers-funded training scholar,
Dr Sarah Mason, completed her residency at Liverpool
in 2013, and is now a lecturer in oncology at the
university. Dr Mason passed the first part of the
European Board examinations in 2011 and is sitting the
final examinations in 2014. n
ABOUT THE AUTHOR
Dr Jane Dobson
MA BVetMed DVetMed DipECVIM (Ca & Onc) MRCVS
Jane is a graduate of the Royal Veterinary College. She then
spent two years as a registrar at the Beaumont Hospital (RVC)
before studying comparative oncology at the Royal Marsden
Hospital, London.
In 1984 Jane moved to the Department of Clinical Oncology
and Radiotherapeutics at the University of Cambridge as a
research assistant to study hyperthermia in the treatment of
cancer, leading to her DVetMed in 1989. She was appointed
University Lecturer in Veterinary Oncology in 1987. Jane
received the BSAVA Woodrow Award in 1994, became a
Diplomate of the ECVIM-CA in 1997, received the BSAVA
Blaine Award in 2001 and is a founding Diplomate in the
subspecialty Oncology of the ECVIM. She is also co-editor of
the BSAVA Manual of Canine and Feline Oncology.
The £200 Project and you
In this 40th anniversary year we are asking for the
support of small animal practices from across the UK
in finding inventive ways to raise £200 to help us
continue funding crucial clinical research to improve
our knowledge and understanding of the many
conditions affecting small animals.
Clients and staff can all get involved when you organize a
fundraising event – and it can also generate some great publicity for
the practice. If every small animal practice can raise at least £200 we
can continue to fund clinical research projects into small animal
diseases well into the future.
To find out how we can help you become part of the PetSavers
£200 Project please contact Emma Sansom on 01452 726723 or
email info@petsavers.org.uk.
© BSAVA 2014
| companion JULY 2014 | 27
Muscle
condition
score
The WSAVA Global Nutrition
Committee has developed a
new tool for patient assessment
I
t can be challenging to calculate the body condition
score for animals that have lost muscle mass but
have retained fat. To help assess companion
animals more accurately, the Nutrition Service at
Tufts University, led by Dr Lisa Freeman, has
developed a unique WSAVA Muscle Condition Score
system that now forms part of the WSAVA’s Nutrition
Toolkit, developed by the Global Nutrition Committee
(GNC). A muscle condition score is based on the
palpation of skeletal muscle over the skull, scapulae,
spine and pelvis.
Marge Chandler, Co-Chair of the GNC, explains:
“The value of the muscle condition score to the
veterinarian is to enable them to better evaluate the
health status of their patient. While the body condition
score evaluates body fat, it is possible for a pet to be
28 | companion JULY 2014 | © BSAVA 2014
overweight but still have muscle loss – indicating a
potential underlying problem, especially in diabetic,
otherwise ill or elderly patients.
“For example, in some diabetic cats the inguinal fat
pads still exist but the cat has lost the epaxial muscles.
Muscle mass is also lost with diseases such as chronic
kidney disease, cancer, hyperadrenocorticism and
osteoarthritis, and with corticosteroid administration.
Acute and chronic disease may cause loss of muscle
mass disproportionate to the loss of fat due to the
cytokine and neurohormonal effects on metabolism.
There is also muscle mass loss (sarcopenia)
associated with ageing.
“Our Muscle Condition Score system is just one
element of the GNC’s Nutrition Toolkit, which
contains a whole range of practical aids for the
veterinary healthcare team and educational
materials for pet owners.” ■
MORE ONLINE
Additional resources and information are available online
■ Muscle Condition Score system
■ GNC Nutrition Toolkit
Five minutes with World
Dr Louis Lui Congress
Dr Louis Lui is President of the Beijing
2014
Small Animal Veterinary Association
and recently became Chairman of
the Federation of Asian Small Animal
Are you ready for an
Veterinary Associations. We asked
unmissable scientific
him to tell us more about his work
programme?

I T
graduated from the College of Veterinary
Medicine, Beijing Agricultural University,
now called China Agricultural University,
in 1986, and in 1993 I chose to specialize
in small animals. I still diagnose and treat
sick animals at the Meilianzhonghe Animal
Hospital Union, a hospital union I
established with other experienced
veterinarians which includes six directly
managed hospitals and another twenty
hospitals. It aims to improve veterinary
skills, narrowing the gap between China
and more advanced countries.
I have been involved with BJSAVA
since 2002 and was elected President in
2008. In my role for BJSAVA, I focus on
improving standards of veterinary care in
China and carry out a great deal of CE for
our younger vets to ensure they gain
experience and go on to become leading
vets in China.
In 2004, BJSAVA joined the WSAVA
and, thanks to the CE that the WSAVA
provided, Chinese veterinarians started to
learn from renowned international
veterinarians. Of course, because of our
different culture, we still need an Asian
veterinary organization to help even out the
levels of veterinary expertise across the
continent. This is why FASAVA was
created. FASAVA works closely with the
WSAVA. What we now need to do is
strengthen communication with other
WSAVA members – to help them to get to
know China and to help them realize that
Chinese people also love animals.
I became Chairman of FASAVA in May
2014 and my goals are to unite Asian
countries as one, to continue with CE and
to shrink the veterinary technology
differences between us. We will make full
use of traditional veterinary medicine to
cure those difficult and complicated
diseases that Western medicine can’t cure.
I want FASAVA to become the authority
among all Asian associations and want
every veterinary and specialty association
to work together for the prosperity of the
Asian veterinary profession. I believe that
Chinese veterinary medicine will soon be a
global leader and the concept of Asian
traditional medicine will spread in Western
countries and play a huge alternative role
on the international stage. ■
he Scientific Programme for the
World Congress runs over four
days, with multiple parallel streams
for all members of the veterinary
healthcare team and presentations from
globally renowned speakers. With Master
Classes and State of the Art Lectures on
top, you will be spoilt for choice! World-
class lecturers include:
■ Jane Sykes: Leptospirosis
■ Joerg Steiner: Redefining chronic
pancreatitis
■ Valerie Fadok: Allergic dermatitis
■ Ralph Mueller: Treatment of atopic
dermatitis
■ Leslie Lyons: Cat genetics and
evolution.
Topics of particular relevance in
South Africa are also on offer, including:
■ Andrew Leisewitz: Immunology of
babesiosis
■ Shimon Harrus: Canine monocytic
ehrlichiosis.
Visit www.wsava2014.com for full
details and to register. ■

© BSAVA 2014
| companion JULY 2014 | 29
the companion interview

Martin Alder
Martin Alder is Editor of Veterinary Record and
In Practice, two of the most well-respected veterinary
titles in the UK. He grew up in Newcastle where his
mother and sister still live and to which, despite
having moved south nearly 40 years ago, he still
feels loyal. He graduated from Cambridge University
in 1978 with a degree in Natural Sciences, having
Courtesy of Gill Harris

studied zoology. He is married to Susanna Hourani,

who is Professor of Pharmacology at the University
of Surrey. They have a daughter, Lucy, who is 25.

Q How long have you been involved for it, as it turned out successfully, partly oversee things like printing, advertising
with the BVA’s publications and because the idea of editing a weekly and distribution. For the first 10 years or so,
how did that come about? scientific journal appealed to me and partly we also published journals on behalf of

A
I’m not sure where the time’s gone,
but I’ve been Editor of Veterinary
Record for 24 years. My association
with the journal goes back longer than that
as I worked on it as a subeditor for a
couple of years soon after graduating,
under my predecessor as Editor,
Edward Boden.
Having done a zoology degree, I wasn’t
quite sure what I wanted to do with my life
but that initial period on Veterinary Record
convinced me that I wanted to be a
scientific editor/journalist. I then worked for
a couple of years on a magazine called
World Medicine, which had quite a high
profile at the time, before joining New
Scientist, where I edited the opinion and
letters pages and was also responsible for
the weekly diary column, Feedback.
When the editorship of Veterinary
Record came up five years later I applied
because, naïvely, I thought it would be less
demanding than my role on New Scientist.
I couldn’t have got it more wrong. This was
not long after the Salmonella in eggs
(‘Currie’d eggs’) scandal and interest in
food safety was riding high. Also, BSE was
starting to take off. This kept me and
obviously quite a few other people busy for
most of the 1990s; I still think it was one of
the biggest science stories of the second
half of the 20th century. Although I found
myself working harder than I’d planned, it
was a fascinating period and, in a perverse
kind of a way, I think I almost enjoyed it.
How have your role and the
publications changed?
My role when I started as Editor was wider
than it is today; as well as being
responsible for the content of Veterinary
Record and In Practice, I also had to
other associations, including JSAP for
BSAVA and Veterinary Nursing for BVNA.
Throughout, I have been lucky to work with
an excellent and highly professional
editorial team.
The biggest changes over the past 10
years, affecting not just Veterinary Record
but scientific publishing in general, have
been brought about by the rise of the
internet and the growth in online
publishing, including the push for open
access for research papers. I like to think
we’re on top of this, and an important part
of that was our move, five years ago, to
BMJ, which has considerable expertise in
this and other areas and now publishes the
two titles on behalf of the BVA. We now
have a Veterinary Editor-in-Chief, Professor
Lord Trees, who is responsible for the
clinical and research content, and BMJ
looks after all the commercial aspects,

30 | companion JULY 2014 | © BSAVA 2014


which allows me to focus on commentary
and news.
Veterinary Record now has an open
access facility and, in addition, we have
recently launched an online open access
journal, Veterinary Record Open, to publish
material which, although scientifically
sound, may not be of broad enough appeal
for inclusion in Veterinary Record itself. We
also recently launched the online journal
Veterinary Record Case Reports which,
given that many journals don’t accept case
reports these days, aims to fill a gap by
publishing reports of interesting cases
encountered in all branches of practice.
You’ve probably met thousands of
veterinary professionals over the years.
How would you characterize the
veterinary profession?
There’s definitely something unique about
vets, but I’ve never quite managed to put
my finger on what it is. I used to think it was
the result of bonds formed at vet school as,
when I started, only about 50 people were
entering each vet school each year and
everyone seemed to know everyone else.
However, with so many more vets in the
pipeline these days that can’t be the case
any longer and there has to be more to it
than that.
Maybe it comes down to experiences
in common and a shared interest in
animals and their welfare. There’s also a
strong sense of professionalism. I’ve met
some great people and made some good
friends in the veterinary profession, and
have also had a lot of fun. Although I’ve
never wanted to be a vet myself (I’m much
too squeamish) I was pleased and felt very
honoured when the RCVS made me an
honorary associate a few years ago.
How do you identify topics for your
editorials, and stay so in touch with the
profession? What do you aim to impart
with your editorials?
You’d think, having written more than a
thousand of the things, I’d know the answer
Courtesy of Ian Holloway/RCVS
to that, but I’m not really sure. In some
weeks, certain topics cry out to be written
about; in others, when not much is
happening, I really have to scratch around
for a subject. It’s amazing how fascinating
a previously boring subject can become as
a weekly deadline approaches, and how
that deadline can concentrate the mind.
I get a lot of information from going to
meetings and talking to people and
listening to what they say. I also find things
out by trawling the internet and reading
reports that most people either haven’t got
time to look at or would find too tedious to
contemplate. It’s not just vets who read the
editorials; they are also read by politicians
and the like. The aim is to reflect, rather
than direct, veterinary thinking – to let
people know what is happening, and
perhaps make them look at things in a
slightly different way.
What have been the landmark events
that you have covered in your titles?
Were there any subjects that were
especially challenging?
BSE was big, as already mentioned – and
so was foot-and-mouth disease in 2001.
The impact – politically, economically and
emotionally – was huge, and the outbreak
left a lasting mark on many of the people
who were directly involved in trying to bring
it under control. It was also challenging in
editorial terms because this was before
use of the internet really took off and
people were relying on Veterinary Record
for news.
For me, at least during the initial stages
of the outbreak, this meant traipsing down
to the Ministry of Agriculture, Fisheries and
Food for daily press briefings, often at
short notice, and then, each Wednesday
(when Veterinary Record goes to press)
trying to make sense of it all and write
something that would still be relevant by
the time people received their copies of the
journal on the Saturday. It was all pretty
intense and, like everyone else, I was glad
when it was over.
…there’s definitely
something unique
about vets, but I’ve
never quite managed
to put my finger on
what it is…
On a more positive note, it’s hard not to
feel excited about the official
announcement in 2011 that rinderpest had
been eradicated worldwide, albeit that the
groundwork for this had been laid some
years before. The introduction of the Pet
Travel Scheme in 2000 was another
significant development, and was
preceded by much more debate than the
more recent changes to the pet travel rules
in 2012. On a personal level, I was proud of
a joint issue we did with The BMJ on the
subject of One Medicine in 2005, a topic
which is now getting more attention.
We also did a good issue when
World Rabies Day was launched in 2007.
Although certain events stand out, the
veterinary profession has continued to
evolve over the past 24 years, in terms of
its composition (it was predominately male
when I started), the way practice is
structured and the types of activities vets
are engaged in, and I hope our coverage
has reflected that.
What single thing would improve the
quality of your life?
I often think that life would be better if
emails hadn’t been invented, but I suspect
I’m not alone in that. Also, it would be good
to have a bit more time for windsurfing, but
fortunately I manage to do a fair amount of
that already.
Is there a song that will always get you
on the dance floor?
It would be better to ask if there is a song
that wouldn’t get me on the dance floor
but, even so, I’d be pushed for an answer.
I love dancing and, in the right company,
as at BSAVA Congress, for example, will
have a go at anything. ■
© BSAVA 2014
| companion JULY 2014 | 31
Essential guides
for your practice
Our loyal members should have already received some or all of
these guides as part of their member benefits, or have access
to them via www.bsava.com. However, there is always room
on the practice shelf for extra copies!

BSAVA BSAVA GUIDE TO

Small Animal Formulary Procedures in Small Animal Practice
8th EDITION 2nd EDITION

The latest edition of the The new edition of this handy

indispensable guide to drugs guide has been revised
used in small animal veterinary and updated, with colour
practice – now with hardback illustrations, a hardback
cover to increase durability. cover, and an index to help
information retrieval.

BSAVA Member Price BSAVA Member Price

£45.00 £45.00
Price to non-members: £60.00 Price to non-members: £60.00

BSAVA/VPIS GUIDE TO BSAVA

Common Canine and Feline Poisons How to...
COLLECTED ARTICLES FROM BSAVA companion

Key information covering Practical tips and tricks from

around 150 agents that affect the popular companion
dogs and cats. articles help to address a
wide variety of commonly
“…every practice really will encountered situations.
want to have this book on
the shelf…”
VETERINARY RECORD

BSAVA Member Price BSAVA Member Price

£30.00 £30.00
Price to non-members: £45.00 Price to non-members: £45.00

For more information or to order BSAVA Publications

www.bsava.com/publications COMMUNICATING VETERINARY KNOWLEDGE

BSAVA reserves the right to alter prices where necessary without prior notice.
Local
knowledge
News from BSAVA Regions

North East gets to grips

with inappetent cats
The room, kindly provided by Idexx, was packed
with a record number of delegates for May’s
inappetent cat meeting in the North East. Clearly
this perplexing and frustrating topic was popular
with those keen to find out what to do with a cat
who won’t eat and has normal blood results.
The award-winning local refreshments were
appreciated while we got to grips with some
good practical tips on what else we should be
looking for in the consulting room. Even with a
diagnosis, many cats steadfastly refuse to eat
– so delegates were encouraged not to be
scared of tube feeding, and given some good
ideas for drugs which work well to stimulate
CPD combines with pub quiz
for night of fun
appetite and are well tolerated, and dose
regimes for cats with kidney disease. We were
also reminded that cats can acquire learned
aversions to food when syringe-fed, medicated The first Thursday in February was an evening of give and take for the
orally, Leigh Allen, our local Hill’s rep, not only Southern Region. Delegates were given an excellent and informative talk on
sponsored our food, but also kindly donated the imported diseases from Luke Gamble, followed by a pub quiz where their
prizes for the PetSavers raffle. ■ money was taken in order to raise funds for Mission Rabies and PetSavers.
BSAVA President Michael Day was guest for the evening and spoke about
the invaluable work of both veterinary charities. Delegates were fascinated to

Let’s talk about sex,
say North East Region
Ever wondered about exactly when to do the dog
caesarian? Fed up with trying to interpret mating
dates? Struggle dealing with the owners of the stud
dog that seems to lack that certain something? Or
stressed about seeing pups that seem determined to
pass away?
If you answered yes to any of the above questions
then come to the North East’s meeting with Gary
England on 28 September and all will be revealed
(well, almost all).
This meeting is for vets and VNs, and you can
benefit from our Early Bird discount of over 50% if you
register before 9 August. Visit the website or email
administration@bsava.com for more details. See you
in Darlington. ■
hear about Luke’s first-hand experiences of rabies vaccination in India, and
the tragic loss of life from rabies amongst children in the country. Thanks to the
tremendous support from delegates representing practices from all over the
Southern Region, over £1300 was raised to split between PetSavers and
Mission Rabies.
Luke did an excellent job as quiz master. There was a nail-biting finish in
which nearly all teams scored full marks in the music round before Luke
dramatically announced the winners. Congratulations to the winning quiz
team, ‘Simple Minds’ from the Falkland Veterinary Clinic in Newbury, ably
assisted by Bayer’s Ronan Fitzgerald and Sam Le Vallee. Incredibly close in
second and third places, with just a point between them all, came ‘Clueless’
– the Ashworth Vets team from Farnborough – and ‘Anton Whatevers’ from
Anton Vets in Andover.
Our thanks also to go to our sponsor for the evening, Bayer, and to the
following companies and individuals for their generous donations of raffle and
quiz prizes and donations to the charities: Dignity Pet Crematorium, Winchfield,
Hants; Mérial UK; Zoetis; Hill’s; Anderson Moores Veterinary Specialists;
Dechra; Nutravet; Protexin; KA Veterinary Services Ltd; Jenkyn Place Vineyard,
Bentley, Hants; The Potters Heron Hotel, Romsey, Hants. ■

© BSAVA 2014
| companion JULY 2014 | 33
CPD diary
AFFILIATE WEBINAR
BSAVA & AVA
Tuesday 16 September
21:00–22:00
Making sense of breathing
systems
July LUNCHTIME WEBINAR Speaker: Susannah Taylor
Online
Wednesday 20 August Details from courses@bsava.com
DAY MEETING – 13:00–14:00
SOUTH WEST REGION Analgesia and pain assessment LUNCHTIME WEBINAR
Wednesday 9 July Speaker: Jackie Brearley
Online Wednesday 17 September
Are you flummoxed by fluids? Details from administration@bsava.com
Rethinking fluid therapy in 13:00–14:00
emergency patients LUNCHTIME WEBINAR
Different diagnosis of haematuria
Speakers: Sophie Adamantos and Speaker: Rob Foale
Christina Maunder Wednesday TBC August Online
Darts Farm Shopping Village, Exeter Details from administration@bsava.com
13:00–14:00
Details from southwest.region@bsava.com
Basic ophthalmic exam
Speaker: TBC DAY MEETING –
EVENING MEETING – Online IN CONJUNCTION WITH VCS
EAST MIDLANDS REGION Details from administration@bsava.com
Thursday 18 September
Tuesday 15 July
Getting the most from cardiac
The PUB Clinical Club: Collapse in
the dog – a night at the movies September diagnostics
Speaker: Mike Martin
Speaker: Mike Martin Woodrow House, Gloucester
The Royal Oak, Ockbrook DAY MEETING – Details from administration@bsava.com
Details from eastmidlands.region@bsava.com IN CONJUNCTION WITH BVOA

LUNCHTIME WEBINAR Tuesday 2 September AFFILIATE WEBINAR

Scared of orthopaedics? Building BSAVA & BVRSMA
Wednesday 16 July confidence and skills in practice
13:00–14:00 Speaker: Peter Attenburrow Thursday 18 September
Pericardial disease Oulton Hall, Leeds 21:00–22:00
Details from administration@bsava.com Chronic pain: 20 myths and
Speaker: Rachel James
Online misconceptions
Details from administration@bsava.com DAY MEETING Speaker: Gwen Covey Crump
Online
AFFILIATE WEBINAR Thursday 4 September Details from courses@bsava.com
BSAVA & AVA Handy tips on nursing small exotic
mammals
Tuesday 22 July Speaker: Wendy Bament DAY MEETING –
20:00–21:00 Venue: TBC EAST ANGLIA REGION
Details from administration@bsava.com
What to do when it all goes wrong: Sunday 21 September
updated CPR A day of interactive, case-based
Speaker: Louise Clark DAY MEETING –
Online METROPOLITAN REGION ophthalmology
Details from courses@bsava.com Speakers: Christine Heinrich and
Friday 5 September David Gould
The Animal Health Trust, Newmarket
LUNCHTIME WEBINAR Emergency surgery Details from eastanglia.region@bsava.com
Speakers: Dan Brockman and
Wednesday 23 July Lindsay Kellett-Gregory
13:00–14:00 Venue: Holiday Inn, Elstree, London DAY MEETING –
Details from metropolitan.region@bsava.com
Triage of the poisoned patient SOUTH WEST REGION
Speaker: Daniel Lewis
Online EVENING MEETING – Tuesday 23 September
Details from administration@bsava.com EAST MIDLANDS REGION Defusing the veterinary stress
Tuesday 16 September time bomb
Speaker: Jenny Guyat
The PUB Clinical Club: Oncology
August Speaker: Shirley Van Lelyveld
Exeter Court Hotel, Exeter
Details from southwest.region@bsava.com
The Royal Oak, Ockbrook
AFFILIATE WEBINAR Details from eastmidlands.region@bsava.com
BSAVA & BVBA DAY MEETING –
EVENING MEETING – SOUTH WEST REGION
Tuesday 5 August WEST MIDLANDS REGION
19:00–20:00 Wednesday 24 September
Rabbit behaviour: welfare and Tuesday 16 September Defusing the veterinary stress
handling in a clinical environment Communication time bomb
Speaker: Anne McBride Speaker: Stuart Ellis Speaker: Jenny Guyat
Online Wolverhampton Medical Centre, Wolverhampton Hilton Bristol, Bradley Stoke
Details from courses@bsava.com Details from westmidlands.region@bsava.com Details from southwest.region@bsava.com

34 | companion JULY 2014 | © BSAVA 2014

LUNCHTIME WEBINAR DAY MEETING – DAY MEETING –
IN CONJUNCTION WITH VCS EAST ANGLIA REGION
Wednesday 24 September
13:00–14:00 Wednesday 8 October Sunday 19 October
Behaviour and fireworks Controversies in canine The art and science of internal
Speaker: Daniel Mills cardiology: data or dogma? medicine: developing a
Online Dispelling myths in canine logical approach
Details from administration@bsava.com cardiology Speakers: Ian Battersby and Rob Foale
Speaker: Virginia Luis Fuentes The Cambridge Belfry, Cambridge
DAY MEETING – Woodrow House, Gloucester Details from eastanglia.region@bsava.com
NORTH EAST REGION Details from administration@bsava.com
EVENING MEETING –
Sunday 28 September EAST MIDLANDS REGION
Let’s talk about sex! DAY MEETING –
Speaker: Gary England
IN CONJUNCTION WITH VCS Tuesday 21 October
Blackwell Grange Hotel, Darlington
Thursday 9 October The PUB Clinical Club: Dos and
Details from northeast.region@bsava.com don’ts of cytology
Controversies in feline cardiology:
Speaker: Emma Scurrell
navigating the nightmare of feline The Royal Oak, Ockbrook
heart disease Details from eastmidlands.region@bsava.com
October Speaker: Virginia Luis Fuentes
Woodrow House, Gloucester
Details from administration@bsava.com LUNCHTIME WEBINAR
DAY MEETING –
IN CONJUNCTION WITH BRAVO
Wednesday 22 October
DAY MEETING 13:00–14:00
Wednesday 1 October Nursing the hospitalized
Advanced ophthalmology: just Thursday 9 October seizure patient
above basics and problem cases BSAVA Dispensing Course Speaker: Laurent Garosi
Speaker: Jim Carter Speakers: Fred Nind, Phil Sketchley, Online
Venue: Chilworth Manor, Southampton Sally Everitt, Mike Jessop, Pam Mosedale, Details from administration@bsava.com
Details from administration@bsava.com John Millward, Mike Stanford
Aldwark Frimley Hall, Surrey
Details from administration@bsava.com
DAY MEETING – OTHER UPCOMING BSAVA CPD COURSES
WEST MIDLANDS REGION See www.bsava.com for further details
LUNCHTIME WEBINAR
Saturday 4 October ■■ South West Region
Veterinary examination, handling Wednesday 15 October Wednesday 22 October
and husbandry of reptiles, 13:00–14:00 Fracture planning in practice:
PUO interactive case discussions
small mammals and cage birds:
a hands-on day with the animals Speaker: Nat Whitley ■■ North East Region
Speakers: Sarah Pellett and Online Sunday 26 October
Nathalie Wissink-Argilaga Details from administration@bsava.com Neurolocalization: how to stop worrying
Animal Care Department, Solihull College and love the neuro exam!
Details from westmidlands.region@bsava.com Affiliate webinar –
AFTERNOON MEETING – ■■

SOUTHERN REGION BSAVA & BAVECC

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
Interactive endocrinology
Speaker: Nick Bexfield
Woodrow House, Gloucester
Details from administration@bsava.com
DAY MEETING
Tuesday 7 October
Making the complicated straight-
forward: surgery for common hind
limb orthopaedic joint conditions
Speaker: Richard Meeson
Venue: Oulton Hall, Leeds
Details from administration@bsava.com
Wednesday 29 October
Wednesday 15 October Goal directed therapy in
emergency and critical care
The colourful consultation
Speaker: Brian Faulkner ■■ Metropolitan Region
Holiday Inn, Basingstoke Sunday 2 November
Details from southern.region@bsava.com Abdominal ultrasound
■■ BSAVA Education in conjunction
with BVZS
EVENING MEETING –
SOUTH EAST REGION Friday 7 November
What you need to know for the first
Wednesday 15 October opinion reptile consult
Practical blood transfusions with ■■ East Anglia Region
an update on Alabama Rot Sunday 9 November
Speaker: David Walker Rabbits: update on the top ten clinical
presentations in practice
Leatherhead Golf Club, Surrey
Details from southeast.region@bsava.com ■■ BSAVA Education
Tuesday 11 November
Feline GI disease: a practical
EVENING MEETING – problem‑oriented approach
METROPOLITAN REGION
Saturday 18 October
How to stay on the VN register and
out of trouble! EXCLUSIVE FOR MEMBERS
Speakers: Hilary Orpet, Perdi Welsh and Extra £5 discount on all
Belinda Andrews-Jones BSAVA publications for members
Royal Veterinary College, attending any BSAVA CPD event.
Hawkshead Campus, Hatfield All dates were correct at time of going to print; however, we
Details from metropolitan.region@bsava.com suggest that you contact the organizers for confirmation.

© BSAVA 2014
| companion JULY 2014 | 35
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29–31 August
Edinburgh Conference Centre, Heriot-Watt,
Edinburgh, Scotland, UK

A warm Celtic welcome

awaits you in Edinburgh
■ Morning lectures and afternoon seminars covering a
wide range of clinically and practically relevant topics
■ Trade Exhibition with over 30 Exhibitors already confirmed
■ Friday Exhibitor-led CPD giving you the view from the
other side
■ Gala Dinner with Ceilidh

Morning lectures covering

■ Vets : : Critical Care – Sophie Adamantos
: : Dentistry – Norman Johnston
■ Nurses : : Welfare vs Ethics – Hayley Walters
: : Critical Care – Sophie Adamantos

Email scottishcongress@bsava.com or
visit www.bsava.com/scottishcongress
to register and for full programme