The essential publication for BSAVA members

Test your diagnostic imaging skillsP9

Update on the Veterinary Surgeons ActP3

The out-of-hours obligationP6

The out-of-hours Test your

The essential publication for BSAVA members

companionJULY 2008

Successful surgery

How to carry out a gastropexy

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CONTENTS3 Latest News

Update on the Veterinry Surgeons Act

45 A Tartan AffairRoss Allan reports on the Scottish Congress

68 Around The ClockJohn Bonner on the challenges of emergency care

913 Clinical ConundrumApproaches to gastrointestinal disease and abdominal pain

1417 How ToSelect and carry out a gastropexy procedure

1819 Formulating the FormularyIan Ramsey on the making of the indispensible pocket guide

2021 PetsaversFundraising news

22 International AffairsBSAVAs supporting the profession worldwide

2325 WSAVA NewsWorld Small Animal Veterinary Association

26 The companion InterviewJulian Hector

27 CPD DiaryWhats 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.

ON YOUR DOORSTEP

Additional stock photography Dreamstime.com Andrew Bayda | Dreamstime.com Bbostjan | Dreamstime.com Kasia Biel | Dreamstime.com Cdukes | Dreamstime.com Olgalis | Dreamstime.com William Park | Dreamstime.com Andrzej Tokarski | Dreamstime.com Maksym Yemelyanov | Dreamstime.com

BSAVA has 13 regions covering the UK and Ireland, run by committed volunteers. Members can access regional CPD at greatly reduced prices (sometimes theres no charge at all), meet other local professionals and even get involved in choosing the subjects covered in the programme. Regional events are a really simple and cost-effective way of topping up your knowledge on a regular basis.

Your localWherever you live there will be a team of regional representatives working on your behalf to deliver relevant courses on a wide range of topics but you are not tied to one region. Many members live on the borders between two, or even three or four regions and you can access courses at any of them.

QualityThroughout the year BSAVA regional committees organise courses that are aimed at the practitioner who is looking to update their current knowledge and techniques. Many of our speakers are international experts who travel to the regions for one-day or evening meetings, allowing members to access the latest advances in a wide range of subjects. In answer to demand, many courses adopt a problem-oriented approach, with appropriate hypothetical and actual

cases and discussions to consolidate the theory learned.

Get in touchFor more information about regional CPD visit the Courses section at www.bsava.com, see the Diary in the back of this edition of companion, or email customerservices@bsava.com to get contact details for your own regional representative.

BSAVA Regions East AngliaKentMetropolitanMidlandNorth EastNorth WestNorthern Ireland

Regional CPD allows you to access courses without spending more time in the car than you do in the classroom

is produced by BSAVA exclusively for its members.

the programme. Regional events are a really simple and cost-effective way of topping up

behalf to deliver relevant courses on a wide

aimed at the practitioner who is looking to

MidlandNorth EastNorth WestNorthern Ireland

Republic of IrelandScotlandSouth WalesSouth WestSouthernSurrey & Sussex

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LATEST NEWS

BALANCING ACT

EFRACom announced its enquiry into the Veterinary Surgeons Act 1966 in July 2007. The terms of reference were to examine whether the provisions of the 1966 Act were out of step with developments in the veterinary and related professions, and whether there was a need to replace the Act. Written submissions were invited, and 42 received, amongst them a submission from BSAVA. Oral evidence was also taken from a number of individuals and bodies, including the RCVS, Defra, BVA and Lord Rooker, Minister for Sustainable Food, Farming and Animal Health.

Process and historyIn 2003 Defra carried out a public consultation, whilst the RCVS had previously held two consultations with the veterinary profession, in 2003 and 2005, to review whether a new Act would be desirable. Discussions have also been held between RCVS and Defra since 2003 on proposals for modernising the regulatory framework for the provision of veterinary services, and the RCVS has proposed a number of changes to the 1966 Act.

However, while Defra initially concluded that it needed to modernise the Act, and indeed intended to apply for Parliamentary time to bring forward new legislation in 20056, this did not happen. Then, during oral submission to EFRACom, Lord Rooker surprised everyone by declaring that Defra has stopped work on this issue, and that the requisite resources will not be available until 2011.

CriticismsThe report of EFRACom is critical in a number of respects. The RCVS is criticised

for failing to sort out the detail in its reform proposals, given the level of consultation with the profession and the time which has elapsed since that consultation. In addition, Defra is strongly criticised for its decision to halt work entirely on the new legislation, and for a failure to communicate this at an early stage to the RCVS.

The overall conclusion is that the veterinary profession must work together to establish exactly what it wants in terms of regulatory reform, before reform is imposed upon it by government. We understand it is the intention of the RCVS to set up a working party to investigate the professions needs.

Way forward?It remains important to safeguard the health and welfare of animals, and to protect them and their owners from those who offer treatments without sufficient knowledge or training. Fundamental to this is the acknowledgement that the veterinary profession must meet modern day standards of quality of service, and must have the transparent and accountable regulatory procedures demanded by the public.

The veterinary nursing profession has evolved to a stage where it also warrants its own framework for regulation. But it is less clear how best to ensure that other paraprofessionals providing animal services are regulated to ensure animal health and welfare.

Additional concepts intertwined with these elements of reform do not have, say EFRACom, the widespread support of the veterinary profession. These include a mandatory practice standards scheme and mandatory continuing professional development and revalidation.

While it is clear that excellent practice standards and ongoing individual professional development should be aspired to by all, it is perhaps more constructive to promote the benefits of the current voluntary practice standards scheme, and to encourage CPD for all.

BSAVA positionThe BSAVA will be arguing for the development of:

Specific proposals to amend the disciplinary process for veterinary professionals, with the aim of producing a new Bill for introduction earlier than 2011The development of a specific regulatory framework for the veterinary nursing profession.

The BSAVA will also willingly co-operate with the RCVS if it wishes to conduct a cost-benefit analysis of the impact of mandatory CPD and revalidation on the profession.

Have your sayComments from members of the BSAVA on any aspect of the EFRACom report and the proposed way forward are welcome, and should be directed to customerservices@bsava.com

An update on the Report of the House of Commons Environment, Food and Rural Affairs Committee (EFRACom) on the Veterinary Surgeons Act 1966

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A TARTAN AFFAIRThe 23rd BSAVA Scottish Congress occurred on the weekend of 911 May and was a huge success. The event took place in the Fairmount Hotel in St Andrews and combined a picturesque location, great accommodation and first-rate CPD. Ross Allan reports

The principal speakers for Mays Scottish Congress weekend were Clare Knottenbelt from the University of Glasgow and Alasdair Hotston Moore from Bristol University. Both presented a series of excellent lectures to the attending delegates, who left armed with more knowledge and skills to take back to practice. Mark Moran also delivered a series of talks to receptionists throughout the weekend, which proved extremely popular.

New formatFor the first time this year, a series of workshops took place during the afternoons, delivered by a wide range of expert speakers. These increased the range of topics available to delegates, with subjects as diverse as renal disease to heart failure; suture materials to anaesthesia. A total of 95 vets, 125 nurses, 25 receptionists and 125 exhibitors (from 42 companies) attended the weekend.

NightlifeA vital part of the Scottish Weekend is what goes on once the lectures have finished. This year on the Friday evening delegates enjoyed a Grease The Movie themed night, where those so-inclined went all-out with their fancy dress costumes.

SCOTTISH CONGRESS

There is always a reason to swing your partner at the annual ceilidh where traditional attire begs that eternal question about men in kilts

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Speakers Clare Knottenbelt and Alasdair Hotston Moore with Barbara Anne Innes of the Scottish Committee

SCOTTISH CONGRESS

On the Saturday there was a stunning Gala Dinner, where traditionalists donned kilts for the ceilidh. After the dinner and the presentation of prizes, Mary Fraser, BSAVA Scottish Region Chair, thanked her committee for their hard work. Then Richard Dixon, President Elect of BSAVA, highlighted the contribution that the Scottish region makes in the development of BSAVA, and encouraged members to consider joining their local group.

ExhibitionThroughout the weekend, the commercial exhibition was attracting delegates looking to take advantage of all the industry expertise on offer, with a total of 42 exhibitors attending. While many exhibitors were return visitors, some were attending for the first time, and all were pleased with the opportunity to meet delegates in a more relaxed environment than the practice office.

2009 dateWith this event now a fond memory, the Scottish region is making plans for next year. The dates for 2009 are 810 May and already talks have begun to create a CPD programme that will bring delegates back for more.

Grease was the word and the motion on Friday night where Pink Ladies showed other delegates how to get into the spirit of the evening

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LEGISLATION

6

LEGISLATION

AROUND THE CLOCK

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Providing emergency care at night and at weekends is no longer the chore it once was for many small animal practitioners, with dedicated out-of-hours clinics having opened up in most large towns across the country. But for colleagues working in mixed practices this traditional professional obligation is causing increasing practical, economic and legal problems. John Bonner reports

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LEGISLATION

AROUND THE CLOCK

Vets see it as a real professional challenge and for many this sort of caseload is the reason why they wanted to be vets in the first place.

In many areas where there is no external provider, groups of practices operate shared out-of-hours rotas or a single large practice runs the emergency services for the rest. John Bowers hospital practice in Plymouth has operated an emergency service for other practices in the city for several years and about 18 months ago set up a dedicated team that does not participate in the normal day rota.

These night staff approach their work with greater keenness, he says, knowing that they will not have to begin a full shift the next day, as would often happen under a traditional on-call rota. There is always the temptation to try to put clients off until the next morning if you are working on call. But with a proper team in place they will say to clients If you are worried, come on in. Moreover, the practice works more efficiently during the day and has been able to improve its service to its regular clientele by extending its normal consultation hours, he adds.

Impact of the professionRichard Dixon believes that the growth in emergency clinics has been good for the veterinary profession as a whole, as it has stimulated interest in emergency medicine as a distinct clinical discipline. Dealing with a regular supply of emergency cases has enabled staff to hone their skills and they are eager to pass on their knowledge to others by lecturing at CPD events and to students at the veterinary schools. That is important because the more undergraduates are trained in emergency medicine, the

higher will be their expectations of the care they can deliver when they go out into practice, he points out.

Out of townHowever, it is a very different story away from the major population centres where traditional mixed practices are struggling to provide an economically viable emergency service and face difficulties in recruiting young veterinary surgeons willing to take on the challenge of treating all species. Those problems will multiply if rural practices find they have to adhere to the letter of the European Working Time Directive, which would set a limit on the number of hours worked and impose mandatory rest periods after any time spent on call.

Sharing an out-of-hours rota with a neighbouring practice is not an option normally open to those businesses operating in less densely populated areas. Steve Grills, a partner in a four vet practice in Ivybridge, Devon, says the idea has been discussed informally with neighbours but is a non-starter because of the equine element to his practices caseload. There are only a few areas of the country where there are enough horses to make this work. We looked and realised that we would need to cover an area that stretched pretty all the way from the north to the south coast of the county, so it simply wouldnt be practical.

Under reviewThe RCVS is well aware of the difficulties that mixed practices are currently facing and has convened a working party to look for possible solutions. Jerry Davies, Royal College Treasurer and chair of the working party, said it would be consulting

Working rabbits arent exactly two a penny so one would expect an owner to provide the best possible care for such a rare beast.

But not the magician who rang Phil Hydes newly opened emergency clinic in Cardiff asking for an estimate. He didnt like what he was told and decided he would wait for an appointment with his usual vet. As a consequence of the delay, the rabbit died, the owner blamed Phil and took his grievance to the Royal College.

After looking at the evidence, the RCVS preliminary investigation committee accepted that the complaint was unfounded. Yet, dealing with resentful clients from other practices was not the only problem Phil faced in 1996 when he set up his clinic the first of its kind outside London. Initially, probably three out of four practices that I approached offering to take over their out-of-hours work said No. They were very concerned about supersession and I had to work really hard to persuade them to come on board. Even now we still have to be careful what our staff say and do, to prove that we are Honest Joes.

Staff recruitmentBuilding up enough business to ensure that the clinic would not have to rely on cross subsidies from his daytime clinic was another major challenge. But to Phils surprise, recruiting staff prepared to work through the night was never a problem.

That has also been the case for Richard Dixon, who founded the Vets Now group in 2002, which now operates 32 emergency clinics around the country. The sort of work that we do in these clinics is very different from routine veterinary practice.

LEGISLATION

AROUND THE CLOCK

widely both within the profession and with the animal-owning public over the next few months.

Alan Marshall, a partner in a seven vet mixed practice in Dumfries, is pessimistic about the likelihood of finding a simple answer. When it last looked at the issue of emergency care, the RCVS changed the wording in the Guide to Professional Conduct, advising members that they should make provision for 24-hour cover rather than necessarily providing it themselves. But he points out that the problems for mixed practice are much broader. These include the long-term economic woes of the livestock sector and the changing demographics of the profession, which has reduced the numbers

Recent months have seen an increase in the prices that cattle farmers have been receiving for their products but neither Steve nor Alan is yet convinced that this will translate into a sustained recovery for UK farm animal practice. Unless things do change for the better, it is very difficult to see where out-of-hours provision for farm animal clients is going to be in 20 years time, Steve warns.

But although both fear for the future, neither is willing to surrender the principle that mixed and farm animal vets should be prepared to go out and see a clients animals around the clock for 365 days a year. There is certainly an option for veterinary surgeons to follow their colleagues in many GP practices in withdrawing from a 24-hour service and passing responsibility to NHS call centres or the local hospital A&E department. I dont think we would want that this is something that we signed up for a very long time ago and I believe we should continue to provide it, Alan says.

of young vets willing to take part in a demanding on-call rota.

The RCVS may have to consider some radical ideas to allow mixed practices to meet their traditional obligations on out-of-hours cover. One idea that has been suggested is moving towards an American system in which farm vets visit clients for herd health consultations but emergency cases are brought into the practice for treatment.

Mixed responseSteve Grills doubts whether such a system would work under UK conditions. Leaving aside the issue of the welfare implications of transporting a typical bovine emergency, such as an abdominal surgery or dystocia case, he believes farmers would be unwilling on cost grounds to transport animals over long distances. I think this would lead to a similar situation that we have already with sheep, that if the farmer cant deal with the cow himself he will simply shoot it.

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24-HOUR EMERGENCY COVER ACROSS EUROPEA recent survey asked National FECAVA representatives about the provision of OOH in their countries

Questions asked1. Is 24-hour emergency cover

a mandatory requirement in your country?

2. If so, is delegation to another practice or dedicated out-of-hours service allowed?

Country Q1 Q2UK Yes YesNorway NoBulgaria NoIreland Yes YesSwitzerland For clinics No Lithuania NoPoland For clinicsMalta Yes YesFinland NoSweden NoFrance NoEstonia NoPortugal For clinics YesBelgium For clinics YesGermany For clinicsLuxembourg Yes YesSerbia Yes YesLatvia NoTurkey NoNetherlands No

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CLINICAL CONUNDRUM

CLINICALCONUNDRUM

Case PresentationA 9-year-old male neutered Labrador is presented with a history of intermittent vomiting and diarrhoea over the preceding 8 months, which has worsened acutely. On presentation he is depressed, appears to be in pain and has a distended abdomen.

This Clinical Conundrum from Esther Barrett of Bristol Veterinary School Imaging Department invites you to consider your diagnostic imaging approach to a case presenting with chronic gastrointestinal disease and acute abdominal pain

Loops of gas-filled intestine are easily appreciated on radiographs, but can hinder a thorough ultrasonographic examination. In a case with acute obstruction and multiple gas-filled intestinal loops, X-ray examination may well provide a rapid diagnosis without the need for ultrasound.The information gained from an ultrasound examination is very operator-dependent, and is also influenced by the quality of the equipment available.The general location of an abdominal mass is often easier to appreciate using X-rays, but determination of the organ of origin may require ultrasonography.Free abdominal fluid results in a marked loss of abdominal detail, limiting the information to be gained from radiographic examination. Conversely, free fluid allows excellent transmission of sound waves, therefore facilitating ultrasonographic examination.Wall thickening and GI motility cannot be assessed on plain radiographs, but are readily evaluated with ultrasound.Any suspicion of neoplasia is an indication for thoracic radiography, looking for evidence of metastases.

Abdominal radiographyThorough radiographic investigation of the abdomen requires a minimum of two views, typically a lateral and a ventrodorsal (VD) projection. In some cases, such as the investigation of a suspected foreign body, adding the opposite lateral and dorsoventral (DV) projections is indicated in order to alter the distribution of gastrointestinal gas and fluid, thereby providing more information about gut contents. For animals

Abdominal radiography or ultrasonography which will be most useful?This is a common clinical dilemma, especially when funds are limited. Radiography and ultrasonography are complementary imaging techniques and ideally you would perform both. Abdominal radiography is best performed first, as this should provide a better overview of the abdominal contents, and may help to direct the ultrasound examination.

Honorata Kawecka | Dreamstime.com

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CLINICAL CONUNDRUM

CLINICAL CONUNDRUM

also undergoing abdominal ultrasonography, it is common practice (but not ideal) to take a single lateral abdominal radiograph.

Gastrointestinal radiography what should you look for?As with all radiographs, it is important that the entire film is read in a logical manner, ensuring that attention is paid to peripheral structures as well as to the abdominal contents.

The normal position, shape and size of the abdominal organs should be assessed; the presence of any abnormal structures and their relationship to adjacent organs should be noted.The GI tract should be assessed for the size of the stomach and intestinal loops, the nature of their contents and the distribution of the intestinal loops. Possible gastric distension is a fairly

subjective judgment in many cases. However, various parameters are used for evaluating small intestinal diameter. In the dog, it is suggested that normal intestine should not exceed twice the width of the 12th

rib. Intestinal diameter that exceeds four times the width of the last rib should be considered pathological.

In the normal fasted dog, the GI tract should contain a mixture of fluid and gas, with variable amounts of faecal material present within the colon. In dogs that scavenge, incidental small mineralized fragments may be seen throughout the intestine. Abnormal dilation of small intestine loops with gas or fluid opacity should be considered as grounds to suspect intestinal obstruction. A localised accumulation of small mineralised opacities (a gravel sign) often occurs just proximal to a chronic partial obstruction. Intestinal foreign bodies may be radiopaque and easily detected, but are frequently radiolucent and harder to visualise on plain radiography.

Small intestinal loops should have a smooth curving appearance and should be fairly evenly distributed throughout the mid and caudal abdomen.

An assessment should be made of the peritoneal cavity. The visible serosal detail of the

abdominal organs should be evaluated. In a normal animal, fat within the mesentery is more radiolucent than adjacent soft tissue structures, allowing the serosal margins of the abdominal organs to be distinguished from each other. A loss of this distinction (serosal detail) typically occurs when the mesentery becomes infiltrated with fluid, inflammatory or neoplastic cells and the normal fat opacity is lost. Instead the mesentery takes on a soft tissue opacity, merging with the surrounding organs and causing their margins to become obscured. A lack of abdominal fat in very young or thin animals will have the same effect.

The peritoneal cavity should be carefully examined for the presence of free gas. Larger pockets of free gas are most easily seen on lateral radiographs highlighting the caudodorsal aspect of the

Figure 1: Lateral abdominal radiograph revealing a poorly defined mid-abdominal mass displacing the small intestine dorsocaudally, small intestinal corrugation, poor serosal detail and several gas lucencies suggestive of free abdominal gas

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CLINICAL CONUNDRUM

diaphragmatic line. Smaller pockets are harder to identify and may appear as irregular gas lucencies throughout the abdomen, but outside the GI tract. The presence of free gas together with a loss of serosal detail is commonly seen after laparotomy, but should be considered suspicious for GI perforation and secondary peritonitis if there is no history of recent surgery.

Contrast radiography may be used to provide additional information about the GI tract. As intestinal walls and fluid intestinal contents are both represented as a soft tissue opacity, they cannot be distinguished from each other and it is not possible to make a judgment of wall thickness from plain radiographs. The use of a positive contrast agent (typically liquid barium, administered orally) allows assessment of wall thickness, outlines the mucosal surface of the intestine, can help to highlight obstructive lesions and foreign bodies, and provides a semi-quantitative assessment of GI motility. In many cases, ultrasonography is now used as a more efficient alternative to contrast studies. The use of barium is contraindicated where GI perforation is suspected.

In the case being discussed, lateral abdominal and thoracic radiographs were taken. The thorax appeared unremarkable. The abdominal radiograph (Figure 1) demonstrated a poorly defined mid-abdominal mass, approximately 8 cm in diameter, displacing the small intestine dorsally and caudally. It was not possible to determine the origin of this mass from this radiograph and a VD view would have been useful in providing more information about its location.

There was no evidence of intestinal dilation, but several loops of small intestine have lost their normal smooth curvature and have an abnormal corrugated appearance (Figure 2). A generalised loss of serosal detail was evident throughout the abdomen, and several small irregular gas lucencies suggesting free gas were identified.

Ultrasonography what should you look for?When performing any ultrasound examination, it is important to be as logical as possible. Ideally the GI tract should be examined as part of an ultrasonographic assessment of the entire abdomen. Particular attention should be paid to the stomach, small intestine, large intestine, the surrounding mesentery and mesenteric lymph nodes, and the presence of any free abdominal fluid. Should an abdominal mass be found, every effort should be made to identify the organ of origin.

The GI tractExamination of the GI tract is often hindered by the presence of gas, which effectively blocks the transmission of the ultrasound waves. In most cases, changing the position of the dog, the contact point of the probe and being patient will overcome this problem. For elective cases, an overnight fast is advised to reduce gastrointestinal contents.

The walls of the GI tract should be examined for evidence of normal wall layering and thickness. They are characterised by having a 5-layered structure (mucosal surface, mucosa, submucosa, muscularis, subserosa), which should be clearly seen with a reasonably high frequency (7.5+MHz) transducer. Normal wall thickness in the dog is up to 5 mm for the stomach, up to 4.8 mm for the small intestine and up to 2 mm for the large intestine. A loss of the normal layered appearance, together with a marked increase in thickness, is suggestive of GI neoplasia. Inflammatory disease typically results in increased wall thickness, but with retention of the layering. Longitudinal corrugation of the wall structure may be seen with a linear foreign body (often visible in the lumen) or with local irritation of the intestine (e.g. due to peritonitis).Ultrasound allows a real time assessment of GI motility. Peristalsis within the stomach and proximal duodenum should be approximately 45 waves/minute and within the rest of the small intestine approximately 13/minute.Intestinal luminal contents and diameter should also be assessed. Gas, dense materials and faecal material

Figure 2: Enlarged

image of loop of small

intestines with corrugated

appearance

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CLINICAL CONUNDRUM

typically cause acoustic shadowing, which prevents the visualisation of the far wall, making it impossible to measure luminal diameter at that point. Most foreign bodies present a brightly reflective interface, the shape of which depends on the shape of the foreign body, and cast an acoustic shadow deep to this interface. Intestinal obstruction is characterised by loops of dilated intestine proximal to the lesion, with the intestine distal to the obstruction often being empty. Depending on the duration of the obstruction, intestinal motility may be increased or decreased.

The surrounding mesentery and lymph nodes

The normal mesentery contains variable amounts of fat, usually appearing hyperechoic compared to the intestinal walls. Infiltration with inflammatory or neoplastic cells or the presence of free fluid will typically cause a marked increase in mesenteric echogenicity.With a high frequency (8.5+MHz) transducer, normal mesenteric lymph nodes are frequently observed adjacent to the mesenteric vessels. These should be moderately echogenic, homogenous in appearance and fusiform in shape, and are typically less than 68 mm in diameter. Lymph nodes that appear markedly enlarged, heterogenous, rounded or irregular are likely to be abnormal.

Abdominal fluidFree abdominal fluid is readily identified on ultrasonography, typically as anechoic-to-hypoechoic spaces separating out the abdominal organs. Increased echogenicity and the identification of swirling echoes within the fluid are consistent with increased cellularity of the fluid, for example with abdominal haemorrhage or peritonitis.

Abdominal masses

Ultrasound is very sensitive for the detection of abdominal masses, but identification of the organ of origin can be challenging. It is often possible to

CLINICAL CONUNDRUM

follow the mass back to a recognisable structure, but this can become increasingly difficult with increasing mass size. The presence of gas within a mass lesion should raise the index of suspicion for GI involvement.

Figures 3 and 4: Abdominal ultrasonograms revealing a hypoechoic mass with hyperechoic region consistent with gas, contiguous with normal intestine

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CLINICAL CONUNDRUM

In this case, a large and fairly well defined hypoechoic mass was observed caudal to the spleen, consistent with the mid-abdominal mass identified on the radiographs. The mass contained an eccentrically located intensely hyperechoic area, consistent with gas, suggesting that it was likely to be of GI origin (Figures 3 and 4).

This was confirmed by following the lesion back to normal-appearing small intestine. The local lymph nodes were markedly enlarged (up to 2 cm in diameter), heterogenous and irregular in shape. A moderate amount of free abdominal fluid was present; this contained some swirling echogenic debris (Figure 5). Several corrugated loops of small intestine, with normal wall layering and thickness, were identified in the caudal abdomen.

Differential diagnosesThe additional information provided by the ultrasound examination suggested that the most likely diagnosis for the mid-abdominal mass was intestinal neoplasia. The presence of intralesional gas, complete loss of any layering structure within the lesion and evidence of marked local lymphadenopathy are typical findings for a malignant GI neoplasia.

Benign GI tumours are less common, and are more likely to arise from a single wall layer (especially the muscle layer), leaving the rest of the layering intact. The most common differential diagnoses for malignant GI neoplasia in the dog would include adenocarcinoma and lymphoma.

Other differential diagnoses for the intestinal mass are less likely. Granulomatous intestinal disease can appear ultrasonographically identical to intestinal neoplasia, but is usually of fungal origin and, although endemic in other parts of the world, is very rare in the UK. Lymphangiectasia has been reported as a focal intestinal mass but this is also rare; a more typical ultrasonographic presentation for this disease would be a normally layered intestinal wall structure

with echogenic striations identified within the normally hypoechoic mucosal layer. Overall wall thickness is sometimes, but not always, increased.

The loss of serosal detail noted on the abdominal radiograph was confirmed to be due to free abdominal fluid. Differential diagnoses for ascites are numerous. A transudate may be seen secondary to hypoproteinaemia, right-sided heart failure and portal hypertension. Causes of abdominal exudates include leakage of bile or urine, haemorrhage, neoplasia, sterile inflammation and peritonitis. In this case, the corrugated, irritated appearance of the small intestinal loops, noted on both radiographic and ultrasonographic examination, was typical of peritonitis. Together with the radiographic suspicion of free abdominal

air, it was considered likely that the mass lesion had resulted in intestinal perforation.

Diagnosis and outcomeIntestinal perforation with secondary peritonitis should be considered a surgical emergency. On exploratory laparotomy, a 10 cm diameter mass was found arising from the descending duodenum, with a single area of intestinal perforation identified.

Three markedly enlarged lymph nodes were located adjacent to the mass, and there was evidence of generalised peritonitis. Given the poor prognosis, the dog was euthanised at the request of the owner. Histopathology was consistent with lymphoma involving the duodenum, adjacent jejunum and local lymph nodes.

Figure 5: Abdominal ultrasonogram revealing hypoechoic free abdominal fluid (arrowed) with swirling echogenic debris adjacent to the spleen

Contribute a Clinical ConundrumIf you have an unusual or interesting case that you would like to share with your colleagues, please submit photographs and brief history, with relevant questions and a short but comprehensive explanation in no more than 1500 words to companion@bsava.com All submissions will be peer-reviewed.

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HOW TO

SELECT AND CARRY OUT A GASTROPEXY PROCEDURE

HOW TO

A gastropexy is the surgical attachment of the stomach to the abdominal wall, most commonly as a means of preventing recurrence of gastric volvulus.

Prophylactic gastropexyDue to the success of gastropexy in preventing recurrence of GDV, it would appear logical to offer prophylactic gastropexy in those breeds or lines at most risk from GDV. In bitches, such a procedure could be readily carried out at the same time as a routine ovariohysterectomy.

Clearly the risks of occurrence of GDV need to be weighed against the risk of anaesthesia and elective surgery in an otherwise healthy animal. From a surgeons and an anaesthetists point of view there is less risk in carrying out a planned elective

procedure than performing emergency surgery on a GDV patient.

Recently the risks versus benefits of prophylactic gastropexy have been examined by comparing the lifetime probability (risk) of a dog dying from GDV against the expected cost-effectiveness of prophylactic gastropexy. In the group of American dogs studied, it was shown that although prophylactic gastropexy would reduce mortality from GDV, it is only cost-effective in very high risk patients. There are also ethical issues in considering carrying out such a prophylactic procedure, which are outside the scope of this article.

John Williams of Oakwood Veterinary Referrals outlines the keys to successful surgery

PRACTICAL TIP:A gastropexy procedure should be performed in all cases of gastric dilatation volvulus (GDV) or gastric dilatation (GD)

Table 1: Gastropexy techniques

Technique Adhesions Advantages Disadvantages

Simple suturing Poor adhesions

Relatively quick High probability of recurrence

Tube gastropexy Adequate adhesions

Low probability of recurrence. Relatively quick to carry out

Patient interference. Increased morbidity. Increased hospitalisation

Incisional gastropexy

Strong adhesions

Low probability of recurrence

Belt-loop gastropexy

Strong adhesions

Low probability of recurrence

Circumcostal gastropexy

Strong adhesions (probably the most secure)

Low probability of recurrence

Technically demanding. Risk of rib fracture. Risk of pneumothorax

Incorporating (linea alba) gastropexy

Strong adhesions

Low probability of recurrence

Not generally suitable as the gastric fundus is sutured into the midline laparotomy closure. There is a risk of gastric perforation if any further abdominal surgery is carried out

Gastrocolopexy Low probability of recurrence

Possibly higher potential for recurrence

Laparoscopic gastropexy

Strong adhesions

Low probability of recurrence

Generally not suitable for the acute case. Specialist equipment required

A gastropexy should always be carried out when surgery is performed in the management of gastric dilatation volvulus (GDV). In cases of simple dilatation, which can be managed initially by gastric decompression and when surgery can be delayed, gastropexy should always be an elective procedure. When there is acute GDV the patient must be stabilised prior to anaesthesia and surgery. This is outside the scope of this article and the reader is referred to the BSAVA Manual of Canine and Feline Abdominal Surgery.

Given that dogs that have had one episode of gastric dilatation (GD) are at an increased risk of repeated episodes, a gastropexy aids in prevention of future volvulus. However, it does not decrease the risk of gastric dilatation.

In cases that present with GDV, recurrence rates can be as high as 80% if gastropexy is not carried out; gastropexy reduces the risk of recurrence to less than 10%. Furthermore, there is a dramatic increase in median survival in gastropexy (547 days) compared with non-gastropexy (188 days) patients. A number of gastropexy techniques have been described and are summarised in Table 1.

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HOW TO

HOW TO SELECT AND CARRY OUT A GASTROPEXY PROCEDURE

BeLT LooP GAsTRoPexyThis is the authors preferred method of creating a gastropexy as it provides excellent adhesions and is the authors technique of choice in both acute cases and for elective gastropexy. It is also technically feasible for the unassisted surgeon.

TechniquePatient positioning: Dorsal recumbency

Assistant: Not essential, but can be useful until the surgeon becomes experienced with the technique

Equipment extras: Balfour abdominal retractor; large abdominal swabs

Surgical procedure

1 A routine, midline abdominal incision.

2 A tongue of seromuscular tissue is created from the stomach wall over the pyloric antrum; the author tries to incorporate at least two short gastric arteries (Figure 1).

3 Two parallel incisions are made in the transversus muscle of the abdominal wall, caudal to the costal arch and a tunnel, wider than the flap, is created by blunt dissection with long artery forceps (Figure 2).

4 The seromuscular pedicle is drawn gently by means of stay sutures, or Babcock forceps through the tunnel (Figure 3) and then sutured into its original bed in the gastric wall (Figure 4).

5 The pedicle is anchored into place with simple interrupted 2 or 3 metric monofilament synthetic suture material. Absorbable sutures such as polydioxanone, glycomer 631 or polyglyconate or non-absorbable polypropylene are suitable choices.

Figure 1: A tongue of seromuscular tissue is created from stomach wall over the pyloric antrum, incorporating two short gastric arteries

Figure 2: Two parallel incisions are made in the transversus muscle of the abdominal wall, caudal to costal arch; a tunnel, wider than the flap, is created by blunt dissection with artery forceps

Figure 3: The seromuscular pedicle is drawn gently through the tunnel with Babcock forceps

Figure 4: The flap is sutured into its original bed in the gastric wall

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HOW TO

HOW TO SELECT AND CARRY OUT A GASTROPEXY PROCEDURE

Figure 5: Foley catheter being drawn into the abdominal cavity

Figure 7: omentum wrapped around catheter. ( John Williams)

Figure 9: Chinese finger trap suture. ( John Williams)

Figure 6: Foley catheter being introduced into the stomach (pyloric antrum) after pre-placing a purse-string suture

Figure 8: Relative positions of catheter, stomach and body wall

TuBe GAsTRoPexy/GAsTRosTomyTube gastropexy has the advantage of being quick to perform and allowing gastric decompression postoperatively. Though easy to place there is increased morbidity and longer hospitalisation periods associated with this technique.

TechniquePositioning: Dorsal recumbency

Assistant: Not essential, but is useful

Equipment extras: Balfour abdominal retractor; large abdominal swabs; long artery forceps

Surgical procedure

1 A routine, midline abdominal incision.

2 A subcutaneous tunnel is made by means of blunt dissection with long artery forceps, from a stab incision in the skin lateral to the laparotomy wound, and caudal to the last rib on the right.

3 A Foley catheter is then drawn through the tunnel into the abdominal cavity (Figure 5).

4 A purse-string suture of 2 metric polydioxanone or glycomer 610 is preplaced in the wall of the pyloric antrum

5 A stab incision is made within the suture into the gastric lumen.

6 The Foley catheter is placed into the stomach (Figure 6), the balloon inflated and the purse-string suture tightened.

7 Omentum is mobilised and wrapped around the Foley catheter (Figure 7).

8 Traction is then placed on the catheter to draw the pyloric antrum into firm contact with the abdominal wall and an absorbable synthetic suture material is used to suture the gastric serosa to the abdominal wall (Figure 8).

9 The catheter is fixed in place either with a Chinese friction finger trap suture pattern (Figure 9) or by means of zinc oxide butterfly tapes.

Postoperative careThe tube can be removed a minimum of 57 days after placement in order to allow firm adhesions to form and thus prevent

leakage of gastric contents into the abdominal cavity. The bulb of the Foley catheter is deflated and the tube is pulled out. The small hole in the body wall will granulate closed in 24 hours.

Complications include premature dislodgement and inflammation around the stoma.

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HOW TO

Key to successChoose the most appropriate technique that you are most familiar with. If you are unfamiliar with gastropexy, carry it out as an elective procedure so that its use in the acute case will be straightforward.The key to successful management of acute GDV is prompt stabilisation followed by surgery to create a gastropexy.Failure to create a gastropexy will inevitably lead to recurrence.

HOW TO SELECT AND CARRY OUT A GASTROPEXY PROCEDURE

CIRCumCosTAL GAsTRoPexyThis is a technically difficult procedure for which an assistant is essential. Though it produces strong adhesions if carried out incorrectly, there is the potential to fracture the rib and/or induce a pneumothorax. This technique is therefore more appropriate for a prophylactic gastropexy, rather than on an emergency basis.

LAPARosCoPIC GAsTRoPexyLaparoscopic stapled gastropexy and laparoscopic-assisted gastropexy have been described. These minimally invasive techniques offer alternatives to open abdominal surgery, but access to specialised equipment is required for these techniques and they will not be described here.

INCIsIoNAL GAsTRoPexyThis is the simplest technique to use as it is straightforward and relies on healing between the edges of a peritoneumtransversus abdominis muscle incision and a seromuscular incision in the pyloric antrum.

TechniquePositioning: Dorsal recumbency

Assistant: Not required, but is useful

Figure 10: Partial thickness incision in the pyloric antrum

Figure 11: Incision in the right lateral body wall through the peritoneum and transversus abdominis muscle

Figure 12: suturing the gastric incision edges to the edges of the body wall incision with a simple continuous suture pattern (caudal edges are sutured in same manner)

Equipment extras: Balfour abdominal retractor; large abdominal swabs

Surgical procedure

1 A routine abdominal midline incision.

2 A 45 cm incision is made in the pyloric antrum (taking care not to penetrate the submucosa) (Figure 10).

3 A similar incision is made through the peritoneum into the transversus abdominis muscle 68 cm from the laparotomy wound edge on the right (Figure 11).

4 Using 3 or 2 metric monofilament absorbable suture material the wound edges are sutured together (Figure 12). The two cranial incisions are closed first and then the caudal incisions.

AcknowledgementTable 1 and the line diagrams in this article have been reproduced from the BSAVA Manual of Canine and Feline Abdominal Surgery, edited by John Williams and Jacqui Niles. The diagrams were drawn by Samantha Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission.

352 pagesPublished October 2005member price: 49.00

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FORMULATING THE FORMULARY

It started with the phone call Would I consider becoming Editor-in-Chief (EIC) of the BSAVA Formulary, as Bryn Tennant had decided to hang up his red pen? The Formulary is probably one of the most tangible and most regularly used benefits of BSAVA membership. So this was like being asked to look after someones family silver. It was both a privilege and a responsibility.

Having edited a BSAVA Manual (the infectious diseases one) a few years previously, I knew that this project would consume about a year of my life. The first stop was to consult with colleagues about my involvement. The reaction of several was you must be mad! Others were more supportive

perhaps recognising that this project was the sort of forensic academic (anally retentive?) work that I enjoy. I was also encouraged by the fact that, having worked with BSAVA Publications and in particular the Publishing Manager Marion Jowett, I knew that there was considerable technical support and plenty of experience to guide me through.

FaceliftThe BSAVA had decided that the Formulary would benefit from a bit of a facelift for its 6th edition. I was keen to see a splash of colour and suggested to the BSAVA that each drug name should be distinguished by a bright, identifiable colour. The idea of tabs down the side was inspired by a telephone directory.

In the future it is planned to use the database of material now gathered to power a web-based version of the

Formulary, with additional features, such as enhanced searchability and references. We are also considering adding doses for species not normally considered to be small animals a dose for alfaxalone for a crab-eating macaque, perhaps?

The Editorial PanelAssembling the Editorial Panel was not initially straightforward the supply of experts in each area is limited and they are busy people with demanding day jobs. They do a huge amount of work, without which the Formulary would not exist. We all owe them a great deal of thanks for giving up their time.

To assemble the database, each member of the panel had to take the old text, check every word, and update/rewrite many sections. New drugs had to be identified from the VMD website and company press releases. In addition, the material was reorganised into a new standard format so that it could be

parsed into a database. This was like taking the family silver, smashing it

into 415 different bits, and then sticking it back together and hoping that it would still look roughly the same. It was a daunting task.

The BSAVA Small Animal Formulary is one of the Associations most valued member benefits. As Editor-in-Chief of the 6th edition, Ian Ramsey describes what it takes to produce this invaluable pocket guide

tangible and most regularly used benefits of BSAVA membership. So this was like being asked to look after someones family silver. It was both a privilege and

Having edited a BSAVA Manual (the infectious diseases one) a few years previously, I knew that this project would consume about a year of my life. The first stop was to consult with

In the future it is planned to use the database of material now gathered to power a web-based version of the

many sections. New drugs had to be identified from the VMD website and company press releases. In addition, the material was reorganised into a new standard format so that it could be

parsed into a database. This was like taking the family silver, smashing it

into 415 different bits, and then sticking it back together and hoping that it would still look roughly the same. It was a daunting task.

Ian Ramsey with BSAVA Publishing Manager, Marion Jowett

PUBLICATIONS

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BSAVA members entitled to a free copy of the BSAVA FormularyEvery BSAVA member is entitled to one complimentary copy of the new edition. This process began at Congress where delegates were able to pick it up hot off the press from the designated stand on the balcony. Those who could not collect it at Congress were sent their copies by post during May and June. If you have not had your copy please contact customerservices@bsava.com. Additional copies can also be purchased online at www.bsava.com or call 01452 726700 for further information.

customerservices@bsava.co

Drugs new to the 6th edition44 new drugs

AglepristoneAlfaxaloneArnicaCarbamazepineCarbomer 981CefovecinCeftiofurClonazepamClopidogrelDeltamethrinDexmedetomidineDifloxacinDirlotapideFirocoxibFluticasone

GabapentinHeparin (low molecular weight)Hydrocortisone aceponateImipenemImipramineIspaghulaLeflunomideLevetiracetamLoratadineLorazepamMaropitantMetaflumizoneMitratapideMoxidectinMycophenolic acid

NimesulideOsateroneP07PParoxetinePiperacillinPiroxicamPyriproleResocortol butyrateSalbutamolSertralineSulfadimethoxineTacrolimusTramadolTravoprost

Drugs deleted from the 5th edition28 drugs deleted

AlbendazoleAlfaxalone/AlfadoloneAlimemazineAnti-bacterial immunoglobulinAuranofinAurothiomalateBenzyl penicillinCalcitoninCefalonium

CefoxitinChlorpropamideClorazepateDexamfetamine sulphateDigitoxinDipropionateDisopyramideEtidronateFlunixin meglumineGriseofulvin

IpecacuanhaLevamisoleMethylphenidateNetilmicinPenicillin VPyriproxyfenSulfadiazineSulfamethoxazoleTesta triticum tricum

Getting stuck inMy role was to act as an academic reviewer of all submissions. I raised questions on diverse issues, such as which drugs should be dropped, which doses were defendable, which species we should exclude. Of particular concern were the chemotherapeutic agents that represent significant health hazards to the people that handle them. Add to these the esoteric antibacterials that should only be used in exceptional circumstances, controlled drugs with addictive properties, and many drugs not authorised for veterinary use with little published data, and the number of questions became huge.

Slowly but surely the editors and I worked our way through them. Over 1000 emails were sent and received. Eventually, after nine months, we succeeded in generating a complete document from the database ready for the BSAVA Publishing Team at Woodrow House to work their magic.

The information in the Formulary contains the very best and most accurate information available to us at the time of creation. However, it seems every week a new dose, indication or drug is published. The sooner we hear about it, the sooner we can put it into the database ready for the next edition. If you find something you think should be included, excluded or improved then please contact me at formulary@bsava.com.

AchievementEditing the Formulary was a steep learning curve. Not only did I have to get to grips with many drugs in a large range of species but also learned about parsing into databases, using those databases to extract useful lists, and websites. The thrill of seeing it finally in print at Congress was amazing and there is not a day that I regretted the decision to do this, even when the going was tough.

PUBLICATIONS

20 | companion

PETSAVERS

Improving the health of the nations pets

MARATHON EFFORThad been wondering what to do to pass that time. However, watching yourself and other people around you on a big screen, admiring the fancy dress costumes and enjoying this remarkable warm sunshine made the time fly. I had thought I would be nervous but, on the contrary, I felt pretty relaxed, whether that was due to the good weather or to that tiny amount of red wine I had had the night before the first drop of alcohol for many months.

Getting off the blocksI had begun training about eight months prior, as soon as I knew I had received a London Marathon place via Petsavers. To be

one of the 35,000 runners who run the Flora London Marathon each year you can either enter a lottery system, where you only hear in December whether you have a place, or you can run for a charity that has already organised an entry. Most charities request that the runner raises a minimum sponsorship of 1500 and this was indeed what Petsavers asked me to do (as well as running the 26 miles!). Raising this amount of money was somewhat daunting and I thought the earlier I started, the better.

Show me the moneyAnybody who has done something for charity may by now be shaking his or her head because, as I found out, people dont like to give money when the event is still many months away. It was around Congress time that I started to panic because I had only managed to raise the halfway mark and the Marathon was just two weeks away.

From the Petsavers stand at the NIA a campaign was launched, and old colleagues of mine must have regretted walking past the Petsavers stand this year. Then a miracle happened thanks to one extremely generous donation I was out of the woods. The pressure of fundraising now lifted, I was relieved and worried at the same time: it started to look like I had no excuse but would actually run this Marathon.

Mind, body and solesThe commitment of running 26 miles being made, to become physically fit you first need to become mentally focussed. Previously, every day seemed to contain a mental battle wanting to exercise but finding other things to do instead. Making

Simone der Weduwen describes the pleasure and pain of running the London Marathon to raise funds for Petsavers

After months of training in British winter weather, Sunday 13 April Marathon day started with glorious sunshine. I was more prepared for gale-force winds, rain, hail and even snow, but not for running under a burning sun. When I saw people putting on sun cream I had to admit that my preparations for race day had lacked this optimism in the British weather.

Race day nervesThe atmosphere at Greenwich Park was amazingly relaxed. Due to early roadblocks most runners are dropped off at least two hours before the start of the event and I

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PETSAVERS

PHOTO COMPETITIONThe theme for the 2009 Petsavers photography competition is Pets at holiday time. This is a great opportunity for vets and pet owners alike to demonstrate their amateur camera skills, with great prizes on offer and a chance to have their work displayed publicly in the ICC during BSAVA Congress 2009.

This also provides a great opportunity to talk to your clients about the work of Petsavers and how they can get involved.

Further details will be outlined here in companion, on the Petsavers website, and in emails over the coming months. If you want to know more about getting some promotional material for your practice, email info@petsavers.org.uk or call 01452 726700. n

the decision to put exercise before other tasks was an effort in itself, but I knew the training needed to be done above and before everything else.

I had done a fair amount of training in the past, though I knew you will always wish you had done more. Especially when, around mile 19, things dont seem to be going so smoothly anymore and you start to wonder whether you will ever reach the finish line. On the day, although the first 12 miles or so had been in glorious sunshine, this suddenly changed and a cool rain came down which, at first, was rather nice.

However, when the rain proved relentless it was a completely different story. It was then time for the runners to applaud the people watching, rather than the other way around. I dont know how I got through from mile 19 to mile 23, but that is what the marathon is all about. It is absolutely crazy to choose to run a distance of 26 miles, yet with mind over matter we all got there.

All worthwhileNever, never, never again goes through your mind when going over the finish line, but once you collect your medal and goodie bag and have limped towards your supporters to receive their congratulations on your achievement, the euphoria begins. It wasnt so bad after all, you tell yourself. Plus, 4 hours 18 minutes is a reasonably good time for someone in the category of vets!

I would like to thank everybody who sponsored me, helping to raise around 3000 for Petsavers. Supporting an important cause isnt always about just putting your hand in your pocket you can also put on a running vest. So now its your turn n

GRANT APPLICATIONS REMINDERApplications for Petsavers grants to be submitted by 1 September 2008Each year Petsavers awards grants as part of its commitment to moving veterinary medicine forward. The results of the funded research are published in the Journal of Small Animal Practice and other channels to ultimately improve the health of all small animals.

Clinical Research ProjectsQualified veterinary surgeons are invited to apply for funds to support a clinical

study in small animal pets, the objective of which is to advance the understanding of the cause and/or management of a clinical disorder. The projects should not involve experimental animals and should further the knowledge of the small animal practitioner. Joint applications between veterinarians in practice and academia are welcome. Funding is available for grants between 1,000 and 8,000.

If you are interested in applying, call Petsavers on 01452 726737 or email info@petsavers.org.uk for more information. n

Suprijono Suharjoto | Dreamstime.com

22 | companion

INTERNATIONAL AFFAIRS

INTERNATIONAL AFFAIRS

SUPPORTING SOUTH AFRICA

ANIMAL HEALTH STRATEGY

PET PASSPORTS

Last year BSAVA Council voted to support a CPD meeting in Malelane, South Africa, in conjunction with WSAVA. The meeting was held in April at the Malelane Intervet farm, close to the Mozambique border, and the topic was Anaesthesia and Pain Control (including the use of local anaesthetic).

The speaker was Dr Kenneth Joubert, a specialist anaesthetist and world class speaker who works in specialist practices in and around Johannesberg. There were 33 delegates, including 24 from Mozambique, plus local state vets. Evidently a significant number of vets are unable to attend other CPD events because of cost, and so they were very appreciative of a free course presented by such an excellent lecturer. n

The European Parliaments vote to extend the derogation (which applies to the UK, Ireland, Sweden, Finland and Malta) of the Non-Commercial Movement of Pet Animals Regulation (EC No 998/2003) to 30 June 2010 is good news.

The UKCG needs to make the best use of this extension to argue our case for making the special arrangements permanent, and to this end have set up a working group to produce a position paper and action plan.

UEVP congratulates the Commission of the European Parliament on producing a concise and well balanced report, but has several points to make with regard to preventing the spread of rabies and tick-borne disease to those countries which are islands, as wildlife cross-border transmission is less likely.

These include insisting on the treatment of animals with a product containing praziquantel before entry, that the passport be amended to certify that the veterinary surgeon has administered the tick and tapeworm treatment, increased surveillance and data collection on the spread of tick-borne disease, and the compulsory registration of all microchipped animals on a central European database. n

The EU Animal Health Strategy was established in 2004, and initially evaluated EU animal health policy from 1995 to 2004. The Communication on Animal Health Strategy (CAHS) for 20072013 was published on 19 September 2007. In broad terms it aims to promote animal welfare and health, and thereby prevent the spread of disease.

The BSAVA International Affairs Committee (IAC ) has raised concerns that companion animal issues are being dumbed down in favour of the farm animal side. Both BSAVA and the Union of European Veterinary Practitioners (UEVP) are keen to get companion animal issues moved up the agenda and have identified six areas on which they wish to lobby the Commission, which include: registration of companion animals moving across borders; infectious disease surveillance; education on control measures to prevent the spread of disease; wider acceptance of the European Convention for the Protection of Pet Animals (including in the UK); the economic value of pet ownership; and companion animal representation on the Advisory Committee to the Commission.

For further details on The Communication on Animal Health Strategy, visit www.defra.gov.uk/animalh/ahws n

Concerns have been raised that companion animal issues are being dumbed down in favour of the farm animal approaches

Jo Arthur from BSAVAs International Affairs Committee reports on the opportunity to extend the UKs special arrangements

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WSAVA NEWS

ANIMAL WELFARE UPDATE

The British Veterinary Association (BVA) used World Veterinary Day to showcase the global role of the veterinary profession in raising standards of animal welfare by signing up to the Universal Declaration on Animal Welfare (UDAW). Further demonstrating its commitment to animal welfare, the BVA has also formally supported the UDAW. The Declaration, which represents the worlds first international agreement on animal welfare, is an agreement amongst people and nations to recognise that sentient animals are capable of pain and suffering, deserving consideration and respect, and calls for effective animal welfare legislation to be developed and enforced around the world. It is hoped that the Declaration will ultimately be adopted by the United Nations.

Presidential endorsementBVA President Nick Blayney stated I am delighted that BVA is supporting this vital campaign to recognise the responsibilities that humans have towards the welfare of sentient animals. I wholeheartedly endorse the inclusion within the Declaration of the Five Freedoms as the guiding principles of animal welfare.

I strongly believe that the veterinary profession should be part of this important global initiative, and hope that other veterinary associations around the world will sign up to this campaign. I also fully support the proposal to take the campaign to the United Nations, and hope that the Declaration will represent a huge step forward in gaining international recognition that animal welfare matters.

Justine Smith, the World Society for the Protection of Animals (WSPA) spokesperson for the campaign, said WSPA is delighted to have BVA backing for the campaign this will go far in terms of building recognition for the UDAW from overseas governments, as well as in the UK. Vets have a vital role to play in promoting animal welfare.

Reaching overseasThe BVA Overseas Group, which provides an essential link between the BVA and veterinary organisations and individuals and animal welfare charities across the developing world, firmly opines that the profession should play a key role in defining the future of animal welfare on a global level by supporting the progress of UDAW. Speaking on behalf of the Group, Sean Wensley said Animal welfare is gaining ever-increasing importance across the world, and is increasingly being used as a measure of the social progress of nations. Over a billion people around the world rely directly on animals for their livelihoods as well as for companionship,

and good animal welfare frequently benefits human welfare.

The veterinary profession is pivotal in maintaining and restoring the strong bond that exists between humans and animals across the world. Wherever animals are influenced by humans, whether on farms, in research institutions, in zoos or in peoples homes, members of the profession are present to ensure that animals remain healthy and happy, and that provision for their good welfare remains paramount. Veterinarians are also key contributors to ethical review processes, speaking with authority and pragmatism as the animals advocate.

VPAT signs upThe Veterinary Practitioners Association of Thailand (VPAT) continues to strive to develop its role in better serving society; in a step to better fulfil this role, VPAT has taken the opportunity to help raise standards of animal welfare by signing up to the UDAW.

VPAT President, Dr Siraya Chunekamrai, said I am delighted that VPAT is supporting the Universal Declaration on Animal Welfare to emphasise the responsibilities that veterinarians have towards the welfare of sentient animals. The stand generated from this Declaration is in accordance with the veterinary professions commitment to be in stewardship of all animals, and creates a social impact on the way we as human beings treat life itself. Consequential to this

BVA and VPAT sign the Universal Declaration on Animal Welfare

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WSAVA NEWS

ANIMAL WELFARE UPDATE

WSAVA NEWSWSAVA NEWS

Declaration, the veterinary profession will be aligned to make this become a society that respects animal life and life itself.

Saneekan Rosamontri, the WSPA Regional Programme Manager in Asia for the UDAW, said WSPA is delighted that VPAT

Blue Dog is aimed at teaching children of 37 years of age (and their parents), to recognise and avoid potential risk situations when dealing with their dog at home. It has been developed by a group of multidisciplinary professionals, under the umbrella of the Blue Dog Trust. Its development was prompted by scientific evidence that most bite injuries occur in children, usually in their own home, by a dog that is familiar to them.

Young children are much more likely to suffer severe injuries to the head and neck, and a significant number go on to develop post-traumatic stress disorders. It has further been shown that many of the dogchild interactions that trigger the bite are initiated by the child.

Sadly the problem seems to be getting worse. In the UK, National Health statistics reported in 2008 show the number of people attending Accident and Emergency Departments following dog attacks has risen by more than 40% in the last four years. Despite the evidence to the contrary, the reaction of governments is to

put the blame on dangerous breeds and rely on breed-specific legislation; a strategy that has been shown to be misguided.

Going globalThe English version of Blue Dog was successfully launched at the 2006 WSAVA/FECAVA Congress in Prague. Since then, the parent guide has been translated into Norwegian, Dutch, Serbian and German, with the Czech, Polish, Italian, Danish, American, Flemish and French versions all due for publication in 2008.

The German version was successfully launched in November 2007 at the DVG Congress in Berlin, along with Blue Dog stickers, balloons and cuddly toys! Thanks to the enthusiastic efforts of Suzanne Aldinger, Hildegard Jung and their team, it has achieved good sales among DVG members. In the Netherlands, the programme is managed by the LICG. They successfully negotiated local government funding and Leen den Otter presided over a successful launch in October 2007. Nikoleta and Denis Novak have worked tirelessly on the Serbian version, which was launched in January 2008. The BSAVA has agreed to distribute Blue Dog within the UK, and negotiations are in progress with

Veterinary Ireland as to how best to launch there.

Tiny De Keuster and Ray Butcher presented an oral presentation and poster at

the most recent International Association of Human Animal Interaction Organisations (IAHAIO) conference in Tokyo in 2007, and attracted much interest from delegates. A Japanese version may be the result.

Further developmentsThe programme is managed by the Blue Dog Trust, a registered charity which is committed to reinvest all financial surpluses achieved from royalty payments into further research and development into dog bite prevention issues.

In 2008 the Blue Dog Trust initiated the production of a promotional DVD, which can be shown in the waiting rooms of veterinary clinics; it is also looking into ways of enhancing the website. In addition, a new project has been initiated to investigate ways of developing resources suitable for getting the message across in a classroom setting.

The Blue Dog Trust is also supporting scientific research. Kerstin Meints of the Child Psychology Department of Lincoln University (UK) will be investigating how young children investigate novel situations, hoping to explain the high incidence of head and neck bites in young children. The Trust also hope to initiate some research into the trigger factors that cause bites in other cultures, with a view to developing appropriate educational material. It is hoped that this will have an impact on rabies control strategies.

is the first Thai Veterinary Association backing the UDAW and urges other Asian veterinary associations to also support the UDAW officially. It is essential that the Declaration be supported by the veterinary profession. Veterinary support of an

international declaration on the sentience of animals would be an important step towards building recognition for the UDAW from Asian governments, as well as in Thailand.

The full UDAW document can be viewed at www.udaw.org

HELPING PREVENT DOG BITESBlue Dog is an interactive CD-ROM with a printed parent guide, which is proving a valuable tool in the prevention of dog bites

Veterinary Ireland as to how best to launch there.

Tiny De Keuster and Ray Butcher presented an oral presentation and poster at

Emergency Departments following dog attacks has risen by more than 40% in the last four years. Despite the evidence to the contrary, the reaction of governments is to

Veterinary Ireland as to how Emergency Departments following dog attacks has risen by more than 40% in the last four years. Despite the evidence to the contrary, the reaction of governments is to

Veterinary Ireland as to how best to launch there.

Butcher presented an oral presentation and poster at

companion | 25

WSAVA NEWS

In addition to the long-standing WSAVA Walthams International Award for Scientific Achievement, the WSAVA Walthams Service to the Profession Award, and the WSAVA Hills Excellence in Veterinary Healthcare Award, two new WSAVA Awards, will be presented this year.

WSAVA Hills Pet Mobility AwardThis award recognises the outstanding work of a clinical researcher in the field of

The control of free-roaming dog populations remains a major welfare issue in many parts of the world. These dog populations may be associated with many problems, including:

Direct injury to people, livestock or pets Indirect injury to people and pets from road traffic accidentsSource of infection (especially rabies) Pollution from faeces and urine General nuisance from noise.

The financial costs involved with these can be high, and so municipalities have often turned to mass slaughter as a way of addressing the problem. Often inhumane methods are used, which are not only a welfare problem, alienating many of the

stakeholders, but may also be indiscriminate, with risks to humans and their pets. These methods are also invariably unsuccessful in the medium term.

Strategy frameworkAccordingly, in 1990, the World Health Organisation (WHO) and the World Society for the Protection of Animals (WSPA) formulated joint guidelines, which provided 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 of these elements are important, although 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.

Ray Butcher, Co-Chairman of the WSAVA Welfare Committee, outlines the new guidelines available on humane stray dog control

Updated guidelinesMuch 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 WSPA, the Humane Society International (HSI), the International Fund for Animal Welfare (IFAW), the international arm of the Royal Society for the Protection of Animals (RSPCA International), the Universities Federation for Animal Welfare (UFAW), WSAVA and the Alliance for Rabies Control (ARC).

In January 2008 ICAM published a document entitled 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.

The WSAVA Welfare Committee strongly recommends this to WSAVA members. The document can be downloaded from the WSAVA website (www.wsava.org).

NEW AWARDS FOR DUBLINcanine and feline orthopaedic medicine and surgery. Through improvements in the mobility and quality of life of pets, this persons research has contributed significantly to the wellbeing of pets lives and to the humananimal bond worldwide.

WSAVA Presidents AwardThis award will be presented on a time-to-time basis by the President to a member of the WSAVA in recognition of the recipients outstanding contribution to the Association,

as selected by the Executive Board.These new awards provide two more

reasons to attend the WSAVA World Congress in Dublin, in addition to the various extensive continuing education offerings, dynamic social events and culturally rich city of Dublin.

For those that have not yet registered, dont delay as the Congress is only a month away. For more information, visit the WSAVA Congress website at www.wsava2008.com. See you there!

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CONTROL OF STRAY DOGS

26 | companion

companion INTERVIEW

Julian Hector is editor of the BBC Radio Natural History Unit in Bristol. His father was in the Colonial Service and Julian was born in Kenya in 1958, the middle one of three brothers. After independence, the family returned to England. He took a degree in zoology at the University of Bristol where he stayed on to complete a PhD on the reproductive endocrinology of albatrosses. He worked for the British Antarctic Survey, Bristol Zoo, the Wildfowl and Wetlands Trust and in academia before joining the BBC in 1992

Julian Hector is editor of the BBC Radio Natural History Unit in Bristol. His father was in

THEcompanionINTERVIEW

What exactly does your job involve?Whatever changes have occurred in the rest of the BBC, the Natural History department has always been bi-media. So it produces both radio and television programmes, and more recently on-line content. My role is to develop ideas and obtain commissions for radio programmes, sold mainly to Radio 4 and some to World Service. I also sit on the board of the NHU and our job is to stitch together the different broadcast platforms a good example of this is the major series World on the Move which runs to the end of the year and involves all three elements of our output.

The units television output is justifiably famous, its radio less so. How do you generate an interest in natural history without using pictures?Some people do think that natural history radio is all about sound effects it isnt. Most of our radio output involves finding and talking to people, who are specialists in their subject and passionate about it. We use them to get as close as possible to the nature concerned, whether its an ancient oak tree or a guillemot. That combination of knowledge and real life experience is ideal for the sort of story and ideas-led content that radio is so good at.

What aspect of your broadcasting career has given you most satisfaction?The World on the Move project is probably the most exciting thing that I have been

involved in. It is doing many things that are new for natural history radio, beginning with its sheer size. The commission is for 40 live programmes through the year, when you would normally expect a commission for three of four programmes. It also involves collaborations with research institutes and NGOs (non-governmental organisations) to get close to migrating animals and tell their stories.

Who has been the most inspiring influence on your career?One person with extraordinary vision, determination and passion was the late Sir Peter Scott, who I knew when I worked for the Wildfowl Trust. We talked a lot about conservation and much of what he predicted in the early 1980s has since been proved true. Another major influence on my media career is a field biologist called Peter Prince, my superior when working for the BAS on South Georgia. Both of these people I met very early during my career and their legacy has been lasting.

Imagine you have been given an unlimited programme budget, what would you do with it?I would like to find a way to bring together the worlds leading ecologists, the most important religious and other thinkers, and the worlds greatest economists to show how all three can develop a sustainable approach to the future of the Earth. I believe that these three populations of people could work

together to shed new light on our understanding of the natural world.

If you could change one thing about your appearance or personality what would it be?I hurt my neck when diving during a filming trip and subsequently I had to go and see a physiotherapist. He told me that I have a slightly vulturine posture. So I guess my answer would be the ability to stand up straight.

Whats your most important possession?My most loved possession is my boat but my most important is my Breitling watch. Without a watch I am not very good at knowing what time of day it is. During my career I have been on maybe 3000 marine dives; my watch has been with me every time and it has helped keep me alive.

What would you have been if you hadnt been a broadcaster?I suppose I would have liked to have been a news journalist. But I also have a boys own style passion for aeroplanes and boats. I guess I would have liked to have done something with one or other of those probably the boats.

What is the most important lesson you have learned in life?I have three children from my first marriage. The lesson I learned from that period of my life is that whatever you do, you have to look after your children.

CPD DIARY

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5 OctoberSundayPractical dentistrySpeaker Norman JohnstoneDay meeting at the Dunkeld House Hotel, Dunkeld. Scottish Region.Details from Susan Macaldowie, telephone 07711 633698, email smacaldowie@btinternet.com

8 OctoberWednesdayFeline chronic gingivostomatitisSpeaker Diane AddieEvening meeting at IDEXX, Wetherby. North East Region.Details from Karen Goff, telephone 01943 462726, email northeastregion@bsava.com

8 OctoberWednesdayGeriatricsSpeaker Stijn NiessonEvening meeting at The Holiday Inn, Haydock. North West Region.Details from Simone der Weduwen, email beestenhof@ntlworld.com

10 SeptemberWednesdayOncology in practiceSpeaker Rob HarperEvening meeting at Park Inn, Cardiff. South Wales Region.Details from Susanna Brown, email southwalesregion@bsava.com

13 SeptemberSaturdayAnnual Dinner at Horncliffe MansionNorth West Region.Details from Simone der Weduwen, email beestenhof@ntlworld.com

14 SeptemberSundayFracture managementSpeaker Andy TorringtonDay meeting at Normanton Golf Club, Wakefield. North East Region.Details from Karen Goff, telephone 01943 462726, email northeastregion@bsava.com

16 SeptemberTuesdayInfectious diseases in neonatesSpeaker Susan DawsonEvening meeting at Corus Hotel, Romsey. Southern Region.Details from Michelle Stead, telephone 01722 321185, email mmstead@btinternet.com

18 SeptemberThursdayClinical pathology in practiceSpeaker Tim JaggerEvening 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

CPDDIARY

21 SeptemberSundayCase-based endocrinologySpeakers Grant Petrie and Lucy DavisonDay meeting at The Cambridge Belfry, Cambridge. East Anglia Region.Details from Gerry Polton, email eastanglia.region@bsava.com

23 SeptemberTuesdayKidney diseaseSpeaker Hattie SymeDay meeting (modular course) at BSAVA HQ, Gloucester. Organised by BSAVA.Details from BSAVA Customer Services, telephone 01452 726700,email customerservices@bsava.com

22 OctoberWednesdayHeart murmurs in catsSpeaker Adrian BoswoodEvening meeting at Corus Hotel, Romsey. Southern Region.Details from Michelle Stead, telephone 01722 321185, email mmstead@btinternet.com

14 OctoberTuesdayImmune-mediated diseaseSpeaker Sheena WarmanAfternoon meeting at Park Inn, Cardiff. South Wales Region.Details from Craig Connolly, email southwalesregion@bsava.com

15 OctoberWednesdayWildlife and exotic emergenciesSpeakers Anna Meredith and Sharon RedrobeDay meeting at Hilton, Bromsgrove. Organised by BSAVA.Details from BSAVA Customer Service, telephone 01452 726700, email customerservices@bsava.com

22 OctoberWednesdayCurrent feline issuesSpeakers Rachel Dean and Sheila WillsDay event at Janson Laboratories, High Wycombe. Metropolitan Region.Details from Allison van Gelderen, email allivetuk@yahoo.co.uk

23 OctoberThursdaySmall animal dispensing courseSpeakers Phil Sketchley, Steve Dean, John Hird, Fred Nind and Peter GripperDay meeting at Basingstoke Country Hotel, Basingstoke. Organised by BSAVA.Details from BSAVA Customer Service, telephone 01452 726700, email customerservices@bsava.com

24 SeptemberWednesdaySA endocrinology ISpeaker Peter GrahamDay meeting (modular course) at BSAVA HQ, Gloucester. Organised by BSAVA.Details from BSAVA Customer Services, telephone 01452 726700,email customerservices@bsava.com

2527 SeptemberThursdaySaturdayBVA CongressSpeakers Gary Clayton Jones and Peter Bedford2-day meeting at the Royal College of Physicians, London. Metropolitan Region.Details from Pedro Martin Bartolome, email pmbartolome@googlemail.com

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Small Animal Dispensing CourseDate: Thursday 23 OctoberSpeakers: Fred Nind John Hird Peter Gripper Steve Dean Philip SketchleyVenue: Basingstoke Country HotelCourse Fees: BSAVA Members: 176.00 + VAT (206.80 inc. VAT) Non Members: 236.00 + VAT (277.30 inc. VAT)

Wildlife and Exotic Emergencies for Vets and Veterinary NursesDate: Wednesday 15 OctoberSpeakers: Anna Meredith & Sharon RedrobeVenue: Hilton, BromsgroveCourse Fees: 140.00 + VAT (164.50 inc VAT)

Urinary Tract IKidney disease in the dog and catDate: Tuesday 23 SeptemberSpeaker: Hattie SymeVenue: Woodrow House, GloucesterCourse Fees: BSAVA Members: 161.70 + VAT (190.00 inc. VAT) Non Members: 315.00 + VAT (370.13 inc. VAT)

Urinary Tract IILower urinary tract diseases in the dog and catDate: Tuesday 28 OctoberSpeaker: Hattie SymeVenue: Woodrow House, GloucesterCourse Fees: BSAVA Members: 161.70 + VAT (190.00 inc. VAT) Non Members: 315.00 + VAT (370.13 inc. VAT)

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