The essential publication for BSAVA members

Feline DementiaCognitive dysfunction in catsP7

Clinical ConundrumDiagnosis and management of diarrhoea in a middle-aged GSD P4

companionAPRIL 2009

How To…Treat hyperthyroid cats with radioactive iodineP10

Ferrets: habits, handling and health care

The essential publication for BSAVA members

companioncompanionThe essential publication for BSAVA members

companionThe essential publication for BSAVA members

companioncompanioncompanioncompanioncompanionAPRIL 2009companion

Ferrets: habits, handling and health care

companion

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Ferrets and RodentsThursday 4 June 2009

Speaker: Emma Keeble

Mottram Hall, Wilmslow Road, Mottram St Andrew, Cheshire

Registration: 10:00; Lectures: 10:30; End: 18:00

Course Fees:■ Member: £170.22 +VAT

(£195.75 inc VAT)■ Non Member: £255.32 +VAT

(£293.62 inc VAT)

3 Round Up RCVS Elections

4–6 Clinical Conundrum Diagnosis and management of diarrhoea in a middle-aged GSD

7–9 Cognitive dysfunction in cats John Bonner on feline dementia

10–13 How To… Treat hyperthyroid cats with radioactive iodine

14–15 GrapeVINe From the Veterinary Information Network

16–18 Euthanasia Coping with the responsibility and supporting clients

19 Petsavers Canine quality-of-life project

20–21 Ferrets Habits, handling and health care

22 Petsavers Latest fundraising news

23–25 WSAVA News World Small Animal Veterinary Association

26 The companion Interview Vic Simpson

27 CPD Diary What’s on in your area

companion is produced by BSAVA exclusively for its members.BSAVA, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB.Telephone 01452 726700 or email companion@bsava.com to contribute and comment.

FERRETS AND RODENTS COURSE

Additional stock photography Dreamstime.com© Eric Isselée | Dreamstime.com© James Steidl | Dreamstime.com© Lane Erickson | Dreamstime.com© Linqong | Dreamstime.com© Stephen Coburn | Dreamstime.com

In the last few years the number of pet ferrets and rodents has grown considerably and along with this a

consequent growth in demand for appropriate veterinary care. Many pet owners develop a strong emotional attachment to their ferret or rodent and expect high-quality medical care. The small size, susceptibility to stress-related problems and short natural life expectancy of these species present challenges compared with traditional companion animals.

Veterinary undergraduate training may not cover pet ferrets and rodents in any great detail and often vets have to rely on extrapolation from other species. These animals however have significant differences in anatomy and physiology.

BSAVA has developed a new one-day course that will cover the diagnosis and treatment of common diseases of ferrets and rodents, with practical tips and an emphasis on clinical approach. There will be opportunities for case discussion and

interaction with the speaker. It is designed to equip vets in practice with the knowledge required to deal confidently and effectively with these delightful animals.

See page 20 for information about treating ferrets and details about the new BSAVA Manual of Rodents and Ferrets. ■

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ROUND UP

RCVS NEEDS YOUR VOTES

Last year just 17% of the profession exercised their right to vote in the RCVS elections.

The College recognises that this disappointing lack of enthusiasm may have been a result of members not being aware of the candidates or their views, so they are trying to change that for the elections now underway.

There’s a special edition of RCVS News Extra, containing candidate biographies and

Voter apathy has resulted in a consistently low turn-out in RCVS elections for several years, which is why this year they are finding more ways to introduce the candidates and generate debate

their manifesto statements, together with the all-important contact details so you can put any questions to them directly. Members should have received this along with their ballot paper in the College’s March mailing.

The College has also teamed up with the online veterinary community website www.vetsurgeon.org in order to generate discussions between voters and the candidates. You can go online to read more about them and their work, ask your own questions, and see what others have to say. The RCVS hopes that by joining in, or even just following the discussions, you will be able to make more informed choices and engage in the debates.

This year, there are nine people standing for six places on the Council, including five veterinary surgeons who currently sit on Council, one former Council member and three previously unelected candidates. They are:

Although at the time of writing it looked like delegate figures would be up on last year, we know that

not all our members can attend Congress every single year – and even if you do, you can’t attend every lecture. This is why from the middle of April you will be able to download any lecture you want from the 2009 programme online. This adds to the

MEMBERS GET CONGRESS ALL YEAR LONG

Whether you were there in person or not – all BSAVA members have exclusive access to all the science online

archive which allows you to download and listen to any MP3 from the nursing and veterinary programme from the last three years.

If you did miss out on Congress this year look out for the full update in the May edition of companion – and we hope you can make it next year (8–11 April 2010). n

1. Dr Jerry Davies BSAVA Member2. Mr Chris Gray BSAVA Member3. Mr Peter Jinman BSAVA Member4. Mr Thomas Lonsdale5. Mr David McDowell6. Mrs Jill Nute BSAVA Member7. Mr Nigel Swayne BSAVA Member8. Mr Chris Tufnell BSAVA Member9. Dr Bradley Viner BSAVA Member

Voting opened on 13 March 2009, and you can vote by post, over the phone (freephone 0800 197 4622), or online (www.votebyinternet.com/rcvscouncil09), right up to the deadline of 5 pm on Friday 1 May. Voting instructions can be found on the back of your ballot paper or on RCVS online at www.rcvs.org.uk/rcvscouncil09.

Newly elected Council members will take their seats at RCVS Day, the College’s AGM and awards ceremony, on Friday 3 July 2009. n

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CLINICAL CONUNDRUM

CLINICALCONUNDRUMPatricia Ibarrola, of Davies Veterinary Specialists, discusses the diagnosis and management of diarrhoea in a middle-aged GSD

insipidus) or any disease that interferes with the renal ability to concentrate urine (e.g. renal disease, hypoadreno-corticism, hyperadrenocorticism, liver disease, hypercalcaemia)

3) Severe dehydration and hypovolaemia

(The latter was manifested by the tachycardia, weak pulses, pale mucous membranes with prolonged CRT and low rectal temperature). The dehydration and hypovolaemia was thought to be secondary to the diarrhoea and excessive fluid loss.

4) AnorexiaA vague sign of many different disorders.

How would you investigate and manage this case?Given the patient’s significant hypovolaemia, urgent fluid therapy is a priority. Given the severe dehydration, hypovolaemia and hypotension (mean arterial pressure (MAP) was 60 mmHg), the patient required both expansion of circulating volume and replacement of fluid deficits, so 20 ml/kg/h of 0.9% NaCl and 5 ml/kg/h of Hetastarch was initiated.

A complete blood count (Figure 1), biochemistry profile (Figure 2) and urinalysis (Figure 3) were performed in order to assess the dog systemically.

What is your interpretation of the test results and do they aid in refining the differential diagnosis list?CBC

A poorly regenerative, microcytic n

anaemia. Microcytosis was most likely due to iron deficiency secondary to gastrointestinal haemorrhage

Case Presentation

A 6-year-old female neutered German Shepherd Dog was presented with a one-week history of anorexia, polydipsia and diarrhoea. On examination the bitch was quiet but responsive. Rectal temperature was 37.8ºC. Cardiac auscultation revealed tachycardia (160 bpm) but no murmur or muffled heart sounds. Respiratory rate was 26 breaths/min. Mucous membranes were pale and tacky, with a capillary refill time of 3 seconds. Femoral pulses were weak but regular, with no pulse deficits. There was a loss of skin turgor (estimated 10–12% dehydrated). Body condition score was 4/9. The remainder of the physical examination including abdominal palpation was unremarkable.

pulses were weak but regular, with no pulse deficits. There was a loss of skin turgor (estimated 10–12% dehydrated). Body condition score was 4/9. The remainder of the physical examination including abdominal palpation was unremarkable.

Based on the information you have so far, create a problem list and consider the differential diagnoses

1) DiarrhoeaPrimary intestinal disease n (e.g. infectious process, inflammatory disease, dietary intolerance, neoplasia or partial intestinal obstruction)Secondary to systemic disease (e.g. n

hepatic disease, hypoadrenocorticism, exocrine pancreatic insufficiency)

At this stage, it was not clear whether the diarrhoea was due to primary gastrointestinal disease or secondary to systemic disease.

2) PolydipsiaAn appropriate response to n

dehydration.More commonly, polydipsia is secondary n

to polyuria. Causes of polyuria include lack of ADH secretion (central diabetes

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CLINICAL CONUNDRUM

A marked neutrophilia (left shift), n

moderate lymphocytosis and absence of eosinopenia. Neutrophilia with a moderate left shift is commonly seen with inflammatory (infectious or non-infectious) processes. The documented lymphocytosis was considered a striking finding in such a sick dog; possible causes include hypoadrenocorticism, certain infectious diseases, lymphoma or leukaemia. The absence of an eosinopenia in a metabolically stressed dog, together with lymphocytosis, made Addison’s disease (hypoadrenocorticism) a possible differential.

Biochemistry and urinalysisMarked hyponatraemia and n

hypochloraemia (Na:K ratio 27:1). Both biochemical abnormalities can occur with severe vomiting and diarrhoea, hypoadrenocorticism and renal insufficiency.Marked azotaemia. Prerenal causes n

include severe dehydration and hypovolaemia. Renal azotaemia occurs as a result of primary renal disease or systemic disease with renal manifestation, e.g. pancreatitis or infection. Postrenal azotaemia caused by obstruction or rupture of the urinary tract was unlikely in this case. Urine specific gravity (1.043) was supportive of adequate renal concentration ability, making prerenal azotaemia most likely.

Parameter Day 1 Day 9 Reference range

RBC (x 1012/l) 4.59 3.62 5.4–8.0

Hb (g/dl) 10.7 9.9 12–18

HCT (l/l) 0.27 0.25 0.35–0.55

MCV (fl) 59.3 69.8 65–75

MCH (pg) 23.3 27.3 19.5–24.5

MCHC (g/dl) 39.1 39.1 32–37

Platelets (x 109/l ) 319 196.0 150–400

Reticulocytes (x 109/l) 170 1013

WBC (x 109/l) 41.1 17.1 6–18

Segmented neutrophils (x 109/l)

31.0 14.3 3–12

Band neutrophils (x 109/l) 2.87 1.05 0–0.3

Lymphocytes (x 109/l) 5.08 1.47 1.2–3.8

Monocytes (x 109/l) 0.65 <0.01 0–1.2

Eosinophils (x 109/l) 1.30 0.21 0.1–1.3

Basophils (x 109/l) <0.01 <0.01 0–0.1

Normoblasts (x 109/l) 0.13 35.5

Figure 1: Haematology results

Parameter Day 1 Day 3 Reference range

Sodium (mmol/l) 131 147 140–153

Potassium (mmol/l) 4.9 3.6 3.8–5.3

Chloride (mmol/l) 105.0 112.0 99–115

Calcium (mmol/l) 2.36 2.18 2.2–2.7

Phosphorus (mmol/l) 2.05 1.05 0.8–2.0

Glucose (mmol/l) 5.4 7.0 3.5–5.5

Urea (mmol/l) 22.9 3.8 3.5–6.0

Creatinine (µmol/l) 104.0 47.0 20–110

Cholesterol (mmol/l) 3.7 3.4 3.2–6.5

Protein (g/l) 54.0 51.0 57–78

Albumin (g/l) 26.0 21.0 23–31

Globulin (g/l) 28.0 30.0 27–40

Alkaline phosphatase (IU/l)

42.0 27.0 0–100

Alaninine aminotransferase (IU/l)

64.0 41.0 7–50

Figure 2: Biochemistry results

Parameter Day 1

Source Cystocentesis

Colour Yellow

Specific gravity 1.043

pH 6.0

Protein 1.8 g/l

Creatinine 13.9 mmol/l

Glucose Negative

Bilirubin Negative

Blood Trace

Leucocytes/HPF <5

Epithelial cells/HPF Negative

Erythrocytes/HPF 5

Crystals Negative

Bacteria Negative

Figure 3: Urinalysis results

Parameter Result Units Reference range

Basal cortisol level

<20 nmol/l Normal: up to 250

Cortisol 1 hour post-ACTH

<20 nmol/l Normal: up to 400

Figure 4: Results of ACTH stimulation test

Mild hypoproteinaemia may be the n

result of reduced protein synthesis (e.g. starvation, malabsorption, liver disease or acute injury) or increased protein loss (e.g. protein-losing nephropathy or enteropathy, haemorrhage, formation of exudates). Urine protein:creatinine ratio was 1 making a protein-losing nephropathy unlikely. Given the suspicion of gastrointestinal ulceration, enteric loss was considered most likely.

As the dog was hypovolaemic and dehydrated, the hypoproteinaemia and anaemia were likely to be more severe and clinically significant. Given the clinical presentation, unexpected lymphocytosis and electrolyte changes, hypoadreno-corticism and intestinal disease were considered the main differentials.

What further diagnostic tests would aid in diagnosis?An ACTH stimulation test was performed (Figure 4).

As the MAP had normalised, fluid rates were adjusted to provide the remaining volume replacement and maintenance fluid requirement over the following 24 hours. Gastroprotectants were prescribed (sucralfate/ranitidine) in case of gastrointestinal ulceration. The electrolytes were monitored closely to ensure gradual correction of the hyponatraemia to prevent sudden changes in osmolality which can lead to severe neurological signs.

What is your diagnosis and how does it affect your management of the case?ACTH stimulation results confirmed hypoadrenocorticism, and an intravenous infusion of hydrocortisone (0.5 mg/kg/h)

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CLINICAL CONUNDRUM

Figure 5: VD and lateral abdominal radiographs

commenced in addition to the gut protectants and fluid therapy. Intravenous hydrocortisone was chosen because of concerns over poor intestinal absorption of any oral medication. Hydrocortisone only provides glucocorticoid supplementation; mineralocorticoids are required in the long-term management of such cases.

All clinical parameters remained stable; the dog started eating and passed solid faeces. Repeat blood tests showed a persistence of the poorly regenerative microcytic anaemia and moderate hypoalbuminaemia, but a complete resolution of the azotaemia. Hypokalaemia was addressed by changing the fluid therapy to Hartmann’s solution supplemented with potassium chloride.

On Day 5 the dog started vomiting and abdominal discomfort was evident on palpation. What would be your plan of action now?Vomiting and, rarely, abdominal pain can be seen in Addisonian patients. However, given the dog’s therapy and improvement in the

biochemical parameters, another disease process was considered likely. Biochemistry and a manual PCV were performed to reassess the patient’s metabolic status. Abdominal imaging was also carried out.

Biochemistry and PCV were relatively unchanged with a mild anaemia and hypoproteinaemia.

What changes are evident on the radiographs and what is the most likely cause of the changes?There is gas and faecal material in the descending and transverse colon, and some small intestinal loops are gas-filled (Figure 5). There is an air-distended loop of small intestine in the mid-abdomen; at the ventral aspect of this is a region with expanded serosal-to-serosal width and mottled gas and soft tissue opacity contents, consistent with a gravel sign. These findings are highly suggestive of a partial obstruction.

What would you do next and what are your differentials?Differentials for intestinal obstruction include a foreign body or neoplasia. An ultrasound examination is therefore indicated but the presence of gas in the intestine prevented examination of the area of interest.

In view of the radiographic findings and

CLINICAL CONUNDRUM

the clinical deterioration, an exploratory laparotomy was performed. This confirmed the presence of a foreign body (piece of rubber) in the mid jejunum.

How would you manage this dog postoperatively and in the long term?Addisonian dogs require glucocorticoid supplementation at times of stress. Given the vomiting, an intravenous infusion of hydrocortisone was used. Oral gut protectants were continued and fluid therapy adjusted based on serial monitoring.

The dog recovered well from surgery, electrolytes remained stable and the protein levels gradually improved. Treatment with oral prednisolone (0.2 mg/kg every 24 hours) and fludrocortisone (0.01 mg/kg every 24 hours) was initiated and intravenous therapy slowly withdrawn.

Four days after surgery the dog had a markedly regenerative anaemia, which was considered appropriate for the previous chronic gastrointestinal blood loss.

The dog was maintained long term on fludrocortisone alone, as it has both glucocorticoid and mineralocorticoid activity. However, in times of stress (e.g. if she has surgery, goes into kennels, etc.) the glucocorticoid requirements may increase, and additional supplementation with prednisolone was suggested. n

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DEMENTIA

COGNITIVE DYSFUNCTIONIN CATSContrary to popular belief, cats only have one life, but that life is becoming longer and longer lasting. With better diets and veterinary care, more of Britain’s cats and dogs are living to a ripe old age. With this, they are also becoming increasingly prone to the same dementia-type diseases as their owners, conditions which are putting massive strains on the National Health Service. John Bonner asks veterinary experts how the profession is dealing with its own demographic time bomb

Roughly 40 per cent of Britain’s pets have reached that stage of their lives when their veterinary surgeon will

mentally reclassify them as ‘seniors’ rather than ‘mature adults’. That boundary, reached at around 7 years of age in dogs and 10 years in cats, marks the point where the pet will become increasingly vulnerable to cognitive dysfunction diseases.

Clinical signsClinical signs often appear relatively soon after the transition to ‘seniority’ – in cats aged 11–14 years, it is estimated that 28

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DEMENTIA

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DEMENTIA

percent have the sort of behaviour problems that occur in human geriatrics, rising to more than 50 per cent in cats aged 15 years and older. Similarly, in dogs aged 7 and above, about one in three shows signs of confusion, restlessness and a reduced appetite for life, while up to 20 per cent start to cause more serious problems by urinating or defecating inside the house.

Those problems in an ageing population present both a challenge and an opportunity for first-opinion practitioners. It can be extremely difficult to tease out the relative contribution played by mental senility when there are other pathological processes involved, points out Danièlle Gunn-Moore, Professor of Feline Medicine at the University of Edinburgh veterinary school. “Is the cat failing to use its litter tray because it is senile? Or is it arthritic and finding it difficult to step over the side of the litter box? There are so many factors that may interact in these cases.”

Jon Bowen, a veterinary behaviourist at the Royal Veterinary College, agrees that is often difficult to say whether behaviour problems are entirely due to this type of cognitive change. It can certainly be a factor in a lot of his cases, with many dogs referred because of separation anxiety or increased fearfulness that are at least partly caused by dementia.

Role of the ownerIf veterinary surgeons have difficulty in reaching a definitive diagnosis, what chance is there for the owner? Gwyn Eggington is an Essex-based practitioner with a particular interest in pet behaviour problems. “I don’t see many cases involving dementia in my behaviour referrals but I do see them in my general practice. The biggest problem is in getting clients to recognise that the changes in their pet are due to dementia. They assume that it is just one of

COGNITIVE DYSFUNCTION IN CATS

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DEMENTIA

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DEMENTIA

those things they have to put up with, but it is often a condition that we can do something about.”

Indeed owners have expectations of the changes that might occur in their pet’s behaviour as a normal consequence of ageing which may make it difficult for them to recognise any specific problems caused by dementia.

Increasingly, owners are surrendering pets with other chronic degenerative conditions for which they claim they can no longer afford veterinary treatment but it is extremely rare for them to be brought in specifically because of dementia, notes Chris Laurence, veterinary director for the welfare charity. Indeed, it is much more common for dogs to be abandoned because the owners themselves have Alzheimer’s disease or some other neurological condition that prevents them looking after themselves or their pets. More than 15,000 dogs were looked after by the Dogs Trust last year, some percentage of which must have had some signs of dementia. Yet, as dogs taken in for rehoming suffer high levels of stress, changes from their normal behaviour will be extremely common, as such even experienced observers may be limited in their ability to identify real cognitive dysfunction in animals in unusual environments.

The vast majority of dogs cared for by the welfare charities only stay for a short while before they are reunited with their family or rehomed. So it would be unusual for kennel staff to see the gradual deterioration in a pet that will eventually become apparent to its normal carers.

Treatment and expectationsFortunately, effective treatment is available for such cases, particularly as the expectations for its success are lower

than they might be for the families of human patients with degenerative brain disease. Ultimately, the goal in human medicine will be to restore all aspects of complex personality – in a pet animal it is often enough for them to regain their appetite for life.

As with most disease conditions, the success of treatment in slowing down the effects of cognitive dysfunction depends upon the stage that this process has reached. Nutraceutical diet supplements and formulations specifically designed for the older pet have been shown to help dogs with mild to moderate disease. These contain essential fatty acids, antioxidants and free-radical scavengers that can reduce the rate of degenerative changes in the brain. “Significant positive changes occurred in both the objective behaviour of dogs suffering from canine cognitive dysfunction as well as in the perception of the dogs’ condition by people in regular contact with them”, noted veterinary behaviourist Sarah Heath in a report of a placebo-controlled trial of one type of nutritional supplement published in 2007. There are few equivalent studies on the role of nutritional factors in feline disease but anecdotal evidence suggests that they do provide similar benefits, adds Danièlle Gunn-Moore.

In more advanced cases it is better for the veterinary practitioner to start immediately on medical treatment such as a monoamine oxidase inhibitor and/or a xanthine derivative. Improvement may take several weeks and so it is important to minimise any further deterioration, says Jon Bowen.

It is of prime importance that the practitioner investigates, identifies and treats any accompanying diseases, such as

osteoarthritis or cardiovascular conditions. Improving the animal’s general health will improve its tolerance of exercise and produce further improvements in its quality of life. “The importance of physical activity in reducing the impact of dementia should not be underestimated – getting blood flowing faster around the brain will make a big difference”, Danièlle points out.

The end of the roadHowever, there are limits to what can be achieved, even by the highest quality care. At some stage the owners of a senile dog or cat and their veterinary advisor will have to discuss the topic of euthanasia. In some cases, that decision may be unavoidable when the relationship between the animal and its owner is ‘broken’ under the stress caused by unwanted behaviour such as soiling inside the house or constant wailing at night. Even in these situations, it needs to be explained to the owners that the behaviour is not wilfulness on the part of their animal and is the result of a genuine disease. Pointing out that the condition is likely to affect the animal’s enjoyment of life also helps assuage any guilt felt by members of its human family, says Danièlle.

In other cases, though, it is much more difficult to decide when it is better to put the animal to sleep. Danièlle suggests to owners of any pet with irreversible degenerative disease that they keep a diary of their pet’s behaviour. This should note roughly how much the animal ate that day and how much time it spent in playing or in other favourite activities. Even just a rough visual analogue scale of 1–5 will give the owners some form of objective evidence on which to base their assessment of the pet’s quality of life, she says. n

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HOW TO…

TREAT HYPERTHYROID CATS WITH RADIOACTIVE IODINE

HOW TO…

Although a wealth of data are available on the consequences and outcome of feline hyperthyroidism,

the exact cause remains unclear. Prevention is therefore not possible but because of the benign nature of the lesions in most affected cats, the disease carries a favourable prognosis with effective therapy.

Treatment of hyperthyroidism is achieved by removing or destroying the abnormally functioning thyroid tissue or

Carmel T Mooney MVB MPhil PhD DECVIM-CA MRCVS is an RCVS Specialist in Small Animal Medicine (Endocrinology) working at the University College Dublin. Here she discusses one of the most common conditions affecting the older cat

Each treatment method carries its own specific advantages and disadvantages that must be taken into consideration for each individual case. Few studies exist that directly compare the outcome of each of the different treatment methods in hyperthyroid cats. However, radioactive iodine therapy, if available, is considered by most to be the optimal treatment in terms of safety, simplicity and efficacy.

How does radioactive iodine work?Radioactive iodine as 131I, like stable iodine, is actively concentrated by the thyroid gland. It has a half-life of eight days and emits both β-particles and γ-radiation. The β-particles cause over 80 per cent of tissue damage, and are locally destructive, travelling a maximum of 2 mm with an average penetration of 400 µm. The radiation therefore destroys abnormally functioning thyroid tissue, but carries minimal risk of significant damage to adjacent parathyroid tissue, atrophic thyroid tissue or other cervical structures.

How is the dose of radioactive iodine calculated?The overall aim of radioactive iodine therapy is to restore euthyroidism with a single dose whilst minimising the risk of hypothyroidism. The smallest dose possible should be used – radiation exposure should be kept ‘as low as reasonably achievable’ (ALARA principle) to decrease potential risk for humans. Various methods have been used to calculate the optimum dose for individual cats. In initial reports, tracer kinetic studies were performed with low doses of intravenous radioactive iodine.

Data were collected on percentage

inhibiting thyroid hormone synthesis and release. Surgical thyroidectomy and thyroid ablation using radioactive iodine are the only curative methods. Medical management controls thyroid hormone production but has no effect on the underlying disorder. Although an option long-term, medical management is also often used to stabilise patients prior to surgical thyroidectomy or to control clinical signs until radioactive iodine administration.

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HOW TO…

TREAT HYPERTHYROID CATS WITH RADIOACTIVE IODINE

iodine uptake, effective half-life and estimation of thyroid gland weight (all factors known to influence therapeutic dose) and the therapeutic dose subsequently calculated. However this method requires access to sophisticated computerised nuclear medicine equipment, is time-consuming, expensive, involves repeated sedation of the patient and it has been shown to be a poor predictor of actual therapeutic dose kinetics. It is therefore rarely used today. Another method is to use a relatively high fixed dose of between 150 and 250 MBq in all cats regardless of their

clinical presentation. Although this method is successful and simple, it potentially results in the under- or overtreatment of a significant proportion of cats.

Markedly elevated pretreatment serum thyroid hormone concentration, the size of goitre and the severity of the clinical thyrotoxicosis all have potentially adverse effects on the eventual response to radioactive iodine therapy. These factors can be used in a scoring system to calculate the therapeutic dose – an example is presented in the table on page 13. When such a scoring system is used, doses range

from approximately 50 to 250 MBq allowing titration to each individual cat, avoiding unnecessary under- or overtreatment. It is a simple method that does not require access to sophisticated nuclear medicine equipment. Success is comparable to dose estimation by tracer kinetic studies. Although some variations are applied, it is the principle method used by most centres offering radioactive iodine today.

How is radioactive iodine administered?Traditionally, 131I was administered intravenously. Oral administration has been attempted but higher doses are generally required, the risks of radiation spillage are greater, and vomiting may occur. Subcutaneous administration is equally effective, simpler to administer, safer for personnel and less stressful to cats, and is currently preferred. Although not strictly required, patients are usually lightly sedated prior to injection to avoid any risks to those handling the cat.

How successful is radioactive iodine therapy?Whatever method of dose calculation or route of administration, attainment of euthyroidism is expected in approximately 95 per cent of cases with a single dose. A small percentage of cats remain persistently hyperthyroid. In some of these cases, serum total T4 concentrations continue to decline after treatment and euthyroidism is eventually attained up to 3 months later. Those that remain persistently hyperthyroid are usually the most severely affected but will respond to a second treatment. Recurrent hyperthyroidism can develop but appears

Radioactive iodine offers a non surgical, curative

therapy for hyperthyroidism

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HOW TO…

to be rare and other side effects are minimal. Serum total T4 concentrations may become subnormal after treatment but the development of clinical signs of hypothyroidism is rare, and there is eventual reactivation of normal or ectopic thyroid tissue with time.

Renal failure may develop or worsen as glomerular filtration rate declines when cats become euthyroid. This may occur in up to 25 per cent of treated cats. Generally the decline in renal function becomes evident within one month of therapy and then remains relatively stable for up to 6 months. It is an unavoidable consequence of any treatment modality but should not preclude treatment of the hyperthyroidism. To date, there is no simple biochemical test capable of predicting cats at risk. However, it is prudent to assess renal function one month after treatment and institute renal support as necessary.

How do I prepare cats and their owners for radioactive iodine therapy?Currently within the UK there are six centres offering radioactive iodine therapy:

Animal Health Trust, Newmarket, ■■

Suffolk (www.aht.org.uk)Barton Veterinary Hospital, Canterbury, ■■

Kent (www.barton-vets.co.uk)Bishopton Veterinary Group, ■■

Ripon, North Yorkshire (www.bishoptonvets.co.uk)Glasgow University Veterinary School, ■■

Glasgow, Scotland (www.gla.ac.uk)Langford Veterinary Services, ■■

Langford, North Somerset (www.langfordvets.co.uk)Queen Mother Hospital, ■■

Royal Veterinary College, London (www.rvc.ac.uk)

Capacity at each centre is limited to 1 to 2 cases per week and isolation times vary from a minimum of 2 weeks to a maximum of approximately 4 weeks. Shorter isolation periods necessitate greater restrictions in the home environment (limited close contact, no children, etc.) Waiting lists vary but can be up to 6 weeks. Only Langford Veterinary Services can use the extremely high doses required for the treatment of thyroid carcinoma.

Most hyperthyroid cats can be treated with radioactive iodine. However, given the prolonged period of boarding and restrictions on handling, the presence of

any concurrent illness that adversely affects appetite or necessitates frequent medications usually precludes radioactive iodine therapy. Most centres require full haematological and biochemical screening, often with cardiac ultrasound, before accepting patients for treatment.

The effect of prior antithyroid medication on efficacy of radioactive iodine therapy is controversial. Prior methimazole (and therefore carbimazole) therapy has been variably suggested to enhance, worsen or have no effect on radioiodine treatment outcome. Overall prior therapy probably has a minimal effect if at all. However,

TREAT HYPERTHYROID CATS WITH RADIOACTIVE IODINE

Scintigraphy revealing asymmetric, bilateral disease

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HOW TO…

TREAT HYPERTHYROID CATS WITH RADIOACTIVE IODINE

Estimating the dose of radioactive iodine from clinical signs, total thyroxine (T4) and size of goitre as estimated by palpation. Adapted from Mooney CT. Radioactive iodine therapy for feline hyperthyroidism: efficacy and administration routes. J Small Anim Pract 1994;35:289.

Score Severity of clinical signs

Total T4 (nmol/L)

Size of goitre Total score

Dose 131I (MBq)

1 Mild < 80 Barely palpable

2 Mild – moderate < 100 1.0 x 0.5 cm 3–9 < 120

3 Moderate 100–150 1.5 x 0.5 cm 9–12 120–150

4 Moderate–severe 150–400 >1.5 x 0.5 cm > 12 160 or more

5 Severe > 400 Visible to naked eye

Further readingBoag AK, Neiger R, Slater L, et al. Changes in the glomerular filtration rate of 27 cats

with hyperthyroidism after treatment with radioactive iodine. Vet Rec 2007;161:711.Milner RJ, Channell CD, Levy JK, et al. Survival times for cats with hyperthyroidism

treated with iodine 131, methimazole, or both: 167 cases (1996–2003). J Am Vet Med Assoc 2006;228:559.

Mooney CT. Radioactive iodine therapy for feline hyperthyroidism: efficacy and administration routes. J Small Anim Pract 1994;35:289.

Peterson ME, Becker DV. Radioiodine treatment of 524 cats with hyperthyroidism. J Am Vet Med Assoc 1995;207:1422.

Slater MR, Geller S, Rogers K. Long-term health and predictors of survival for hyperthyroid cats treated with iodine 131. J Vet Intern Med 2001;15:47–51.

Slater MR, Komkov A, Robinson LE, et al. Long-term follow-up of hyperthyroid cats treated with iodine-131. Vet Radiol Ultrasound 1994;35:204.

Van Hoek I, Lefebvre K, Peremans K, et al. Short and long term follow up of glomerular and tubular markers of kidney function in hyperthyroid acts after treatment with radioiodine. Dom Anim Endocrin 2009; 36:45.

concurrent administration adversely affects effective half-life of radioactive iodine and is not recommended. Therefore, such drugs are withdrawn for at least 5 days and up to 2 weeks prior to administration of radioactive iodine. While some centres accept untreated hyperthyroid cats, others require assessment while euthyroid on antithyroid medication in order to assess renal function accurately.

How can I establish a radioactive iodine unit at my practice?The main drawback to widespread establishment of radioactive iodine units is the requirement for special licensing, specific personnel training and suitable premises for receipt, administration and disposal of radioactive iodine. A dedicated isolation unit and a means of storing radioactive waste (for up to 3 months) are

required. In addition, an attainable source of radioactive iodine is required. Many centres are supplied by local hospitals but not all hospitals use radioactive iodine. Obtaining radioactive iodine direct from manufacturers can be difficult and erratic. Advice should first be sought from your local radiation protection adviser (www.hpa.org.uk).

Most of the requirements will be dictated by national and local ionising radiation protection legislation. However, consideration must also be given to

minimising the adverse effects of prolonged hospitalisation through appropriate environmental management. This may include, but is not confined to, using larger cages with separate areas for feeding and sleeping and of a size that allows some movement, in a room with some form of stimulation. It may be worth checking out the USA website www.hypurrcat.com for an example of one of the most successful large scale dedicated radioactive iodine units together with its webcam system for owners to look in on their pet. ■

Patient quarters following iodine 131 treatment at Langford Veterinary Services.Photo courtesy of University of Bristol Veterinary School.

14 | companion

VIN

The Veterinary Information Network brings together veterinary professionals from across the globe to share their experience and expertise. At vin.com users get instant access to vast amounts of up-to-date veterinary information from colleagues, many of whom have specialised knowledge and skills. In this regular feature, VIN shares with companion readers a small animal discussion that has recently taken place in their forums

.comGRAPEVINEheard on the

Adam Honeckman, DVM Diplomate ACVIM (Small Animal Internal Medicine) Mobile Veterinary Diagnostics, Casselberry, FLThe radiograph is difficult to evaluate.

I would do Chest x-rays and send out blasto antigen testing (urine) if there is a concern for Blasto. Any big lymph nodes you can do FNA cytology on?

Carolyn EichkornBlastomycosis – Negative. “Kaiser” was in today with his owner...seems to be doing fabulously...Not lame, bright and alert, but still has a swelling (Grapefruit size) on the inside of his thigh...Seems a bit more localized than before but not

appreciably changed in size. I repeated the x-rays today...essentially the same, maybe a wee bit more lysis on the proximal tibia. I have started him on a course of clindamycin pending your reply here. I am thinking more all the time that this is some sort of osteomyelitis with perhaps an organizing abscess (did not feel any soft spots)...I didn’t feel really comfortable poking around in the lump for a fine needle aspirate but if you think that might yield some useful data, I could try. His lymph nodes are all normal, his chest x-ray was clear....His case is still quite a mystery...but at least the dog is doing well!?! Anyway....any further thoughts you might have at this point would sure be appreciated.

Carolyn Eichkorn DVM, Winrose Animal Hospital, Winnipeg MB, CanadaMy patient is a 2 year old M/N Rottie who presented with marked swelling of the left hind leg extending from the inguinal area to just distal of the stifle joint. The

dog walks quite well on the leg. Palpation reveals no pain; however, the dog does tense up when I try to elicit a cranial drawer. No sign of punctures or wounds.

X-rayed and really don’t like what I found. There is an area of translucency (I think some refer to it as moth-eaten or cotton ball appearance?) mid to distal femur and the cortical bone is “fluffy”/ periosteal reaction. The right femur appears normal. There also appears to be lysis on the distal femur near the stifle joint and on the proximal tibia. Dog has a history of going to a blastomycosis endemic area several times over summer and history of human blastomycosis in the family acquired on the same property.

Tried to get some bone aspirates and a bone biopsy but the bone is very hard and I am unable to penetrate the cortex well with either a 16 gauge biopsy needle or a core biopsy punch (with as much force as I could exert!!). I am hoping that being unable to penetrate the cortex is good prognosis-wise.

My rule outs are bacterial osteomyelitis, blastomycosis and osteosarcoma. I have started the dog on Cephalexin for now but am wondering where to go from here if I can’t get my tools to penetrate the bone for a biopsy. Would you try again? Look elsewhere for lesions? Other??

Thanks so much in advance.

companion | 15

VIN

All content published courtesy of vin.com. For more details about the Veterinary Information Network visit vin.com. As VIN is a global veterinary discussion forum not all diets, drugs or equipment referred to in this feature will be available in the UK, nor do all drug choices necessarily conform to the prescribing rules of the Cascade. Discussions may appear in an edited form.

Carolyn EichkornJust a quick update,...Kaiser is undergoing an amputation tomorrow by disarticulation at the hip. Pathology report came back with a suspect Grade 1 soft tissue sarcoma though they did not specify a cell of origin.

Pathology report:

“The histologic findings suggest a soft tissue sarcoma – the lesion has high cellularity. For prudence, recommend aspiration of regional lymph nodes and survey abdominal and thoracic imaging (done) to rule out metastatic disease (nothing on the histo strongly suggest metastatic potential at this point, however it would be worth performing for completeness).

Histopathology: Section of the joint capsule/synovium are available for evaluation. Extending from the joint capsule into portions of the synovial lining is a large, unencapsulated, moderately-well demarcated mass comprising dense, multilayered, highly cellular and occasionally intersecting streams of mildly pleomorphic, neoplastic spindle cells with minimal surrounding connective tissue matrix.

Re: bone core sections: “Along the endosteal surface of one biopsy, and along the periosteal surface of another are small, yet moderately thickened sheets of mildly plump spindle cells (several layers thick)..There is mild anisocytosis/anisokaryosis in this population and a single mitotic figure is noted.”

Sooooooooooo....I don’t see that we have much choice with this dog but to amputate the leg but we will make sure that the owner understands that there is always potential that the mass has already metastasized.

Do you have any other thoughts?

Carolyn EichkornUpdate…

We had Kaiser’s leg amputated at the hip and sent it for pathology (we covered the cost as the owner didn’t want to send it but I thought there was much to be learned!!)…

Came back “grade II Sarcoma, suspect fibrosarcoma… though rhabdomyosarcoma cannot be completely ruled out”...Recommended monitoring regional lymph nodes, rule out metastasis, which is not highly anticipated, though possible. Margin clean by 2–3 cm on proximal end.”…

Mass was approx. 28 cm long by 16 cm wide!!!

He’s a great dog so hopefully this is his bad luck for the next long while!!

Thanks again for all the help.

Cathy Wilkie, DVM Associate Editor, Diagnostic Imaging Animal Medical Hospital, West Vancouver, BC CanadaA 2 year old Rottie with a lytic bone mass needs a biopsy. There is a spike of osteosarcoma in this age group (1–2

years), in addition to the old dogs. I would sample from the center of the lytic area in the femur, hoping to get tumor (if it’s there, it will be central, not peripheral). Use a Jamshidi if you can.

Mike Harter, DVM VIN Associate Editor, Parasitology, Diagnostic Imaging, Animal Medical Clinics, Rockford, ILIt may not be OSA, with multiple sites metastatic histiocytic sarcoma or any hematogenous pathology could be

involved, but they’d all need biopsies.

ps. The patella is elevated, too. Could you biopsy the soft tissue component?

Cathy Wilkie, DVMSo if it’s a soft tissue sarc, are the bone lesions all mets? (I’m thinking of the diaphyseal femur lesion ) If it’s a synovial sarcoma, the stifle may be the primary but if it’s some other kind of sarcoma, don’t we still have a primary

out there somewhere? “

It sounds to me like we have local invasion of the tumour into the bone at the site of the identified mass...

Adam HoneckmanHi Bill,

I just wanted to say hi. It’s been a long time (Purdue Vet School class of 1992, internship 92-93), but I saw your ad in JVIM and decided to join as a VIN consultant.

I think you let me do my first ultrasound guided liver biopsy when I was an intern. Who knew then that I would do mobile ultrasounds/biopsies for a living?

Bill Blevins, DVM, MS, DACVR School of Veterinary Medicine, Purdue University, West Lafayette, INCarolyn

A synovial sarcoma in the stifle could cause radiographic changes like this;

however, there is a lesion in the diaphysis of the femur. This is a location where we commonly see metastasis to bone.

In any event, a neoplastic process is likely and a biopsy is needed for a definitive diagnosis. I would also make radiographs of the thorax. It may also be filled up with metastasis.

Oh yes, fibrosarcoma of the joint capsule can also cause lesions like this.

Bill BlevinsHi Adam;

Welcome to VIN.

Who knows what path we will follow. It seems to eventually work out. My work with VIN is the most rewarding thing that

I do.....and it is on a worldwide stage.

16 | companion

EUTHANASIA

EUTHANASIASUPPORT IN THE PRA CTICEProviding a kind, gentle end to a pet’s life may be viewed as a privilege – part of the vet’s everyday work to preserve animal welfare. However, as it often provokes strong emotions, euthanasia can be a significant cause of stress. Jenna Maryniak talked with a vet and a psychologist about coping with the responsibility of euthanasia and supporting grieving clients

Many vets, particularly young graduates, find themselves quite unprepared to cope with the

ethical dilemmas surrounding certain euthanasia cases, and their bereaved clients. Elizabeth Ormerod is a practising vet in Lancashire and chairman of the Society for Companion Animal Studies (SCAS). She believes that the importance of undergraduate training in this area should not be underestimated: “When I was a student in the 1970s, there was little understanding of how to support bereaved clients. During my training, I was greatly influenced by two veterinary surgeons, Dr Mary Stewart and the late Dorothy Campbell, both of whom demonstrated the importance of compassionate care. However, as a young graduate, although I

children should be told the truth about n

pet lossterminology should be used carefully, n

especially when working with childrenyoungsters of different ages require n

different approaches in support.

“Colleagues advised that clients who were well supported would cope better with pet loss, would be more likely to adopt another animal and would have strong loyalty to the veterinary practice. I realised that there were wide implications for the mental health of clients, for animal welfare and for the success of the veterinary practice,” she says.

As she developed a deeper understanding of the issues surrounding terminal illness and euthanasia, Elizabeth

EUTHANASIA

could empathise with the clients, I was unsure how to support them after those dreaded euthanasia consultations.”

The road to supportWhile travelling throughout the USA, meeting researchers and practitioners who were assessing the potential of the human–animal bond and its applications, Elizabeth learned that the keys to supporting clients included:

advising all bereaved clients of available n

pet loss supportunderstanding that pet loss could n

generate strong emotions in clients – which could be negative and directed at the veterinary surgeon – and not to respond with anger

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EUTHANASIA

EUTHANASIASUPPORT IN THE PRA CTICE

became more comfortable with helping grieving clients. The level of support she provided in her UK practice increased greatly following her travels. Detailed written handouts for grieving clients and the offer of one-to-one support were introduced, in line with the best practice witnessed in the USA.

“I admit I was apprehensive about offering to support clients after their loss – I was concerned that I could end up spending hours in client support, rather than treating patients but was encouraged by American colleagues. Very few clients actually feel the need to come and talk, and even fewer since the excellent befriending service introduced by Pet Bereavement Support Service in 1994,” notes Elizabeth.

“However, my clients tell me the fact

that we provide literature and offer a ‘listening ear’ gives them tremendous support and the feeling of having a ‘safety net’ if everything gets too much for them. I believe all clients who have lost a pet should be informed about the support available from the PBSS. It is a very simple act, but it is much appreciated and may help to prevent mental health problems in some clients.”

Communicating with childrenFor young children, the euthanasia of a pet may be their first experience of death. Dr June McNicholas, a human psychologist, explains that children under the age of seven often have limited understanding of the finality of death and may also have a less-developed sense of cause and effect. “This can cause a feeling that something they have done may have caused an animal’s death; for example, ‘If I had not been naughty, my dog would not have died’. Illness and death need to be explained simply and honestly to children.

A common mistake (although understandable) is for adults to ‘sanitise’ a pet’s death by saying that the dog/cat has gone to ‘live on a farm’. In fact, this can cause great distress and resentment on the part of the child as he/she was not allowed to say goodbye.

In other cases well-meaning euphemisms, such as ‘put to sleep’, can result in lasting psychological trauma. I have dealt with a number of cases of night phobia where the reason for a child’s inability to sleep or be settled at night can be traced to a pet being ‘put to sleep’.

Children of all ages can be helped to accept death. A simple ‘funeral’, laying of flowers, etc., can help enormously, as can encouraging children to think about the good things they remember about owning a

pet. It all helps children come to terms with the death of a pet and it can also lay the foundation for coping with other losses. Early psychiatric research has linked unresolved death of a pet with greater difficulty in coping with other losses, particularly deaths of close family.”

Staff emotion and stressElizabeth advises students that showing some emotion during euthanasia consults is not unprofessional. “I myself was advised by health care colleagues that clients would, in fact, appreciate it if veterinary staff appeared moved – and this has been my experience.” She also has no hesitation in advising her clients on when the ‘right time’ has come. “How can we expect people with no knowledge of terminal disease to know when the time is right? I don’t believe it is wrong to guide them.”

The request to euthanase a healthy pet, however, presents a whole different set of problems for the veterinary surgeon and can be particularly stressful. In some countries, such as Italy, legislation has been enacted to prevent euthanasia of healthy companion animals. “As a young graduate, I was unprepared for clients who wanted healthy animals euthanased,” said Elizabeth. “There are many reasons given for unwarranted euthanasia requests – ‘the dog grew too big’; ‘having the kitten is inconvenient now we have a caravan’; ‘the dog’s hair shows up against the new carpet’; ‘we’re emigrating’; ‘we’re getting divorced’; ‘we can’t find homes for the kittens/rabbits/pups’ – and myriad minor behaviour problems.”

Over the years, Elizabeth learned that there’s no point in getting angry with such clients. To do so can result in the animal losing its life. She explained: “It’s all about suspending your own judgements, actively

18 | companion

EUTHANASIA

listening to the client and never losing your temper or criticising. I aim to appear understanding, empathetic, non-judgemental and accepting. During this, I sit next to them, rather than face them across a table. “When I judge that we have developed a rapport, I lean toward them, smile kindly, touch their arm and advise that the practice has a solution for such circumstances. We offer to care for the animal until we can select a suitable home.” The practice charges the same fee for rehoming as for euthanasia and cremation; this covers any necessary veterinary care and treatment until the animal is rehomed. The owner also signs a consent form transferring ownership to the practice.

Elizabeth has also learned not to query the client’s reason for an apparently unwarranted euthanasia request over the telephone. “We should also be aware that there may be more sinister motives behind euthanasia of healthy animals,” she said. “For example, people may arrange such euthanasia to get revenge against former partners. I have experience of fathers ‘getting rid’ of their teenage sons’ dogs. Companion animal euthanasia can also be a precursor to someone committing suicide.”

Elderly ownersDr McNicholas recently carried out an in-depth analysis of the situation for older pet owners moving into sheltered accommodation or care. The SCAS study looked at 234 care homes and sheltered housing units in six UK cities: only 29 per cent of which routinely allowed pets. Despite the growing body of evidence of the health and social benefits of pets to older people, the importance of pet ownership seemed to be largely ignored. Indeed, only 24 per cent of facilities actually asked potential residents whether they had a pet. Being forced to have a much-loved pet euthanased or rehomed can be a major cause of distress.

Elizabeth Ormerod has found that in many cases where pets are initially refused,

an approach from the veterinary surgeon to the housing provider or care home manager can result in a reversal of that decision – and the older person being allowed to keep their pet. Details of how to prepare a case for an older pet owner can be found at the SCAS website (www.scas.org.uk; follow the link to Pets for Life). Where this fails, alternative accommodation might be found that permits pets – the Cinnamon Trust (www.cinnamon.org.uk) keeps a register of pet-friendly accommodation, as does the Elderly Accommodation Counsel (www.eac.org.uk).

Practice protocolElizabeth and her husband Edward, a veterinary pathologist, introduced a written protocol on euthanasia for their practice. This defines the circumstances under which they will perform euthanasia. “We feel that the protocol has resulted in fewer healthy animals being presented for euthanasia and has helped to develop a greater reverence for the lives of animals in our district. It also reduces staff stress and raises the perception of the practice within the community.”

Elizabeth believes that through reflection and analysis it is possible to identify and categorise the reasons for the breakdown in the human–animal bond and to implement supportive strategies. “Many problems could be avoided with pet selection counselling by veterinary practices and animal welfare centres. We’ve all experienced that sinking feeling when we see a client mismatched with a new pet – and just know that relationship is doomed. It’s so sad, when another animal would have suited them very well.

Veterinary practices can support the bond in many ways and early intervention in pet behaviour problems is very important. Behaviour problems are a leading cause of relinquishment of animals, but by the time many owners realise there is a behaviour problem, they are at the point of

surrendering the animal. I encourage all staff to be alert for potential behaviour problems and then tactfully draw the client’s attention to these.”

Professional supportFor vets feeling the responsibility and stresses surrounding euthanasia, Elizabeth recommends training available through the PBSS. She believes that the more you know about the subject of bereavement, the more confident you will become in helping clients in distress, coping with your own feelings and making decisions. The Pet Bereavement Support Service (0800 096 6606; email pbssmail@bluecross.org.uk or go to www.bluecross.org.uk) operates 12 hours a day, seven days a week and there is no charge to the client or to the referring veterinary practice. PBSS also offers one-day workshops, or a one-year accredited distance-learning programme for those who wish to develop a deeper understanding.

For those who need support themselves, the Veterinary Benevolent Fund (www.vetlife.org.uk) supports veterinary professionals who are struggling to cope with work-related stress and other problems.

Many people believe that losing a pet is like losing a family member – and the acute sense of loss and stages of grief, can indeed be seen with pet bereavement. Dr McNicholas says, however, “Personally, I have never fully subscribed to the loss of a pet equating the loss of a human relationship, except in exceptional circumstances. It is true that some feel pet loss acutely, and the more stresses in life a person has, the more they may feel the added effect of losing a gentle companion. However, the majority of pet owners quickly go about looking for another pet, sometimes within a matter of weeks, even days. This does not devalue the relationship that an owner has had with a previous individual animal, rather it points to a desire to maintain a lifestyle. Controversial, but worth researching…” n

companion | 19

FEATURE TYPEPETSAVERS

CANINE QUALITY-OF-LIFE PROJECTIn collaboration with the Bristol RSPCA clinic, Petsavers has funded a Clinical Training Scholar at the University of Bristol in Animal Welfare, Ethics and Law. James Yeates, who qualified in 2004 from the University of Bristol, has been recruited to the position. Here James describes a research project which will evaluate a quality-of-life screening programme for use with dogs

to use their common sense, and it can allow for a more holistic style of practice.

The art of veterinary practiceMore ‘technical’ matters, such as those based on pathology and physiology, have well established and reported protocols. But other aspects are still very much part of the ‘art’ of veterinary practice. Dealing with these involves skill and wisdom that vets have gained through practical experience. Every vet has gained an appreciation of the levels and severities of these conditions and every vet has valuable ideas that they give their clients to improve their animals’ lives.

Expensive academic studies can try to quantify the levels of problems but such descriptions rarely determine how the problems can be remedied. They cannot look at what changes owners could make, what stops them making those changes, and how vets can help. Studies that do not take vets’ views into account can provide information that is useless for veterinary surgeons, because they do not address the nature of real life in practice situations. Even when the information is appropriate for use in practice, some studies erroneously treat vets as passive recipients of information, able only to receive the teachings of academics and robotically repeat them to clients.

This fails to make use of the valuable

acumen of vets, who are involved daily in a complex balancing of the thousands of different issues and factors. This gives vets an intuitive and deep understanding of the problems, which further allows them to suggest changes to improve those problems – because this is what they do in their job every day.

Petsavers projectThis Petsavers project has created an easy method for bringing together vets’ ideas on what are the important issues for canine quality of life. It will tap vets’ knowledge by asking questions and will collate the responses. This will then allow vets to share their experiences on what they think would improve these issues and what steps are needed to bring about this about.

Members will be contacted by email that will lead them to a two-page questionnaire that takes about four minutes to complete. Vets will be asked to share their opinions on issues concerning particular species and in each region. Thank you very much to those who help.

Contact Petsavers on 01452 726723 or email info@petsavers.org.uk

Written enquiries should be sent c/o BSAVA, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB. ■

Advising owners on how to improve their animals’ lives is a fundamental desire of veterinary practice. Every

day a large proportion of each vet’s time is given to advising on quality-of-life matters that impact on the animals in more ways than just affecting their health. In fact, advising on these more personal matters can be one of the main enjoyments of practice. It can strengthen the bond between vet and client, it can allow the vet

20 | companion

PUBLICATIONS

FERRETS: HABITS, HANDLING AND HEALTH CARERelated to weasels, otters, badgers and skunks, the Latin name for the domestic ferret, Mustela putorius furo, literally means ‘mouse-like stinking thief ’. Despite this obvious drawback, ferrets are increasingly popular as pets. Gidona Goodman (BSAVA Publications Committee) and Anna Meredith (co-editor of the new BSAVA Manual of Rodents and Ferrets) discuss some important aspects of their veterinary care

Domesticated from the European polecat, probably around 1800bc, ferrets were introduced to Britain

by the Romans. In addition to the common polecat or ‘fitch’ variety and the albino, many other varieties are now bred, including sable, silver, chocolate, siamese, panda and black-eyed white. Ferrets are still used for hunting rabbits in many countries, though not in the USA or Japan, where they are kept almost exclusively as pets. The UK ferret population is estimated at 250,000 to 400,000, with pet ferrets on the increase.

Ferrets have an elongated body that can turn on itself – an adaptation to hunting in tunnels or burrows. They have relatively poor eyesight compared to their senses of smell, taste, and hearing; their eyes are correspondingly small. Ferrets typically show short energetic bouts of activity, followed by deep sleep, and it is common for them to sleep for up to 18 hours a day, which may make lethargy difficult to assess.

That scent…Ferret skin is extremely tough and seasonal alopecia is common during the summer, with a thicker coat developing over winter. Sebaceous glands in the skin produce the

characteristic ferret odour and may excrete a brownish yellow substance that discolours the fur. Neutering reduces these glandular secretions and thus may decrease smell.

RestraintMost pet ferrets are easy to handle using gentle restraint around the neck and shoulders, with support of the hindquarters. It may be necessary to ‘scruff’ a fractious animal, but it is often better to encircle the neck with one hand (acting as a neck brace). The bodyweight and hindlimbs are supported with the other hand, or can be tucked under the elbow to free up that hand for clinical examination.

Take care not to bring a fractious animal close to your face: ferrets have poor eyesight and reflex reactions may result in a bite to your face or nose. Ferret bites may be deep and, once attached, the animal may be difficult to dislodge. If this occurs, place the ferret on a table and attempt to pry

open its mouth. Cold water applied to its head may encourage it to let go.

Very fractious individuals may need sedation prior to clinical examination. These animals may appear frightened and hiss or scream, indicating that they are likely to be difficult to handle.

Clinical examinationObserve the animal at a distance initially. It may be placed on the consulting room floor and be allowed to investigate its surroundings whilst a history is being taken from the owner. A healthy animal will appear alert and should be active, moving with a typical arched back posture.

Ferrets resent having their temperature ■■

taken rectally and this may prove difficult, resulting in an increased reading. An unbreakable digital plastic thermometer is best, and the ferret may be distracted by a treat.

Colour varieties: from left to right, polecat-ferret, sandy, silver mink. (Courtesy of John Chitty)

Bodyweight Male (hob) 1–2 kgFemale (jill) 500–900 g

Lifespan 5–15 years, though it is rare to see ferrets older than 10 years

Body temperature 37.8–40ºC

Resting heart rate 200–400/min

Resting respiratory rate 33–36/min

Biological data for ferrets

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PUBLICATIONS

FERRETS: HABITS, HANDLING AND HEALTH CAREHydration status should be assessed as ■■

in other mammals by skin turgidity.Dental problems are common, with ■■

similar lesions to cats (dental tartar and gingivitis).Mucous membranes should be assessed ■■

for signs of anaemia in females.Cataracts occur in both adult and ■■

juvenile animals and the eyes should always be checked on clinical examination.Ear mites (■■ Otodectes cynotis) are also common and infection is indicated by excessive brown waxy discharge.Peripheral lymph nodes should be ■■

palpated for evidence of enlargement (which may indicate lymphoma). In fat animals these may be surrounded by fat and appear falsely enlarged.The heart may be auscultated over the ■■

6th–8th ribs (more caudal than in dogs and cats). Heart rate is rapid and may be difficult to record, particularly in an excited animal. There should be minimal lung sounds.Palpation of the abdomen is aided by ■■

holding the ferret in a semi-vertical position. Splenic enlargement is commonly found in older animals and may be insignificant, although further diagnostic tests are indicated if this is found.Females should be examined for vulval ■■

swelling, which may be associated in the intact animal with oestrus and in the neutered animal with adrenal gland disease or ovarian remnant. An intact female in oestrus should be examined

Travelling with ferretsPet passports can be issued for ferrets. Up-to-date information can be found on the DEFRA website: http://www.defra.gov.uk/animalh/quarantine/pets/procedures/support-info/vetferret.htm

To enter or re-enter the UK from a listed country without quarantine a ferret must be:

1 microchipped2 vaccinated against rabies3 issued with an EU pet passport or a third country official veterinary

certificate and treated against ticks and tapeworms.

The product used for the tapeworm treatment must contain praziquantel. The product used for the tick treatment must be licensed for that use and have a marketing authorisation in the country of use. Tick collars are not acceptable.The treatment must be carried out not less than 24 hours and not more than 48 hours before the pet is checked in with the approved transport company to travel on the return journey to the UK.

New BSAVA ManualThe BSAVA Manual of Rodents and Ferrets, edited by Emma Keeble and Anna Meredith, is available from BSAVA Publications: tel. 01452 726700; fax 01452 726701; or go to www.bsava.com.

Member price: £49.00Non-member price: £75.00

Meredith, is available from

Careful examination of the teeth in an older ferret. (Courtesy of John Chitty)

for clinical signs of hyperoestrogenism, such as anaemia, and problems related to immunosuppression.The testicles in males are only palpable ■■

in the scrotum during the breeding season (December to July).Seasonal weight loss is common during ■■

summer months.

Health checks and preventive careOwners should be encouraged to have their pet ferret checked by a veterinary surgeon yearly, or twice-yearly for older animals. Common conditions to be ruled out include ear mite infections, dental disease, cardiac disease, neoplasia and splenic enlargement.

Ferrets should be vaccinated annually against distemper virus. There is no product licensed for use in ferrets in the UK, but multivalent dog vaccines are generally given at half the dog dose (seek manufacturer’s advice). This should be given initially at 12–14 weeks of age (in endemic areas this should be given at 6 weeks and the dog regime should be followed).

Flea treatments safely used in ferrets include fipronil, imidacloprid and lufenuron. These have all been given at cat doses; however frequency of dosing has been

reduced due to the greater sebum layer in ferret skin compared with dogs and cats.

There have been significant changes in neutering advice over recent years, particularly in respect of our improved understanding of the pathogenesis of adrenal gland disease and the commercial availability of GnRH analogue implants. Research has shown that neutering is associated with an increased risk of the ferret developing adrenal gland disease. Current advice for jills and hobs is detailed in the new BSAVA Manual of Rodents and Ferrets. ■

22 | companion

Improving the health of the nation’s pets

PETSAVERS

LEAVING A GIFT FOR PETSAVERS

Improving the health of the nation’s petsImproving the health of the nation’s pets

percentage of your estate to a charity.Pecuniary Bequest: You may wish to ■

leave a fixed sum of money to a charity. This is known as a pecuniary bequest.Specific Bequest: You may wish to leave ■

a specific gift to a charity, which can then be used by that charity to generate funds. This could include shares, property or an item of value.

We hope that you will consider Petsavers after you have taken care of your family. Should you need advice on the wording for certain requests, or for a codicil for an existing will, we are happy to help, but please always remember to seek legal advice when making a will to make sure that your wishes are conveyed in the correct legal manner.

Contact Petsavers on 01452 726723 or email info@petsavers.org.uk

Written enquiries should be sent c/o BSAVA, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB. ■

Since Petsavers began 35 years ago we have funded numerous studies into the treatments of diseases such as

diabetes, cancer, arthritis, heart disease and many more. Further clinical studies that have received Petsavers support include anaesthesia and critical care, internal medicine, surgery, neurology, parasitology, diagnostic imaging, ophthalmology, dermatology, pathology and genetics.

Clinical studiesIn addition to helping to fund James Yeates’s study into quality of life for dogs (see page 19), Petsavers is currently funding a number of other scholarships and training programmes, including a clinical training scholarship in anaesthesia and analgesia, a scholarship in evidence-based small animal medicine, and a clinical training programme in small animal behavioural medicine. Petsavers also funds clinical research projects into subjects including canine hepatic encephalopathy, postoperative analgesia for elbow arthroscopy, and canine immune-mediated haemolytic anaemia.

To be able to continue this vital work Petsavers relies on the generosity of

supporters and volunteers. There are many ways in which you can help, but one not often considered is leaving a gift to Petsavers in your will.

Currently over half of Petsavers funding is raised through legacies; without this vital source of income Petsavers simply would not be able to fund the amount of research or training it currently does. Writing or updating your will can often seem complicated, but it does not need to be. Your solicitor can guide you through the process and many solicitors operate a free will-writing service.

Types of bequestThere are three main types of bequest or legacy:

Residuary Bequest: You may wish to ■

leave specific sums of money or possessions to family and friends. Once those wishes have been fulfilled, the rest of your assets are known as your ‘residual estate’. You can then leave a

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WSAVA NEWS

EXECUTIVE BOARD AND FUTURE PLANNINGThe WSAVA Executive Board met

during the recent North American Veterinary Conference in Orlando,

Florida, which took place on 17–22 January 2009. Key association items discussed and prioritised during the Executive Board meetings included: strategic planning; succession planning/leadership identification; formalisation of WSAVA as an incorporated and not-for-profit association, to include the establishment of a charitable WSAVA Foundation; exploring and/or establishing an Executive Director position to assist with the day-to-day management of our ever-growing and busy association; and

more direct WSAVA/member association involvement in Congress planning and administration. Discussion papers on many of the issues will be sent for member association input prior to our Assembly meeting in São Paulo. Please take the time to review and respond in a timely manner as the future of the WSAVA depends on your involvement!

The 2008 finances were reviewed and were reflective of a very strong 2008 for the WSAVA. Busy agendas of the WSAVA committees and standardization projects were also reviewed, including meetings with the Animal Welfare Committee, the Financial Advisory Committee, and

NEWS FROM AROUND THE WORLDLabrador Retriever holds top spot on list of most popular dogs in USAFor the 18th consecutive year, the Labrador Retriever is the most popular purebred dog in the United States, according to 2008 registration statistics released by the American Kennel Club (AKC). In 2008 more than twice as many Labradors were registered than any other breed, making it a likely leader for many years to come. The Bulldog, which made news the previous year by returning to the AKC’s Top 10 for the first time in more than 70 years, continues to amble its way up the list, jumping up 6 per cent into eighth place. ■

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members of the Standardization Projects. In addition, the EB had a team-building exercise, generously sponsored by our Prime Congress Partner, Hill’s Pet Nutrition. The Board also provided opening remarks at the WSAVA Animal Welfare Symposium, which was included as part of the TNAVC scientific programme, and took the opportunity to catch up with many colleagues from around the globe, including many WSAVA member association representatives.

Thank you to the wonderful hospitality of Dr Colin Burrows and the tremendous TNAVC organization team! ■

2008 Most Popular Dogs in the USA1. Labrador Retriever2. Yorkshire Terrier3. German Shepherd Dog4. Golden Retriever5. Beagle6. Boxer7. Dachshund8. Bulldog9. Poodle10. Shih Tzu

24 | companion

WSAVA NEWS

WSAVA NEWSWSAVA NEWS

The scientific programme is set and features over 80 world-renowned veterinary lecturers covering over

30 disciplines in 9 simultaneous session streams, including 7 State-of-the-Art Lectures (SOTALs), a WSAVA Animal Welfare stream, and a North American Veterinary Conference stream. This will not only be complemented by the vibrancy of São Paulo itself, but also by a lively social programme.

Opening ceremoniesPresented in English, the opening ceremonies will take place on Tuesday 21 July 2009 in the Alpha Theater. A lively dance show will feature many cultural dances of Brazil, including frevo and samba.

Also included will be greetings from various dignitaries, as well as the presentation of the WSAVA awards. This will be followed by a cocktail and the opportunity to mingle with your colleagues.

Gala DinnerThe Gala Dinner will be held on Wednesday 22 July 2009 at the Hyatt Hotel, with live entertainment featuring Brazilian music.

Brazilian PartyScheduled to take place on Thursday 23 July 2009 at HSBC space (www.hsbcbrasil.com.br) this will be an evening of immersion in Brazilian culture.

Closing ceremoniesThe closing ceremonies will take place on Friday 24 July 2009 at the Transamerican SP Congress hotel and will feature a presentation highlighting the 2010 WSAVA Congress to be held in Geneva, Switzerland.

RegistrationDon’t delay – register today! Do you need a VISA to enter Brazil? Visit the WSAVA 2009 São Paulo World Congress website at www.wsava2009.com ■

WSAVA WORLD CONGRESSSÃO PAULO, 2009

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WSAVA NEWS

CONTINUING EDUCATIONIranThe 5th WSAVA CE meeting was held in Hamedi Hall, at the veterinary faculty of the University of Tehran, Iran on 21 November 2008, reports associate professor Dr Seyed Javid Aldavood. More than 500 delegates attended the lectures, mostly undergraduate and postgraduate students. The lectures were also provided online and a number of veterinarians from throughout Iran ‘attended’ in this way. Mr Ray Butcher gave four lectures on veterinary practice management, followed by an interactive question and answer session. The lectures given were:

An introduction to assessing ■

performance and business planningThe team concept ■

Image and communicating with the ■

clientPromoting your clinic. ■

Sri LankaDr Niranjala de Silva reports on a very successful and invaluable training programme from 5–15 January at Peradeniya, Sri Lanka. Each day, Dr Graeme Allan spent 2 hours teaching veterinary imaging to the students, delivering an entire semester’s programme during his stay, as well as providing ultrasound guidance on clinical cases. On 13 January there was a practitioners training day with integrated imaging lectures and a live ultrasonography demonstration. The participants were very happy as they

Dr Graeme Allan lectures a class on ultrasonographic technique during his teaching time in Sri Lanka

benefited a lot and all hoped that Dr Allan would come back to teach again. Dr Allan, who also toured the elephant orphanage during his stay, said that he “would love to return one day to build on what I left behind, as well as to help them develop their practical imaging a bit further. I’d also like to help the elephant orphanage vets start using their elephant radiology facility.”

CubaDr Jesús Moreno Lazo, President of the Asociación Consejo Cientifico Veterinario de Cuba, reports on WSAVA-sponsored CE

on veterinary dermatology given by Dr Babette in October and November 2008 in Piñar del Rio City and in Havana. Registration was 500 delegates and the lectures were rated as excellent by the Cuban Small Animal Association’s Arbitration Committee, based on their high scientific content and masterful delivery. Despite the devastating hurricane in Piñar del Rio, which affected many of our members, there was tremendous attendance, even including associate members who lost their houses. This shows WSAVA members the great prestige that WSAVA has among our members as well as the level of cooperation between our two associations. The Scientific Veterinary Council of Cuba deeply appreciates the support of WSAVA to our association, which was recognized publicly in a rally commemorating the 100 years of the Veterinary Association in Cuba, awarding WSAVA the acknowledgment of Distinguished Guest. ■

26 | companion

companion INTERVIEW

Vic Simpson was born in Kings Heath, Birmingham during World War II and grew up in Warwickshire, initially at Water Orton and later at Kingsbury where his father was head teacher. Vic is married with two children and has three grandchildren. He was educated at Coleshill Grammar School, gained his veterinary qualification from Bristol, and later a Diploma in veterinary tropical medicine at Edinburgh. Vic has now earned a reputation as a veterinary pathologist with a passionate interest in the diseases of wildlife species, and is a contributor to the BSAVA Manual of Wildlife Casualties.

THEcompanionINTERVIEW

You have become known within the profession through your work investigating wildlife diseases – how did you first become involved in that area?

In 1973, whilst working at Sutton Bonington Veterinary Investigation Centre (now VLA) near Nottingham, I started an investigation into mute swan deaths at Trent Bridge and discovered that they were dying from lead poisoning due to ingestion of anglers’ weights. This eventually led to legislation banning the use of lead fishing weights.

Did you spend any time in practice earlier in your career?

Yes, I was an assistant with J Donald and partners, a mixed practice in Warwickshire, for four years. I also did some private practice alongside my government work as a District Veterinary Office in Kenya.

What do you consider to be your most important achievement during your career?

My initial reaction is to say it is the longterm study I have made on otters. However, on reflection the most important achievement has been simply to succeed in carrying out – and promoting – the study of wildlife diseases in the UK. This did not endear me to my management in MAFF (Defra)!

What has been your main interest outside work?

Wildlife photography, especially when I was living in Africa. I also enjoy travelling to areas of natural beauty.

Who has been the most inspiring influence on your professional career?

The late Gordon Scott, lecturer at the Centre for Tropical Veterinary Medicine, Edinburgh. He instilled in me the need to ‘observe & record, observe & record, observe & record…’

What is the most significant lesson you have learned so far in life?

Have confidence in your own judgement – too often in my younger days I was persuaded that an idea I had was wrong or unimportant, only then to see others claim it as theirs!

If you were given unlimited political power, what would you do with it?

Don’t tempt me! Seriously though, humans are wrecking the world and the single biggest problem is that our populations are expanding in a totally irresponsible way. I would want to enforce birth control worldwide.

If you could change one thing about your appearance or personality, what would it be?

I sometimes wish I was not so argumentative – but what the hell!

What is your most important possession?

My wildlife files and photographs.

What would you have done if you hadn’t been a vet?

As a boy I was a keen taxidermist – I had built up quite a collection by the age of 15 – but my father pointed out that I was unlikely to make a living doing that and I realized he was right.

How do you see the future for veterinarians who wish to work with wildlife?

There has been a remarkable change in attitude in the last few years. It is now realized that veterinarians have a major – probably THE major – role to play in identifying emerging diseases, whether affecting livestock, humans or wildlife. Job opportunities for wildlife veterinarians are still limited but at least one is no longer regarded as a bit of a crank! n

CPD DIARY

companion | 27

CPDDIARY

20 MayWednesday

Imported disease: diseases to watch out for in travelling petsSpeaker Susan ShawRussell Hotel, Maidstone. Kent Region.Details from Hannah Perrin, hannah@burnhamhousevets.com

EVENINGMEEtING

21 MayThursday

Reading abdominal x-raysSpeakers Nic Hayward and Esther BarrettPark Inn Hotel, Llanederyn, Cardiff. South Wales Region.Details from the Chairman or Secretary, southwalesregion@bsava.com

EVENINGMEEtING

28 MayThursday

Endocrinology IISpeaker Mike HerrtageThorpe Park Hotel & Spa, Leeds. Organised by BSAVA.Details from the Membership and Customer Service Team, 01452 726700, administration@bsava.com

DAYMEEtING

18 MayMonday

BSAVA Cardiology RoadshowSpeakers Rebecca Stepien and Virginia Luis Fuentes. Canalside, Bridgwater, South West Region. Organised by BSAVA.Details from the Membership and Customer Service Team, 01452 726700, administration@bsava.com

DAYMEEtING

30 AprilThursday

Cardiovascular medicineSpeaker Jo Dukes McEwanThorpe Park Hotel & Spa, Leeds. Organised by BSAVA.Details from the Membership and Customer Service Team, 01452 726700, administration@bsava.com

DAYMEEtING

29 AprilWednesday

Reconstructive surgery: from simple closures for beginners to advanced microvascular techniques for the specialistsSpeaker Gary LewinIDEXX Laboratories, Wetherby. North East Region.Details from Karen Goff, 01924 275249, northeastregion@bsava.com

EVENINGMEEtING

TBC May

Neurology: spinal disease in dogs and catsSpeaker to be confirmedLeatherhead Golf Club, Surrey. Surrey and Sussex Region.Details from Jo Arthur, 01243 841111, joarthur85@btinternet.com, or Jackie Casey, 01483 797707, Jackie.casey@greendale.co.uk

EVENINGMEEtING TBC June

Rabbit anaesthesia and surgerySpeaker to be confirmedHoliday Inn, Gatwick. Surrey and Sussex Region.Details from Jo Arthur, 01243 841111, joarthur85@btinternet.com, or Jackie Casey, 01483 797707, Jackie.casey@greendale.co.uk

DAYMEEtING

13 MayWednesday

Ocular manifestations of systemic diseaseSpeaker David WilliamsPotters Heron Hotel, Romsey. Southern Region.Details from Michelle Stead, 01722 321185, mmstead@btinternet.com

EVENINGMEEtING

17 MaySunday

Is it respiratory or cardiac disease? Case-based approachSpeaker Clive ElwoodCambridge Belfry, Cambourne. East Anglia Region.Details from Graham Bilbrough, graham-bilbrough@idexx.com

DAYMEEtING

19 MayTuesday

Endocrinology ISpeaker Ian RamseyBSAVA, Woodrow House, Quedgeley. Organised by BSAVA.Details from the Membership and Customer Service Team, 01452 726700, administration@bsava.com

DAYMEEtING

8–10 MayFriday–Sunday

24th Annual Scottish Congress‘Raising the bar’ in SA practice, for veterinary surgeons & nursesSpeakers Andrew Mackin and Ronan DoyleFairmont Hotel, St Andrews. Scottish RegionDetails from Susan Macaldowie, 07711 633698, smacaldowie@btinternet.com

WEEKEND

21 AprilTuesday

Infectious diseasesSpeaker Susan DawsonBSAVA, Woodrow House, Quedgeley. Organised by BSAVA.Details from the Membership and Customer Service Team, 01452 726700, administration@bsava.com

DAYMEEtING

20 MayWednesday

BSAVA Cardiology RoadshowSpeakers Rebecca Stepien and Mike MartinDay meeting at the Daventry Hotel, Beaconsfield. Midland Region. Organised by BSAVA.Details from the Membership and Customer Service Team, 01452 726700, administration@bsava.com

22 MayFriday

BSAVA Cardiology RoadshowSpeakers Rebecca Stepien and Virginia Luis FuentesDay meeting at the Bellhouse, Beaconsfield. Metropolitan Region. Organised by BSAVA.Details from the Membership and Customer Service Team, 01452 726700, administration@bsava.com

14 MayThursday

BSAVA Cardiology RoadshowSpeakers Rebecca Stepien and Mike MartinDay meeting at the Radisson SAS Hotel, Belfast, Northern Irish Region. Organised by BSAVA.Details from the Membership and Customer Service Team, 01452 726700, administration@bsava.com

Wound worries?

British Small Animal Veterinary AssociationWoodrow House, 1 Telford Way,

Waterwells Business Park, Quedgeley, Gloucester GL2 2AB

Tel: 01452 726700 Fax: 01452 726701Email: administration@bsava.com

Web: www.bsava.com

Non-member price: £70

Member price: £49

For further information, please contact the Membership and

Customer Service Team.

■ Should I close this wound?

■ How do I promote healing?

■ How do I use a fl ap to cover this defect?

■ How can I maximise the chance of ‘take’ in my skin graft?

■ How do I keep MRSA at bay?

■ What can go wrong?

These and many more questions are addressed in this important new edition