The essential publication for BSAVA members

Weathering the
storm
Management issues
at Congress P4
Developments in
Oncology
Jane Dobson on
latest advances P7
companion
JANUARY 2011
How To
perform rhinoscopy
with Philip Lhermette
P14
A case of
acute respiratory
distress in a
young cat
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3 Association News
Latest news from BSAVA
46 Weathering the Storm
John Bonner reports on how veterinary practices are
affected by the current economic climate
79 Recent Advances in Veterinary Oncology
An update on the latest developments
1013 Clinical Conundrum
Consider the approach to acute respiratory distress in a
young cat
1418 How To
Perform rhinoscopy in the dog and cat
1920 Congress News
A look at the new Education Stream at Congress 2011 and
an update on Congress social
2122 CPD
On the right tract with Hattie Syme
2324 Petsavers
Latest fundraising news
2527 WSAVA News
The World Small Animal Veterinary Association
2829 The companion Interview
Carole Clarke
30 Meet Your Region
Spotlight on the Midland Region
31 CPD Diary
Whats on in your area
Additional stock photography Dreamstime.com
Dmitry Baevskiy; Drx; Elnur Amikishiyev; Eric Issele; Regien Paassen
companion is published monthly by the British Small
Animal Veterinary Association, Woodrow House,
1 Telford Way, Waterwells Business Park, Quedgeley,
Gloucester GL2 2AB. This magazine is a member
only benefit and is not available on subscription. We
welcome all comments and ideas for future articles.
Tel: 01452 726700
Email: companion@bsava.com
Web: www.bsava.com
ISSN: 2041-2487
Editorial Board
Editor Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVS
Senior Vice-President Richard Dixon BVMS PhD CertVR MRCVS FRSE
CPD Editorial Team
Ian Battersby BVSc DSAM DipECVIM-CA MRCVS
Esther Barrett MA VetMB DVDI DipECVDI MRCVS
Simon Tappin MA VetMB CertSAM DipECVIM-CA MRCVS
Features Editorial Team
Caroline Bower BVM&S MRCVS
Andrew Fullerton BVSc (Hons) MRCVS
Design and Production
BSAVA Headquarters, Woodrow House
No part of this publication may be reproduced in any form without written permission
of the publisher. Views expressed within this publication do not necessarily represent
those of the Editor or the British Small Animal Veterinary Association.
For future issues, unsolicited features, particularly Clinical Conundrums, are
welcomed and guidelines for authors are available on request; while the publishers
will take every care of material received no responsibility can be accepted for any loss
or damage incurred.
BSAVA is committed to reducing the environmental impact of its publications wherever
possible and companion is printed on paper made from sustainable resources and
can be recycled. When you have finished with this edition please recycle it in your
kerbside collection or local recycling point. Members can access the online archive of
companion at www.bsava.com .
A
s a BSAVA member you can save
15 off the normal member price
of the BSAVA Manual of Wildlife
Casualties, edited by Elizabeth
Mullineaux, Dick Best and John Cooper this special
offer has now been extended until 30 April 2011. (Member price:
was 49, now 34. Price to non-members: 74).
Half-price offer on Infectious diseases Manual
The BSAVA Manual of Canine and Feline Infectious Diseases,
edited by Ian Ramsey and Bryn Tennant, is now available at
half price (27.00) weve limited stock, so order quickly to make
the most of this opportunity.
Dermatology and Endocrinology offer
Dont forget, the BSAVA Manual of Small Animal Dermatology,
2nd edition and the BSAVA Manual of Canine and Feline
Endocrinology, 3rd edition are both still available at half price
while stocks last. New editions of both of these Manuals will be
published during 2011.
C
ompleting your 35 hours of CPD each year, and keeping in
budget at the same time, can feel like an impossible task
which is where BSAVA regional courses can prove
invaluable. Not only do BSAVA members pay nominal and
subsidised rates for regional courses, you will also save time and
money by making the most of CPD on your doorstep.
Your Region would be very happy for you to get involved
anything from suggesting subjects and speakers, to becoming a
part of the team. Of course you can also attend courses and get
involved in any of the 12 BSAVA Regions, especially useful if you
live on the boundary between regions. Sign up for a secondary
region in your profile at www.bsava.com and get to choose from
2 Regions CPD courses.
For details about courses in your Region visit the website or
email b.dales@bsava.com for information about getting
involved.
Regional
resolution
Make a New Years resolution in 2011
to make the most of your BSAVA
Region and the courses available on
your doorstep
Manual offers
Exclusive member
deal on Wildlife Manual
Buy online www.bsava.com or call 01452 726700.
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ASSOCIATION NEWS
has the
answer
W
ith the VAT increase kicking in on
everything from the 4th of January, were
all looking for more and more ways to
save money and Congress ticks a lot of boxes,
especially when youre a member
receive subsidised registration fees (save
another 5% when you do it online)
benefit from quality science without
breaking the bank
discover the best offers and get great
deals in the exhibition
enjoy a Saturday night of top comedy,
music and dancing for just 28
listen to all the lectures online after the
event FREE
this year collect your free new edition of
the Formulary from the BSAVA Balcony
get even more discount on BSAVA
Publications
So if you havent already booked for Congress
then now is the time to do it. You should have
been sent a personalised registration pack before
Christmas, however you can also register online or
download the registration forms from www.bsava.
com. If you have any questions then do call a
member of our Congress team on 01452 726700
or email congress@bsava.com. n
F
rances Barr, BSAVAs new Academic
Director, invites you to meet her on the
BSAVA Balcony to discuss the Associations
new postgraduate certificate, which will be
introduced to delegates at Congress. Frances
and members of the Education team are keen to
talk to anyone interested in furthering their careers
Meet Frances Barr
T
he Veterinary Poisons Information Service saw a noteable upsurge in
cases of antifreeze poisoning in the last two years, and expect 2010 to
reach similar levels. At the time of writing not all 2010 results were in, and
VPIS warns that a complete picture wont emerge until all the follow-up reports
come back, usually by around March. However, 12 fatal outcomes had already
been reported by the end of November 2010.
Alex Campbell of the VPIS says, Antifreeze chemicals are generally highly
toxic to companion animals, and mortality is high even after ingestion of
relatively small quantities of the diluted product. Owners should be cautioned
to take care to mop up any spillages that occur when diluting the products and
filling the engine reserves, and generally to keep animals away from the
garage! Where poisoning is suspected, immediate transfer to a veterinary
practice is vital as prompt; aggressive intervention is the major determinant of
survival. Once the glycols are metabolised then treatments are usually
ineffective, sadly.
VPIS cases of antifreeze poisoning (all animals)
Antifreeze
still a problem
Many of us will have relied on antifreeze to
keep our cars going during the recent big
chill but UK vets are still seeing the negative
impact of the substance on pets
Year Total no. of
referrals to VPIS
Deaths Euthanased Total fatal
outcomes
2010 (to date) 112 1 11 12
2009 145 7 29 36
2008 130 6 21 27
2007 57 5 10 15
2006 60 0 5 5
2005 41 1 5 5
and education, and find out what they are looking for
from a postgraduate programme. No appointment
necessary just come along any time during
Congress.
If you are not attending Congress and would like to
talk to Frances about the course, then you can email
her at f.barr@bsava.com. n
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MANAGEMENT
Weathering
the storm
Todays business barometer is set firm on
stormy, making conditions difficult for nearly all
commercial operations, and veterinary
practices are certainly feeling the chill of the
current recession. So every member of the
practice team must work together to insulate
their workplace from the worst effects of the
economic climate. John Bonner asks
management consultant and Congress speaker
Mark Moran for some weather-proofing tips
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MANAGEMENT
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RUNNING HEADER
E
very practice has them. They are the ones that
we call our best clients they know every staff
members first name, they leave a box of
chocolates as thanks for a job well done, and maybe
even a bottle of wine at Christmas. They are among
the main incentives we have for going to work but are
they the reason why your practice will still be there
when the recession is finally over?
No, says Mark Moran. He maintains that our best
clients may be important to the morale of the staff and
the financial health of the practice but not nearly as
much as we sometimes think. He says it is the clients
who turn up only when absolutely necessary and
may even grumble about the bill when they leave
who are key to the financial success of the business.
All to be revealed at Congress
Mark will be explaining why veterinary surgeons, VNs
and reception staff should be making an extra effort to
nurture their relationship with these non-bonded
clients in his presentations at BSAVA Congress 2011.
This is the first time that BSAVA has included a
dedicated session on management issues as part of
the main programme, rather than in one of the satellite
sessions. It reflects the Associations commitment to
improving the whole range of knowledge and practical
skills needed in a successful small animal practice
and particularly at a time when many clients are facing
economic hardship.
Mark is a regular speaker on the veterinary circuit.
Trained as a mechanical engineer, he had a managerial
role in a major multinational before taking an MBA and
setting up a business as an advisor to small companies.
By chance he was asked for guidance by a veterinary
practice and 11 years later he now works exclusively
with the profession, offering help to practitioners and lay
staff on management and communication skills. His
presentations on the Friday morning at Congress will be
followed by two further talks by acknowledged expert
communicators from within the profession, Christine
Magrath and Geoff Little, in a session on dealing with
complaints, organised in association with the Veterinary
Defence Society.
Identifying potential
In a typical veterinary practice the top 20 per cent of
clients are responsible for 40 per cent of the total
turnover. They have developed an emotional bond with
the practice and its staff, and their pets annual
vaccinations and worming treatments are likely to be
fully up to date. But we also know that in that respect
they are in a minority. Most puppies and kittens
receive their initial vaccinations but the numbers that
return for annual boosters fall away quickly such that
only 40 per cent of adult pets are fully protected.
To ensure the future health of those animals and
the practices business position it is essential that their
owners visit more frequently. As these clients have no
strong emotional bond with the practice they will only
do so if they perceive that the service they receive is
worth the time, effort and financial cost. So Mark will
challenge his audience to critically evaluate the
services they offer in their practice and see where it
might be improved. Many practices place too much
emphasis on the response of their best clients, and so
perceive that their service is better than it actually is.
As a result, they may fail to recognise and
acknowledge the role that poor client service is having
on their clients willingness to pay, he says.
Yet before the practice can win over these
occasional clients with the quality of the services
offered, they must be encouraged to come through the
door in the first place. Mark is surprised at how little
use some practices make of the vaccination reminder
system. This is the number-1 marketing tool and
practices need to drive it hard with second reminders
and follow up telephone calls. That will bring further
benefits in helping to clean up the practice database,
allowing more targeted campaigns vaccination
amnesties, special events for older pets, etc.
Knowing your client
Veterinary practices are in a stronger position than
businesses in most other sectors from which to reach
out to their customer base and explain what they
have to offer, Mark suggests. We dont have to deal
with huge numbers of clients, even the largest
practice will not see more than, perhaps, 1800 clients
in a year and we should know where they all are.
A company like Tesco is delighted if it manages to
get 25 per cent of its clients to use a loyalty card,
which will give the company valuable information
Many practices place too much emphasis on
the response of their best clientsas a result,
they may fail to recognise and acknowledge the
role that poor client service is having on their
clients willingness to pay
Mark Moran
MANAGEMENT
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MANAGEMENT
Weathering the storm
about their wants and needs. In contrast we have got
the key records for nearly 100 per cent of our clients
and we dont use this information properly.
Finding new clients
Marketing the practices services externally to pet
owners that are not already registered is rather more
challenging. Mark questions the cost effectiveness of
some of the traditional methods used to try to draw in
new clients, such as the Yellow Pages or local
newspaper advertising. However, he does think the
local press provides huge opportunities for
enhancing the practices reputation. Every good news
story that happens in the practice is an opportunity.
Somebody needs to take responsibility for getting the
story out with a picture and quotes from the owner.
Attracting these new clients is essential if the
practice is to withstand the effects of the inevitable
erosion in its client base. Even the best run practices
are going to lose about 20 per cent of their clients
each year through a pet dying or the owners moving
away. So it is important that the practice tries to
analyse who and where its clients are. This approach
probably wasnt necessary during past decades of
sustained growth in small animal practice but the
situation has changed, and to be successful
practitioners must learn to cope with an increasingly
competitive business environment, he says.
Money matters
One obvious consequence of the increasingly difficult
economic situation is an increased risk of practices
incurring bad debts. Mark says there is a lot of
anecdotal evidence that this happening and that
practices are taking steps to avoid incurring losses.
For example, new clients are being asked to pay up
front for treatment; and some practices have withdrawn
from directly handling clients insurance claims.
Mark notes that the effects of the recession are not
the same for all practices. Inner city clinics are likely to
experience more problems because the downturn is
having a disproportionate effect on poorer clients.
Indeed, some businesses based in the more
prosperous areas are hardly noticing any change, with
clients incomes remaining fairly steady while their
outgoings have fallen as a result of factors such as low
mortgage rates.
However, there is no place for complacency as
practices must be alert to any dangers ahead. Marks
presentation in Birmingham will introduce the concept
of two very different types of clients, apostles and
terrorists. The former are much the same as the best
clients that appeared earlier bearing gifts of
chocolates and flowers. They are the people who sing
the practices praises and help to attract the clients
who choose their practice on the basis of a personal
recommendation. The second are just the opposite,
although they are perhaps not as frightening as Marks
term for them suggests. They are the people who will
grumble about the service they experienced to anyone
who will listen, even though usually without foundation.
Many practitioners and their staff will be grateful to
see the latter leave the premises and never come
back. However, that is the wrong approach to take,
Mark warns. Practices get their good clients by word
of mouth. They choose their practice carefully
according to its reputation and the people with a
grievance, whom I am calling terrorists, can do an
awful lot of harm to that reputation. So it is important to
identify those people, talk to them, understand what
has happened and try and convert them. If the
situation is handled properly, it is possible to turn a
terrorist into an apostle, he says.
For full details of the scientific programme for
2011 download the details at www.bsava.com or
email congress@bsava.com to request a
registration pack.
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PUBLICATIONS
C
ancer is one of the major causes of death in
insured dogs (Bonnett et al., 1997; Michell,
1999) and elderly cats. It is not known whether
the prevalence of cancer in dogs and cats is actually
increasing; however, a number of factors may
contribute to the increase in the diagnosis of cancer in
companion animals.
As a result of improvements in health and welfare
animals are living longer, and cancer is generally a
disease of older age. Advances in veterinary medicine,
particularly diagnostic techniques, and higher
expectations of the pet-owning public are likely to
result in an increased rate of diagnosis. The attitude
and approach of both the 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.
Diagnostic techniques
New technology is having an impact on the veterinary
approach to the cancer patient. In terms of diagnostics,
use of monoclonal antibodies to aid in determining the
cell of origin and subtype of tumours such as
lymphoma and leukaemia has been shown to be of
prognostic value, and immunohistochemistry has
become more widely used in the diagnosis and
classification of types of cancer (e.g. soft tissue
sarcomas; see Case 1). The increased availability of
advanced imaging techniques, such as contrast-
enhanced ultrasonography, computed tomography
(CT) and magnetic resonance imaging (MRI), is starting
to revolutionize our ability to detect and determine the
true extent of some tumours, allowing better planning
for surgical approaches and radiotherapy.
Conventional therapies
In terms of therapeutics, the clinical management of
cancer in pet animals is still largely reliant on the
conventional methods of surgery, radiotherapy and
chemotherapy.
Surgery is the most effective method of treatment
for many solid tumours such as mast cell tumours,
low grade sarcomas and low grade carcinomas. The
recognition that these locally invasive tumours require
surgical resection of a margin of normal tissue to allow
complete eradication, and the development of surgical
techniques to achieve such margins, can frequently
result in a surgical cure.
The growing availability of radiotherapy facilities
has lead to an increase in the application of radiation
either as a primary treatment (e.g. for brain and nasal
tumours) or in conjunction with surgery for mast cell
tumours and sarcomas at sites which may prove
difficult to manage by surgery alone.
Chemotherapy remains the treatment of choice
for systemic malignant diseases, particularly
lymphoma. Protocols based on cytotoxic drugs
including vincristine, cyclophosphamide,
prednisolone and doxorubicin are now routinely
used to treat this disease. Chemotherapy is
increasingly used as an adjunct to surgery for those
tumours with a high risk of metastasis (e.g. in
osteosarcoma, the use of carboplatin following
amputation has been established as a means of
delaying development of metastasis and thus
extending postoperative survival times).
Novel approaches
Alongside these conventional therapies some novel
approaches have been used in veterinary medicine; for
example, photodynamic therapy for treatment of
superficial squamous cell carcinomas and other head
and neck tumours (see Case 2). A novel immune
modulator, imiquimod (Aldara, Laboratoires 3M Sant),
which possesses both antiviral and antitumour activity,
has been used with variable success in human patients
with cutaneous tumours, including basal and squamous
cell carcinoma and epitheliotrophic lymphoma, and has
also been used in cats and horses (Gill et al., 2008).
In human medicine major advances in the
treatment of certain cancers have been achieved
through the use of novel targeted methods of cancer
Recent advances in
veterinary oncology
Cancer is estimated to affect
as many as one in four dogs.
Dr Jane Dobson from the
University of Cambridge
updates companion readers
on the latest developments in
this area
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PUBLICATIONS
Recent advances in veterinary oncology
therapy. The small tyrosine kinase inhibitor
molecule imatinib (Gleevec, Novartis),
which targets cells with activating
mutations in the KIT gene, has
revolutionised the treatment of chronic
myeloid leukaemia (CML) and
gastrointestinal stromal tumours (GIST).
Twenty to thirty percent of canine mast
cell tumours have activating mutations in
the juxtamembrane region of the KIT
molecule, implicating KIT tyrosine kinase in
the pathogenesis of canine mast cell
tumours and as a potential therapeutic
target. Two tyrosine kinase inhibitors,
masitinib (Masivet, AB Science) and
toceranib (Palladia, Pfizer), have recently
been licensed in Europe and the USA
for treatment of non-resectable grade II
or grade III mast cell tumours in dogs
(Hahn et al., 2008; London et al., 2009).
Furthermore, due to their mechanism of
action these agents may yet find
indications beyond canine mast
cell tumours.
Specific growth factor receptors may
also be targeted by monoclonal antibodies.
The antibody targeting the human
epidermal growth factor receptor (HER-2),
Herceptin (Trastuzumab, Genentech), has
proven to be effective in the treatment of
HER-2 positive breast cancer. Antibodies
have also been developed to target cell
ONCOLOGY MANUAL
Jane Dobson is co-editor of the forthcoming BSAVA Manual of
Canine and Feline Oncology, 3rd edition. Building on the
success of the previous editions, the Editors have sought to
marry the best of the old with the new. All chapters have been
updated, or rewritten, by international experts to encompass
the important advances made over the last several years, while
keeping the text practical and user-friendly.
The new edition will be available later this month. Register your
interest online at www.bsava.com.
CASE 1
Max: 6-year-old male neutered
Flat-coated Retriever
History and
clinical signs
6-week history of
progressive left
forelimb
lameness,
associated with
periarticular
swelling of the left
elbow with no
bone involvement.
signalling pathways; CD20 is a
transmembrane protein which regulates
early steps in the activation of cell cycle
initiation and differentiation. The antigen is
expressed on most B-cell non-Hodgkins
lymphomas, but is not found on stem cells,
pro-B cells, normal plasma cells or other
normal tissues. Rituximab (Rituxan or
MabThera, Roche), an anti-human CD20
antibody, has added greatly to treatment of
B-cell lymphoma in adults.
The future
Whilst these developments are very
exciting, advances in the human field do
not always translate directly into veterinary
oncology medicine. For example, none of
the antibodies directed against extracellular
domains of human CD20 bind to canine
CD20. Therefore, for rational application of
targeted cytostatic treatments in veterinary
cancer medicine we need to define relevant
targets in animal tumours. Research is
urgently required to determine which cell
surface receptors are expressed in
different tumours, and which signalling
pathways are functional or dysfunctional in
the neoplastic cells. Work already in
progress in these areas offers a promising
start to an exciting future.
References available online at www.bsava.com
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PUBLICATIONS
CASE 2
Basil: 10-year-old male neutered Domestic
Shorthaired Cat
History
Basil was presented for evaluation and treatment of a superficial
squamous cell carcinoma of his nasal planum. The scabby
lesion on his right
nares had been
present for 68
months, gradually
enlarging. A small
punch biopsy
confirmed the
diagnosis.
Treatment
Although superficial,
early nasal planum
squamous cell
carcinoma in cats
may be treated
successfully using
several methods. At
the University of
Cambridge we have
developed a form of
photodynamic
therapy (PDT) using
topical application of
5-amino-levulinic
acid, a
photosensitising
agent, with
subsequent
illumination of the
affected area by a
high intensity red
light. Basils nose
responded very well
to PDT.
Diagnostic techniques
An incisional biopsy from the elbow mass showed an infiltrative
tumour composed of sheets of round to oval neoplastic cells with
scant stroma, consistent with an anaplastic sarcoma.
Immunohistochemistry confirmed the diagnosis of histiocytic
sarcoma (vimentin and CD18 positive).
Treatment
Max completed a 4-week course of palliative radiotherapy for his
elbow tumour. The swelling has substantially reduced and his
lameness has resolved. The longer term prognosis remains
guarded.
Note
The University of
Cambridge
Veterinary School
has an established
interest in tumours in
Flat-coated
Retrievers, and has
worked with owners
and breeders for
many years to
document and
define the incidence
of histiocytic
sarcoma in the
breed and to
investigate its
molecular genetics.
CD18 Vimentin
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CLINICAL CONUNDRUM
Clinical
conundrum
Andrea Harvey, RCVS Specialist in Feline
Medicine, invites companion readers to
consider the approach to acute respiratory
distress in a young cat
Create a problem list
Problems identified are:
Chronic coughing
Acute tachypnoea/dyspnoea with shallow
breathing, increased inspiratory effort and
hyper-resonance on percussion.
Consider the differential diagnosis for
your problems. Can your differentials be
prioritized based on the history and
physical examination findings?
Chronic coughing is most commonly caused by chronic
bronchial disease, but may also be caused by feline
lungworm (Aelurostrongylus abstrusus), an inhaled
bronchial foreign body, extramural airway compression
(e.g. by a mediastinal mass), bronchial or pulmonary
neoplasia, or bronchopneumonia (e.g. secondary to
aspiration, URT viruses, inhaled foreign body).
Dyspnoea may be caused by upper airway, lower
airway or pleural space disease, or may be due to
non-respiratory causes (e.g. anaemia, pain, stress).
Features of the respiratory pattern can help to
distinguish between these groups of disorders.
Acute-onset dyspnoea in a cat with chronic coughing
may often be the result of an acute episode of
bronchoconstriction (e.g. asthma). However, in this
situation, increased expiratory effort would be
expected. Increased inspiratory effort occurs with
upper airway disease and pleural space disease.
Rapid shallow breathing with increased inspiratory
effort is suggestive of pleural space disease. Pleural
space disease can be effusive (transudate, modified
transudate, septic exudates, non-septic exudates,
chylous, haemorrhagic) or non-effusive (soft tissue,
e.g. diaphragmatic rupture, or air, pneumothorax). In
this case the hyper-resonance on percussion, in
combination with the respiratory pattern, is suggestive
of pneumothorax.
What is your initial priority?
Given that the patient is in respiratory distress at rest,
the handling and intervention necessary for full
examination and diagnostic procedures risks
exacerbation and fatal decompensation. The priority is
to stabilise the patient sufficiently that investigation can
proceed with reduced risk.
The cat was first placed in an oxygen chamber in a
quiet room. Terbutaline was administered for
bronchodilation. After 10 minutes, left-sided
thoracocentesis, which is both therapeutic and
diagnostic, was performed, and 45 ml of air was
removed from the pleural space.
Construct an initial diagnostic and
treatment plan
Pneumothorax may be caused by blunt or penetrating
trauma, bullae, or any severe pulmonary pathology
that could cause disruption and rupture of alveoli (e.g.
chronic lower airway disease, neoplasia). Following
thoracocentesis, the degree of dyspnoea had much
Case presentation
A 1.5-year-old male neutered DSH cat was
presented with acute-onset severe
tachypnoea and dyspnoea. Intermittent
coughing for the previous 2 months was also
reported. No other clinical signs had been
observed. He was a mixed indoor/outdoor cat,
fully vaccinated (FCV, FHV-1, FPV, FeLV), fed a
commercial dry diet. He was last wormed at 6
months of age. There was no access to toxins
and the cat had never been outside the UK. On
presentation the cat was tachypnoiec with
very rapid (80 breaths per minute) shallow
breaths and was mouth breathing. On
observation there was increased inspiratory
effort. Thoracic percussion revealed hyper-
resonance bilaterally. Further examination
was not possible at this stage without causing
more severe dyspnoea.
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CLINICAL CONUNDRUM
How does your interpretation of the test
results help you refine your differential
diagnosis?
Thoracic radiographs (Figure 1) revealed a severe diffuse
bronchial pattern, with presence of doughnuts and
tramlines. No bullae were evident and there was little or
no residual air in the pleural space. This is suggestive of
the presence of lower airway pathology. This finding can
explain the chronic cough and audible wheezes.
Furthermore the lack of evidence of trauma, suggests the
pneumothorax is most likely to have occurred as a
consequence of the lower airway pathology and
coughing and that the leak is not ongoing.
What further investigations may be helpful
at this stage?
Lower airway disease in cats has been referred to as
feline bronchial disease, feline bronchopulmonary
disease or feline asthma. However, these umbrella terms
probably describe a range of diseases with similar end
pathology. In this case a young cat with a relatively
short course of disease infectious or parasitic causes
of bronchitis are particular possibilities.
Bronchoalveolar lavage, with or without endoscopy,
would be useful in further investigating the lower airway
disease; however, healing time is required for
parenchymal repair prior to these procedures being
performed, due to risk of worsening the pneumothorax.
Faecal parasitology and culture were performed to
assess for Aelurostrongylus, and were negative.
Treatment with terbutaline was continued for a few days
prior to general anaesthesia for bronchoscopy.
What are your specific concerns regarding
anaesthesia and bronchoscopy in this
case ?
Preoxygenation is advised prior to induction of
general anaesthesia in all patients, but especially
those with respiratory compromise.
Ensure a stress-free induction By minimising
people and noise in the induction room, both the
anxiety of the patient and the dose of anaesthetic
required can be kept to a minimum.
Monitoring In addition to conventional monitoring,
careful attention should be paid to pulse oximetry.
Figure 1:
Right lateral and
DV thoracic
radiographs
48 hours after
presentation
improved (respiratory rate 40/min) and a complete
physical examination was possible.
The cat was in good body condition (body
condition score 2.5/5) and weighed 4.1 kg. There
was no evidence of trauma. Cardiac auscultation
was normal (heart rate 180/min). Mucous membranes
were pink with CRT < 2 seconds. Thoracic
percussion was normal, and there were audible
wheezes on auscultation.
After 48 hours the cat was considered fully
stabilised and fit for further investigation. The
patient was sedated for thoracic radiography to
further investigate the cause of the chronic cough,
audible wheezes, and underlying reason for
development of pneumothorax.
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CLINICAL CONUNDRUM
Clinical conundrum
Also, there is a specific risk of a pneumothorax
developing either during or after the procedure.
Ensure that thoracocentesis equipment is quickly
to hand and ready in case it is required
At bronchoscopy (Figure 2) the airways were
moderately hyperaemic with irregular mucosa and
excessive mucus. There were no purulent secretions
observed and no evidence of a foreign body.
Bronchoalveolar lavage was performed and samples
submitted for bacterial culture and sensitivity, and
cytology. Extended culture for Mycoplasma spp. was
also performed. Cytology revealed high cellularity with
a mixed predominantly neutrophilic inflammation and
dysplastic epithelial cells. Mycoplasma culture was
positive. Routine culture yielded no growth.
Diagnosis
Chronic bronchitis and Mycoplasma infection.
Pneumothorax was considered to be a consequence
of the airway disease.
Given the diagnosis, how would you
further manage this case?
To treat Mycoplasma infection, doxycycline is the
drug of choice. Oral administration of doxycycline has
been associated with oesophagitis and formation of
oesophageal strictures. Therefore, after
administration of this medication, a few millilitres of
water should be given to the patient, to ensure the
tablet has passed into the stomach.
Given the severity of the bronchial changes,
control of the infection alone was considered
insufficient and anti-inflammatory drugs were also
required. Systemic corticosteroids were first initiated
for rapid control of the clinical signs: prednisolone
0.5 mg/kg q12h. Inhalational fluticasone was also
initiated at a dose of 250 micrograms by metered dose
inhaler, 2 puffs twice daily, to be administered using an
Aerokat spacer chamber.
Most cats tolerate the Aerokat inhaler very well.
Cats should be introduced to it slowly for example by
Figure 2:
Bronchoscopy
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CLINICAL CONUNDRUM
Figure 3: Acclimisation to the Aerokat inhaler
Figure: 4: Range of inhalational and enteral drugs
suitable for therapy
first allowing them to become used to the mask without
the spacer chamber attached, putting treats in the
mask so that they get used to putting their head into
the mask and associate it with a positive outcome.
When they are acclimatised to the mask the chamber
can be attached and the cat slowly allowed to become
used to having the mask with spacer held over the
face for a few seconds, without drug being used to
begin with. Using treats to reward the cat afterwards
can be helpful. Once the cat is used to the mask and
chamber, then drug can be initiated. The noise of
depressing the metered dose inhaler can make some
cats anxious so this should be performed before
placing the mask over the cats face.
After 3 weeks on systemic prednisolone, the owner
reported no further coughing, respiratory rate was
normal and the cat was also a lot more active. No
further dyspnoeic/tachypnoeic episodes had
occurred. The cat was weaned off systemic
prednisolone and continued on inhalational
fluticasone. Clinical signs remained well controlled and
the dose was gradually reduced to a maintenance
dose of one puff once daily.
Whenever Mycoplasma is detected in the feline
respiratory tract, its significance is difficult to determine,
since Mycoplasma spp. can be part of the normal
respiratory flora in addition to being a respiratory tract
pathogen. The possibility of contamination from the
upper respiratory tract should be considered, and
whenever bronchoalveolar lavage is performed, care
needs to be taken to ensure that the bronchoscope is
not contaminated in the upper respiratory tract.
Negative culture of a flush of the bronchoscope
performed prior to BAL, ensures that any positive BAL
culture is not the result of contamination of the
bronchoscope from another source. Mycoplasma spp.
may also proliferate in the lower airways as a
consequence of airway disease, in addition to being
implicated as a causative agent of airway inflammation.
When identified, it is advisable to treat mycoplasmosis,
but when severe airway inflammation is present,
anti-inflammatory therapy is also indicated.
CARDIORESPIRATORY MANUAL
The diagnosis and management of acute
respiratory distress is just one of the topics covered
in the new edition of the BSAVA Manual of Canine
and Feline Cardiorespiratory Medicine.
Clinical problems
Diagnostic techniques
Mechanisms of disease
Therapeutic strategies
Specific diseases
Order your copy online at www.bsava.com or call our Membership and
Customer Services Team on 01452 726700 to purchase your copy.
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HOW TO
How to
How to perform
rhinoscopy in the
dog and cat
Philip J. Lhermette, co-editor of the BSAVA Manual
of Canine and Feline Endoscopy and Endosurgery,
takes us on a guided tour of the nose
T
he nose is a difficult site both to
image effectively and to access.
Surgical rhinotomy is an extremely
invasive and painful procedure and is
rarely necessary except for extensive
debulking of tumours prior to
radiotherapy. CT and MRI provide the best
means for delineating the margins of nasal
masses but rhinoscopy is the gold
standard for visualising nasal lesions,
taking biopsy samples and removing
foreign bodies. Treatment of various nasal
conditions can also be carried out
rhinoscopically, including treatment for
nasal aspergillosis, removal of polyps, and
laser debulking of tumours.
Instrumentation
A 2.7 mm 30 rigid endoscope with a
working length of 18 cm is used for the
majority of rhinoscopic examinations in
both the dog and cat. The endoscope is
most commonly used with a matching
cystoscope sheath, which provides an
instrument channel through which
grasping or biopsy forceps can be
introduced (Figure 1). In some cats a
smaller arthroscope sheath is used but
this lacks an instrument channel and
requires instruments to be placed
alongside the endoscope in order to take
samples. Rigid endoscopes smaller than
4 mm should never be used without a
protective sheath of some kind as they are
very easily damaged.
A protective sheath also provides an
irrigation port, and effective saline irrigation
is the key to performing an effective
rhinoscopic examination.
A second pair of 3 mm rigid biopsy
forceps is invaluable. Nasal mucosa swells
rapidly when inflamed and can easily
obscure underlying pathology. Small
superficial pinch biopsy may not be
diagnostic so getting a sufficiently large
and deep sample is imperative if a
diagnosis is to be obtained.
A flexible bronchoscope of around
3.54 mm diameter is also useful to obtain
a retroflexed view of the choanae over the
free edge of the soft palate. In large dogs a
small gastroscope can be used.
Finally, a good light source, preferably
xenon, and a camera system are essential.
Patient preparation
Radiographs should always be taken prior
to rhinoscopy as the procedure will
inevitably result in changes that will make
subsequent radiography impossible to
interpret. Intra-oral, lateral and skyline views
should be taken to examine the turbinates,
tympanic bullae and frontal sinuses in
detail. If dental disease is suspected,
additional dental radiographs may also be
taken. In any case a complete oral and
dental examination should be undertaken
under anaesthesia prior to rhinoscopy.
Blood samples for Aspergillus serology
and routine biochemistry and haematology
can also be useful, and a basic clotting
profile is advised. Nasal mucosa is
extremely well vascularised and
haemorrhage can be a problem, especially
when the mucosa is inflamed. Adequate
clotting ability is a prerequisite to a
successful procedure. Culture of nasal
bacterial swabs are rarely helpful and
usually only return commensals organisms.
Similarly examination of discharge for
Aspergillus may be attempted but is often
unrewarding. True primary bacterial rhinitis
is extremely rare if it occurs at all.
Caudal (flexible) retroflexed
rhinoscopy
The anaesthetised patient is placed in
sternal recumbency with the head
positioned over a wet table or gridded tray.
It may be helpful to place a rolled up towel
under the lower jaw to raise the nose a
little. A mouth gag is inserted and the
flexible endoscope is inserted to the free
edge of the soft palate and then retroflexed
up and around into the nasopharynx in a
J manoeuvre. Alternatively, where there is
space, the tip may be preflexed and
pushed past the free edge of the soft
palate, then hooked over the dorsal edge.
This gives an inverted view of the choanae
on the monitor so up is down and left is
right! (Figure 2). This is a common site for
foreign bodies and nasal masses including
nasopharyngeal polyps in cats, but
strictures and Aspergillus colonies may
also be seen here.
Tissue samples may be taken but it is
important to remove the endoscope from
the mouth first and straighten the end
Figure 1: Rigid endoscope with protective
sheath
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HOW TO
giving set and the valves opened to allow
flow to be controlled via the tap on the
cystoscopy sheath. Saline should be at
room temperature; cold saline can result in
hypothermia during a prolonged
procedure due to the highly vascularised
nasal mucosa acting as a heat sink.
Raising the drip stand should give
sufficient gravity flow for most cases, but a
pressure bag can be useful where
increased irrigation is required to dislodge
mucus or where there is extensive
haemorrhage. When visualisation is poor,
the depth to which the scope can be
Figure 2: The right choanal mass is seen
on the left of the image
before inserting the biopsy forceps right to
the tip. The endoscope is then replaced
and the sample taken before removing and
straightening the endoscope prior to
withdrawing the forceps. Forcing
instruments through a flexed endoscope
will damage the lining of the instrument
channel, resulting in expensive repairs or a
worthless endoscope.
Anterior (rigid) rhinoscopy
Following examination of the nasopharynx
the cuff of the endotracheal tube is
checked to ensure a good seal and a swab
is placed over the larynx. Anterior
rhinoscopy is invariably carried out with a
rigid endoscope under vigorous saline
irrigation. Flexible endoscopes do not have
a large enough channel to permit irrigation
and any haemorrhage will make further
examination impossible. Rigid endoscopes
have superior optics, magnification and
illumination and are used within a sheath
that can provide copious irrigation to wash
away mucus debris and haemorrhage.
The endoscope is placed into the
cystoscopy sheath and attached to the
light guide cable and camera system. The
system is then white balanced to ensure
accurate representation of the image. A
litre bag of normal saline is attached to
one of the irrigation ports via a standard
Middle nasal meatus
Dorsal nasal concha
Dorsal nasal meatus
Common nasal
meatus
Ventral nasal
concha
Cartilage of
nasal septum
Ventral nasal
meatus
Vascular plexus
of hard palate
Vomeronasal organ
First premolar
Palatine process of maxilla
Palatine process of incisive bone
Lip
Vestibule
Canine tooth
Maxilla
Nasal process of incisive bone
Nasal bone
Vomeronasal cartilage
Ethmoidal labyrinth
Cribriform plate
Lateral part of frontal sinus
Medial part of frontal sinus
Entrance to maxillary recess
Dorsal nasal concha
Ventral nasal concha
Transverse and longitudinal sections to show the anatomy of the canine/feline nose
Illustrations by S.J. Elmhurst (www.livingart.com) and reproduced with her permission
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HOW TO
How to perform rhinoscopy
in the dog and cat
inserted without passing the medial
canthus of the eye should be marked with
tape to prevent iatrogenic damage to the
cribriform plate.
Visualisation
The normal side is usually examined first.
A small amount of sterile water-soluble
lubricant is applied to the outside of the
sheath. Then the alar cartilage is elevated
to allow insertion of the tip of the
endoscope into the anterior nares and
saline flow is started. Extreme care must be
taken to prevent unnecessary trauma to the
delicate nasal mucosa. It is helpful for the
surgeon to be sitting down with one hand
placed on the top of the animals nose with
the index finger and thumb controlling and
stabilising the tip of the endoscope.
The other hand holds the camera and
provides directional control. It is vital to
remember that the angle of view is at
30 degrees to the long axis of the
endoscope and is directed diagonally
opposite to the light guide post. This
means that when the endoscope is
placed in a tubular structure with the light
guide post in the ventral position, the
lumen should appear at the bottom of the
picture on the monitor. This can be
appreciated more fully by attaching a
camera to a bare endoscope and then
inserting it into a sheath and watching the
position of the lumen on the monitor. If the
surgeon attempts to keep the lumen in the
centre of the picture on the monitor then
the tip of the endoscope will actually be
gouging a neat trough in the ventral nasal
mucosa! If the endoscope is turned on its
side during the procedure, as it often is,
compensation must be made for the
direction of insertion relative to the position
of the lumen on the monitor.
Following a set routine will help
prevent mistakes and ensure
nothing is missed
1. The nasal cavity is divided into the
dorsal, middle, common and ventral
meati by the dorsal, ventral and
ethmoidal nasal conchae or
turbinates. Following insertion into the
rostral nares, the endoscope is aligned
with the nasal septum and the rostral
nares examined first. The dorsal and
ventral meati are identified and
examined separately.
2. The dorsal meatus is examined first by
directing the tip of the endoscope
dorsally and medially towards the
septum. The dorsal meatus is a single
domed area delineated by the dorsal
turbinate and is easily identified
(Figure 3) and followed back towards
the cribriform plate until it gets too
narrow to proceed further. Nasal
mucosa should be uniformly pink and
smooth and should not bleed
excessively on touch. There should be
no visible mucus or discharge. Any
discharge is abnormal and indicates
underlying pathology. Mucus can be
quite tenacious and it may be necessary
to attach a syringe of saline to the other
accessory port and direct a forceful jet
directly at the mucus to dislodge it.
3. The endoscope is withdrawn and the
middle meatus is then examined as far
back as the ethmoid turbinates which
appear as a corrugated area (Figure 4).
4. The common meatus can then be
examined before pointing the tip of the
endoscope ventrally to enter the ventral
meatus. Here the ventral turbinates
appear as folds which should almost
interdigitate (Figure 5).
Figure 5: Normal ventral turbinates Figure 3: Normal dorsal meatus Figure 4: Normal ethmoid turbinates (left)
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HOW TO
with this endoscope as it has a smaller
cross-sectional area. In kittens a 1.9 or
2.4 mm endoscope is used with an
appropriate sheath. Sometimes nasal
pathology or severe haemorrhage can
seriously hamper visualisation and where
this occurs a rigid endoscope should never
be inserted beyond the level of the medial
canthus of the eye to prevent damage to
the delicate cribriform plate.
Obtaining good biopsy samples
Lesions should always be noted on the way
in as iatrogenic damage may otherwise be
mistaken for pathology. Multiple biopsies
should always be taken. Nasal mucosa is
very reactive and it is not possible to make
a diagnosis on gross appearance alone as
many different conditions may appear very
similar. Biopsies taken with flexible forceps
through the instrument channel are
necessarily small and may only be quite
superficial. Taking several biopsies at the
same site can obtain biopsies of deeper
tissues that may be more diagnostic. A pair
of 3 mm oval cupped biopsy forceps is
used to obtain larger samples once the
initial ones have been taken. These forceps
must be inserted alongside the endoscope
until the tips come into view. Placing them
alongside the sheath before inserting the
endoscope into the patient will enable the
surgeon to match landmarks on the sheath
with points on the forceps when the tips
are aligned. In this way the depth of
insertion can be judged accurately and the
surgeon knows when the forceps should
come into view.
With the endoscope in position in the
nose the tip of the forceps is walked along
the top edge of the endoscope sheath.
This is essential since the angled view of
the endoscope looks up, so insertion of the
forceps at the side or beneath the
endoscope will prevent the forceps being
seen at all. If the forceps do not appear
when inserted to the correct depth, they
may have passed to one side of a turbinate
Figure 6: Normal Eustachian tube
opening
with the endoscope on the other. Withdraw
the forceps and try again. With practice the
forceps can be visualised and large
biopsies taken under direct guidance.
Monitoring recovery
At the end of the procedure the endoscope
is removed and the nose flushed with saline
via a 50 ml syringe. The pharynx is cleaned,
preferably with suction, the swab removed
and the nose lowered to allow drainage
forward to the anterior nares. Anaesthesia is
maintained until any haemorrhage is
controlled. Postoperative acepromazine
may be considered to ensure a smooth
recovery and to lower blood pressure to
reduce haemorrhage. Extubation is left until
pharyngeal gag reflexes return. Analgesia
and antibiotic therapy may be required
depending on the procedure performed
and the underlying condition.
Sinusoscopy
Examination of the frontal sinuses is not
normally possible during anterior
rhinoscopy unless there is extensive
turbinate destruction such as occurs in
some cases of aspergillosis. Access to the
frontal sinuses for sinusoscopy is obtained
by making a small incision and drilling a
45 mm hole directly into the frontal sinus,
halfway between the midline of the skull and
the zygomatic process of the frontal bone,
with a sterile surgical drill. The endoscope
can then be inserted and the sinus
examined under saline irrigation. Samples
for cytology or culture can be obtained in
the normal way and skin closure is routine.
See Phil Lhermettes video
accompanying this article online in the
Publications section of the BSAVA
website www.bsava.com if you
have any problems viewing this video
email companion@bsava.com and
a member of our team will endeavour
to help.
5. The ventral meatus can be followed
back to the nasopharynx. Great care
should be taken especially in small
dogs and cats. As the cystoscope has
an oval cross section, gently rotating
the endoscope to move the turbinates
out of the way allows passage of the
endoscope, always being aware of the
30-degree angle of view. The curve of
the caudal septum becomes visible as
the nasopharynx is entered and the
openings of the Eustachian (auditory)
tubes can be clearly seen (Figure 6).
6. As the nasopharynx is entered the wide
space often leads to turbulence in the
saline irrigant, obscuring the view.
Turning off the saline flow will improve
the view and allow examination of the
nasopharynx in air. If visualisation is
poor, for instance in the presence of
severe haemorrhage, inserting the
scope to a depth necessary to enter
the nasopharynx is not advised.
With care the 2.7 mm 30 degrees
endoscope and cystoscopy sheath will get
back as far as the nasopharynx in most
adult cats. However, in smaller cats it may
be necessary to use an arthroscopy sheath
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HOW TO
How to perform rhinoscopy
in the dog and cat
Many of the images in this article are
reproduced from the
BSAVA MANUAL OF
CANINE AND FELINE
ENDOSCOPY AND
ENDOSURGERY
Edited by: Philip Lhermette
and David Sobel
Member price: 49
Non-member price: 75
Aspergillus colonies at the choanae,
viewed by posterior rhinoscopy. The
endoscope is retroflexed through
180 degrees, giving an inverted image, so
this colony is in the right nostril
A piece of stick (A) embedded in the nose
of a spaniel (middle of the image). (B) A
piece of stick following removal from the
nose of a spaniel.
A
B
Nasal adenocarcinoma at the choanae
viewed by (A) posterior rhinoscopy and
(B) anterior rhinoscopy. Note the
difference in appearance when viewed
under saline irrigation
B
A
Nasal aspergillosis. (A,B) Colonies in the
noses of two dogs: (A) demonstrating
the classic white plaques; and (B)
showing a greenish tinge due to
secondary infection. Note the extensive
turbinate damage, leading to an
abnormally large airspace. In (A)
turbinate destruction has exposed the
frontal sinus and Aspergillus plaques
can be seen within the sinus cavity (rear
of the image). (C) Close-up view of the
Aspergillus colony showing the cotton
wool appearance of the fungal hyphae.
A
B
C
GALLERY OF NASAL PATHOLOGY
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19
Congress
How to write up a good case
Speaker: Jon Wray
BVSc DSAM CertVC MRCVS
There are many reasons to consider writing
up a case, including:
Reporting a case in a peer-reviewed
journal that significantly adds to the
published literature
Providing material for assessment in a
postgraduate qualification
Providing material for CPD assessment
Reporting an interesting case in a
non-peer-reviewed publication.
This talk will look at how to structure
and write a case, but also examine the
different considerations to take into
account depending on what the case
report is for. What is appropriate for an
examination may not be suitable for
publication choosing the right approach
from the outset can save considerable time
and effort.
Jon Wray is
Honorary Associate
Professor (Small
Animal Internal
Medicine) at the
University of
Nottingham and is
based at Dick
White Referrals in
Newmarket. Jon is an RCVS Diploma-
holder and an RCVS Recognised
Specialist in Small Animal Medicine
(Internal Medicine).
How to design a scientific study
Speaker: Mark A. Holmes
MA VetMB PhD MRCVS
When we perform a scientific study we
are trying to learn the truth about some
small aspect of the world. In doing so, we
need to try to avoid sources of bias
(particularly arising from our own
preconceived ideas or beliefs) and
systematic errors (arising from poor design
or interpretation of results). This talk will
examine the key considerations when
designing a study, including:
Sources of error
How to ask the right question
Case definitions and outcome
measures
Finding subjects and how many do
you need?
Ethical issues
Types of study
Statistics and data analysis.
Mark Holmes is a
Senior Lecturer in
Preventive
Veterinary
Medicine at the
University of
Cambridge, and is
a former Honorary
Secretary of the
BSAVA.
How to read a scientific paper
Speaker: Adrian Boswood
MA VetMB DVC DipECVIM-CA FHEA MRCVS
Reading original articles from the
peer-reviewed literature can at first seem
a daunting task. It is, however, only by
evaluating full papers (rather than
skimming and believing abstracts!) that the
strengths and weaknesses of published
studies can be truly appreciated.
This talk is designed to give attendees
a basic understanding of how to approach
original papers. It will begin with an outline
of the formal structure of a scientific paper
and give guidelines for readers as to where
critical information in the paper should be
sought. Examples from the veterinary and
medical literature examples of good (and in
some cases bad!) practice will be used to
illustrate this critical approach. The talk is
designed for practitioners wishing to
develop a more questioning approach and
for those in the early stages of a clinical
academic career.
Adrian Boswood is
Professor of
Veterinary
Cardiology at the
Royal Veterinary
College and an
RCVS Recognised
Specialist in
Veterinary
Cardiology and European Specialist in
Veterinary Internal Medicine
(Cardiology).
BSAVA Postgraduate Certificate:
an introduction
Speaker: Frances Barr
MA VetMB PhD DVR DipECVDI MRCVS
Academic Director, BSAVA
BSAVA will be launching new
programmes of modular continuing
education in 2012 which will lead to the
award of BSAVA Postgraduate Certificates.
These new certificates in small animal
medicine and surgery will combine
traditional taught courses, a wide range of
Get it write
BSAVA Congress 2011 features a new Education Stream which will not only
introduce the forthcoming BSAVA Certificate but also aims to give helpful advice
and confidence when writing up cases, embarking on a scientific
study, or critically evaluating the published literature. Here, the
speakers give a sneak preview of what you can expect to learn
19-20 Congress.indd 19 17/12/2010 10:16
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Congress
Get it write
web-based material including interactive
sessions, and workplace-based project
work. This lecture will provide an overview
of the structure of the new programmes
and will consider the practicalities too:
How will I enrol?
How can I fit the required studying
around a busy lifestyle?
Will I have the support I need to
persevere and succeed?
If I achieve one of these certificates,
how widely will it be recognised?
Delegates will be
encouraged to register
their interest in receiving
more information about
the programmes, either
at the end of the lecture
session itself or in the
BSAVA area on the NIA
balcony. Questions,
comments, and expressions of interest
are very welcome at any time please
contact the Academic Director
(academicdirector@bsava.com).
F
riday night is all about putting on the
glitz BSAVA Banquet is an
enjoyably glamorous night, with
dressed-up delegates and excellent
entertainment. This year it will be a
ballroom blitz with an orchestra made up
of musicians and singers that have
featured both with Robbie Williams on his
Swing When Your Winning tour, and on
BBCs Strictly Come Dancing; plus
professional dancers from the show,
Anton Du Beke and Erin Boag.
Saturdays Party Night is the one that
gets us all very excited with top comedy
acts and chart-busting bands. Last year
we even celebrated with Scouting for Girls
when they got to number 1. This year we
are offering a particularly brilliant line-up.
We told you about Scottish funny man
Fred MacAulay returning to host the
Comedy Club and now we can reveal he
will be introducing the hysterical
ventriloquist Paul Zerdin.
We first saw Zerdin on our TV screens
as the winner of the Big, Big, Talent
Show presented by Jonathan Ross, and he
has since appeared three times at the
Royal Variety Performance with a
particularly impressive and popular
performance in 2009, which brought him
to a much wider audience. The
Scotsman said of him, Every now and
then you stumble across a finished
article, a show so polished it shines.
Paul Zerdin is a ventriloquist at the top
of his game, Zerdin is so sure of his
skills and so in control of his material
that he isnt just performing hes
showing off, clearly having as much of
a laugh as his audience.
Once youve controlled your laughter
after the Comedy Club, youll struggle
not to start singing-along with tribute act
extraordinaire Counterfeit Stone and
kings of the catchy pop hit The Feeling.
Their big hits Never Be Lonely and
Love It When You Call immediately
became radio favourites. Afterwards if
you still have the stamina theres
always the disco to take you into the
early hours.
For more information on Congress
registration and buying social tickets visit
www.bsava.com or email congress@
bsava.com and a member of our team
will get back to you.
More
stylish
social
In the December issue
of companion we
revealed Fred MacAulay
and the Counterfeit
Stones for Party Night
and now we can tell you
who will be joining them
to entertain you at
Congress
The BSAVA Education
Stream will take place in
Austin Court (next to the
ICC) Friday 1st April from
2.15 pm.
19-20 Congress.indd 20 17/12/2010 10:16
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CPD
H
arriet Syme, Senior Lecturer in Small Animal
Internal Medicine at RVC, has an impressive
academic record. She graduated from the Royal
Veterinary College in 1994 where she also completed
a Junior Clinical Training Scholarship. She went on to
do a Small Animal Internship and then a Small Animal
Medicine Residency at Purdue University in the USA,
before returning to the RVC to study for a PhD.
Harriet gained her Diplomate ACVIM in 1999 and
her Diplomate ECVIM-CA in 2002. She was awarded
the International Renal Interest Society (IRIS) Award in
2002 for her contribution to the field of veterinary
nephrology & urology and the Dame Olga Uvarov
award for clinical research in 2008.
Research and teaching
Harriets main research interests are diseases of the
geriatric cat, in particular chronic renal failure,
hypertension and hyperthyroidism. As well as teaching
the urogenital system module to the fourth year at the
RVC, she enjoys supervising PhD students and
Residents. Her involvement in other CPD teaching
allows Harriet to share her enthusiasm and in-depth
knowledge in nephrology, urology and endocrinology.
Her vast knowledge and ability to communicate even
the most complex aspects of the subject means that
delegates will return to their practice with much more
confidence and understanding. By taking on the first
two courses Harriet will be providing a great start to
this Modular series. S ee www.bsava.com for full
details about the whole programme or to book these
individual courses.
Understanding practice
Harriet alternates between working at the RVC, the first
opinion Beaumont Animals Hospital and the central
London PDSA. This gives her considerable insight into
what can be achieved within general practice. Her
current clinical research interests include identifying
which patients are likely to develop chronic kidney
disease (CKD), attempts to slow the progression of
CKD and unravelling the links between CKD and
hyperthyroidism. As well as publishing research articles
Harriet has written book chapters for the BSAVA Manual
of Nephrology and Urology and the BSAVA Manual of
Canine and Feline Cardiorespiratory Medicine.
Upper urinary tract disease: an evidence-
based approach to failing kidneys
Tuesday 25 January Woodrow House,
Gloucester
This course will predominantly focus on the treatment
of CKD in the dog and cat, emphasising what can be
done to manage this condition in general practice.
Causes of CKD will be discussed and the diagnostic
work-up appropriate to dogs and cats with suspected
CKD will be considered, including an introduction to
the IRIS staging scheme for those not familiar with it.
An in-depth consideration of the management of
CKD will include interventions that may slow the
progression of CKD but we will also discuss treatments
that while not altering survival may reduce patient
morbidity. This will include the diagnosis and treatment
of systemic hypertension. A couple of case examples
will then be used to guide consideration of the
interplay between CKD and hyperthyroidism in the
geriatric cat.
On the
right tract
with Harriet
Syme
Harriet Hattie Syme will be
presenting courses on upper
and lower urinary tract disease in
January and February
21-22 CE.indd 21 17/12/2010 12:14
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CPD
On the right tract with Harriet Syme
After lunch, to prevent that postprandial lull, there
will be an interactive session to collectively decide on
the appropriate diagnostic work-up for a pair of
Springer Spaniels with polyuria/polydipsia. Further
topics for the afternoon will include prevention and
management of acute kidney injury, management of
protein-losing nephropathy, and a brief overview of the
renal tumours that occur in the dog and cat.
Throughout the day case examples will be used with
the opportunity to ask questions.
Lower urinary tract disease: plumbing
problems old and new approaches to
lower urinary tract disease
Tuesday 15 February Woodrow House,
Gloucester
The day will start with a series of interactive cases of
stone disease, emphasising the ways in which these
problems can be managed without resorting to
surgery. While some of the newer technologies (e.g.
lithotripsy) are only ever likely to be available in a
referral centre, some of the methods that will be
described, such as voiding urohydropulsion, require
no specialist equipment and can easily be performed
in general practice. Guestimation of the likely
composition of stones will also be reviewed, so that
delegates will leave the course feeling confident that
they can identify the patients for which medical
management is most appropriate.
After the morning break urinary tract infections and
feline lower urinary tract disease (FLUTD) will be
discussed in detail. The evidence for different
treatments for idiopathic FLUTD will be discussed, as
well as considering different theories as to the
aetiology of this frustrating condition. This course will
not provide the solution for all your difficult cases but it
should at least show you that you are not alone in
struggling to know how best to treat them.
In the afternoon we will consider the treatment of
bladder and urethral tumours in dogs and cats before
taking a more in-depth look at micturition disorders.
Causes of both urine retention and urinary incontinence
will be considered in turn, and the advantages and
disadvantages of the various surgical and non-surgical
methods for managing these disorders discussed. The
emergency management of urethral obstruction in both
the dog and the cat will also be highlighted.
Throughout the day there will be case examples and
the opportunity to ask questions.
INTRODUCTION TO FLEXIBLE GI ENDOSCOPY
Wednesday 9 February Woodrow House, Gloucester
More and more practices are investing in a
flexible endoscopy system. However, there
are limited training opportunities available
at which to learn how to succeed and to
maximise the return on such a major
capital investment. This course will suit
both vets thinking of purchasing
endoscopy equipment, and those who feel
they are not using their current equipment
optimally. How to perform upper and lower
GI endoscopy, how to get through the
pylorus, how to biopsy the ileum, and how
to obtain optimal samples will all be
covered by lectures, videos and practical
experience using endoscopy models.
Expert speaker
Ed Hall is Professor of Small Animal
Internal Medicine at the University of
Bristols School of Clinical Veterinary
Science, where he is Deputy Head of
School. A Cambridge graduate, he
undertook postgraduate clinical and
research training in Philadelphia and
Liverpool, and is a Diplomate of the
ECVIM-CA. He has clinical and research
interests in small animal
gastroenterology,
and performs
video-endoscopy
procedures. He is
a Past President of
BSAVA, and wrote
two chapters on
flexible endoscopy
for the BSAVA
Manual of Canine
and Feline
Endoscopy and
Endosurgery.
Reproduced from the BSAVA Manual of Canine and
Feline Endoscopy and Endosurgery
21-22 CE.indd 22 17/12/2010 10:15
PETSAVERS
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23
R
ita Gonalves was funded by
Petsavers to undertake a residency
in veterinary neurology at the
University of Glasgow, enabling her to
obtain her European Diploma. Her
Petsavers scholarship also funded
research undertaken during her training
programme and was mostly based on the
refinement of the current techniques for
hearing testing in dogs, including the
development of a brand new type of test,
which is commonly used in human
neonatal hearing testing but has yet to be
adapted for veterinary use.
Increasing awareness
Deafness is being diagnosed in small
animal practice with increasing frequency,
largely as a result of heightened awareness
among owners, breeders and clinicians.
Pet owners and breeders want to
understand why their animals are deaf and,
in the case of inherited deafness, what they
can do to prevent transmission to future
litters. Congenital sensorineural deafness
is most commonly identified in dog and cat
breeds with white pigmentation and blue
eye colour and has been reported in over
80 dog breeds and several cat breeds. The
Dalmatian has the highest reported
incidence of deafness with reported
incidences of 18% in the UK, of which 13% is
unilateral and 5% bilateral.
Behavioural testing
Behavioural testing of hearing can be
performed by producing a sound outside
the animals visual field or while the animal
is asleep, and observing for a response.
However, the failure of the patient to
respond to noise may represent an anxious
or distracted animal, whilst a response may
simply be the result of a response to visual,
vibration, or air current stimuli. As a result,
this kind of testing is subjective and limited
in its applications.
BAER
The most commonly used objective test for
assessment of auditory function in dogs
and cats is the brainstem auditory-evoked
response (BAER). The test uses three
subdermal needle electrodes placed on the
vertex of the head, rostral to the tragus of
the test ear, and on the dorsal midline of the
neck. The BAER is elicited with click stimuli
generated by headphones. The earphones
repeatedly stimulate the test ear with the
Improving the health of the nations pets
Innovative research
into new hearing test
chosen intensity stimulus and the needle
electrodes repeatedly sample the electrical
responses of the cranial nerve VIII and of
the auditory portion of the brainstem; these
responses are amplified and averaged. In
the initial part of the study, the use of
contralateral masking noise (one of the
variables that influences this test) was
analysed in Dalmatian puppies with
unilateral deafness. Guidelines to improve
the specificity of this test were suggested in
view of the results obtained.
Ongoing research
The second part of the study is still
underway and has been directed at
assessing the possible use of a new type
of hearing test, most commonly used as a
first line screening test in human
neonatology. This test is faster, simpler and
less invasive to perform (as it does not
require the use of subdermal needles, just
insert earphones), although its usefulness
in dogs is yet undetermined, as it is highly
influenced by movement and external
sound. The test identifies the presence of
otoacoustic emissions (OAEs), which are
low-level sounds produced by the inner
ear as part of the normal hearing process
and can be measured with the use of a
microphone placed in the ear canal.
It is hoped that this research, and
future developments based on the
findings, will help to ultimately reduce the
incidence of deafness in dogs and cats via
selective breeding.
Deafness is an important
issue for many pets and
pet owners, and
Petsavers has funded
work undertaken at the
University of Glasgow by
Rita Gonalves into
developing a brand new
type of hearing test
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PETSAVERS
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PETSAVERS CLINICAL TRAINING
PROGRAMMES 2011
Petsavers invites applications for clinical training programmes in the disciplines of
Rabbits and/or Rodents, and Anaesthesia and Analgesia. The programme is for the
duration of three years and funding is available to a maximum of 50,000. Joint
applications from university and private practice will be considered; the main
applicant must be registered with a bona fide university. The closing date for clinical
training programmes applications is 28 February 2011. Further details can be found
in the Petsavers area at www.bsava.com
Get running for Petsavers
The London 10K
The London 10K is a huge annual event,
with over 25,000 runners converging in
London to take part and raise money for
various charities. This is a great race to
take part in if you are new to running, as its
a shorter distance then most (6.2 miles)
and is not taken too seriously many
runners turn out in fancy dress! Petsavers
has a limited amount of places reserved
in the London 10K, so if you would like
to take part then please contact us at
info@petsavers.org.uk or call 01452
726723. This years run will take place on
Sunday 10 July, so theres plenty of time to
get in shape!
The Great North Run
The Great North Run is one of the landmark
races in the running calendar and is the
worlds most popular half marathon road
running event. In 2010 an incredible 39,459
runners completed the run, and one of
those successful runners was Bev
Woodruffe of the Oakwood Veterinary
Group, Norfolk. Bev raised a fantastic total
of 563 for Petsavers, which will go towards
funding much-needed clinical research. A
big thank you is therefore due to Bev and
all those that supported her with
sponsorship. At the time of writing the event
is not currently open for entries, but a
reminder service is available on this web
page: www.greatrun.org/
reminderservice/?raceid=222
The London Marathon
The London Marathon is one of the
biggest running events in the
world and has grown year on year
since its beginnings in 1981. The
2010 marathon had a record
36,000 participants. Due to its
popularity, it can be difficult to
obtain a place in the marathon.
For 2011 Petsavers has luckily
obtained a silver bond place,
which has gone to Petsavers supporter
Abby Boles. If you would like to support
Abby, then you can sponsor her on her
Justgiving page: www.justgiving.com/
user/23727610. If you would like to take
part in the London Marathon on behalf of
Petsavers, then please contact us early so
that we can attempt to obtain a place for
you. The ballot for 2011 is already closed
and the ballot for 2012 will not open until
after the 2011 marathon on 17 April, so its
important to get in touch soon if you would
like to take part in 2012.
If you want to take part in a running
event or any other event on behalf of
Petsavers, then we are happy to
help you obtain a place
and to provide you with
tips to maximise your
sponsorship.
The Petsavers
fundraising guide
is available from the
Petsavers pages at
www.bsava.com
Theres a long Petsavers tradition of running as a
fundraising activity and thousands of pounds have
been raised. Heres how to get fit and support your
veterinary charity
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A
t the recent WSAVA Assembly Meeting held in
Geneva, four countries including South Africa
presented bids to host the 2014 WSAVA
Congress. There were some excellent submissions
from Germany, Singapore and Thailand and so it was
with great excitement that the South African delegation
witnessed the Assembly voting in favour of Cape
Town. It will have been 20 years since we last held the
WSAVA Congress in Durban (1994) and we are
ecstatic to get the WSAVA back in Africa.
Africa has a mystical attraction.wildlife and
scenery, a friendly hospitable people with a wonderful
lifestyle waiting to welcome you to our beautiful land.
Game drives, majestic mountains, a rainbow of
interesting cultures all blended together
South Africa was on show as host of the recent FIFA
World Cup and is now firmly positioned on the
international event map. Besides the organisational skills
and the spectacular stadia, the true spirit of our nation
beamed through. A nation once divided can now
celebrate and bond together and reflect the true warm
hospitality and vibrancy that is so unique to Africa. The
vuvuzela may be banned but will never be forgotten!
Cape Town, affectionately known as the mother
city, is a gem with a beauty that is truly breathtaking.
Table Mountain and the two oceans with the
windswept vineyards epitomise this beauty. The
International Convention Centre is a state-of-the-art
facility and is situated centrally, with ample affordable
accommodation within walking distance of the venue.
The scientific content will include an African tone,
highlighting our pertinent epidemiological problems.
This will be a stage for our own veterinary surgeons to
be heard. It will also be a true privilege to bring
high-calibre WSAVA lecturers to our continent to
present talks on all aspects of small animal veterinary
medicine, surgery and animal welfare, and to fulfil the
vision of WSAVA dedicated to the continuing
development of companion animal care around the
world. There will be a drive to draw fellow African vets
to Cape Town incentive schemes have been
discussed to encourage neighbouring vets to attend.
For the first time WSAVA will make use of a central
Conference Organiser, who will work in conjunction
with local organisers (see page 27). The National
Veterinary Clinicians Group (NVCG) of the South
African Veterinary Association will be your host and the
congress will take place on 1519 September 2014.
We are expecting to attract in excess of 2000 vets from
all over the world. This is an event not to be missed!
Please put the dates in your diary now and start
preparing for your mystical African experience.
An African
adventure
Dr Kevin Stevens, Chairman of the
National Veterinary Clinicians Group of the
South African Veterinary Association,
looks ahead to WSAVA World Congress
2014 in Cape Town, South Africa
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WSAVA NEWS
Get ready for Korea!
Korean culture is surging due to
Hallyu, the Korean wave
A
new term Hallyu (the Korean wave) has
emerged to epitomise a social and cultural
phenomenon in Korea. This term was coined by
the Chinese media and followed the popularity of
Korean television dramas exported to China in the
1990s. As well as China, this Korean media and music
culture has become a great sensation in Taiwan and
Hong Kong, and Korean entertainers have become
highly regarded. In particular, this phenomenon has
served as an opportunity to change global perceptions
about Korea, and has galvanised a cultural exchange
between Korea and Japan. One of the archetypal
Hallyu dramas was the Winter Sonata which was
broadcast in 2002 and was a huge hit in Japan. Hallyu
is now spreading across the globe the singer Rain
was ranked in The Times top 100 most influential
people in the world and Bae Young-jun (star of the
Winter Sonata) and other Hallyu performers such as
Lee Byeong-hun, Lee Young-ae and Choi Ji-woo have
gained tremendous popularity.
Confirmed speakers at WSAVA Congress 2011
Acupuncture/herbal medicine
Huisheng Xie, University of Florida
Allen M. Schoen, Global Communications for
Conservation, Inc.
Kum Hwa Choi, University of Minnesota
MinSu Kim, Chonbuk National University
Animal welfare
Soon-wuk Jeong, Konkuk University
Hansjoachim Hackbarth, Hannover University
Behaviour
Karen L. Overall, University of Pennsylvania
Yeon S.C, Gyeongsang National University
Cardiology and pulmonology
Christophe Lombard, University of Bern
Clarke Atkins, University of North Carolina
Changbaig Hyun, Kangwon National University
International Lecture
Albert Osterhaus, Erasmus Medical Centre
Rotterdam, University of Utrecht
Critical Care & Anaesthesiology & Traumatology
(Anaesthesia / E&CC)
Lyon Yonghoon Lee, Western University
Luis H. Tello, Banfield The Pet Hospital
Kathy Clarke, Royal Veterinary College
Christopher G. Byers, VCA Veterinary Referral Asscs
Cytology, haematology and clinical pathology
Hiroyuki Namba, NAMBA Veterinary Pathological
Laboratory
DaeYoung Kim, University of Missouri
Dentistry
Frank J.M. Verstraete, University of California, Davis
Cecilia Gorrel, Veterinary Dentistry and Oral Surgery
Referrals
Marco Antonio Gioso, University of Sao Paulo
Steven E. Holmstrom, Animal Dental Clinic
Dermatology
Masahiko Nagata, Animal Specialist Center
Ralf S. Mueller, Ludwig Maximilian University
Sonja Zabel, Colorado State University
Chiara Noli, European Society of Veterinary
Dermatology
Diagnostic Imaging
Donald Thrall, North Carolina State University
Hock Gan Heng, Purdue University
John Mattoon, Washington State University
Dan Feeney, University of Minnesota
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WSAVA NEWS
Ear-Nose-Throat
Marijke Peeters, Utrecht University
Ter Haar, Utrecht University
Endocrinology
Edward C. Feldman, University of
California, Davis
Johan P. Schoeman, University of
Pretoria
Exotics
Mark A. Mitchell, University of Illinois
Barry K. Hartup, International Crane
Foundation
Bairbre OMalley, University College
Dublin
Feline medicine
Takuo Ishida, Japanese Animal Hospital
Association
Debra L. Zoran, Texas A&M University
Karin Ulrikke Sorenmo, University of
Pennsylvania
Rod Rosychuk, Colorado State University
Gastroenterology
Michael J. Day, University of Bristol
Caroline Mansfield, Murdoch University
Hepatology
Shido Torisu, Miyazaki University
Mike Willard, Texas A&M University
Hereditary and genetic diseases
Urs Giger, University Of Pennsylvania
Parasitic diseases
Edward B. Breitschwerdt, North
Carolina State University
Michael R. Lappin, Colorado State
University
Medicine (standards of care)
Jan Rothuizen, University Utrecht
Hee Myung Park, Konkuk University
Michael D. Willard, Texas A & M
University
Angela E. Frimberger, Veterinary
Oncology Consultants Pty Ltd
Richard A. LeCouteur, University of
California, Davis
Barbara Kohn, Free University of Berlin
Nephrology and urology
Larry D. Cowgill, University of California,
Davis
Nutrition
Won-Seok Oh, Neodin Vet Science Inst.
Jane Armstrong, University of Minnesota
Claudia Kirk, University of Tennessee
Oncology
Tetsuya Kobayashi, Japan Animal
Medical Center
Ruthanne Chun, University of Wisconsin
Anthony Zambelli, St. Helier Specialist
Veterinary Centre
Richard R. Dubielzig, University of
Wisconsin
Ophthalmology
Kristina Narfstrm, University of
Missouri
Ron Ofri, Hebrew University of Jerusalem
Ellison Bentley, University of Wisconsin
Gillian McLellan, University of Wisconsin
Pharmacology
Joe Bertone, Western University of
Health Sciences
Reproduction
Byeong Chun Lee, Seoul National
University
Surgery (soft tissue surgery)
MaryAnn Radlinsky, University of
Georgia
Geraldine Briony Hunt, University of
California, Davis
Dale E. Bjorling, University of Wisconsin
Surgery (orthopaedic surgery)
Kei Hayashi, University of California
Katsuyoshi Nagaoka, Minato Yokohama
Veterinary Medical Hospital
Richard A. Read, Murdoch University
Surgery (cardiac surgery)
Peter L. Vogel, Southern California
Veterinary Specialty Group
Surgery (surgical oncology)
Nick Bacon, University of Florida
Veterinary management
Henry K. Yoo, Infinity Medical Consulting
& Co.
Louise S. Dunn, Snowgoose Veterinary
Management Consulting
Peter Weinstein, Southern California
Veterinary Medical Association
More speakers will be confirmed for the State
of the Art Lectures, WSAVA Award Lectures
and NAVC Stream Lectures check out
www.wsava2011.org for updates.
WSAVA WORLD
CONGRESS 2011
REGISTRATION
Early-Bird Registration: 1 January
to 28 February 2011
Pre-Registration: 1 March to
30 September 2011
Please contact
wsava2011@unineo.com
or visit www.wsava2011.org
for more information:
CENTRAL PCO
A NEW ERA FOR
WSAVA
CONGRESS
T
he WSAVA Congress Steering
Committee (CSC) appointed in
2009 is chaired by Dr Nicola
Neumann (NN) with four members:
Colin Burrows (NAVC), Siraya
Chunekamrai (VPAT), Ed Hall (BSAVA)
and Amanda Evans (industry). The
CSC has met several times since its
appointment and has reviewed a
number of different professional
congress organiser (PCO) models
appropriate to the current needs of
WSAVA. It was concluded that a core
PCO working directly for and with the
WSAVA for a contractual period of 5
years would work best to assure the
longer term stability of the WSAVA.
Some of the advantages of a core
PCO include:
Consistency in service delivery
Leverage of core conference costs
Ability to develop long-term
contracts with sponsors
Accountability to WSAVA without
local host associations having to
reinvent the wheel every year.
We will see the vibrant WSAVA
Congress enhanced while providing
for the future financial sustainability of
the Association. The branding of
WSAVA Congress and penetration into
new markets will be better facilitated
by a core PCO. This proposal was
adopted by a majority vote of 2010
Assembly participants in Geneva.
The WSAVA World Congress will rotate
through three global regions the
Americas; Europe, Africa and the
Middle East; and Oceania/Asia. The
first Congress to work with a core PCO
will be Cape Town in 2014.
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THE companion INTERVIEW
Carole
Clarke
MA VetMB CVPM
MRCVS
Carole Clarke was born in South Norwood, South London, the younger of two girls.
Her father was a printing machine minder and her mother a secretary/PA. Both
daughters inherited an animal gene her older sister Lesley breeds and shows
dogs and runs a small grooming business from home. Carole wanted to be a vet
from about the age of 12. She earned a scholarship to Haberdashers Askes School
in Acton and then went to Cambridge veterinary school, graduating in 1981. It was
at Cambridge that she met her husband David who was a university assistant
physician at the time. They have three sons. Carole has actively been involved as a
BSAVA volunteer in several roles, and is currently co-editing the BSAVA Manual of
Best Practice Management, due out next year.
Q
Where did you begin your career
in practice?
A
I took my first job in Witham, Essex,
with Bill Hughes and John Wicks in
mixed practice and stayed 2
years until David and I set up our own plate
in January 1984 in Kings Lynn, having
married the previous summer. We bought a
Grade II listed building in King Street in the
centre of town and restored the building,
living upstairs for the first two years. Things
were rather different then, with no mobile
phones we were on call all the time, and
if we went out for a meal, had to put the
phone through to the restaurant which
limited our choices! It was good fun though
(if you like DIY), and we still see lots of our
clients from that time.
This year your practice was the first in
the country to achieve the highest level
of the Investors in People scheme. How
did you develop your interest in
management issues?
Having always been keen on the
management side, as the practice grew, I
moved more and more into a management
role, and found this less frustrating than
trying to do interesting clinical work part
time and fitting that around family
commitments. I joined the Veterinary
Practice Management Association soon
after its formation and was one of the first
six candidates awarded the CVPM
certificate in 1996, around the time we first
achieved IiP status, again the first vet
practice to do so. I then joined the CVPM
Exam Board and VPMA Council and was
President in 20012002. I really enjoy
working with the VPMA it is a good mix of
vets, nurses and managers.
What other professional associations
have you been active in?
I have also been a BSAVA volunteer for a
number of years, on Publications and
International Affairs committees and most
recently chaired International Affairs in
20062009. I now represent BSAVA on the
RCVS Awarding Body Board and attend
meetings at Lantra and VN Council. As a
committed employer of 16 RVNs and
students, I have been following closely the
changes to training over the last year.
I also represent VPMA on the Practice
Standards Group.
THE companion INTERVIEW
28-29 Interview.indd 28 17/12/2010 10:30
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THE companion INTERVIEW
times, although Im sure thats just because
I look back with rose-tinted glasses. I
definitely feel I was happier without the
intrusive amount of IT communication we
have to deal with nowadays or maybe Im
just getting older!
Who has been the most inspiring
influence on your professional career?
I think my first job was a really good start
to my career. Bill Hughes and John
Wicks looked after me well as a new
assistant (my name appeared on a plate
by the front door very soon after I
started). Bills professional approach and
support for me as a new graduate was
inspiring he always made sure my
position as a fellow professional was
never undermined. I think that was what
got me thinking so much about developing
people and teams.
What is the most significant lesson you
have learned so far in life?
That you can really change things if you
just make the effort I suppose thats the
rationale behind my work in veterinary
associations although I do get frustrated
if nothing happens. Im a doer, rather than
a politician! Oh and the most important
ongoing lesson always remember where
you put your keys.
What do you regard as the most
important decision that you have made
in your life?
Marrying David, definitely, and as a result,
starting up our own business and having
our family.
What is the most frustrating aspect of
your work?
Not having enough hours in the day. Most
of my frustrations are self-inflicted taking
too much on, spending too much time
checking emails, etc. I do feel that
computers and all IT communications
have sucked a lot of time out of everyones
day as well as revolutionised the way we
work. The focus is moving away from
personal service in some areas and that
can take away a lot of the enjoyment of
veterinary practice.
What do you consider to be your most
important achievement?
Apart from our family, I feel most proud of
the team we have built up at the surgery
and the way they work together and
support each other and the aims of our
business. We are very lucky to have such
great people to work with, and we have
developed a very supportive culture.
What has been your main interest
outside work?
Without doubt my family I have really
enjoyed having our three boys and
although one is now a hospital doctor and
one at medical school, its great when we
do see them. The third, Nick, is hoping to
go to vet school. Holidays are very
important and we have enjoyed diving
together in recent years Im happy
anywhere the sun is shining and I can be
swimming in natural water, diving under the
water or wandering around some ruins! I
enjoy reading about archaeology and
visiting ancient places Egypt, Italy and
Greece, as well as here in the UK. I am a
keen photographer and we have been on
two excellent safaris in the last couple of
years I really feel at home in a (luxury) tent
in Africa!
When and where were you happiest?
Thats a very difficult question, because I
think I live in the moment really. I suppose
setting up the practice and when the
children were small were particularly happy
THE companion INTERVIEW
If you were given unlimited political
power, what would you do with it?
It would be nice to find a way of reducing
the pressure for defensive medicine, and to
reduce the burden of regulation on small
businesses (although I can see the sense
in having controls and safe practices in
place). Id give Mike Jessop a senior role at
the Environment Agency.
Which historical or literary figure do
you most identify with and why?
Im not sure I identify with anyone in
particular, but I would love to have just a
fraction of the knowledge and writing ability
of Stephen Jay Gould.
If you could change one thing about
your appearance or personality, what
would it be?
I am a terrible procrastinator if I have
things to do that Im not really keen on, I will
put them off and do anything else first. If
only I could learn to say No more often. Im
always tight to the deadline I know that
can be really frustrating for some people.
What is your most important
possession?
Im not sure there is anything I couldnt live
without, but I suppose our home and
garden would probably be the most
important as it holds so many memories
and is a focus for all the family and our
friends to get together, relax and have a
good time.
What would you have done if you hadnt
chosen the veterinary profession?
I always wanted to be palaeontologist
I love old dusty museums, and as a child
in the Natural History Museum would stand
and wonder just what was behind that
door at the end labelled Department of
Palaeontology. I studied palaeontology for
a year at Cambridge it was great, and
veterinary anatomy gave me quite an
advantage! Realistically though, I probably
would have ended up managing
something or other, and digging up bones
in Montana is probably not all its cracked
up to be. n
you can really change things if
you just make the effort I suppose
thats the rationale behind my work
in veterinary associations
28-29 Interview.indd 29 17/12/2010 10:30
30
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companion
REGIONS
profession and clinical work,
and she looks forward to
returning to working in practice
in the future.

Rachael Mort
Rachael graduated from
Glasgow and worked in mixed
practice for 18 months in
Yorkshire before moving to
Leicestershire into small animal
practice to study for her
CertAVP in Small Animal
Medicine. She currently works
in a 22-vet hospital first opinion
and referral practice.

Derek Attride
Derek qualified in 1993 from
Cambridge, initially working in
mixed practice before
concentrating on small animal
practice. He works near
Wolverhampton, at a branch
surgery of a large veterinary
practice, where he recently
gained a GP certificate in small
animal practice. He is also a
member of the BSAVA
Membership Development
Committee. Outside of work he
enjoys mountain-biking, golf
and skiing.

Mike Davies Chair
Mike is currently Associate
Professor in Small Animal
Clinical Practice at the
University of Nottingham
School of Veterinary Medicine
and Science. In the past he
has worked in small animal
practice (11 years in his own
practice on the Wirral) , in
academia (as Director of the
Beaumont Animals Hospital at
the RVC) and in industry with
several pet food manufacturers
(including Hills and Iams) and
pharmaceutical companies
(including Fort Dodge Animal
Health and Pfizer). His special
interests are in veterinary
geriatric medicine and clinical
nutrition.

Helen Ozelton
Secretary
Helen graduated from London
in 2004 and worked in mixed
practice for a year before
undertaking an internship at a
referral centre. For the last
2 years she has worked at a
7-vet small animal hospital in
Derbyshire and is currently
Over the coming months we will be
featuring the people who make the BSAVA
Regions work on your behalf. But the best
way to get to know these hardworking
people is to go along to a meeting and
access the quality CPD that is on offer on
your doorstep. This month the Midland
team, a relatively new group of volunteers
determined to make this a vibrant and
valuable part of your membership
Meet
Your
Region
Midland
working towards her RCVS
CertAVP. The combination of
this and being the BSAVA
Midlands Regional Secretary
keeps her busy!

David Godfrey
Treasurer
David used to be partner in the
Nine Lives Veterinary Practice
for Cats in Solihull and still lives
in the area despite now
working for Axiom Veterinary
Laboratory which is based in
Devon. He also undertakes
some clinical work for a local
veterinary practice (The Animal
Doctor) and some research
and writing, mostly for UFAW
(Universities Federation for
Animal Welfare).

Carol Dickson
Carol is one of the Midland
Region committee members.
She graduated from Glasgow
in 1993, and was working in
small animal practice in
Brighton until moving to
Birmingham 3 years ago.
Currently she is a full-time mum
but being involved in BSAVA is
keeping her up to date with the
SUGGEST A TOPIC
Your Region is always going to be keen to hear suggestions
on topics or speakers you would like to see and will,
wherever possible, try to include your ideas. These are the
topics covered by the Midland Region in 2010
Endocrinology Interpreting musculoskeletal radiographs
common mistakes and weird diseases! Essentials of small
animal ophthalmology Getting the most from your practice
ECG Steps towards more successful dentistry Top tips in
abdominal surgery
For more information or to suggest CPD topics, venues or
speakers, email midlandregion@bsava.com
MIDLAND CPD 2011
Please visit www.bsava.com for information on more courses
within your Region, as new courses and updates appear there first.
Thursday 27 January 2011 7.009.30pm
The geriatric cat
Speaker: Mike Davies
Venue: Hilton Puckrup Hall Hotel, Tewkesbury GL20 6EL
BSAVA Members: 30 plus VAT
Non BSAVA Members: 50 plus VAT
Tuesday 8 February 2011 7.009.30pm
Interpretation of diagnostic tests in skin disease
Speaker: Ross Bond
Venue: The Hilton Warwick, A429 Stratford Road,
Warwick CV34 6RE
BSAVA Members: 30 plus VAT
Non BSAVA Members: 50 plus VAT
Wednesday 4 May 2011 7.009.30pm
A practical approach to collapse and exercise
intolerance in small animals
Speaker: Malcolm Cobb
Venue: Best Western Premier, Yew Lodge Hotel,
Kegworth DE74 2DF
BSAVA Members: 30 plus VAT
Non BSAVA Members: 50 plus VAT
Tuesday 14 June 2011 7.009.30pm
Ultrasonography versus radiography for
abdominal imaging
Speaker: Fraser McConnell
Venue: The Moat House, Acton Trussell ST17 0RJ
BSAVA Members: 30 plus VAT
Non BSAVA Members: 50 plus VAT
30-31 Diary.indd 30 17/12/2010 10:11
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31
CPD diary
EVENING MEETING
SOUTH WALES REGION
Wednesday 12 January
Feline endocrinopathies
Speaker: Andrea Harvey
The SMART Clinic, Cardiff
Details from southwalesregion@bsava.com
EVENING MEETING
SOUTH WEST REGION
Wednesday 12 January
Local anaesthesia and pain
management
Speaker: Jo Murrell
Communal Building, School of Veterinary
Science, University of Bristol, Langford,
North Somerset BS40 5DU
Details from southwestregion@bsava.com
DAY MEETING
NORTH EAST REGION
Sunday 23 January
Lameness and acquired heart
disease in the cat: a practical
update
Speakers: Tim Shearman and Rob Williams
Ramada Hotel, Leeds Road, Wetherby,
West Yorkshire LS22 5HE
Details from northeastregion@bsava.com
EVENING MEETING
MIDLAND REGION
Wednesday 19 January
Managing cruciate ruptures
Speaker: Richard Whitelock
The Moat House, Lower Penkridge Road,
Acton Trussell ST17 0RJ
Details from midlandregion@bsava.com
DAY MEETING
SURREY AND SUSSEX REGION
Tuesday 18 January
Anorexic cat
Speaker: Danille Gunn-Moore
Holiday Inn, Gatwick, Povey Cross Road,
Horley RH6 0BA
Details from surreyandsussexregion@bsava.com
EVENING MEETING
SURREY AND SUSSEX REGION
Thursday 27 January
Adrenal disease in dogs and cats
Speaker: Krista Vissert Hooft
Leatherhead Golf Club, Kingston Road,
Surrey KT22 0EE
Details from surreyandsussexregion@bsava.com
EVENING MEETING
NORTHERN IRELAND REGION
Thursday 13 January
Pet chickens
Speaker: Victoria Roberts
Ramada Belfast, Shaws Bridge,
Belfast BT8 7XP
Details from nirelandregion@bsava.com
EVENING MEETING
SOUTHERN REGION
Tuesday 25 January
Ferret medicine and management
Speaker: John Chitty
Potters Heron Hotel, Romsey SO51 9ZF
Details from southernregion@bsava.com
EVENING MEETING
NORTH WEST REGION
Wednesday 2 February
Solving the medical dilemma
Speaker: Rebecca Littler
Swallow Hotel, Preston
Details from northwestregion@bsava.com
EVENING MEETING
SOUTH WEST REGION
Wednesday 2 February
Clinical research in practice
Speaker: Richard Mellanby
Communal Building, School of Veterinary
Science, University of Bristol, Langford,
North Somerset BS40 5DU
Details from southwestregion@bsava.com
EVENING MEETING
NORTH EAST REGION
Tuesday 8 February
Im a small animal vet: what do I
know about chickens?
Speaker: Victoria Roberts
IDEXX Laboratories Wetherby,
Grange House, Sandbeck Way, Wetherby,
West Yorkshire LS22 7DN
Details from northeastregion@bsava.com
EVENING MEETING
MIDLAND REGION
Tuesday 8 February
Current thoughts on the use and
interpretation of diagnostic tests in
skin disease
Speaker: Ross Bond
The Hilton Warwick, A429 Stratford Road,
Warwick, Warwickshire CV34 6RE
Details from midlandregion@bsava.com
DAY MEETING
NORTHERN IRELAND REGION
Sunday 13 February
Ophthalmology
Speaker: Jim Carter
Ramada Belfast, Shaws Bridge,
Belfast BT8 7XP
Details from nirelandregion@bsava.com
EVENING MEETING
MIDLAND REGION
Thursday 27 January
The geriatric cat
Speaker: Mike Davies
Hilton Puckrup Hall Hotel,
Tewkesbury GL20 6EL
Details from midlandregion@bsava.com
DAY MEETING SCOTTISH REGION
Sunday 30 January
Neurology for vets: localisation
and case studies
Speaker: Jacques Penderis
Edinburgh Vet School,
Easter Bush Veterinary Centre, Roslin,
Midlothian EH25 9RG
Details from scottishregion@bsava.com
DAY MEETING SCOTTISH REGION
Sunday 30 January
Nursing care of the neuro patient
Speaker: Gillian Calvo
Edinburgh Vet School,
Easter Bush Veterinary Centre, Roslin,
Midlothian EH25 9RG
Details from scottishregion@bsava.com
DAY MEETING
Wednesday 9 February
Introduction to flexible endoscopy
Speaker: Ed Hall
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Thursday 10 February
Advanced surgical nursing: taking
the trauma out of nursing the
trauma patient
Speakers: Mickey Tivers and Alison Young
Clumber Park Hotel & Spa, Worksop
Details from administration@bsava.com
DAY MEETING
Tuesday 25 January
Upper urinary tract disease:
evidence-based approach to
failing kidneys
Speaker: Hattie Syme
BSAVA Headquarters, Gloucester
Details from administrator@bsava.com
DAY MEETING
Thursday 27 January
Critical care medicine: how to save
the sickest
Speaker: Amanda Boag
Radisson SAS, Manchester Airport
Details from administration@bsava.com
EVENING MEETING KENT REGION
Wednesday 19 January
Repairing jaw fractures
Speaker: Cedric Tutt
Best Western Russell Hotel, 136 Boxley
Road, Maidstone ME14 2AE
Details from kentregion@bsava.com
30-31 Diary.indd 31 17/12/2010 10:11
British Small Animal Veterinary Association
Woodrow House, 1 Telford Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB
Tel: 01452 726700 Fax: 01452 726701
Email: administration@bsava.com Web: www.bsava.com
For more information or to
book visit www.bsava.com,
email administration@bsava.com
or call 01452 726700.
BSAVA Small Animal
Modular Series 2011
Fees:
Full modular Member: 1433.76 Non-member: 2150.64
Individual module Member: 213.83 Non-member: 320.74
Also discounts for booking multiple courses at the same time

Tuesday 25 January
Upper urinary tract
disease
An evidence-based approach to
failing kidneys
Speaker: Hattie Syme

Tuesday 15 February
Plumbing problems
Old and new approaches to lower
urinary tract disease
Speaker: Hattie Syme

Tuesday 26 April
Respiratory disease of
the dog and cat
A comprehensive review
Speaker: Brendan Corcoran

Tuesday 24 May
Too much uid,
too low ow
Caring for the patient with
heart disease
Speaker: Jo Dukes McEwan

Tuesday 28 June
Ill never see a case of
thiswill I?
Emerging infectious diseases of
dogs and cats
Speaker: Sue Shaw

Tuesday 27 September
A practical guide to
oncology
No more lumps in your throat! Part I
Speaker: Mark Goodfellow

Tuesday 25 October
A practical guide to
oncology
No more lumps in your throat! Part II
Speaker: Mark Goodfellow

Tuesday 22 November
Medical neurology of the
dog and cat
How to make sense of the wobbly,
weak or collapsing patient
Speaker: Jacques Penderis
SERIES B
Woodrow House, Gloucester GL2 2AB
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