cascade P7 NEW Veterinary Information Network discussion P18 Happiness and work-life balance P4 companion AUGUST 2008 Haemorrhagic vomiting Test your diagnostic skills companion 2 | companion CONTENTS 3 Latest News Hydatid Disease, Practice Standards, Montenegro guests 46 Dont Worry, Be Happy Pete Wedderburn reviews NI Congress success 79 Coping with the Cascade John Bonner on prescribing new medicines 1013 Clinical Conundrum A collapsed dog with profound haemorrhagic vomiting 1417 How To Navigate the Pet Travel Scheme 1819 Letters from America New feature selected discussions from the Veterinary Information Network 20 Petsavers Fundraising news 21 Getting Tough on Seizures Simon Platt looks at the treatment options 2225 WSAVA News World Small Animal Veterinary Association 26 The companion Interview Victoria Roberts 27 CPD Diary Whats 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. KNOWLEDGE BANK Additional stock photography Dreamstime.com Alexandr Sysoev | Dreamstime.com Amy Harris | Dreamstime.com Bruce Parrott | Dreamstime.com Ina Van Hateren | Dreamstime.com Lyn Baxter | Dreamstime.com Martin Murnsky | Dreamstime.com Orlando Florin Rosu | Dreamstime.com Raja Rc | Dreamstime.com Sgame | Dreamstime.com Stuart Monk | Dreamstime.com Vicente Barcelo Varona | Dreamstime.com H ow does BSAVA contribute to your personal professional development? As well as companion as a BSAVA member you also get a complimentary subscription to the Journal of Small Animal Practice (JSAP) and one free copy of each new edition of the BSAVA Small Animal Formulary plus the opportunity to build your library of BSAVA Manuals at significant discounts. August sees the release of the new Manual of Raptors, Pigeons and Passerine Birds, which promises to be a valuable addition to the series. Edited by John Chitty and Michael Lierz, with contributions from some of the most prominent experts on the subject, the manual will be available from the end of this month. Other new titles planned for the coming year include: Manual of Canine and Feline Advanced Veterinary Nursing, 2nd edition Manual of Canine and Feline Wound Management and Reconstruction, 2nd edition Manual of Rodents and Ferrets Manual of Canine and Feline Abdominal Imaging As these are released they can be purchased online at www.bsava.com or you can of course find all the latest releases when you visit the Publications stand at Congress. In April the Publications stand will have a brand new home offering an even more comprehensive service on the balcony in the NIA. For more information visit the website, email customerservices@bsava.com or call 01452 726700. companion | 3 LATEST NEWS COMMENT ON STANDARDS B SAVA would like to invite members to comment on updating the RCVS Practice Standards scheme. Pam Mosedale sits on the BSAVA Membership Development Committee. She is actively involved in the scheme as an RCVS Practice Standards Inspector. In addition Pam is leading the BSAVA initiative to produce more online tools for members in practice the latest resource is a sample Clinical Governance Policy, which can be adapted specifically for your practice. Find this online in the Resource section at www.bsava.com. Pam would like to hear your comments both on the Practice Standards scheme and the clinical governance policy document. Email companion@bsava.com n MONTENEGRO BENEFITS AT BSAVA s part of BSAVAs commitment to support small animal veterinary associations in developing countries, BSAVAs International Affairs Members of the Montenegrin delegation with BSAVA president Frances Barr at BSAVA Congress 2008. From left: Nebojsa Scekic, Frances Barr (BSAVA President 20072008), Wolfgang Dohne (International Affairs Committee Member and organiser of the Visit Programme), Dusanka Kazic and Savo Nikovic Committee arranged for a small group of surgeons from Montenegro to be guests of honour at this years BSAVA Congress. The majority of veterinary surgeons practicing in Montenegro are graduates from Belgrade and, although now an independent state, Montenegro is still very closely connected with neighbouring Serbia, which meant that delegates had to travel to Belgrade for their UK visas. As there is currently not enough demand for small animal medicine in Montenegro to support 100% small animal practices, all the invited vets were working in mixed practice. However with increasing economic wealth they were beginning to see an increasing demand for small animal work. Only very few clinics are currently using gaseous anaesthesia and with the average cost for a bitch spay at 50, expenses still have to be kept to a minimum. There is no established pet insurance scheme in Montenegro and dogs are by far the main small animal species treated. Montenegrin delegates were amused to learn that a year old tortoise can cost well over 100 in the UK, considering that the same animals are a fairly common sight in their own gardens. The guests from Montenegro took full advantage of the BSAVA Congress Scientific and Social programme, and were delighted to have a meeting with then President Frances Barr. n HYDATID DISEASE CAMPAIGN been known as a hot-spot for the disease, regular supervised worming of farm dogs is taking place and those dogs are then being monitored. During the campaign all farms in the area will be given the opportunity to participate in the scheme and those involved will be visited four times during the year. Rural Affairs Minister Elin Jones said, Hydatid disease can be dangerous to humans and it can be avoided by the simple procedure of regular worming of dogs. More information and a poster can be found online at www.wales.gov.uk/ animaldiseases. n T he regular worming of dogs is the best protection against Hydatid Disease, which can affect both dogs and people, so the Welsh Assembly Government is funding a campaign for control of Echinococcus granulosus. In South Powys, which has previously A 4 | companion CPD Pete Wedderburn reports on the happiness programme at the BSAVA/SPVS/BVNA weekend in Northern Ireland in May mountain biking, a climbing wall, and the usual conference-related social events. By the end of the weekend there was no excuse to return to work feeling stressed, and delegates were well briefed on techniques such as deep breathing, direct talking and anger management. Awareness Most vets are now acutely aware of the professions increased risk of succumbing to drug/alcohol abuse and mental health issues. Yet, despite this wider awareness, the general public still sees vets as cosy, companionable, relaxed James Herriot types. Ironically, Alf Wight, the author of the James Herriot books, suffered from severe depression himself in the early 1960s, before writing his books. Self-awareness of the problem within the profession is just the first stage in dealing with this major issue. Over the next decade, much work still needs to be done in addressing and publicising an issue that remains, at some level, a subject of social taboo. Suicide is clearly the worst of all stress-related events. The rate of suicide among vets is three to four times higher than the national average, higher than for any other profession or sector of population. The problem of the high suicide rate amongst veterinary surgeons was first publicly highlighted when an article was published in the British Medical Journal in 1983. A number of publications confirming the statistics followed. Work published in the Australian Veterinary Journal showed a similar high incidence of suicide, suggesting that the trend may be a global problem in the profession. In 2005 Richard Mellanby, a specialist in small animal internal medicine now at Edinburgh University, published an update in the Veterinary Record on these earlier statistics on veterinary suicide. Studying the causes There is still much debate about the reasons for the high suicide rate. Intuitively, onlookers suspect that the biggest contributory factor is vets access to lethal drugs, and knowledge about the practical procedure of euthanasia. Most suicides among vets, both males and females, are by drug overdose and markedly more vets use this method than other sectors of the population. The veterinary profession has reacted proactively to reports of stress-related O ver the past twenty years, the problem of stress-related crises in the veterinary profession has repeatedly been highlighted in the veterinary media and the profession has been finding ways of addressing the mental health issue. The Society of Practising Veterinary Surgeons recently organised an innovative programme at the joint conference with the Northern Ireland branches of BSAVA and BVNA. The theme of the weekend was Happiness and WorkLife Balance, with lecturers drawn from research psychologists, life coaches and television comedians. As well as lectures, delegates took advantage of DONT WORRY, BE HAPPY John Hill, President of SPVS with partner Susie Turner companion | 5 CPD problems, including suicide. The RCVS has chaired various working parties that have looked into the problem. More recently, it has been recognised that if appropriate preventive action is to be taken, more specific research is needed into the precise nature of the issue. David Bartram, a 1988 graduate of the RVC, is currently working on this subject. David has been working with research psychiatrists at Southampton University, and has been designing and analysing a questionnaire that has enabled a thorough, objective assessment of the problem. In late 2007, he sent out the questionnaire to a stratified random sample that represented 20% of the practising profession, including all who were using their MRCVS in any form. In total, 3200 out of 16,000 vets were contacted. Around 1800 questionnaires were returned, representing a response rate of 56%. It is unusual to achieve higher than a 40% response rate to postal questionnaires, and David feels that this high return rate may reflect the fact that vets feel that the stress problem is highly relevant to their daily lives. The research provides very comprehensive coverage of the profession, from new and recent graduates through to vets approaching retirement, and from vets in all types of work from different types of practice through to industry, government and academia. The parameters measured are compared with those for the general population and for other related professions. David says, The questionnaire was designed to adopt a holistic approach, looking at positive aspects of veterinary careers (so-called satisfiers) as well as the stressors. Previous research has demonstrated that doctors believe that the feel good bits of their job mean that they are able to deal with more stress than they would otherwise be able to do. This same principle may apply to vets. Davids results are currently being collated and he hopes that they will be ready for publication in 2009. Additional work is being carried out by Richard Mellanby, who is undertaking a study with Professor Keith Hawton, head of the Centre for Suicide Research at the University of Oxford. Their research aims to explore further the circumstances immediately preceding veterinary suicides, through examination of coroners reports and interviews with friends and family of the deceased. A further questionnaire- based survey of the mental health status of the profession is also planned, funded by the Veterinary Benevolent Fund, RCVS and Hills Pet Nutrition. It is hoped that the culmination of the various ongoing research projects will allow objective, evidence-based recommendations to be made as to how vets should try to address the alarming incidence of suicide. The profession will then be in a much stronger position to identify subgroups of the population at risk, as well as specific stressors that predict poor health. Todays support Even without the benefit of detailed research into the background to the problem, a number of initiatives have been set up in an attempt to deal with the stress affecting veterinary surgeons. Several years ago, the Veterinary Benevolent Fund, with a core aim of supporting vets in financial difficulties, merged with the two other organisations that were providing support to the profession: 1) The Veterinary Surgeons Health Support Programme (VSHSP) was established by the veterinary profession in March 1999 to help combat problems of alcohol, drugs, eating disorders and other addictive and mental health issues. The programme was based on similar schemes that had been available to members of the dental and pharmaceutical professions. The last independent clinical audit described the VSHSP as highly efficient and effective. The scheme is completely confidential and is run by a National Coordinator who is a health professional. VSHSP treatment DONT WORRY, BE HAPPY An older delegate helping a younger participant on the climbing wall 4 | companion CPD Pete Wedderburn reports on the happiness programme at the BSAVA/SPVS/BVNA weekend in Northern Ireland in May mountain biking, a climbing wall, and the usual conference-related social events. By the end of the weekend there was no excuse to return to work feeling stressed, and delegates were well briefed on techniques such as deep breathing, direct talking and anger management. Awareness Most vets are now acutely aware of the professions increased risk of succumbing to drug/alcohol abuse and mental health issues. Yet, despite this wider awareness, the general public still sees vets as cosy, companionable, relaxed James Herriot types. Ironically, Alf Wight, the author of the James Herriot books, suffered from severe depression himself in the early 1960s, before writing his books. Self-awareness of the problem within the profession is just the first stage in dealing with this major issue. Over the next decade, much work still needs to be done in addressing and publicising an issue that remains, at some level, a subject of social taboo. Suicide is clearly the worst of all stress-related events. The rate of suicide among vets is three to four times higher than the national average, higher than for any other profession or sector of population. The problem of the high suicide rate amongst veterinary surgeons was first publicly highlighted when an article was published in the British Medical Journal in 1983. A number of publications confirming the statistics followed. Work published in the Australian Veterinary Journal showed a similar high incidence of suicide, suggesting that the trend may be a global problem in the profession. In 2005 Richard Mellanby, a specialist in small animal internal medicine now at Edinburgh University, published an update in the Veterinary Record on these earlier statistics on veterinary suicide. Studying the causes There is still much debate about the reasons for the high suicide rate. Intuitively, onlookers suspect that the biggest contributory factor is vets access to lethal drugs, and knowledge about the practical procedure of euthanasia. Most suicides among vets, both males and females, are by drug overdose and markedly more vets use this method than other sectors of the population. The veterinary profession has reacted proactively to reports of stress-related O ver the past twenty years, the problem of stress-related crises in the veterinary profession has repeatedly been highlighted in the veterinary media and the profession has been finding ways of addressing the mental health issue. The Society of Practising Veterinary Surgeons recently organised an innovative programme at the joint conference with the Northern Ireland branches of BSAVA and BVNA. The theme of the weekend was Happiness and WorkLife Balance, with lecturers drawn from research psychologists, life coaches and television comedians. As well as lectures, delegates took advantage of DONT WORRY, BE HAPPY John Hill, President of SPVS with partner Susie Turner companion | 5 CPD problems, including suicide. The RCVS has chaired various working parties that have looked into the problem. More recently, it has been recognised that if appropriate preventive action is to be taken, more specific research is needed into the precise nature of the issue. David Bartram, a 1988 graduate of the RVC, is currently working on this subject. David has been working with research psychiatrists at Southampton University, and has been designing and analysing a questionnaire that has enabled a thorough, objective assessment of the problem. In late 2007, he sent out the questionnaire to a stratified random sample that represented 20% of the practising profession, including all who were using their MRCVS in any form. In total, 3200 out of 16,000 vets were contacted. Around 1800 questionnaires were returned, representing a response rate of 56%. It is unusual to achieve higher than a 40% response rate to postal questionnaires, and David feels that this high return rate may reflect the fact that vets feel that the stress problem is highly relevant to their daily lives. The research provides very comprehensive coverage of the profession, from new and recent graduates through to vets approaching retirement, and from vets in all types of work from different types of practice through to industry, government and academia. The parameters measured are compared with those for the general population and for other related professions. David says, The questionnaire was designed to adopt a holistic approach, looking at positive aspects of veterinary careers (so-called satisfiers) as well as the stressors. Previous research has demonstrated that doctors believe that the feel good bits of their job mean that they are able to deal with more stress than they would otherwise be able to do. This same principle may apply to vets. Davids results are currently being collated and he hopes that they will be ready for publication in 2009. Additional work is being carried out by Richard Mellanby, who is undertaking a study with Professor Keith Hawton, head of the Centre for Suicide Research at the University of Oxford. Their research aims to explore further the circumstances immediately preceding veterinary suicides, through examination of coroners reports and interviews with friends and family of the deceased. A further questionnaire- based survey of the mental health status of the profession is also planned, funded by the Veterinary Benevolent Fund, RCVS and Hills Pet Nutrition. It is hoped that the culmination of the various ongoing research projects will allow objective, evidence-based recommendations to be made as to how vets should try to address the alarming incidence of suicide. The profession will then be in a much stronger position to identify subgroups of the population at risk, as well as specific stressors that predict poor health. Todays support Even without the benefit of detailed research into the background to the problem, a number of initiatives have been set up in an attempt to deal with the stress affecting veterinary surgeons. Several years ago, the Veterinary Benevolent Fund, with a core aim of supporting vets in financial difficulties, merged with the two other organisations that were providing support to the profession: 1) The Veterinary Surgeons Health Support Programme (VSHSP) was established by the veterinary profession in March 1999 to help combat problems of alcohol, drugs, eating disorders and other addictive and mental health issues. The programme was based on similar schemes that had been available to members of the dental and pharmaceutical professions. The last independent clinical audit described the VSHSP as highly efficient and effective. The scheme is completely confidential and is run by a National Coordinator who is a health professional. VSHSP treatment DONT WORRY, BE HAPPY An older delegate helping a younger participant on the climbing wall 6 | companion CPD programmes vary but are designed to suit an individuals addictive state. Often people with a problem of addiction dont recognise that they have an issue, or delude themselves that they can handle it. Family, friends and colleagues are often the first to realise that someone needs help, and they are encouraged to contact the VSHSP. The VSHSP is autonomous and totally confidential both for those needing help and for those seeking help for others. It is recognised that the path to recovery offered by the professions own Health Support Programme is not the only one available to a veterinary surgeon but it is hoped that those seeking help or advice will make use of this freely available, confidential service by contacting the VSHSP Programme Coordinator on 07946 634220. 2) The Vet Helpline There are currently twenty-five anonymous and unpaid volunteer helpers that run this 24-hour service. They are largely veterinary surgeons or their spouses and offer empathetic discussion of emotional, addictive or financial problems, referring callers on for specialist advice where appropriate. Tel: 07659 811118 (local call rates apply; 24-hour rapid response answer phone). The Veterinary Support Working Party, whose chairman is Dr Wendy Harrison, is a group which was formed with representatives from all the main veterinary organisations in response to concern over the high rate of suicide and depression within the veterinary profession. A new website, www.vetlife.org.uk, was launched in October 2007. The website aims to provide information about the support available to veterinary students, veterinary nurses and veterinary surgeons on a wide range of issues from both the established veterinary care organisations and from outside the profession. The veterinary profession has learned much about the fact that it has a stress problem in the past twenty years. It seems that now, at last, we may be on the way to learning how to deal effectively with our problem. DONT WORRY, BE HAPPY Delegates about to head out mountain biking B eautiful weather and a spectacular location dominated by the mountains of Mourne provided the backdrop for a conference combining excellent clinical lectures with a programme on Happiness and WorkLife Balance. Learning how to manage stress was the main SPVS theme at this years combined SPVS, BSAVANI and BVNANI Congress 2008, which took place over three days in late May at the beautiful Slieve Donard Resort and Spa in Newcastle, Co. Down. The happiness lectures, delivered by Joe Griffen, Des Rice and Nuala McKeever, included a series of thought-provoking seminars on how to cope with life as a modern practitioner. As well as coaching delegates on how to manage workloads and how to ensure that we all have adequate amounts of rest and exercise, therapies such as Emotional Freedom Therapy (EFT) and Neurolinguistic Programming (NLP) were explored. BSAVANI supplemented this with excellent lectures on dermatology by Steve Shaw, ophthalmology by Pip Boydell, and alternative therapies from the BVNA. These were lively and informative and included plenty of practical information for vets and nurses to implement when they returned refreshed to their own practices. The closing Keynote Lecture included warmth, wit and wisdom on lessons learnt in practice in the Dales from Jim Wight, who shares the same gift of story telling as his father Alf (James Herriot). The Northern Ireland BSAVA weekend is traditionally a family affair, HAPPY DELEGATES AT NI CONGRESS with a vibrant social programme for all ages, and a superb crche to ensure that vets, nurses and spouses can enjoy lectures and some quality chill-out time, safe in the knowledge that the kids are having fun too. John Hill, the immediate Past-President of SPVS and an Ulsterman, merged the successful SPVS Annual Conference format with the regular Northern Ireland weekend, and it was hard to find a less-than-smiley face anywhere, as delegates from far and wide mingled enthusiastically over salsa dancing, photography, laser clay target shooting, climbing walls, mountain biking, and a spectacular Gala Dinner. Both John Hill and Shane Murray (BSAVA NI Chairman) were grateful for the tremendous support from industry, which ensured a top-class weekend. Over 160 delegates were able to linger over stands representing 40 companies and charities in the beautiful Chandelier Suite overlooking Murlough Bay and the mountains beyond. Overall, the conference demonstrated that when you get the balance right, work and play can be successfully combined, resulting in very contented vets. Jim Wight, son of Alf Wight, with John Hill, President of SPVS companion | 7 COPING WITH THE CASCADE The rapid progress being made by the animal health industry in developing new medicinal products can cause problems for veterinary practitioners. John Bonner reports M any of the drugs in the veterinary armamentarium were originally developed for human use and many have never been specifically tested in domestic animal species. However, increasing numbers of medicines have been launched in recent years for use in companion animals after a rigorous examination of their safety, efficacy and quality. Whilst that makes life easier for us, it also creates difficulties, notably when a licensed veterinary drug arrives to replace a product previously borrowed from the human pharmacy. As the new product will have been through a costly registration process, it will inevitably be considerably more expensive. Seeking advice This issue was highlighted by a letter to the Veterinary Record from Oxfordshire practitioner Martin Whitehead (VR May 3, p599). He complained about being forced to use the veterinary licensed drug Prilactone (CEVA Animal Health) to treat canine heart failure. This replaced use of a human generic drug spironolactone, which he had been using successfully for many years, and which he insists is equivalent in safety and efficacy to the licensed product. In short, I use Prilactone because the law demands it, not because I have been provided with any evidence or reason to think that the change will make a significant difference to my patients, he explained. Dr Whitehead asked for advice from the regulator on whether he would be obliged to switch to the licensed product when treating patients whose condition was stabilised under the generic drug. Steve Dean, chief executive of the Veterinary Medicines Directorate, said his organisation does take account of a veterinary surgeons clinical judgement and would not oblige him or her to interrupt successful treatment but any new patients would be expected to be treated with the licensed drug. VMD position However, in an article published in Veterinary Times earlier this year (VT February 25, p16), Mr Dean reminded veterinary surgeons of their responsibilities under the cascade. He insisted that the changes introduced with the Veterinary Medicines Regulations 2005 were partly a response to the lax way that practitioners had interpreted the requirements of the cascade... to the extent that human- authorised products were used routinely, despite the availability of suitable authorised veterinary products. Where the only consideration applied is the cost of the medication, and particularly where no clinical judgement is applied, the cascade derogation does not, and has never, permitted this. Mr Dean went on to warn practitioners against assuming that the biological activity of a human generic product will necessarily be equivalent to that of the licensed veterinary drug. That assumption cannot be reached unless the appropriate studies are carried out and there are many additional reasons why it would be preferable to use the licensed formulation, such as a lack of technical support from the manufacturer of the human product, he said. Industry view Juliet Penaliggon, small animal marketing manager for CEVA, points out that the safety and efficacy studies carried out in dogs to obtain a licence for Prilactone have generated new information that had not emerged during human tests. They showed, for example, that in the canine gut the drug is absorbed more effectively when given with food. DISPENSING 8 | companion DISPENSING Support from veterinary practice in using the licensed product is essential if the company is to generate the income needed for further studies on the drug. Currently, Prilactone is only licensed for the treatment of heart failure due to mitral valve disease but the company is now carrying out work to obtain a data sheet indication for the treatment of the other main canine heart condition, dilated cardiomyopathy, she added. Meanwhile, Phil McGuire, regulatory affairs manager with the company, suggests that with a veterinary licensed product now available, more dogs are likely to be given an effective treatment for their congestive heart failure. He believes that practitioners like Dr Whitehead are in a minority in the UK profession. CEVA have carried out independent research into the dosages and contraindications of the human drug, but most vets would prefer to wait until there is a data sheet available, rather than taking the risks of using a product off-label. Client concerns Dr Whiteheads concern is for the welfare of his own clients animals. He points out that the licensed drug is only used in combination with a number of other drugs, all of which have to be paid for by the client. Clearly, the cost of using the licensed product depends on the size of the dog and the dosage needed but in a 30 kg animal he calculates that a client would pay another 20 a month on an already considerable drugs bill. John Foster, chairman of the BVA medicines group, warns that owners of dogs with mitral valve disease are not the only ones that may have to face some difficult decisions about the future of their pets. Although there is an increasing array of products available to treat chronic disease in companion animals, some patients will be unable to benefit. New licensed products for conditions such as epilepsy will cost owners many times more than the old generic product. It is very difficult for practitioners to square the circle, simply because a lot of pet owners dont have much money, he notes. There are, of course, other ways of financing the cost of veterinary treatment. Some owners may be eligible for help from one of the animal welfare charities and others may have been prudent enough to take out a pet insurance policy. But as Mr Foster who also acts as a veterinary advisor to the pet insurance industry points out, the expense of long-term treatment for chronic disease is one of the factors driving up the cost of pet insurance premiums. So owners may find it increasingly difficult to obtain policies with appropriate cover. Cascades purpose The cascade system was designed to protect the public, and particularly consumers of animal-derived products, by ensuring that all veterinary medicines are used responsibly. It was seen as providing a rational balance between the legislative requirement for veterinary surgeons to prescribe and use authorised veterinary medicines where they are available, and the need for professional freedom to prescribe other products where they are not. It was also intended to guarantee that a range of medicines is available for use by veterinary surgeons by ensuring that the companies who invest in research are rewarded appropriately for their efforts. On that basis, the system has been largely successful, and representatives of the profession meet regularly with officials from the VMD to sort out any problems as they arise. However, no system is perfect and practitioners are likely to face increasing tensions between their responsibilities under the legislation and their duties towards their clients and their animals. As Mr Dean explained in his article, the VMD feels that on too many occasions in the past practitioners have erred in favour of their clients. So it has now withdrawn its former guidance that the use of human generics might be acceptable in the exceptional circumstances where an animals health and welfare could be compromised because the owner lacked funds. He said this was necessary because of the way practitioners had interpreted the advice in a way that was not within the spirit of the legislation or guidance. Professions concerns For colleagues working in farm practice, euthanasia on economic grounds has always been a fact of life and so it may become with increasing frequency in companion animal practice, Mr Foster warns. It is a very difficult situation for practitioners to find themselves in they know what the diagnosis is and they know what the best treatment is but they cant use it for financial reasons. They will have to say, I am sorry but I have to put your animal to sleep. That is an awful position to be in. COPING WITH THE CASCADE companion | 9 Guidance from the Veterinary Medicines Directorate on the Cascade 1 states that: If there is no medicine authorised in the UK for a condition affecting a non food- producing species, the veterinary surgeon responsible for treating the animal(s) may, in particular to avoid unacceptable suffering, treat the animal(s) in accordance with the following sequence: (a) a veterinary medicine authorised in the UK for use in another animal species or for a different condition in the same species; or, if there is no such product: (b) either (i) a medicine authorised in the UK for human use; or (ii) in accordance with an import certificate (see VMG Note 7), a medicine authorised for veterinary use in accordance with Directive 2001/82 (as amended) in another Member State; or, if there is no such product: (c) a medicine prepared extemporaneously, by a veterinary surgeon, a pharmacist or a person holding an appropriate manufacturers authorisation, as prescribed by the veterinary surgeon responsible for treating the animal. As stated in the article, the Veterinary Medicines Directorate . does take account of a veterinary surgeons clinical judgement. The following cases are practical examples of prescribing under the cascade. Case One You have diagnosed a chronically vomiting dog with lymphoplasmacytic gastritis and gastric ulceration by endoscopy, and the owner is enquiring about treatment. What drugs, under the Cascade, can you prescribe? Zitac (cimetidine (Intervet)) is the only acid blocker with a veterinary market authorisation for the oral treatment of gastritis in dogs, and if cimetidine is your drug of choice you must prescribe this product. You cannot choose a different product containing the same active molecule just because it is cheaper. Thus, you cannot prescribe potentially cheaper human products (e.g. Tagamet (GSK)) or generic cimetidine. Clients may prefer to buy these products over the counter at their local pharmacy, but you must prescribe Zitac. However, as the authorised therapy is a POM-V, the veterinary surgeon should strongly recommend the use of the veterinary product given that the human products are not authorised for veterinary use and the dosage and directions for use could well be different to those described for humans on the label. Should there be an adverse reaction related to the treatment using a human product, the responsibility would rest with the owner and a veterinary surgeon would be expected to strees the risks involved in this course of action. You may make a clinical judgement that you should prescribe a different acid blocker because the potential side-effects of cimetidine are of concern in a particular case and an alternative product may have additional properties that would be useful in a specific case. Ranitidine, for example, is at least as efficacious as cimetidine, may not have some of the side-effects associated with cimetidines cytochrome P 450 inhibition and, perhaps importantly in chronic gastritis, has a prokinetic effect. Chronic gastritis is often associated with delayed gastric emptying and where this is suspected as a complication a prokinetic may be beneficial. As there is currently no veterinary licensed ranitidine preparation, the cascade would permit you to recommend a product authorised for human use such as Zantac (GSK). The owner should be made aware of the reasons for the recommendation and the potential risks associated with the unauthorised medicine. If the gastric ulceration is severe you may make a clinical judgement to use sulcrafate and a proton pump inhibitor. There is no veterinary licensed version of sucralfate, and so you could prescribe the preparation Antepsin (Chugai Pharma) authorised for human treatment. Omeprazole does have a veterinary market authorisation for horses (GastroGard (Merial)), but the concentration of active ingredient in the paste makes safe administration to dogs impossible. Therefore, where safety is an issue, a human licensed preparation (e.g. Losec, AstraZeneca) could be prescribed. If a suitable veterinary authorised proton pump inhibitor became available it must be prescribed. In addition symptomatic treatment with a low-fat, highly digestible diet or an exclusion diet may resolve the problem. Of course, if you believe in Helicobacter as a cause of gastritis, antibiotic therapy alone may be beneficial. 2 Case Two You wish to give an antiemetic to a cat with acute persistent vomiting. Cerenia (maropitant (Pfizer)) has a market authorisation for the treatment of vomiting in dogs, but is not licensed for use in cats. There is no other formulation of maropitant, but the use of a similar human licensed product, aprepitant [Emend (Merck)], as well as being foolhardy because there is no safety data for its use in animals, would not be not allowed under the Cascade. There is reliable evidence that Cerenia is safe and effective in cats even though not specifically licensed in cats 3 . However, you can make a clinical judgement to use an established anti-emetic such as metoclopramide. This judgement must be based on its potential efficacy and safety in cats, and not on cost. 1 http://www.vmd.gov.uk/General/VMR/ vmg_notes07/VMGNote15.pdf 2 Leib MS, Duncan RB & Ward DL. Triple antimicrobial therapy and acid suppression in dogs with chronic vomiting and gastric Helicobacter spp. Journal of Veterinary Internal Medicine 2 3 Hickman MA, Cox SR, Mahabir S, et al. Safety, pharmacokinetics and use of the novel NK-1 receptor antagonist maropitant (CereniaTM) for the prevention of emesis and motion sickness in cats. Journal of Veterinary Pharmacology and Therapeutics. 2008: 31: 220229 PRACTICAL EXAMPLES OF PRESCRIBING UNDER THE CASCADE The popular BSAVA Small Animal Dispensing Course takes place in Basingstoke on 23 October. Places are limited. Please email customerservices@ bsava.com or call 01452 726700 for more information. DISPENSING 10 | companion CLINICAL CONUNDRUM CLINICAL CONUNDRUM Case Presentation A 4-year-old female neutered Hamilton Stovare presented collapsed, as an emergency. Twenty four hours prior to presentation the dog had stolen a large amount of homemade flapjack from a work surface in the owners kitchen. During the course of the following day the dog vomited numerous times. Initially the dog brought up undigested flapjack; however, 6 hours prior to presentation the vomit became haemorrhagic (Figure 1). Clinical examination revealed pale mucous membranes, a moderate tachycardia and poor peripheral pulses. A large haematoma, with bruising, was present at the site of previous venepuncture (Figure 2). Dark tarry melaenic faeces were present on the thermometer after the patients temperature was taken. Simon Tappin of Dick White Referrals invites you to consider your approach to a collapsed dog presenting with profound haemorrhagic vomiting Figure 1: Marked haematemesis shortly after presentation 10 | companion CLINICAL CONUNDRUM CLINICAL CONUNDRUM Case Presentation A 4-year-old female neutered Hamilton Stovare presented collapsed, as an emergency. Twenty four hours prior to presentation the dog had stolen a large amount of homemade flapjack from a work surface in the owners kitchen. During the course of the following day the dog vomited numerous times. Initially the dog brought up undigested flapjack; however, 6 hours prior to presentation the vomit became haemorrhagic (Figure 1). Clinical examination revealed pale mucous membranes, a moderate tachycardia and poor peripheral pulses. A large haematoma, with bruising, was present at the site of previous venepuncture (Figure 2). Dark tarry melaenic faeces were present on the thermometer after the patients temperature was taken. Simon Tappin of Dick White Referrals invites you to consider your approach to a collapsed dog presenting with profound haemorrhagic vomiting Figure 1: Marked haematemesis shortly after presentation companion | 11 CLINICAL CONUNDRUM What differential diagnoses should be considered at this stage? Pale mucous membranes, a moderate tachycardia and poor peripheral pulses suggest hypovolaemia. Marked haematemesis and melaena suggest that the hypovolaemia is likely to have resulted from blood loss originating from the upper gastrointestinal tract, with gastric or duodenal ulceration most likely. An oral or pharyngeal injury should also be considered, as this could lead to blood being ingested. Given the haematemesis, melaena and haematoma, a coagulopathy should be strongly suspected. Given that a coagulopathy is considered, what are the next steps? Trauma and handling should be kept to a minimum to avoid further bleeding. Blood samples for planned diagnostic tests should be taken from peripheral veins (cephalic or saphenous) as bleeding after sampling will be less severe and can be controlled more easily with pressure than at a jugular site. Gastroprotectants such as sucralfate, H2 receptor antagonists and proton pump inhibitors may help protect the gastric mucosa, limiting further bleeding. As hypovolaemia is present, replacing circulating fluid volume is essential; crystalloids should be considered in the first instance, with blood products being considered later to replace red cells, platelets and coagulation factors as appropriate. Is a primary or secondary coagulopathy present? Primary coagulation describes the formation of a platelet plug over the area of blood vessel wall that is damaged. This is then stabilised by a fibrin meshwork, which is the product of the secondary coagulation pathways. Defects in primary haemostasis are caused by inadequate platelet numbers, abnormal platelet function or reduced levels of von Willebrand factor, and usually lead to petechial haemorrhages. Petechial haemorrhages, which may coalesce into ecchymoses, are the hallmark of primary coagulation defects and were not seen in this case. Defects in secondary coagulation are caused by reduced levels of one or more of the coagulation factors and are usually associated with large volumes of blood loss; examples include epistaxis, melaena and haemothorax. In this case the clinical signs are most consistent with a secondary coagulopathy; however, a primary coagulation defect cannot be excluded by clinical signs alone, and tests of haemostatic function are needed to investigate the underling cause (see Table 1). Blood samples were taken which revealed a low PCV (18%) and low total solids (54 g/l; reference interval 6080 g/l), consistent with acute haemorrhage. A blood smear revealed normal platelet numbers and buccal mucosal bleeding time was normal, both of which excluded a primary coagulopathy. Blood taken into an ACT (activated clotting time) tube did not clot after 5 minutes; this, in the presence of normal platelet numbers, suggested a secondary coagulopathy. This was confirmed by the laboratory finding of markedly elevated APTT and PT (both 10-fold greater than the control samples). D-dimers were normal, revealing no evidence of fibrinolysis. This suggested disseminated intravascular coagulation (DIC) was unlikely, which was supported by normal platelet numbers. What differentials should be considered for a secondary coagulopathy? Secondary coagulopathies can be inherited or acquired. Inherited coagulopathies are rare but the most common are haemophilia A (factor VIII deficiency) and haemophilia B (factor IX deficiency). Haemophilia A and B are sex-linked diseases, usually seen in young male dogs, and are diagnosed either by genetic tests or by factor assays. Other factor deficiencies have been occasionally reported, such as factor X deficiency (most commonly reported in American Cocker Figure 2: Brusing and haematoma formation at the site of previous venepuncture 12 | companion CLINICAL CONUNDRUM CLINICAL CONUNDRUM Spaniels) and factor VII deficiency (most commonly reported in Beagles). In this case both the APTT and PT were elevated, implying that either coagulation factors in both the intrinsic and extrinsic pathways or a single factor in the common pathway was affected (Figure 3). This could be further evaluated by individual factor analysis. Acquired secondary coagulopathies are more common and can result from: liver disease leading to decreased factor production; Angiostrongylus infection; or the antagonism of vitamin K. Vitamin K is required for the activation of factors II, VII, IX and X and in its absence the intrinsic (factor IX), extrinsic (factor VII) and common pathways (factors II and X) are all affected. As factor VII has the shortest half-life (6 hours compared with 14 hours for factor IX) the PT will be elevated before changes are seen in the APTT, but both are usually elevated at the point clinical signs develop. The most common cause of Vitamin K antagonism is rodenticide toxicity; however, decreased vitamin K absorption is also possible and can be associated with exocrine pancreatic insufficiency, biliary duct obstruction and lymphangiectasia. Diagnosis Further investigation revealed the dogs liver function was normal on the basis of a bile acid stimulation test. No signs of intestinal disease or biliary tract obstruction were present on ultrasound examination, revealing no evidence of a disease process affecting vitamin K absorption. Angiostrongylus infection was excluded on the basis of negative thoracic imaging and faecal parasitology. D-dimers and platelet numbers were normal, suggesting DIC was unlikely, with investigations revealing no evidence of an underlying trigger such as pancreatitis or haemangiosarcoma. Although there was no known history of exposure to rodenticides, rodenticide toxicity was considered the most likely cause on the basis of the results obtained and appropriate management was commenced. Serum was submitted for analysis for first- and second-generation rodenticides, and was negative for both; however, a markedly increased ratio of vitamin K to vitamin K epoxide was present. This is extremely suggestive of rodenticide toxicity: vitamin K epoxide accumulates in the presence of rodenticides as they inhibit vitamin K epoxide reductase (Figure 4). Studies have shown this is a sensitive way to differentiate dogs that have been exposed to rodenticides from dogs that have not, with the accumulation of the epoxide becoming most marked after vitamin K treatment, allowing samples to be collected after treatment has commenced (see box opposite). Second-generation rodenticides, such as bromodiolone, are commonly used in the UK. These are highly protein-bound, which means they can be absent from serum screens by the time clinical signs develop. In this case a definitive diagnosis can not be made, as a toxin has not been identified. Table 1: Tests to investigate haemostasis Tests of Primary Haemostasis Primary haemostasis relies on normal platelet numbers, normal platelet function and adequate levels of von Willebrand factor. Platelet numbers can be checked by routine automated haematology analysers, but numbers must be confirmed manually by examining a fresh blood smear. The blood smear is checked for platelet clumps and the platelets counted in the mono layer just behind the feathered edge. In this region one platelet per X100 field is equivalent to a circulating platelet count of approximately 15 x 10 9 /l. If platelet clumps are present an accurate count is not possible, but the presence of clumps usually suggests that adequate platelet numbers are indeed present. Platelet function and levels of von Willebrand factor can be assessed crudely by the buccal mucosal bleeding time (BMBT). Platelet numbers should be checked prior to performing a BMBT as thrombocytopenia will lead to markedly increased bleeding time. The BMBT is performed by making an incision on the oral mucosa with a standard device such as the Simplate II
. The upper lip is usually folded and
tied back to allow the incision to be made; once made, excessive bleeding is absorbed using a swab, taking care not to touch the actual incision site. Normal BMBT times are approximately 12 1 /2 minutes for the cat and 1 1 /24 1 /2 minutes in the dog. Both von Willebrand factor and platelet function can be assessed in more detail using laboratory-based tests. Tests of Secondary Haemostasis Secondary haemostasis relies on adequate levels of coagulation factors to allow stabilisation of the platelet plug by a fibrin mesh. The whole blood coagulation time (WBCT) crudely assesses both the intrinsic and common pathways. Blood is taken into a warm glass tube and tilted every 30 seconds until it clots. At 37C this should normally occur within 67 minutes. The activated clotting time (ACT) test is a more sensitive way to examine the intrinsic and common pathways and uses a commercial tube with a clay activator. Blood is taken into the tube and, whilst being warmed at 37C, the tube is tilted every 10 seconds until a clot is seen. Blood should clot within 5075 seconds in cats and 60120 seconds in dogs. The I-Stat analyser can also run ACT as a bedside test. More detailed coagulation times can be run at external laboratories or on bedside analysers such as the Idexx Coag Dx analyser. The prothrombin time (PT) allows investigation of the extrinsic and common pathways of coagulation, with the activated partial thromboplastin time (APTT) allowing investigation of the intrinsic and common pathways. These tests are run on citrated blood samples; test results >25% longer than the control samples are abnormal. companion | 13 CLINICAL CONUNDRUM Test centre Measurement of vitamin K 1 and vitamin K 1 epoxide and screens for first- and second-generation rodenticides can be performed at the Human Nutristasis Unit of Guys and St Thomas Hospital, London. Two millilitres of serum is required for each of the two tests and samples should be protected from strong light as this will inactivate vitamin K. Further information is available at www.nutristasis.com or by contacting the laboratory directly (tel: 0207 188 6816). Diagnostic importance of vitamin K1 and its epoxide measured in serum of dogs exposed to an anticoagulant rodenticide. Mount M.E. & Kass P.H. (1989) Am. J. Vet. Res. 50 17041709 However, there is very strong evidence to support a diagnosis of rodenticide toxicity an elevated vitamin K epoxide ratio, the presence of a coagulopathy, and an appropriate clinical response response to vitamin K. Treatment and outcome Whilst investigations were undertaken an intravenous catheter was placed and the dog was given two 10 ml/kg boluses of lactated Ringers solution each over 15 minutes. During this period the dogs peripheral pulse quality, tachycardia and demeanor all improved. Once vitamin K antagonism was suspected and all diagnostic samples were collected, vitamin K1 was given at 5 mg/kg subcutaneously into several sites. Splitting the injection volume over multiple sites helps to minimize injection- related haematoma formation. To replace vitamin K-dependent coagulation factors, 15 ml/kg of fresh frozen plasma was administered intravenously over the course of 60 minutes, whilst monitoring closely for transfusion reactions. An ACT performed after transfusion was normal. The dog received antiemetics and was started on intravenous gastroprotection, which was continued orally for 7 days once the vomiting had stopped. Oral vitamin K1 was commenced and continued for 28 days (2.5 mg/kg q12h). The dog made a good clinical recovery over the course of the next 24 hours and was discharged. At re-examination 4 weeks after discharge the dog was clinically very well and a repeat PT performed 48 hours after the withdrawal of vitamin K1 was normal; this confirmed that the toxicity had resolved. As factor VII has the shortest half- life, checking that the PT is normal 48 hours after the withdrawal of vitamin K1 ensures adequate treatment has been given. If the PT were still elevated, treatment would be continued for a further 4 weeks and the PT checked again at the end of therapy. At this stage the PCV had also returned to normal and the owner reported she had discovered a neighbour had been using rat poison on land the dog was walked on, 3 days prior to initial presentation. In circumstances of suspected toxicity, identification of the rodenticide ingested allows vitamin K treatment to be tailored to the specific toxin: first-generation coumarin rodenticides, such as warfarin, are treated with vitamin K for 7 days; second- generation coumarin rodenticides, such as brodifacoum and bromodiolone, are treated for 46 weeks; and indaniones, such as diphacinone, are treated for 34 weeks. Most cases reported are due to second- generation coumarin products; thus, when rodenticide toxicity is suspected but the toxin is unknown, treatment is usually instigated for 46 weeks. Figure 3: The coagulation pathways Intrinsic Common APTT PT Contact/Platelets Factor XII Tissue Factor Factor VII Factor XI Factor X Fibrin Thrombin ( II ) Factor V Factor IX Factor VIII Extrinsic Figure 4: The role of vitamin K in clotting factor production Vitamin K Epoxide Reductase Active Vitamin K Inactive Vitamin K Epoxide Inactive Clotting Factors (II, VII, IX & X) Active Clotting Factors (II, VII, IX & X) 14 | companion HOW TO NAVIGATE THE PET TRAVEL SCHEME HOW TO The Animal Health Rabies Operation branch, Chelmsford Animal Health Divisional Office, offers essential advice for vets in practice as a follow-up to our June article The Quarantine Question companion | 15 HOW TO NAVIGATE THE PET TRAVEL SCHEME T he introduction of the UK Pet Travel Scheme (PETS) on 28th February 2000 heralded a much campaigned for end to a quarantine period being the only option for cats and dogs travelling into the UK with their owners. However there was also a predictable fear factor in potentially opening our shorelines to a disease as notorious as rabies. The scheme had a lot to prove in its infancy. Was it robust enough to do a job that had been effectively carried out for generations by the convenience of being an island coupled with a rigorous quarantine system? Modern animal identification techniques and effective vaccines meant that the argument for maintaining quarantine, for most cats and dogs, from many countries, was becoming obsolete and less durable. However the alternative had to provide the same level of protection that quarantine had given for so long. Todays scheme The current legislation is now governed by an EC Regulation, which covers the non-commercial movement of pet animals between listed qualifying countries. The UK, Republic of Ireland, Malta and Sweden have been allowed to retain, for a transitional period, additional requirements for blood sampling and parasite treatment that were already included in their domestic legislation at the time the Regulation came into force. Eight years on the success of the scheme, and popularity with the pet owning public, is due in part to its simplicity. The 4 key steps to the successful entry into the UK Step 1: Identification Firstly an animal must be unquestionably identifiable as that described in the documentation accompanying it. The form of identification must be tamper proof and unique. These criteria are met by the subcutaneous implantation of a microchip. Step 2: Vaccination The animal is vaccinated against rabies. In order to show that the vaccine has provided an adequate level of immunity, a blood test is taken and sent to a recognised laboratory. The sample must indicate a neutralising antibody titration at least equal to 0.5 IU/ml. Step 3: 6-month waiting period To be sure that the antibody level indicated by the blood test is due to the vaccine rather than exposure to disease, the animal must remain in a qualifying country for 6 months from the date that a blood sample which gives a satisfactory result was taken to ensure clinical signs of disease do not develop. Step 4: Additional requirements The Department of Health have added in additional treatments for ticks and tapeworms 2448 hours before checking in to travel to the UK. This aims to prevent the entry to the UK of other exotic zoonotic diseases that can be carried by cats and dogs. The treatment must be administered by a vet practising in the country of treatment. Section VI of the passport must then be completed by this vet, specifying the manufacturer of the treatment, the product used and the date and time of treatment. This entry must be signed and stamped by the vet. Collars impregnated with acaricide should not be used. In the case of Echinococcus multilocularis treatment, the same details must also be recorded in Section VII of the companion | 15 HOW TO NAVIGATE THE PET TRAVEL SCHEME T he introduction of the UK Pet Travel Scheme (PETS) on 28th February 2000 heralded a much campaigned for end to a quarantine period being the only option for cats and dogs travelling into the UK with their owners. However there was also a predictable fear factor in potentially opening our shorelines to a disease as notorious as rabies. The scheme had a lot to prove in its infancy. Was it robust enough to do a job that had been effectively carried out for generations by the convenience of being an island coupled with a rigorous quarantine system? Modern animal identification techniques and effective vaccines meant that the argument for maintaining quarantine, for most cats and dogs, from many countries, was becoming obsolete and less durable. However the alternative had to provide the same level of protection that quarantine had given for so long. Todays scheme The current legislation is now governed by an EC Regulation, which covers the non-commercial movement of pet animals between listed qualifying countries. The UK, Republic of Ireland, Malta and Sweden have been allowed to retain, for a transitional period, additional requirements for blood sampling and parasite treatment that were already included in their domestic legislation at the time the Regulation came into force. Eight years on the success of the scheme, and popularity with the pet owning public, is due in part to its simplicity. The 4 key steps to the successful entry into the UK Step 1: Identification Firstly an animal must be unquestionably identifiable as that described in the documentation accompanying it. The form of identification must be tamper proof and unique. These criteria are met by the subcutaneous implantation of a microchip. Step 2: Vaccination The animal is vaccinated against rabies. In order to show that the vaccine has provided an adequate level of immunity, a blood test is taken and sent to a recognised laboratory. The sample must indicate a neutralising antibody titration at least equal to 0.5 IU/ml. Step 3: 6-month waiting period To be sure that the antibody level indicated by the blood test is due to the vaccine rather than exposure to disease, the animal must remain in a qualifying country for 6 months from the date that a blood sample which gives a satisfactory result was taken to ensure clinical signs of disease do not develop. Step 4: Additional requirements The Department of Health have added in additional treatments for ticks and tapeworms 2448 hours before checking in to travel to the UK. This aims to prevent the entry to the UK of other exotic zoonotic diseases that can be carried by cats and dogs. The treatment must be administered by a vet practising in the country of treatment. Section VI of the passport must then be completed by this vet, specifying the manufacturer of the treatment, the product used and the date and time of treatment. This entry must be signed and stamped by the vet. Collars impregnated with acaricide should not be used. In the case of Echinococcus multilocularis treatment, the same details must also be recorded in Section VII of the 16 | companion HOW TO passport. This treatment must contain praziquantel as the active ingredient. This 4-step procedure, the order of which is paramount, ensures that the cat or dog in question poses no disease risk to the human and animal population of the UK. Success or failure? Eight years on, what are the main problems that have arisen with the scheme? Unfortunately simplicity often creates the most complexity. It is the responsibility of the authorised carrier, be it a ferry company, Eurotunnel or airline, to ensure that the pets they transport comply with the requirements of the scheme. Animal Health audit checks of these carriers have identified some problem areas with the scheme as well some unexpected surprises. So, what can the practising veterinary surgeon, struggling with a flow of clients keen to travel hassle-free with their pets, learn from the problems encountered in the past? Worm and tick worries Approximately 65% of pets entering the UK come through the South Eastern seaports or channel tunnel. Animal Health at Dover audits these particular routes, and its experience in dealing with queries is likely to provide a representative insight into what requirements of the scheme have created the most queries. Over the last 12 months 50% of the queries have related to problems with tick and tapeworm treatments. This can involve one treatment missing, type of treatments not recorded, date or time of treatment missing, or wrong date and time recorded. The best advice a UK vet can give a client is to ensure they visit a veterinary surgeon in the country of departure to receive appropriate treatment and to check that Section VI and VII of the passport have been completed with the correct and complete information. Clients should also be made fully aware of the window of travel time and any treatments that are not acceptable under the legislation. Blood concerns Seventeen percent (17%) of queries related to the blood test. Information may be missing from the passport or may be incorrectly entered. A proportion of blood sample queries will be due to owners attempting to travel before the 6-month waiting time has elapsed. Advice in this case should be to ensure that Section V of the passport has been completed with the date of sampling and signed and stamped by the vet. Making clients aware of the 6-month waiting period is the responsibility of the veterinary surgeon and stressing this point to avoid misunderstanding can prevent an unpleasant souring of the vetclient relationship in the future. Microchip mistakes Microchip problems constitute 11% of queries. The date of insertion may not have been appropriately recorded or may have been incorrect. Unfortunately there are also times when a microchip will fail. It is prudent for a veterinary surgeon to check that the microchip is working properly during routine visits to the surgery and always before an entry is made in the passport, such as before a rabies vaccination booster is administered. In the event of a chip failure it is vital that the correct procedure is followed to ensure continuity of identification. The failed microchip must be located and removed under anaesthetic. A new microchip must be implanted at the same time and the details of that new chip recorded in the passport. The veterinary surgeon should then send the failed chip to the manufacturer who will confirm the failure and provide documentary evidence that the number corresponds to that originally recorded in the passport. Once the vet is in possession of this evidence, a declaration should be made in section XI (Others) of the passport to indicate that the original chip was removed and replaced with another microchip on the same date and that the manufacturers have confirmed the number of the original chip that could not be read. If this procedure is followed the scheme does not need to be re-started. Process problems Confusion over the order of progression through steps 1 to 3 accounts for 8% of queries. In some of these cases, actions will NAVIGATE THE PET TRAVEL SCHEME companion | 17 HOW TO genuinely have been performed in the wrong order but in a significant proportion the pet owner states the dates recorded in the passport are incorrect and may either have supporting documentation with them or be able to obtain correct information from the vet. Where the veterinary surgeon has not followed the correct order of preparation there is no choice but to re-start the scheme. This will include a repeat rabies vaccination and adherence to the 6-month waiting time following a satisfactory blood test result before the pet is eligible for travel into the UK. This will include a repeat rabies vaccination and adherence to the 6-month waiting time following a satisfactory blood test result before the pet is eligible for travel into the UK. Proper procedures There cannot be many more unpleasant ways to end a trip abroad than to be told that your pet will have to remain in quarantine for 6 months. The only way to avoid this eventuality is for the vet issuing the passport to ensure that the procedure has been followed correctly and if not take any appropriate action, advise the client that their pet is not eligible to travel and for what period of time. If there is any doubt enquiries should be made to ensure that all dates entered in the passport are correct and reflect the correct order of preparation. The remainder of the queries regard the inaccurate recording/ missing of the vaccination valid until dates or in circumstances where the vaccine appears to have expired. Careful recording of all necessary information should avoid this problem. Avoiding the issues To avoid the problems listed above it is paramount that the vet ensures that all information is completed accurately and indicates correct order of preparation and full compliance with requirements for entry to the UK. Out of the control of the UK veterinary practitioner, but of real concern, is the importation of a breed or type of dog listed NAVIGATE THE PET TRAVEL SCHEME under the Dangerous Dogs Act (DDA). Unfortunately as the range of countries participating in the scheme has increased, dogs that may be considered pit bull types have been brought to the attention of Animal Health by the authorised carriers. These dogs may be described in their passports as American Bulldog, American Staffordshire or Irish Staffordshire Bull Terriers but the difficulty encountered is that if the dog is PETS compliant, there is little Animal Health can do. At present there is no provision within the existing DDA to prevent the importation of such dogs. All that Animal Health can do in these cases is to refer the details of the dog, including photographs, to the police at the final destination who, along with the district local authority, are the competent authority named in the DDA to act on this information. Owner tactics People will always be passionate about their pets and unfortunately normally law-abiding citizens may feel the need to take illegal action to ensure their pet remains in their possession and avoids quarantine. Owners may be fully aware that their pet does not qualify for entry to the UK and will still attempt to travel with them, hiding them in vehicles and not declaring their presence. Thankfully these incidences are rare. What now? At the time of writing, the EC Regulation governing the movement of non-commercial pet animals is under review. The transitional period that allowed the UK to retain the additional requirements for entry has been extended but there is no guarantee that these will be kept indefinitely. If we are required to harmonise with other Member States there is a chance that the blood sampling and tick and tapeworm treatment procedures will be removed. However that is for the future. For now, the Pet Passport Scheme has proved itself to be an effective method of disease control. It has allowed pets are now able to travel with their families around the world, and more importantly, to come home again. As long as issuing veterinary surgeons are conversant with the requirements and able to make these clear to their client, the successful outcome will see many more travelling pets in the future. For more information, including factsheets for distribution to clients, visit http://www.defra.gov.uk/animalh/ quarantine/index.htm When pit bull type dogs are identified at Dover during entry into the UK, the local authority and police at its destination are informed 18 | companion VIN FORUMS 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 who have specialized knowledge and skills. In this new feature, VIN shares with companion readers a small animal discussion that has recently taken place in their forums. Discussion Creator Jessie is a 4 year old Springer who got into the laundry hamper. Four days later he came to see me for his vomiting. I ended up removing 52 of his jejunum. I was able to keep his ileum and a few feet of his upper SI. It is now day three post-op. He is eating well, his Jackson- Pratt drain has had minimal discharge and he has been weaned off of IV fuids and IV antibiotics. Jessie is having explosive/liquid bowel movements. He does not have urgency and seems to have no anxiety/ discomfort. I seem to remember that the remaining bowel will compensate for the lost bowel over a period of time. When would I expect to see some form to his stool? I estimate I removed 50% of his bowel. I used the GIA/TA for the R&A as well the Jackson-Pratt drain. The staplers have sped up my surgery considerably and the JP drain gives piece of mind. I did not use an LDS for this procedure, but ordered one as soon as I was finished, it is AMAZING how quick you can ligate with the proper instruments. Intestinal surgery is now FUN!! Discussion Creator ....and just when I thought all was well, Jessie decided to eat his vetwrap bandage! I didnt know if it would pass, so ended up inducing vomiting to regain possession. (Did I mention he also had a gastrotomy as well? That TA makes it fast!) Reply 1 I dont know what the rule is for how much gut they can use (Im sure theres a formula somewhere), but one of the first times I ever posted on VIN was a similar case. Rottweiler with whips and intussusception. Ended up removing about 4 feet on SI with a little ileum thrown in. He was blowing out for about 3 or 4 days. Im a surgery wimp and the boss was out of town, so I was on my own. The surgery gurus here said not to worry, and sure enough he straightened out. Good luck! LETTERS FROM AMERICA 18 | companion VIN FORUMS 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 who have specialized knowledge and skills. In this new feature, VIN shares with companion readers a small animal discussion that has recently taken place in their forums. Discussion Creator Jessie is a 4 year old Springer who got into the laundry hamper. Four days later he came to see me for his vomiting. I ended up removing 52 of his jejunum. I was able to keep his ileum and a few feet of his upper SI. It is now day three post-op. He is eating well, his Jackson- Pratt drain has had minimal discharge and he has been weaned off of IV fuids and IV antibiotics. Jessie is having explosive/liquid bowel movements. He does not have urgency and seems to have no anxiety/ discomfort. I seem to remember that the remaining bowel will compensate for the lost bowel over a period of time. When would I expect to see some form to his stool? I estimate I removed 50% of his bowel. I used the GIA/TA for the R&A as well the Jackson-Pratt drain. The staplers have sped up my surgery considerably and the JP drain gives piece of mind. I did not use an LDS for this procedure, but ordered one as soon as I was finished, it is AMAZING how quick you can ligate with the proper instruments. Intestinal surgery is now FUN!! Discussion Creator ....and just when I thought all was well, Jessie decided to eat his vetwrap bandage! I didnt know if it would pass, so ended up inducing vomiting to regain possession. (Did I mention he also had a gastrotomy as well? That TA makes it fast!) Reply 1 I dont know what the rule is for how much gut they can use (Im sure theres a formula somewhere), but one of the first times I ever posted on VIN was a similar case. Rottweiler with whips and intussusception. Ended up removing about 4 feet on SI with a little ileum thrown in. He was blowing out for about 3 or 4 days. Im a surgery wimp and the boss was out of town, so I was on my own. The surgery gurus here said not to worry, and sure enough he straightened out. Good luck! LETTERS FROM AMERICA companion | 19 VIN FORUMS Reply 2 52 inches of small bowel in a Springer sized dog is a lot of bowel. There is a fair chance that he will end up with short bowel syndrome, but it is too soon to say. All content published courtesy of vin.com. The names of participants have been removed from this feature. 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. His weight prior to sx was 41 lb, he now weighs 40.6 lb and is at an ideal weight. I found a JAVMA article that suggests the ileum can hypertrophy as can the remaining small intestine. Would this dog need supplementation/testing now, or is the cobalamin he had prior to his sx sustain him until his bowel recovers? Vin members can access the link to the JAVMA article: http://www.vin.com/Members/Viewer/Viewer. ashx?FileId=2766802&FileTypeId=6&IsOld=0 I was assuming the liquid BM was a consequence of his shortened bowel and may resolve over time. How do I know if its a problem that needs medical attention? He seems to be doing great otherwise, hes boarding at my clinic for another week, so I get to keep a close eye on him. Hes back to normal as far as attitude and energy. Im just not sure how worried I need to be. Id rather nip a problem early if it needs to be addressed. Thank you for the help! Vin Consultant I agree, short bowel might be a concern but usually you can get away with 70-80%. At least you steered clear of the ileocecocolic valve its when you lose that, you really have problems. What diet is he on? Id go with something highly digestible like EN, low res in small frequent feedings (46/day). You could add soluble fibre. I doubt youll need cobalamin, questran etc if the ileum is intact, although it might be worth checking a cobalamin/folate. A course of tylan and a probiotic wouldnt hurt either :) Discussion Creator >>> 52 inches of small bowel in a Springer sized dog is a lot of bowel. <<< I agree! Jessie measures 24 inches from the back of his skull to his tailhead. Im using the measurement of 4X this length is the approximate bowel length, and 75% of this may be removed without seeing short bowel syndrome. Total bowel length = 96, so percent removed is 52/96=54%. Hes on I/D right now. Vin Consultant >>> Would this dog need supplementation/testing now, or is the cobalamin he had prior to his sx sustain him until his bowel recovers? <<< No, as I mentioned above with the ileum intact cobalamin, bile salts etc should not be an issue but you could check levels if the diarrhea persists. >>> How do I know if its a problem that needs medical attention? <<< Time :) But as I said, keep with small frequentt meals and tylan (for 6 weeks) and a probiotic sol. fibre wont hurt. 20 | companion PETSAVERS Improving the health of the nations pets T he Petsavers products available from your wholesaler represent really great value for money, plus they are designed specifically to meet the requirements of small animal practice. A royalty is paid to Petsavers for each and every product bought and this provides a valuable source of income, which in turn is used to fund studies that advance our knowledge of small animal medicine and surgery. PETSAVERS PRODUCTS FOR PRACTICE When you buy Petsavers merchandise through your wholesaler you get the highest standard products whilst raising essential funds for the charity These items are listed under Petsavers in your wholesalers product catalogue. If you have any difficulty ordering products or would like more information, please contact Petsavers on 01452 726700 or email info@ petsavers.org.uk. The money raised through these purchases really helps to continue to fund research into conditions that affect the animals that we treat. Protective collars These are available in either clear plastic or opaque finishes. Assembly is easy and they come in a range of sizes. Every practice uses these, so why not use the Petsavers protective collar and help fund the future of veterinary expertise. Recovery blankets Compared to some blankets, these are very tough indeed. They are made of polyester and retain 95% of radiated body heat. The blankets can be used with a hypothermic patient and are great for preventing hypothermia during the anaesthetic period. They are also radiolucent and so diagnostic radiographs can be taken whilst the animal remains wrapped in the recovery blanket. Pet carriers These cardboard or plastic pet carriers are inexpensive and very popular with clients. They also help to advertise Petsavers with our logo and website address on the side. The hardwearing wire carrier is easily cleaned and has a hinged lid that allows full access to the interior of the carrier, making it easy to get pets into and out of, especially in the surgery. Heated pads The Petsavers heated pad has been hugely popular since it was introduced in 2006. It is ideal for cats, small dogs and other small pets when you need to minimise the risk of postoperative hypothermia or just to keep them warm. The key features of the pad are: Detachable plug allowing wire to be passed through cage bars Low operating voltage (12v) for increased safety Thick durable cover to cope with normal wear and tear, and which can be easily cleaned. companion | 21 GETTING TOUGH ON SEIZURES Simon Platt, Associate Professor in the Neurology Service at the University of Georgia and co-editor of the BSAVA Manual of Canine and Feline Neurology, looks at treatment options in managing epilepsy C ontrol of canine epilepsy is only possible in 7080% of cases with phenobarbital (PB) alone. Success may be improved if combination therapy with potassium bromide (KBr) is used. More recently, several human drugs have been evaluated for seizure therapy in veterinary patients. Such polytherapy has several potential disadvantages, including the increased cost, the need to monitor and to interpret serum concentrations of multiple drugs, potential drug interactions, and more complicated dosing schedules. Before polytherapy is started, all reasonable options for monotherapy should be tried. If the initial drug is ineffective, a second drug should be added. What are the available drug options for canine refractory epilepsy? If treatment with PB and/or KBr is not an option for reasons of toxicity for instance, or if treatment with a combination of both has not been successful, there are now some human anticonvulsants that can be considered for use in the dog. Their safety and pharmacokinetics have been investigated and their clinical use in a small number of refractory epileptics have been evaluated. However, there is nothing to prevent their use in the appropriate circumstances as sole therapy. 1. Gabapentin Gabapentin has primarily been used as an adjunctive drug for humans with uncontrolled partial seizures with and without secondary generalisation. Gabapentin is well absorbed from the duodenum in dogs, with maximum blood levels reached in 1 hour after oral administration. The elimination half-life of gabapentin in dogs is 34 hours, meaning that it may be difficult to attain steady state levels with q8h dosing. The currently estimated required dose to achieve some effect in dogs is 1020 mg/kg q8h. In dogs, gabapentin is metabolised in the liver; therefore, liver function needs to be closely evaluated when dogs are on this treatment. The author has used this drug with no deleterious effects as a third drug for dogs refractory to PB and KBr. At this point, about 50% of dogs seem to respond well to this addition, though sedation may be a problem in some dogs. 2. Levetiracetam Studies show that levetiracetam displays potent protection in a broad range of animal models of chronic epilepsy. Levetiracetam is not metabolised by the liver, is excreted by the kidneys and is free of significant drugdrug interactions; therefore, this is potentially a very safe drug to use in dogs and even cats. The dose range suggested for dogs is 1020 mg/kg orally q8h. No therapeutic range has been established and in humans serum levels do not seem to correlate with efficacy. No long-term trials have been undertaken evaluating the safety and efficacy of this drug; however, a recent short-term clinical trial demonstrated that using it as a third anticonvulsant decreased seizure frequency by over 50% in epileptic dogs. 3. Zonisamide This drug has been shown to be effective for both focal and generalised seizures in human patients. Zonisamide is metabolised mainly by hepatic microsomal enzymes, and the half-life in dogs is approximately 15 hours. The dose suggested for use as an add-on drug in dogs is approximately 5 mg/kg orally q12h. A high safety margin has been demonstrated in chronic dosing studies in Transverse (cross-sectional) MRI (T2-weighted) image indicating the presence of bilateral symmetrical oedema (arrowed) subsequent to prolonged generalised tonic seizure activity. Such oedema may lead to long-term damage and may create a more difficult to treat seizure focus PUBLICATIONS dogs, but the drug is sulphonamide-based. A recent clinical trial has shown that the use of zonisamide has decreased seizure frequency by over 50% in approximately 50% of dogs on polytherapy, additionally enabling a reduction in the concurrent dose of PB. These options may be expensive but provide owners with something further to try. Over the next few years, even more therapeutic options are to become available for the treatment of canine epilepsy and so we may anticipate a future with less problematic canine seizure cases. For now, they remain a common clinical problem in our practices. n companion | 21 GETTING TOUGH ON SEIZURES Simon Platt, Associate Professor in the Neurology Service at the University of Georgia and co-editor of the BSAVA Manual of Canine and Feline Neurology, looks at treatment options in managing epilepsy C ontrol of canine epilepsy is only possible in 7080% of cases with phenobarbital (PB) alone. Success may be improved if combination therapy with potassium bromide (KBr) is used. More recently, several human drugs have been evaluated for seizure therapy in veterinary patients. Such polytherapy has several potential disadvantages, including the increased cost, the need to monitor and to interpret serum concentrations of multiple drugs, potential drug interactions, and more complicated dosing schedules. Before polytherapy is started, all reasonable options for monotherapy should be tried. If the initial drug is ineffective, a second drug should be added. What are the available drug options for canine refractory epilepsy? If treatment with PB and/or KBr is not an option for reasons of toxicity for instance, or if treatment with a combination of both has not been successful, there are now some human anticonvulsants that can be considered for use in the dog. Their safety and pharmacokinetics have been investigated and their clinical use in a small number of refractory epileptics have been evaluated. However, there is nothing to prevent their use in the appropriate circumstances as sole therapy. 1. Gabapentin Gabapentin has primarily been used as an adjunctive drug for humans with uncontrolled partial seizures with and without secondary generalisation. Gabapentin is well absorbed from the duodenum in dogs, with maximum blood levels reached in 1 hour after oral administration. The elimination half-life of gabapentin in dogs is 34 hours, meaning that it may be difficult to attain steady state levels with q8h dosing. The currently estimated required dose to achieve some effect in dogs is 1020 mg/kg q8h. In dogs, gabapentin is metabolised in the liver; therefore, liver function needs to be closely evaluated when dogs are on this treatment. The author has used this drug with no deleterious effects as a third drug for dogs refractory to PB and KBr. At this point, about 50% of dogs seem to respond well to this addition, though sedation may be a problem in some dogs. 2. Levetiracetam Studies show that levetiracetam displays potent protection in a broad range of animal models of chronic epilepsy. Levetiracetam is not metabolised by the liver, is excreted by the kidneys and is free of significant drugdrug interactions; therefore, this is potentially a very safe drug to use in dogs and even cats. The dose range suggested for dogs is 1020 mg/kg orally q8h. No therapeutic range has been established and in humans serum levels do not seem to correlate with efficacy. No long-term trials have been undertaken evaluating the safety and efficacy of this drug; however, a recent short-term clinical trial demonstrated that using it as a third anticonvulsant decreased seizure frequency by over 50% in epileptic dogs. 3. Zonisamide This drug has been shown to be effective for both focal and generalised seizures in human patients. Zonisamide is metabolised mainly by hepatic microsomal enzymes, and the half-life in dogs is approximately 15 hours. The dose suggested for use as an add-on drug in dogs is approximately 5 mg/kg orally q12h. A high safety margin has been demonstrated in chronic dosing studies in Transverse (cross-sectional) MRI (T2-weighted) image indicating the presence of bilateral symmetrical oedema (arrowed) subsequent to prolonged generalised tonic seizure activity. Such oedema may lead to long-term damage and may create a more difficult to treat seizure focus PUBLICATIONS dogs, but the drug is sulphonamide-based. A recent clinical trial has shown that the use of zonisamide has decreased seizure frequency by over 50% in approximately 50% of dogs on polytherapy, additionally enabling a reduction in the concurrent dose of PB. These options may be expensive but provide owners with something further to try. Over the next few years, even more therapeutic options are to become available for the treatment of canine epilepsy and so we may anticipate a future with less problematic canine seizure cases. For now, they remain a common clinical problem in our practices. n 22 | companion WSAVA NEWS F ollowing a 2004 publication in the Journal of the American Veterinary Medical Association that identified marked discrepancies in the histopathological evaluation of gastrointestinal biopsies, a group of veterinarians specialising in GI diseases approached the WSAVA with the concept of standardising the collection and assessment of GI biopsies. (See Willard MD, et al. Interobserver variation among histopathological evaluation of intestinal tissues from dogs and cats. J Am Vet Med Assoc 2004; 220: 1177). Based on similar goals and the ultimate success of the Liver Disease Standardization Group (www.wsava.org/LiverStandard.htm), a formal GI Standardization Group was organised, consisting of Drs Washabau (chair), Bilzer, Day, Guilford, Hall, Jergens, Mansell, Minami, Wilcock, and Willard, and its remit set. With support from Hills Pet Nutrition, the group has enjoyed tremendous productivity, including: Histopathological Standards for the Diagnosis of Gastrointestinal Inflammation in Endoscopic Biopsy Samples from the Dog and Cat: A Report from the World Small Animal Veterinary Association Gastrointestinal Standardization Group. ( J Comp Path 2008;138:S1S44) This monograph presents a standardised pictorial and textual template of the major histopathological changes that occur in inflammatory disease of the canine and feline gastric body, gastric antrum, duodenum and colon. Standardized GI Endoscopy Reporting Forms available online www.wsava. org/StandardizationGroup.htm The group recognised early the need to also standardise endoscopic examination and sampling of the GI tract to ensure the highest procedural diagnostic yield. These endoscopy report forms help address this, namely that endoscopic examination is complete and thorough. Development of an ACVIM Consensus Statement on IBD The ACVIM Board of Regents invited the WSAVA Gastrointestinal Standardization Group to develop, present and publish an ACVIM Consensus Statement on Histopathologic Standards for Canine and Feline IBD. This was presented in a special session at the 2008 ACVIM Forum in San Antonio and is awaiting ratification and eventual publication in the Journal of Veterinary Internal Medicine. Dr Robert Washabau proposed the Consensus Statement on IBD, based on the work of the WSAVA Standardization Group, at the 2008 ACVIM Forum in San Antonio, Texas. Congratulations to the GI GI STANDARDIZATION GROUP Standardization Group for their outstanding contribution to the betterment of of medicine and hence the lives of dogs and cats throughout the world. For more information visit their committee page on the WSAVA website. LATEST WSAVA NEWS P eriodically, WSAVA produces a News Bulletin that highlights the initiatives and accomplishments of the association, its committees, member associations, and individual members. The most recent News Bulletin is now available for viewing online www.wsava.org companion | 23 WSAVA NEWS N EWStat is the American Animal Hospital Associations bi-weekly email newsletter. NEWStat includes easy-to-digest briefs on timely topics and breaking news in companion animal practice. It has a convenient format thats easy to read and share with others, and has links to additional information. WSAVA MEMBER ASSOCIATION UPDATES While password protected and not freely available online, AAHA has agreed to make this resource available to WSAVA members via their www.aahanet.org website. Username and password can be requested and provided through your specific WSAVA member associations to determine if you are a WSAVA member, AAHA makes NEWStat and Trends magazine available to WSAVA members please access the Member Association pages for more details www.wsava.org/ Handbook.htm. Additional resources that AAHA has made available for WSAVA members include: Trends Magazine ( trends.aahanet.org/ eweb/) a resource providing information on management, business, and other workplace issues designed for the entire veterinary clinic staff Healthy Pet ( www.healthypet.com/) a pet owner online information resource AAHA Standards of Accreditation (www.aahanet.org/accreditation/index. aspx) AAHA, along with a group of veterinary experts, developed the AAHA Standards of Accreditation as benchmarks of excellence to raise the level of care being provided to companion animals. Username and password access can be obtained as for NEWStat above. T he WSAVA 2008 Dublin Congress scientific proceedings will be available online to coincide with the opening of the Congress in Dublin, Ireland. The proceedings contain exciting scientific information that includes more than 200 lectures from 70 different speakers in more than 20 different disciplines and cover three different levels WSAVA WORLD CONGRESS PROCEEDINGS ONLINE of interest advanced/specialist, general companion animal, and new to/refresher companion animal medicine. Additionally, the proceedings will include three State-of- the-Art Lectures (SOTALs) as well as the free communications/abstracts. So, if you cant attend in person, the scientific information is still at your finger tips at www.wsava.org 24 | companion WSAVA NEWS Peruvian Small Animal Veterinary Medical Association WSAVA NEWS WSAVA NEWS WSAVA NEWS W ith more and more veterinary professionals outside the UK wanting to benefit from the range of CPD resources on offer to its members, the British Small Animal Veterinary Association is pleased to offer its new overseas membership category, at a discounted subscription rate. With more than 700 hours of Congress MP3s available online, this alone is worth the membership fee. Along with these valuable scientific lectures overseas members will also be able to access the BSAVA Small Animal Formulary, the Journal of Small Animal Practice and companion online at www.bsava.com anytime, day or night. However, not all the benefits are online Overseas Members will also be entitled to significant discounts on the wide range of BSAVA manuals with savings of more than a third off the non- member price. Prof. Ed Hall, President of BSAVA, says, We already have many members outside the UK, and wanted to offer those who arent able to come to our Congress each year, or attend one of our courses in the UK, an opportunity to be a part of this growing association and access the other benefits we offer, such as the Congress MP3s. With our new website going live in the early part of 2009 there will be even more resources available and we would encourage the global perspective an international membership would bring. Overseas Members must have a permanent home and work address outside of the UK and Eire. They must also be a registered overseas member of the RCVS (or equivalent body). If you would like more information regarding joining the BSAVA please email customerservices@bsava.com. The current fee for 2008 is 92 (compared with 184 for Full Membership). BSAVA OFFERS MORE TO INTERNATIONAL COLLEAGUES First Persian Veterinary Forum The Persian Veterinary Forum is an online information resource consisting of 24 departments covering various fields of veterinary medicine, such as large animal medicine, small animal medicine, surgery, poultry, wild animals, etc. The forum was established in 2005 and is now in its 4th year with more than 2500 articles available online in Persian (Farsi). The Forum has two major sections, one on special veterinary medicine, which is suitable for veterinary surgeons, students and academics, and the other is the public section, including discussions on various veterinary topics. Access is free and membership is easy please visit www.ardalan.id.ir/forum On 1 May 2008, WSAVA and Hills Pet Nutrition sponsored a continuing education seminar by Dr Jesus Paredes from the University of Mexico on soft-tissue surgery in Lima, Peru, which was well received by the packed room of attendees. Also in attendance were dignitaries from various veterinary medical associations. Pictured from left to right Drs Gilberto Santillan (Vice President AMVEPPA), Jesus Paredes (speaker), Rau Benavente (President AMVEPPA), Ronald Torres (Treasurer AMVEPPA), Vladimir Valdivia (Secretary AMVEPPA), Richard Arguezo (Chair AMVEPPA/WSAVA CE Committee), and Guillermo Rico (Peruvian speaker). companion | 25 WSAVA NEWS T he control of free-roaming dog populations remains a major welfare issue in many parts of the world. These may be associated with many problems such as: Direct injury to people, livestock or pets Indirect injury to people and pets from road traffic accidents Source of infection (esp. rabies) Pollution from faeces and urine General nuisance from noise. The financial costs involved with these can be high, and mass slaughter has been chosen as one way of addressing the problem. Often inhumane methods are used which are not only a welfare problem, alienating many of the stake holders, but may also be indiscriminate with risks to humans and their pets. These methods are also invariably unsuccessful in the medium term. Accordingly, in 1990, the World Health Organisation (WHO) and the Word Society for the Protection of Animals (WSPA) formulated joint international arm of the Royal Society for the Protection of Animals, the Universities Federation for Animal Welfare (UFAW), the World Small Animal Veterinary Association (WSAVA) and the Alliance for Rabies Control (ARC). In January 2008, ICAM published a document titled Humane Dog Population Management Guidance. This essentially builds on and replaces the original WHO/WSPA framework, and is illustrated by a number of real life case studies. To access this document, visit the Animal Welfare page of the WSAVA website (www.wsava.org/AnimalWelfare.htm) The WSAVA Welfare committee strongly recommends this to WSAVA members. The document can be downloaded from the WSAVA website as a pdf document. NEW GUIDELINES ON HUMANE STRAY DOG CONTROL AVAILABLE guidelines providing a framework on which a strategy might be developed. The key elements were: Legislation Registration and identification Garbage control Neutering of owned and un-owned dogs Control of breeders and sales outlets Education. All elements are important, though the priorities in different situations may vary. However, it is essential that all the major stakeholders agree a common strategy and that population studies are carried out to help formulate the most appropriate strategy. Much has happened since 1990, and recently the International Companion Animal Management (ICAM) Coalition was formed to share information and ideas on companion animal population dynamics. Currently, ICAM is made up of representatives from the World Society for the Protection of Animals (WSPA), the Humane Society International (HSI), the International Fund for Animal Welfare (IFAW), RSPCA International (the 26 | companion companion INTERVIEW Victoria Roberts grew up in rural Suffolk, with an elder brother and sister, surrounded by horses, dogs, poultry and farmland. Having run a pure breed visitor attraction and breeding programme before attending Liverpool Vet School, she has made her name as a leading avian expert. As well as contributing to BSAVA publications, Victoria has been a valued volunteer for the Association for many years. THE companion INTERVIEW What childhood memories remain with you? Aged 4, I was sent to prevent the Christmas turkeys from fighting by ringing a railway bell in their ears! A bucket of water was the usual method, but of course I was too small for this. If missing, I could always be found in the cowshed or piggery at the neighbouring farm and enjoyed the sport of trying to catch escaped piglets in our large garden. What did you do before graduating from Liverpool as a mature student? I ran an outdoor pure breed poultry attraction on 23 acres with about 80 breeds and 3,000 birds to look after. I had an incubator that I could walk in to and we hatched about 300400 chicks, ducklings, goslings and turkey poults weekly in the season. I became highly skilled at multi- tasking as we had a poultry shop, caf, school parties, plus a Childrens Farm Berkshire piglets were a grand attraction and also very good to eat. I began writing books as I was tired of answering the same questions about poultry, (including two while I was an undergraduate, but my book on poultry diseases had to wait until I could add the magic letters after my name in 2000). Fortunately, I had decided early on not to have children and can be heard to say that all mine have fur or feathers. Had veterinary medicine been a long-held ambition or did you experience a late epiphany? I knew I wanted to be with animals and when six years old, and considered joining the circus or running a zoo. Veterinary medicine was discussed briefly as a career option but dismissed by my father who was afraid I would end up in an inner city treating only cats and dogs. So I was removed from the science stream at school (which I loved) and took English and History A levels in those days you did what you were told! It took many years to realise that veterinary medicine was a possibility and then I had to obtain the correct A levels (aged 42) before attending Liverpool. Did you find that being an older student was a problem or an advantage? Certainly an advantage, since I had moved heaven and earth to get on the course and therefore was very focussed the older brain needed pins sticking in it frequently but the greatest problem was that I could no longer drink all night and work all day, unlike the other much younger undergraduates! How did you get involved in BSAVA and contributing to the manuals? I got involved with BSAVA North East region immediately on graduating and then joined the Publications Committee. With the amalgamation of mixed and farm practices over the past few years, it became more likely that SA vets would be presented with farm-type species, so the idea of the BSAVA Farm Pets Manual was to cover these and of course, I was keen to do the chicken chapters it was a very interesting experience co-editing the whole book, however. I am also interested in exotics and have been editing the British Veterinary Zoological Society publications for 10 years. Have you always worked as a locum? I have. When I graduated I was too old to start my own practice and had already run my own business, so just wanted just to treat animals. It seems to work and of course I go back to the same places on a regular basis. I have taught bird and small furry anatomy, physiology and handling at Liverpool since 1998, and subsequently also teach clinical poultry, since backyard poultry are becoming more popular and owners want the same high standard of care that their dogs and cats receive. I am the Honorary Veterinary Surgeon to The Poultry Club, have been on their Council for 15 years, a Panel B judge, Secretary of the Dorking Breed Club for 18 years and just finished editing the 6th edition of British Poultry Standards. What do you consider to be your most important achievement? Enhancing the welfare of backyard poultry. Who has been the most inspiring influence on your career? John Cooper, a fellow enthusiast and teacher. What would you have done if you hadnt been a vet? I never considered the possibility of not graduating once my mind had been made up. I am delighted to say that being a vet has exceeded all my expectations. C o u r t e s y
D a v i d
T o m l i n s o n CPD DIARY companion | 27 5 October Sunday Practical dentistry Speaker Norman Johnstone Day meeting at the Dunkeld House Hotel, Dunkeld. Scottish Region. Details from Susan Macaldowie, telephone 07711 633698, email smacaldowie@btinternet.com 8 October Wednesday Feline chronic gingivostomatitis Speaker Diane Addie Evening meeting at IDEXX, Wetherby. North East Region. Details from Karen Goff, telephone 01943 462726, email northeastregion@bsava.com 8 October Wednesday Geriatrics Speaker Stijn Niesson Evening meeting at The Holiday Inn, Haydock. North West Region. Details from Simone der Weduwen, email beestenhof@ntlworld.com 10 September Wednesday Oncology in practice Speaker Rob Harper Evening meeting at Park Inn, Cardiff. South Wales Region. Details from Susanna Brown, email southwalesregion@bsava.com 13 September Saturday Annual Dinner at Horncliffe Mansion North West Region. Details from Simone der Weduwen, email beestenhof@ntlworld.com 14 September Sunday Fracture management Speaker Andy Torrington Day meeting at Normanton Golf Club, Wakefield. North East Region. Details from Karen Goff, telephone 01943 462726, email northeastregion@bsava.com 16 September Tuesday Infectious diseases in neonates Speaker Susan Dawson Evening meeting at Corus Hotel, Romsey. Southern Region. Details from Michelle Stead, telephone 01722 321185, email mmstead@btinternet.com 18 September Thursday Clinical pathology in practice Speaker Tim Jagger Evening meeting at LA Lecture Theatre, Royal (Dick) School of Veterinary Studies, Edinburgh. Scottish Region. Details from Susan Macaldowie, telephone 07711 633698, email smacaldowie@btinternet.com CPD DIARY 21 September Sunday Case-based endocrinology Speakers Grant Petrie and Lucy Davison Day meeting at The Cambridge Belfry, Cambridge. East Anglia Region. Details from Gerry Polton, email eastanglia.region@bsava.com 23 September Tuesday Kidney disease Speaker Hattie Syme Day meeting (modular course) at BSAVA HQ, Gloucester. Organised by BSAVA. Details from BSAVA Customer Services, telephone 01452 726700, email customerservices@bsava.com 22 October Wednesday Heart murmurs in cats Speaker Adrian Boswood Evening meeting at Corus Hotel, Romsey. Southern Region. Details from Michelle Stead, telephone 01722 321185, email mmstead@btinternet.com 14 October Tuesday Immune-mediated disease Speaker Sheena Warman Afternoon meeting at Park Inn, Cardiff. South Wales Region. Details from Craig Connolly, email southwalesregion@bsava.com 15 October Wednesday Wildlife and exotic emergencies Speakers Anna Meredith and Sharon Redrobe Day meeting at Hilton, Bromsgrove. Organised by BSAVA. Details from BSAVA Customer Service, telephone 01452 726700, email customerservices@bsava.com 22 October Wednesday Current feline issues Speakers Rachel Dean and Sheila Wills Day event at Janson Laboratories, High Wycombe. Metropolitan Region. Details from Allison van Gelderen, email allivetuk@yahoo.co.uk 23 October Thursday Canine lymphoma Speaker Gerry Polton Evening meeting at Leatherhead Golf Club, Leatherhead. Surrey and Sussex Region. Details from Jo Arthur, telephone 01243 841111, email surreyandsussexregion@bsava.com 24 September Wednesday SA endocrinology I Speaker Peter Graham Day meeting (modular course) at BSAVA HQ, Gloucester. Organised by BSAVA. Details from BSAVA Customer Services, telephone 01452 726700, email customerservices@bsava.com 2527 September ThursdaySaturday BVA Congress Speakers Gary Clayton Jones and Peter Bedford 2-day meeting at the Royal College of Physicians, London. Metropolitan Region. Details from Pedro Martin Bartolome, email pmbartolome@googlemail.com CPD DIARY companion | 27 5 October Sunday Practical dentistry Speaker Norman Johnstone Day meeting at the Dunkeld House Hotel, Dunkeld. Scottish Region. Details from Susan Macaldowie, telephone 07711 633698, email smacaldowie@btinternet.com 8 October Wednesday Feline chronic gingivostomatitis Speaker Diane Addie Evening meeting at IDEXX, Wetherby. North East Region. Details from Karen Goff, telephone 01943 462726, email northeastregion@bsava.com 8 October Wednesday Geriatrics Speaker Stijn Niesson Evening meeting at The Holiday Inn, Haydock. North West Region. Details from Simone der Weduwen, email beestenhof@ntlworld.com 10 September Wednesday Oncology in practice Speaker Rob Harper Evening meeting at Park Inn, Cardiff. South Wales Region. Details from Susanna Brown, email southwalesregion@bsava.com 13 September Saturday Annual Dinner at Horncliffe Mansion North West Region. Details from Simone der Weduwen, email beestenhof@ntlworld.com 14 September Sunday Fracture management Speaker Andy Torrington Day meeting at Normanton Golf Club, Wakefield. North East Region. Details from Karen Goff, telephone 01943 462726, email northeastregion@bsava.com 16 September Tuesday Infectious diseases in neonates Speaker Susan Dawson Evening meeting at Corus Hotel, Romsey. Southern Region. Details from Michelle Stead, telephone 01722 321185, email mmstead@btinternet.com 18 September Thursday Clinical pathology in practice Speaker Tim Jagger Evening meeting at LA Lecture Theatre, Royal (Dick) School of Veterinary Studies, Edinburgh. Scottish Region. Details from Susan Macaldowie, telephone 07711 633698, email smacaldowie@btinternet.com CPD DIARY 21 September Sunday Case-based endocrinology Speakers Grant Petrie and Lucy Davison Day meeting at The Cambridge Belfry, Cambridge. East Anglia Region. Details from Gerry Polton, email eastanglia.region@bsava.com 23 September Tuesday Kidney disease Speaker Hattie Syme Day meeting (modular course) at BSAVA HQ, Gloucester. Organised by BSAVA. Details from BSAVA Customer Services, telephone 01452 726700, email customerservices@bsava.com 22 October Wednesday Heart murmurs in cats Speaker Adrian Boswood Evening meeting at Corus Hotel, Romsey. Southern Region. Details from Michelle Stead, telephone 01722 321185, email mmstead@btinternet.com 14 October Tuesday Immune-mediated disease Speaker Sheena Warman Afternoon meeting at Park Inn, Cardiff. South Wales Region. Details from Craig Connolly, email southwalesregion@bsava.com 15 October Wednesday Wildlife and exotic emergencies Speakers Anna Meredith and Sharon Redrobe Day meeting at Hilton, Bromsgrove. Organised by BSAVA. Details from BSAVA Customer Service, telephone 01452 726700, email customerservices@bsava.com 22 October Wednesday Current feline issues Speakers Rachel Dean and Sheila Wills Day event at Janson Laboratories, High Wycombe. Metropolitan Region. Details from Allison van Gelderen, email allivetuk@yahoo.co.uk 23 October Thursday Canine lymphoma Speaker Gerry Polton Evening meeting at Leatherhead Golf Club, Leatherhead. Surrey and Sussex Region. Details from Jo Arthur, telephone 01243 841111, email surreyandsussexregion@bsava.com 24 September Wednesday SA endocrinology I Speaker Peter Graham Day meeting (modular course) at BSAVA HQ, Gloucester. Organised by BSAVA. Details from BSAVA Customer Services, telephone 01452 726700, email customerservices@bsava.com 2527 September ThursdaySaturday BVA Congress Speakers Gary Clayton Jones and Peter Bedford 2-day meeting at the Royal College of Physicians, London. Metropolitan Region. Details from Pedro Martin Bartolome, email pmbartolome@googlemail.com 420 pages Published August 2008 ISBN 978 1 905319 04 6 Non-member price: 84.00 Member price: 54.00 336 pages Published April 2005 ISBN 978 0 905214 76 4 Non-member price: 78.00 Member price: 49.00 Replaces Manual of Raptors, Pigeons and Waterfowl Health, husbandry and disease Formulary Biology and husbandry Practical examination techniques Disorders by body system Diagnostic algorithms Related titles from the BSAVA BSAVA, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB Tel: 01452 726700 Fax: 01452 726701 Email: customerservices@bsava.com Web: www.bsava.com Contact BSAVA Customer Services for further information 28 OBC.indd 1 22/7/08 14:23:32