The essential publication for BSAVA members

Keeping Britain SafeUK’s defence against imported diseaseP4

How to…Manage lymphoma casesP12

The essential publication for BSAVA members

companionAUGUST 2009

Blood typing…For blood transfusionsP21

Investigation of a depressed and

vomiting cat

companion

2 | companion

3 Association News Introducing the International Affairs Committee

4–6 Keeping Britain Safe Defending the UK from imported diseases

7 BSAVA Expands CPD Roadshows Haematology, Feline Infectious Disease and Orthopaedics

8–11 Clinical Conundrum Consider investigation of a depressed and vomiting cat

12–15 How To… Manage the systemically unwell, substage b, case of canine lymphoma

16–18 GrapeVINe From the Veterinary Information Network

19–20 Barrier Nursing Paula Hotston Moore explains the role of barrier nursing

21–22 Petsavers Latest fundraising news

23–25 WSAVA News The World Small Animal Veterinary Association

26 The companion Interview Maggie Fisher

27 CPD Diary What’s on in your area

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

GET INVOLVED

Additional stock photography Dreamstime.com© Anton Nosirev | Dreamstime.com© Emin Ozkan | Dreamstime.com© Emir Memedovski | Dreamstime.com© Ivan Akinin | Dreamstime.com© Jkitan | Dreamstime.com© Nataliya Litova | Dreamstime.com© Saporob | Dreamstime.com© Tabgac | Dreamstime.com© Vikatoria Makarova | Dreamstime.com

By the time an Officer joins the Board they are likely to have been volunteering with the Association for

more than a decade. So why do they do it?“I first got involved in the regions largely

by accident, but quickly found I really enjoyed meeting the other people on our committee and influencing the kind of CPD I could access in Scotland,” says Richard Dixon, current BSAVA President. “Quickly I came to really enjoy the camaraderie and friendships I made and, as well as contributing to something valuable in the profession, I have made some great friends and had a lot of fun albeit I never for a second imagined I might end up being President. I have spent time with some great people and learned a huge amount from them, not to mention it has been a great laugh!”

How to get startedLike Richard, most of our volunteers, began in the regions, where you really get to influence the Association at grass roots level – creating relevant, valued CPD for your local colleagues – and obviously you get to attend the courses free of charge when you are on the committee. You will get to help decide on subjects, speakers and venues for courses, as well as influence the wider activities in the Association – the views of our Regional Officers are key in our decision making. If you want to know more about volunteering in the regions then

ISSN 2041-2487

why not go along to your next regional meeting (details online at www.bsava.com and in the back of companion) or email c.haile@bsava.com and we will put you in touch with your relevant Chairperson.

Other opportunitiesAs well as the regions, the BSAVA is run by a series of standing committees, including Publications, Education, Scientific, Congress and Membership Development (see opposite for more information on International Affairs). All are run by volunteers. Each meet around 3 times a year, in either London or Gloucester. The Chairman for each committee sits on Advisory & Management, the group that represents the membership and leads the agenda for the Association.

What’s in it for you?As well as the opportunities to network and the feeling of ‘giving something back’, we like to think we look after our volunteers well. Of course, all expenses are reimbursed, so when you travel to a meeting or stay overnight your costs are covered, and we try to make any committee fun as well as effective. Plus, many key volunteer positions have free Congress registration. So if you want to know more and get involved we’d like to hear from you. Email c.haile@bsava.com or call 01452 726717. n

The BSAVA is your Association, run by vets for vets. We often get asked about how to get started as a volunteer – so here’s what you need to know…

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ASSOCIATION NEWS

INTRODUCING THEINTERNATIONAL AFFAIRS COMMITTEESo that members can understand how the Association works on your behalf, over the coming months companion will introduce the work of its various committees. Here is what IAC is doing on your behalf…

The International Affairs Committee (IAC) liaises between BSAVA and international veterinary associations, providing information and recommendations about issues in Europe

and worldwide that impact on the small animal practitioner. Also, via its member representatives on various European and international veterinary associations, IAC works to inform debate on animal welfare and matters affecting the veterinary profession, plus advancing the dissemination of veterinary scientific knowledge internationally. IAC members ensure that communication is maintained with other UK veterinary associations active internationally, in particular working with the BVA and the RCVS within the UK Coordination Group.

Recent issues for IAC include: lobbying to maintain the derogation in order to decrease the risk of rabies, vector-borne disease and Echinococcus multilocularis entering the UK; and also raising concerns that the EU Animal Health Stategy, which covers the health of animals transported to, from and within the EU, concentrates on food-producing animals and therefore needs to better safeguard and promote the welfare of companion animals. Members of IAC also play a role in UEVP/FVE discussions on professional codes of conduct, the provision of out-of-hours emergency care and CPD requirements in the veterinary profession throughout the EU.

IAC aims to promote veterinary CPD internationally. Each year, a group of vets from another European country are invited to BSAVA Congress, free of charge, providing them with an opportunity to benefit not only from the scientific lectures, but also to meet vets from many different countries and exchange knowledge and experiences. BSAVA, via WSAVA, also contributes funds for the provision of CPD in sub-Saharan Africa (information about the latter is regularly published in the WSAVA News section of companion). n

Acronyms:FECAVA: Federation of European Companion Animal Veterinary AssociationsFVE: Federation of Veterinarians of the EEC (European BVA)UEVP: Union European of Veterinary Practitioners (European SPVS)

David WadsworthAs WSAVA President, David’s role is to provide extra insight into the WSAVA and its activities during his term of office.

Mike JessopMike is BSAVA’s representative for UEVP (Union of European Veterinary Practitioners). This is a committee to represent the practitioners at the Federation of Veterinarians in Europe (FVE).

Jo ArthurJo is responsible for informing the BSAVA membership of the international veterinary issues dealt with by the other members of the IAC, and BSAVA’s support (via IAC and WSAVA ) of veterinary CPD in other countries.

Kenelm LewisKenelm is past president of SPVS and elected to be SPVS representative at UEVP.

Julian WellsThe WSAVA is represented on IAC by Julian Wells, the BSAVA’s WSAVA Assembly representative.

Richard DixonAs President, Richard sits on IAC as the BSAVA Officer. The Officer is there to bring a more diverse experience of other BSAVA activities to IAC and help identify any opportunities for collaboration with other committees.

Alistair GibsonAlistair recently took on the role of Chair of IAC, co-ordinating all activities of the committee. He has previously volunteered for BSAVA in the regions and as Public Relations Officer.

Stephen WareStephen has served IAC for some years. As a Vice-President of FVE he acts as a link between UK interests (especially practitioner interests) and the FVE.

Chris LaurencePets in Europe, a group of companion animal welfare organisations, is raising the profile of companion animals in the EU.

As Chairman of PIE he has common interests with IAC’s European work and they work closely together on issues such as the PETS scheme.

Simon OrrSimon is an Officer of FECAVA and a BSAVA Past President. This liaison gives BSAVA immediate access to the FECAVA Board and from there provides another avenue to influence UEVP and FVE.

Wolfgang DohneWolfgang is BSAVA representative at FECAVA and responsible for the Annual Visiting Program of Veterinarians from Emerging Veterinary Associations to BSAVA Congress.

Andrew RobinsonAndrew is Secretary General of UEVP.

Want to get more involved with BSAVA? For details about volunteering email Carole Haile – c.haile@bsava.com or call 01452 726717.

Who’s who on IAC

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DEROGATION

KEEPING BRITA IN SAFEAshford resident Mrs Janet Hunt

found a route into the veterinary textbooks when she took her dog

for a walk along a pathway near a long distance lorry park. It seems likely that this is where the dog was bitten by a tick which is presumed to have been brought to Britain as an unwelcome passenger on a vehicle arriving from the Continent. As a result, Caffreys, a 10-year-old Welsh Springer Spaniel, contracted the first case of canine babesiosis to be confirmed in an animal that had never travelled outside the UK.

Mrs Hunt and her dog took their fateful walk in 2005. Since then there has been no evidence that an infective population of the brown dog tick Rhipicephalus sanguineus – the normal host for the babesiosis parasite – has become established in Kent, or anywhere else in the UK. The main factor keeping the disease out of these islands is the requirement for any dog entering the

British veterinary organisations were pleased with the European Commission’s proposal to extend the UK derogation from EU harmonised rules on pet imports until December 2011. This gives the BVA and BSAVA more time to lobby for an effective system that facilitates movement of animals into the UK without increasing the risks of introducing exotic disease. Yet, whatever future decisions are made in Brussels, our main defence against imported disease will not be through international trade rules – but the professional skills of individual veterinary surgeons. John Bonner reports

Caffreys, a 10-year-old Welsh Springer Spaniel that had the first case of canine babesiosis to be confirmed in an animal that had never travelled outside the UK. Courtesy of Veterinary Record.

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DEROGATION

KEEPING BRITA IN SAFEcountry under the Pet Travel Scheme to have been treated with an acaricide 24 to 48 hours before arrival.

The risks and youAs the Ashford incident showed, a treatment given to animals entering these islands through a properly regulated process will not guarantee the UK and Ireland’s continued freedom from canine babesiosis. So, in future negotiations with EU partners, the pre-entry acaricide administration could well be lost as Britain may have to concentrate on maintaining controls on other diseases such as rabies and echinococcosis. Yet if that element of the derogation is discarded, there will be a significantly increased risk of the condition becoming endemic. In that event, small animal practices will have responsibilities in both tracking the spread of the disease and ameliorating its effects on the native dog population.

Along with leishmaniosis, ehrlichiosis and dirofilariasis, babesiosis is one of those conditions present on the Continent which Defra asks practices to monitor through its DACTARI voluntary surveillance scheme. As those practitioners who have seen cases in animals entering Britain through the PETS scheme will know, the diagnosis and management of these diseases can be challenging.

DiagnosisLaura Holm was a veterinary assistant at Peter Edgar’s practice in Ashford when Mrs Hunt brought in her dog. She recalls that the dog was pyrexic but there was nothing particularly remarkable in the clinical examination. Certainly babesiosis would not have been at the forefront of her mind. It

was an unlikely diagnosis as the dog had never been abroad nor been a recipient of donated blood. Moreover, like most vets, her first suspicion on seeing a Springer Spaniel with haemolytic anaemia was that it would be an immune-mediated condition.

However, by the next morning the dog was markedly jaundiced and this surprisingly rapid deterioration suggested that the condition could be more serious. Laura sent a blood sample for analysis to a commercial laboratory, which proved a wise decision. An external lab will usually be better equipped than an in-house facility to diagnose accurately a condition like babesiosis from a blood smear. But even with an appropriate staining agent, spotting the protozoan merozoites within the dog’s erythrocytes was not straightforward, as only about 1.5 per cent of the cells had been

parasitised. Despite the rapid diagnosis and treatment with imidocarb – a treatment for bovine babesiosis available for use in dogs under the Cascade system – the dog died about 60 hours after the initial presentation.

LeishmaniosisThe exotic disease most likely to be seen in a dog arriving in Britain from the Continent is leishmaniosis. The DACTARI website lists 49 cases in PETS scheme travellers and residents of quarantine kennels between 2001 and 2008. However, that is a mere fraction of the actual number of cases here in the UK that could provide a reservoir of infection for this important zoonotic pathogen if global warming allows its vector, the sandfly (Phlebotomus spp.) to gain a foothold in Britain. In a paper in Veterinary Parasitology, Sue Shaw of Bristol University

Leishmaniosis: nasal and pinnal dermatopathy with onychopathy

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DEROGATION

reports 257 cases between 2005 and 2007 diagnosed either at her own or at one of her collaborating labs.

Even with this recent influx of cases, the majority of small animal practices have never seen a dog with leishmaniosis and they will find that making a definitive diagnosis is extremely tricky, according to Jon Wray, an internal medicine specialist at Dick White’s Newmarket referral practice. He has seen several cases with typical presenting signs, including crusting skin lesions, enlarged lymph nodes, uveitis and epistaxis. However, a definitive diagnosis is achieved through direct observation of the parasite in bone marrow or spleen aspirates. These are not routine techniques in most first opinion practices and the chances of obtaining a false negative are high, even when supplemented by PCR tests to detect the parasite’s DNA, he warns.

Brighton-based veterinary dermatologist Charlie Walker points out another problem in diagnosing leishmaniosis is that it may take up to a year between infection and the onset of clinical signs. As such a foreign trip may not be mentioned immediately by the client and it is up to the clinician to probe into the dog’s travel history. On their own, the skin lesions are not very specific and with the pressures of a 10 minute appointment system, there would be a strong likelihood of the owner being sent home with antibiotics and a medicated shampoo, he says.

TreatmentGiven the lack of an authorised product for treating leishmaniosis in the UK, both vet and owner are likely to face an unpleasant surprise when a diagnosis is confirmed. The Veterinary Medicines Directorate is able to

KEEPING BRITAIN SAFE

Clinical symptoms of leishmaniosisRight: Pinnal margin ulceration

Below right: Onychopathy – haemorrhagic paronychia

advise practitioners on sourcing treatments from abroad but these are likely to eye-wateringly expensive. Charlie says he was quoted a figure of £450 (before any mark up) by the importing company for supplying one of the two products available on the Continent.

Spanish veterinary surgeon Carlos Macias confirms that even where there is a locally licensed product available the treatment costs will be substantial, though well below the prices paid in the UK. Vets at his neighbouring practices in Malaga would expect to pay the wholesaler about 110 Euros for a 60 ml bottle of milteforan, sufficient to treat a 20 kg dog for the recommended 28 day course, he says.

After the initial course of treatment, the disease can be kept under control by the much cheaper drug allopurinol and the chances of a complete remission are good, provided the dog is not re-exposed to

infective sandflies, Jon Wray states. “Before starting down that road, it is important for the vet to spend a lot of time discussing the practicalities with the owner. They must be aware that this is a very demanding treatment, financially, emotionally and in terms of time.”

Mary Crackles, from the Westmoreland Veterinary Group in Kendal, has just confirmed her first leishmaniosis case and highlights the need to educate clients about the risks before they take their animals abroad. In endemic areas it is possible to minimise the chances of exposure by keeping the animal indoors when the flies are most active at early morning and late evening and to use insect repellent collars or pour-ons. “Of course, it is important to tell the client that in most cases when they are only going abroad for a couple of weeks, it is in the dog’s best interests for it to be kept at home.” ■

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CPD

BSAVA EXPANDS CPD ROADSHOWS

In the coming months there are three Roadshows touring the UK, bringing more choice and international

specialists to a region near you. This is the very best CPD, at a convenient location and at a cost that means members

are getting great value from their CPD budget

Roadshow FeesFor more information or to book visit www.bsava.com, email administration@bsava.com or call 01452 726700.

Members price £191.83 inc. VAT Non members price £287.74 inc. VAT

Mike Conzemius & John Innes4 November 2009 – Northern Ireland: Venue to be confirmed

11 November 2009 – Metropolitan: Bellhouse Hotel, Beaconsfield

Mike Conzemius & Michael Gulliard6 November 2009 – Kent/Surrey & Sussex: Venue to be confirmed

9 November 2009 – North East: Novotel, Newcastle

Michael Lappin & Danièlle Gunn-Moore16 October – Chilworth Manor, Southampton

18 October – Hilton, Dunkeld

19 October – Mottram Hall, Cheshire

21 October – Miskin Manor, Nr Cardiff

Guillermo Couto & Michael Day09 September – Daventry Hotel, Northamptonshire

11 September – Mottram Hall, Cheshire

14 September – Marriott Hotel, Huntingdon

16 September – Gorse Hill, Woking

Mike Conzemius &

Metropolitan: Bellhouse Hotel,

Mike Conzemius & Michael

– Kent/Surrey & Sussex: Venue to be confirmed

– North East:

Haematology in practice – all you need to knowIn eight largely case-based presentations you will be taken through laboratory evaluation of the haemogram, the types of anaemia and disorders of leucocytes, disorders of haemostasis and the practical aspects of blood transfusion. Led by Professor Guillermo Couto from the Ohio

State University and supported by Professor Michael Day from the University of Bristol, this day of CPD will bring you up-to-date with the latest developments in clinical haematology. Both are internationally recognized speakers in this fundamental area of clinical practice.

Feline infectious diseaseThere have been a number of significant advances in feline medicine in the last several years. Professor Danièlle Gunn-Moore of the UK and Professor Michael Lappin of the USA both have active, ongoing clinical research studies concerning respiratory diseases, gastrointestinal diseases, vaccines, and blood borne agents. They will provide you with an enlightening group of case based lectures emphasizing issues that will provide immediate benefit to

your feline patients. For selected lectures, audience response devices will be used to highlight important questions and the opinions of the group. Emphasis will be placed on new techniques for the diagnosis and management of cats with rhinitis, cough, dyspnoea, diarrhoea, and fever. In addition, Professor Lappin will provide a brief update on feline vaccine guidelines and his work with antibodies against feline tissues induced by over vaccination.

OrthopaedicsPelvic limb lameness is very common in dogs with hip dysplasia and cruciate disease being the two most common orthopaedic conditions. Accurate diagnosis, disease-staging and appropriate decision-making are critical for successful case management. This roadshow will deal with common conditions of the canine pelvic limb and is designed for primary care practitioners who wish to update or refresh their knowledge in this area. Understanding hip dysplasia (HD) and the methods used to diagnose the condition is a key core skill for first-opinion

practitioners because advising clients appropriately is essential. Newer radiographic methods will be discussed and the role they play in understanding HD will be explained. Dr Conzemius is a leading authority on cruciate disease and has published some paradigm-shifting papers in this area. John Innes has research programmes in cruciate disease at University of Liverpool and Mike Guilliard brings a wealth of experience from referral practice. In a rapidly changing area, it is essential for vets to be up to date with current thinking.

Guillermo Couto & Michael Day

– Marriott Hotel,

– Gorse Hill, Woking

Michael Lappin & Danièlle Gunn-Moore

– Chilworth Manor, Southampton

– Hilton,

– Mottram Hall,

– Miskin Manor,

BSAVA EXPANDS CPD ROADSHOWS

In the coming months there are three Roadshows touring the UK, bringing more choice and international

specialists to a region near you. This is the very best CPD, at a convenient location and at a cost that means members

8 | companion

CLINICAL CONUNDRUM

CLINICALCONUNDRUMSamantha Taylor of the Feline Centre, University of Bristol, invites companion readers to consider investigation of a depressed and vomiting cat

Parameter Result Reference range

Urea 43.0 mmol/l1

6.5–10.5

Creatinine 1099 µmol/l

133–175

Phosphate 3.21 mmol/l

0.95–1.55

Potassium 7.80 mmol/l

4.00–5.00

Total calcium

2.50 mmol/l

2.30–2.50

Glucose 6.20 mmol/l

3.50–7.50

Table 1

Case History

A 5-year-old, male neutered, exotic shorthaired cat presented with a 24-hour history of acute vomiting, depression and inappetence. The cat had access outdoors, was fed a normal commercial cat food and was up to date with vaccination and worming. Treatment with intravenous fluids and antibiotics for 12 hours prior to presentation had not resulted in an improvement in demeanour and, although the vomiting had stopped, the cat had become progressively more depressed.

On examination the cat was extremely dull and depressed but responded to stimulation. The cat was hypotensive (systolic blood pressure 80 mmHg, Doppler method) and bradycardic (heart rate 100 beats per minute). Abdominal palpation was unremarkable and the bladder small and non-painful.

Create a problem list; consider differentials and suggest management priorities at this pointThe cat’s main problems are vomiting, hypotension and bradycardia. The depression and anorexia are likely to be secondary to the primary disease. Vomiting can occur due to primary GI disease (e.g. viral enteritis) or as a consequence of systemic disease (e.g. renal failure). Given the history of vomiting, the hypotension could be the consequence of fluid loss. The bradycardia is a concern and, given the hypotension, sepsis is a consideration; but electrolyte abnormalities such as hyperkalaemia should also be considered.

The patient’s clinical status is critical, so there are a number of diagnostic and therapeutic priorities. Biochemistry (especially glucose and electrolytes) and haematology should be performed and whilst results are pending the patient should have an ECG performed in view of the bradycardia. Fluid resuscitation is appropriate given the hypotension, beginning with a crystalloid bolus (10 ml/kg over 20 minutes) whilst monitoring the response with repeat blood pressure measurement, along with heart and respiratory rates.

ResultsRelevant findings are shown in Table 1.

Outline the ECG findings and interpret the biochemical findingsBiochemistry showed:

Severe azotaemia■■

Severe hyperkalaemia■■

Moderate hyperphosphataemia■■

The ECG (Figure 1) shows absent P waves, tall T waves, bradycardia and a prolonged PR interval, typical of hyperkalaemia. The azotaemia could be pre-renal, renal or post-renal in aetiology. Renal failure was considered most likely given the hyperkalaemia and hyperphosphataemia. The absence of a palpable bladder and ascites made

Figure 1

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CLINICAL CONUNDRUM

post-renal causes less likely, although a uroabdomen could not be fully excluded.

Following the bolus of fluids the blood pressure increased to 100 mmHg, suggesting the hypotension could be due to hypovolaemia. The bradycardia persisted and the cat remained dull and depressed.

What further diagnostics and treatment are appropriate at this point?Given the azotaemia it is vital to obtain a urine sample. This will help characterise the azotaemia as pre-renal or renal in origin and to quantify urine output. Successful urethral catheterisation does not completely exclude post-renal azotaemia (e.g. ruptured bladder) but allows monitoring of urine output and further diagnostic imaging if required (for example a retrograde urine contrast study). This patient is also likely to have a metabolic acidosis, so blood gas analysis, if available, could help determine whether aggressive management measures such as bicarbonate therapy are required. A urinary catheter was placed and 5 ml urine drained from the bladder (it was not known when the cat last urinated). The urine was isosthenuric (1.017), positive on a dipstick for blood, protein and glucose. Urine revealed numerous structures as shown in Figure 2.

Identify the structure seen on urine sediment examination and refine the diagnosis of azotaemia in light of the urinalysisThe structure is a granular cast. This type of cast is the result of cellular degeneration and presence can indicate tubular degeneration, inflammation or necrosis. A few can be seen in normal cats, but a large

number indicates tubular damage.

The isosthenuria combined with the azotaemia suggests intrinsic renal failure and the presence of blood, protein and glucose in urine (with normal blood glucose) is consistent with tubular damage. The urinalysis results, along with the clinical examination and biochemical results, are consistent with acute intrinsic renal failure (ARF).

Irrespective of cause, treatment must be aggressive and has three priorities

Continued correction of fluid deficits and restoration of renal perfusion

Fluid therapy should be continued to correct remaining fluid volume deficits. Continued boluses of crystalloid (0.9% sodium chloride) along with close monitoring of blood pressure, heart rate and respiratory rate, or a reduced continuous rate infusion are appropriate, according to response and considering the risk of overhydration. Fluid therapy can then be adjusted according to ongoing losses and by monitoring urine production.

Correction of electrolyte and acid–base abnormalities

The severe hyperkalaemia requires prompt treatment and may be resolved by the fluid therapy and by restoring urine production. In this case, treatment was initiated during ongoing fluid therapy. Calcium gluconate was administered to increase the threshold potential for cardiac excitation and antagonise the cardiotoxic effects of hyperkalaemia. Treatment with an intravenous bolus of glucose was also given to induce endogenous insulin release and reduce serum potassium. Hypertonic glucose solutions must be given via a central vein, or diluted appropriately. Treatment with insulin was reserved to assess response to the above therapies and fluid resuscitation, and to avoid complications such as severe iatrogenic hypoglycaemia.

Treatment with sodium bicarbonate should not be routinely used without appropriate blood gas monitoring, even when acidosis is suspected, as inappropriate dosing can cause severe metabolic alkalosis and paradoxical CNS acidosis. In hypovolaemic patients with hyperkalaemia and a metabolic acidosis, the use of sodium

Figure 2: Urine sample (stained using standard techniques)Picture K. Tennant

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CLINICAL CONUNDRUM

CLINICAL CONUNDRUM

bicarbonate is often not necessary with adequate fluid therapy; it should be reserved for cases with severe acidosis and only used after adequate volume replacement. A detailed discussion of bicarbonate therapy is beyond the scope of this article but further information is available in the BSAVA Manual of Canine and Feline Emergency Medicine and Critical Care.

Restoration of urine production

The most important factor in the restoration of urine output is ensuring adequate circulating volume and renal perfusion.

In this case, after adequate volume replacement, urine output remained less

than 0.5 ml/kg/hour, so one dose of intravenous furosemide (2 mg/kg) was administered. Furosemide is a loop diuretic that also induces kaliuresis and so is indicated in hyperkalaemic cats with oliguria/anuric renal failure. This resulted in an improvement of urine production to 2 ml/kg/hour.

A repeat dose of 2 mg/kg can be given intravenously if oliguria persists. Alternative diuretics include mannitol, which as an osmotic diuretic can potentiate overhydration, and dopamine, which as a positive inotrope probably exerts most effects via improvement of blood pressure as cats lack specific renal dopamine receptors.

What parameters should be monitored during treatment?

Urine output – placement of a urinary ■■

catheter was possible in this case without sedation as the cat was severely depressed. The catheter can be drained intermittently to calculate urine output or attached to a collection system (Figure 3)Pulmonary oedema, using physical ■■

examination including auscultation of the thorax, particularly in the face of aggressive fluid therapyBody weight at presentation and during ■■

volume replacement to assess correction of fluids deficits and indicate volume overload

Figure 3: Cat with simple closed urinary collection system

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CLINICAL CONUNDRUM

Figure 4: Lilium spp. and antifreeze, common cause of ARF in cats

List the potential causes of acute renal failure in cats and from this list suggest the most common toxic causes?

Causes of ARF in cats1. Toxins■ Therapeutic medications

– antibiotics (aminoglycosides, tetracyclines)

– NSAIDs– Chemotherapeutics (e.g.

doxorubicin, cisplatin)– Antifungals (amphotericin B)– Radiocontrast agents

■ Organic compounds– Ethylene glycol– Pesticides– Solvents

■ Plants – Lilium spp. (e.g. tiger lily, easter lily, day lily)

■ Heavy metals – mercury, lead, gold salts

■ Endogenous compounds – haemoglobin, myoglobin

■ Miscellaneous toxins – grapes/raisins, illegal drugs

2. Ischaemia■ Hypovolaemia – blood loss,

shock■ Hypotension – anaesthesia,

reduced cardiac output, hypovolaemia

■ NSAIDs

3. Miscellaneous causes■ Systemic diseases –

hypercalcaemia, FIP, lymphoma■ Pyelonephritis■ End-stage chronic renal failure

The most common toxic causes of acute renal failure in cats reported to the Veterinary Poisons Service are:

1. Ethylene glycol toxicity (recent increase in malicious poisonings reported)

2. Lilium spp.3. Unknown toxicity.

(Alex Campbell personal communication, illustrated in Figure 4) ■

ECG (particularly important in this case ■■

during administration of calcium gluconate and whilst the cat remained hyperkalaemic)Blood pressure – adjust intervention ■■

to maintain blood pressure above 90 mmHg to ensure adequate renal perfusionUrea, creatinine and phosphate to ■■

document success of therapyElectrolytes – hypokalaemia may ■■

develop during the polyuric phase of ARF and serum potassium should therefore be evaluated frequently during treatment and supplemented if requiredAcid–base status, if possible■■

PCV and total solids (to monitor for ■■

overhydration)Central venous pressure, if possible■■

Monitoring of central venous pressure allows adjustment of fluid therapy accurately and avoidance of overhydration. If equipment is not available, then body weight, urine output, PCV and total solids, along with blood pressure, should be monitored. Signs of overhydration include tachypnoea, chemosis, serous nasal discharge and pulmonary oedema.

OutcomeThe cat remained polyuric, and fluid therapy was adjusted accordingly. After 24 hours the azotaemia had reduced and the cat’s demeanour slowly improved. The cat recovered normal urine-concentrating ability with normal biochemistry after 72 hours of treatment, and remains biochemically and clinically normal 3 months later. In this case the cause of the ARF remained unknown.

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HOW TO…

MANAGE THE SYSTEMICALLY UNWELL, SUBSTAGE b, CASE OF CANINE LYMPHOMA

HOW TO…

Gerry Polton of North Downs Specialist Referrals discusses the management of those more difficult canine lymphoma cases

It has long been recognised that prognosis in cases of canine lymphoma is significantly affected by the apparent state

of systemic health at the time of diagnosis. This reflects more than the simple fact that moribund cases are fewer steps from mortality. The management of these cases

is not something that receives attention in the veterinary literature. The purpose of this article is to help clinicians to consider the management of those cases systemically unwell at presentation, so called substage b. While some cases of substage b lymphoma sadly do show little or no response to the management offered, others achieve complete remission and a full quality of life for prolonged periods.

PresentationAffected cases can be divided into two groups, those with obvious multicentric lymphoma and those without. The importance of this distinction is that the former are usually diagnosed promptly, and speed may be of the essence in regaining control of the disease.

The aetiology of the substage b status is varied (see Table 1). Efforts should be made to understand the pathophysiology of the patient’s ill health in order to optimise management. Pathogenesis is often multifactorial.

It has long been recognised in human haemato-oncology that lymphoma represents a broad umbrella classification of lymphoproliferative disease. Refinements in diagnostic capacity have led to the development of a classification system that incorporates clinical, histomorphological, cytomorphological, flow cytometric and cytogenetic characteristics to define subtypes of disease. This extensive classification effort is rewarded by more accurate prediction of biological behaviour and responses to therapy. Similar efforts have been made in veterinary oncology with a landmark study by Frédérique Ponce and others (2004) demonstrating significant survival implications for six different canine lymphoma subtypes.

Substage b patients may present without peripheral lymphadenopathy

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HOW TO…

Pathogenesis Notes

Metabolic derangements

Hypercalcaemia Varied causes, including PTHrP, IL-6, OAF

Hypoglycaemia Consumption by tumour

Uncoupling of energy transduction pathways

Due to aberrant cytokine elaboration

Organ dysfunction due to infiltration

Renal insufficiency Chemotherapy doses may require adjustment

Hepatic insufficiency Chemotherapy doses may require adjustment

CNS involvement Neurological signs may be generalised or focal

Respiratory compromise Widespread pulmonary infiltration is unusual

Bone marrow See haematological aberrations

Haematological aberrations

NeutropeniaThrombocytopeniaAnaemia

Failure of production or immune-mediated destruction of blood cells

Mass effect Partial airway obstructionVascular occlusion

Typically only in advanced cases without other systemic compromise

Table 1: Causes of failure of systemic health seen in substage b lymphomaPTHrP: parathyroid hormone related peptide, IL-6: interleukin 6, OAF: osteoclast activating factor

Diagnostic considerations: definitive diagnosis

CytologyCases of suspected lymphoma should undergo appropriate diagnostic testing to make a definitive diagnosis. For patients with generalised lymphadenopathy, fine needle aspiration and cytology can yield a robust diagnosis and spare the need for chemical restraint for biopsy. Further refinements of the diagnosis can be obtained by immuno cytochemistry or flow cytometry. These should be discussed with your laboratory prior to sampling, in case specific sample-handling practices must be observed.

Across a population of cases, histological evaluation of an entire lymph node remains a more reliable means of diagnosis of lymphoma. However, in addition to issues of anaesthetic safety, both time and cost factors merit consideration. A competent cytologist could make a diagnosis of lymphoma in minutes; the author advises that practitioners interested in managing lymphoma cases obtain lymph node aspirates and perform in house cytological evaluations regularly to gain confidence with the techniques. While a diagnosis of lymphoma may be best made by an experienced cytologist, practitioners can do both themselves and their cases a

tremendous service by confidently defining that sample quality is adequate for diagnosis and that the appropriate target has been sampled prior to submission.

Lymphoid cells are easily disrupted by forceful aspiration or smearing. The author advises that samples are obtained without suction and that only the weight of the spreading slide is used to disperse cells in the expelled sample.

Diagnostic considerations: supporting data

Haematological evaluationHaematological aberrations can arise for numerous reasons. Cytopenias arise due to bone marrow infiltration, immune-mediated destruction of mature cells or precursors, anaemia of chronic disease (lymphoma or chemotherapy for lymphoma) and significant haemorrhage. Significant neutropenia predisposes patients to sepsis, so broad spectrum antibiotic therapy is indicated. Thrombocytopenia can result in spontaneous haemorrhage that is really only responsive to prophylaxis by transfusion of fresh whole blood. Clinicians must be aware that administration of chemotherapy in these instances may precipitate a lethal complication.

Anaemia due to haemorrhage is best managed by diagnosis and treatment of the inciting cause, and whole blood transfusion

Cranial vena caval syndrome as a consequence of lymphadenopathyPhoto courtesy of Mark Goodfellow, UoB

if indicated. Anaemia of chronic disease is usually mild to moderate and is typically not addressed. In cases with other significant signs of ill health, anaemia with a PCV of 20% or greater does not warrant intervention. If PCV is less than 20% and the patient is symptomatic, transfusion should be considered as a short-term measure while other health parameters are given a chance to improve.

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HOW TO…

MANAGE THE SYSTEMICALLY UNWELL, SUBSTAGE b, CASE OF CANINE LYMPHOMA

Biochemical evaluationHypercalcaemia and indicators of renal and hepatic compromise are readily identified on serum biochemical profiles. Hypercalcaemia frequently responds promptly to the administration of lymphocytolytic therapy, such as corticosteroids. It is critical that diagnostic quality samples are obtained prior to steroid administration, however, as the chances of harvesting diagnostic samples subsequently are reduced. Hypercalcaemia induces cardiovascular and neuromuscular compromise, and uncontrolled hypercalcaemia precipitates renal failure. This effect is exacerbated by reduced renal perfusion, for example under anaesthesia.

Renal compromise may be due to pre-renal effects, such as hypovolaemia due to hypercalcaemia, or it may reflect renal disease. Renal lymphoma can be diagnosed on renal aspirate biopsy. If a diagnosis is already made, ultrasonographic changes consistent with lymphoma are adequate.

Hepatic compromise has far-reaching implications. Frequently these cases are anorectic, hypoproteinaemic, icteric and vomiting. Dramatic weight loss can be seen. Both renal and hepatic disease can lead to marked alterations in metabolism of chemotherapeutic agents. Usually this results in increased plasma drug concentrations due to failure of elimination, and dose reductions are critical. Patients with hepatic compromise can need aggressive support in order to give them a chance of recovery.

Imaging studiesThoracic radiography is indicated to identify the presence of intrathoracic masses. Hypercalcaemia is more common among cases with cranial mediastinal lymphoma and there may be no evidence of lymphoma affecting other sites. Massive intrathoracic

lesions can compromise respiratory function. A single lateral thoracic projection is often adequate to define presence or absence of mediastinal disease.

Abdominal radiography is rarely helpful. Significant lymphadenopathy can be missed whereas hepatomegaly and renomegaly may be recognised. Ultrasonography yields more valuable information and, if a diagnosis remains in doubt, aids biopsy of abnormal structures. Clinicians must be aware of the potential for biopsy-induced haemorrhage, which is of greater concern in hepatic or renal compromise.

Bone marrow samplingLymphoma can reside solely in the bone marrow, so the diagnosis should not be

ruled out on the basis of absence of evidence of disease in other body systems. If haematological parameters indicate bone marrow involvement and a diagnosis has already been made, there are few indications for marrow sampling. If the diagnosis remains in doubt, however, or if immune-mediated destruction of blood cell precursors is suspected, sampling can be of benefit for subsequent management.

Other considerations

NutritionInappetence or anorexia, vomiting, infiltrative intestinal disease and hepatopathy will all contribute to a negative energy balance. The metabolic demands of

Pretreatment lateral thoracic radiograph revealing mediastinal lymphadenopathy in a severely hypercalcaemic Boxer

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HOW TO…

advanced lymphoma are great; adequate and balanced nutrition can make the difference between success and failure in these cases.

Risk of sepsisNeutropenia due to bone marrow infiltration and/or chemotherapy, exposes patients to risk of bacteraemia and sepsis. Extra attention to infection control measures is warranted. In addition, lymphoma can induce vasculitis, with consequential systemic inflammatory response syndrome (SIRS), mimicking changes associated with septicaemia. Sepsis promotes inappropriate cycles of coagulation and thrombolysis; concurrent thrombocytopenia exacerbates risk of disseminated intravascular coagulation (DIC).

Water and electrolyte turnoverSubstage b patients typically fail to consume adequate water to compensate for insensible losses. An attempt should be made to quantify losses so that appropriate replacement therapy can be provided. Medications to limit losses through vomiting and diarrhoea are advised.

Most patients are significantly hypokalaemic. Plasma potassium concentration may not accurately reflect total body potassium depletion, as potassium is primarily an intracellular cation. Hypomagnesaemia is also recognised. Potassium and magnesium deficiencies can result in inappetence or anorexia.

Hypercalcaemia can be managed by saline diuresis. Excessive volume replacement should be avoided as cases with significant renal insufficiency are unable to excrete significant water loads; cerebral oedema may result.

Case managementWhen a diagnosis of substage b lymphoma has been made, priority must be given to:–

1. Supporting the patient2. Controlling the disease process

In order to support the patient, basic nutrition, warmth, fluid and electrolyte needs must be attended to. Inappetent or anorexic patients should not be supported on intravenous fluids alone. Assisted feeding is mandatory; this can be greatly aided by the placement of an appropriate feeding tube. Investigations should be undertaken to obtain supporting data, as presented earlier, so that potential problems can be anticipated and prevented or managed.

Control of the disease requires the judicious use of chemotherapy. Hypoalbuminaemia, hepatopathy and renal insufficiency can all lead to apparent overdose of chemotherapy due to reduced plasma protein drug binding or relative deficiencies of excretory metabolism. Biochemical and haematological parameters must be known prior to chemotherapy so that appropriate dose adjustments can be made.

Clinicians are strongly advised not to embark upon unfamiliar chemotherapy protocols when presented with a case of lymphoma that is complicated by systemic illness. Good decision-making in these cases requires confident and timely identification of progressive changes, whether those changes represent improvement or deterioration.

PrognosisAt the current time, knowledge of the behaviour of distinct canine lymphoma subtypes is rudimentary. Historically, B or T cell immunophenotype has been regarded to be predictive of outcome but this is an oversimplification. In fact, in the Ponce study (2004), the group of cases exhibiting the best survival outcome were a subgroup of T cell immunophenotype

whilst the cases exhibiting the poorest prognosis were a subgroup of B cell immunophenotype. Such a pattern would not be predicted by the traditional interpretation of effect of immunophenotype on prognosis. This is a rapidly developing field of veterinary oncology; an experienced veterinary haemato-oncologist should be consulted to offer insight into the prognostic information provided by flow cytometry and detailed cytomorphological evaluations.

ConclusionAs a group, cases of substage b lymphoma carry a poor prognosis. While in part this is simply a reflection of their ill health, it is unclear whether their prognosis would remain poorer than comparable substage a cases if complete remission were achieved. Initial management of these cases can be intensive and, with no guarantee of a successful outcome, not all owners would choose to pursue such an approach. It is the author’s experience, however, that many of these cases can enjoy a normal-for-lymphoma quality and length of life if appropriate management is implemented at an early stage. n

Ponce F, Magnol J-P, Ledieu D et al. (2004) Prognostic significance of morphological subtypes in canine malignant lymphomas during chemotherapy. The Veterinary Journal 167, 158–166

Dramatic clinical improvement following treatment and resolution of hypercalcaemia – same dog as in radiograph

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VIN

James Fingeroth DVM, Diplomate ACVS, Orchard Park Veterinary Medical Center, Orchard Park, NY

The palisading periosteal reaction would be consistent with HO, but only having a single bone involved would be quite atypical. If no other lesions are found, you may need to work up for osteomyelitis or primary neoplasia at that site.

William Hornof DVM, MS, DACVR, VIN Consultant, Chief Medical Officer, Eklin Medical Systems, Inc., Santa Clara, CA

Jim

I agree. The hallmark of HO is symmetry, and like you, I would not rule out localized tumor, and I would radiograph the chest anyway.

Todd Beatty

Hello and thanks for the response!

Chest and abdominal rads were taken after the digit radiographs and nothing was found. A CBC, profile and U/A was WNL barring a slightly elevated ALKP (248mg/dl). Abdominal ultrasound warranted? Or go straight to biopsy of digit? Wound you trephine or take the entire digit? Thanks

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

Discussion: Hypertrophic Osteopathy

Todd Beatty DVM, Garden Grove Animal Hospital, Winter Haven, FL

Hello: 6yr Male german shepard presented for intermittent left rear lameness. Proximal phalanx of third digit swollen and painful. Radiographs taken. My interpretation based on the periosteal pattern is hypertrophic osteopathy (HO). Would you concur?

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VIN

James Fingeroth

Sometimes an excisional biopsy via digit amputation makes the most sense, but since this is a weight-bearing digit, I would think about just doing a needle biopsy to start. Be sure the client (and you) are prepared for the results being inconclusive however. Hopefully you will get a definitive answer, but sometimes small specimens from a Jamshidi needle or small trephine can be hard to process, or only show reactive bone (which you already knew). If the client knows in advance that the biopsy could fail to establish a diagnosis, they will be less upset than if their expectation is for a definite answer is unfulfilled.

Todd Beatty

Hello

Have been meaning to update this case. Abdominal ultrasound was negative. I went ahead in Feb 08 and biopsied the lesion.....reports is as follows.

The dog did very well after amputation. Only limped for 24 to 48 hours after heavy exercise. Otherwise normal.

The dog represented for routine yearly evaluation a few days ago. PE unremarkable barring a firm swelling on the medial aspect of the second digit. Owner notes that dog seems more uncomfortable in recent weeks. Radiographs follow. I have asked the pathologist for a recut. Any other opinions or ideas??

The owner was prepared for a “reactive bone” diagnosis possibility. Five months later (July 08) we amputated the digit due to progressive patient discomfort. Biopsy report as follows.

Biopsy--------Amended Report--------Microscopic Description: These are sections of tissue derived from multiple specimens submitted together in one container. The specimens exhibit no natural borders and consist of varying proportions of well differentiated dense mature bone and collagenous fibrous tissue. Several specimens contain small amounts of immature reactive bone.Microscopic Findings: MULTIPLE SPECIMENS: WELL DIFFERENTIATED BONE AND FIBROUS TISSUE WITH REACTIVE BONE.Comment: The specimen indicates reactive periosteal bone proliferation, which is a response of bone tissue to etiologies as diverse as trauma, infection and neoplasia. The cause was not apparent in these sections. There is no evidence of neoplasia or inflammation.

BiopsyMICROSCOPIC DESCRIPTION: This specimen represents an amputated digit, part of the distal digital bone affected by fragmentation and necrosis. The adjoining bone is reactive and a zone of periosteal fibrosis is identified. Synovial tissues are reactive. Inflammation is limited to a few plasma cells.MICROSCOPIC FINDINGS: MILD FIBROSING CELLULITIS WITH NECROSIS OF DIGITAL BONE AND ASSOCIATED REACTIVE CELLULITIS, THIRD DIGIT OF REAR FOOTCOMMENT: Morphology is consistent with a chronic response to some type of trauma. No evidence of active infection or neoplasia is seen.

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VIN

Cathy Wilkie DVM, VIN Associate Editor, Diagnostic Imaging, Animal Medical Hospital, West Vancouver, BC Canada

Todd, that looks more like atypical OA reaction on the lateral toe. My theory would be that the absence of the 3rd digit is allowing the 2nd to come across laterally, putting strain on the medial collateral ligament at M-P1 of digit 2 and causing this large enthesiophyte. It’s a pretty theory; I’ll see if anyone can come up with a better one.

Todd Beatty

I could explain the 2nd digit as a result of increased strain, but I was also concerned about the palisading periosteal reaction on the proximal phalanx of the fourth digit as well. This is very similar to the original problem.

Michael Harter VIN Associate Editor, Diagnostic Imaging, Parasitology, Animal Medical Clinics, Rockford, IL

The fourth would now be the main weight-bearing digit.... I don’t know.

Have you checked thorax radiographs again, lately?

Cathy Wilkie

I guess I’m still not convinced for HO. It certainly wouldn’t be wrong to repeat thoracic rads, though. No other feet involved, right?

Todd Beatty

I was waiting for recut and VIN opinions before deciding on repeating rads. My theory is excess stress on the bone.

He is not lame on any other limbs despite having early cruciate disease on the right rear. I have not radiographed the other digits.

William Blevins DVM,MS, DACVR, VIN Consultant, Otterbein, IN

Todd;

An additional cause of the periosteal reaction that you are seeing in these digits is local inflammation. If you increase the blood flow to bone, it will make bone. The lateral digital reaction is probably as Cathy described.

I suspect that there was soft tissue inflammation that caused the periosteal reaction.

Todd Beatty

Additional sections from pathology are back......no new findings :/ Currently on anti-inflammatories. We’ll see how we do!

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

This discussion has been edited for print. Find the full discussion online at www.vin.com/Link.plx?ID=71598

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PUBLICATIONS

BARRIER NURSING

Barrier nursing creates a physical barrier between the member of staff and the patient. The precise nature of

the barrier depends upon the type of cross-infection, e.g. organisms spread via the aerosol route require consideration of shared air space, whereas faecal parasites require attention to fomites.

Barrier nursing is employed:

When a suspected infectious disease is ■■

present, in order to control the spread of possible infection between patients – for example, in cases of MRSA, canine parvovirus and cat flu. In these situations other patients within the veterinary hospital need to be protected from the infected patientTo protect staff from a suspected ■■

zoonotic disease – for example, in a suspected case of leptospirosis or psittacosis. In cases of possible zoonosis, human health and safety is of prime importance and the spread of infection from the patient to all personnel must be avoided

To protect the patient itself from ■■

infections elsewhere in the practice – for example, in neutropenic patients and neonates or very young patients. In these situations, it is the patient that is at increased risk of contracting a disease from elsewhere in the practice due to its own health status.

Protective clothingSince barrier nursing requires an actual barrier between the member of staff and the patient, a set of special clothing is worn to create this barrier. A layer of clothing over the top of usual work wear is essential, ideally covering the whole uniform rather than just the torso as would be the case with a disposable apron. Disposable gloves should be worn and disposed of after handling the patient. The clothing worn to nurse a particular patient is then taken off, as it should only

be used for that one patient: this limits the likelihood of transferring disease between patients.

IsolationIsolation of patients is often used in conjunction with barrier nursing. For isolation, a kennel area, situated away from the main kennels, which is a separate kennel unit in itself is used. In some practices, an isolation kennel is not available due to space constraints; however, in certain instances a dog can be placed in the cat kennel area and a cat placed in the dog kennel area. This does not isolate the patient, but what it does do is to reduce the risk of the spread of disease between species. This practice of dog/cat isolation may be utilised in cases where the infectious disease is limited to a particular species, for example in cases of cat flu. It is by no means ideal, as the cat is surrounded by dogs rather than in a quieter

Preventing the spread of infection is an important consideration in veterinary practice. Here, Paula Hotston Moore, Internal Verifier in Veterinary Nursing at the University of Bristol and co-editor of the BSAVA Manual of Practical Animal Care, explains the role of barrier nursing

Dog with suspected canine parvovirus in an isolation kennel

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PUBLICATIONS

place, but is preferable to leaving the patient in the cat ward with the likelihood of spreading the disease to other cats.

The ideal isolation kennel is completely separate to the main dog and cat wards. The isolation kennel needs to be a complete entire unit, with its own hand-washing facilities and all its own equipment: bedding, mop, bucket, cleaning materials, clinical waste receptacles, thermometer and stethoscope. Personal protective equipment for personnel should be available in the isolation area, as barrier nursing should always be used in the isolation kennel. All veterinary staff entering the isolation area must wear protective clothing in order to limit the spread of disease to other areas of the practice premises. A viricidal disinfectant bath should be placed at the entrance to the isolation kennels and all footwear should be dipped on the way into and out of the isolation area. One member of nursing staff should take charge of isolation nursing to limit the possible spread of disease between patients. Routine hand disinfection must take place between isolated inpatients (as with all inpatients) and also on entry and exit of the isolation area. The isolation kennels must not be a walk-through area, again in order to restrict the number of personnel entering and leaving the isolation zone.

Nursing considerationsThought must be given to the daily nursing routine of inpatients. Some consider that isolation cases should be nursed before other patients in the main kennel area, due to immunosuppressed isolated patients being vulnerable to disease from the main

hospital area. Others feel that isolation inpatients should be nursed after the main hospitalised patients to cut down on the possibility of transferring disease from isolation to the main kennel area. Due consideration should be given to the nursing protocol and the reasons disseminated to all staff so that they understand the rationale behind such decisions.

Consideration should also be given as to whether patients require isolation plus barrier nursing, or whether barrier nursing alone is required.

Patients with endoparasite infections ■■

need barrier nursing rather than being placed in isolation. This is because the

More information on isolation and barrier nursing in veterinary practice can be found in the BSAVA Nursing Manual series:

To purchase your copy of these titles, visit our website at www.bsava.com or telephone the Membership and Customer Services Team on 01452 726700.

BARRIERNURSING

infection is not transmitted by airborne means and the patient can therefore share the same environment and air space as other patients. Barrier nursing will reduce the spread of infection in this caseA cat with suspected cat flu should be ■■

both isolated and barrier nursed to limit the spread of the disease to other cats in the practice. A bird with suspected psittacosis needs ■■

to be isolated to limit the spread between other patients as the disease is transmitted via air space. Barrier nursing must also be in place to limit the spread of the disease to humans, since it is zoonotic. ■

An isolation unit(Reproduced from the BSAVA Manual of Practical Animal Care)

A patient receiving barrier nursing care in the critical care unit(Reproduced from BSAVA Manual of Canine and Feline Advanced Veterinary Nursing, 2nd edition)

BSAVA Manual of Practical Animal Care

Member price £24.99 Non-member price £29.99

BSAVA Manual of Practical Veterinary

Nursing

Member price £36.00 Non-member price £56.00

BSAVA Manual of Canine and Feline

Advanced Veterinary Nursing, 2nd edition

Member price £49.00 Non-member price £70.00

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PETSAVERS

Improving the health of the nation’s pets

BLOOD TYPING IN CATS

PETSAVERS

Petsavers Grant Awarding Committee funds both residencies at academic institutions and small projects both at

academic institutions and by vets in practice. In the late 1990s Petsavers funded Claire Knottenbelt’s residency and project on feline blood typing at the Royal (Dick) School of Veterinary Studies, Edinburgh.

Identifying typesClaire’s work clarified the prevalence of the three blood groups (A, B and AB) in cats in the UK. Most domestic short hair cats and domestic long hair cats are type A, with smaller numbers of types B and AB. In pedigree cats, more type B cats are found, but there is both breed variation and, even within specific pedigree breeds, blood type prevalence may show marked geographic variation. In the group of pedigree cats tested by Claire, 58.7% of British Shorthairs, 29.2% of Birmans, 11.8% of Persians and 10% of Burmese were Type B. In contrast 50% of Bengals and Abyssinians, 22.2% of Somalis and 8.3% of Birmans were Type AB (However it is notable that in some cases the total number of cats tested for a given breed was small).

Type B cats have naturally occuring high titres of anti-A alloantibodies and transfusion of type A blood into a type B recipient results in an immediate, dramatic and often fatal transfusion reaction. At first it was believed that only one third of type A cats have anti-B alloantibodies, but later work in a group of cats in the USA showed all the type A cats tested did so. Thus type A blood transfused into a type B cat also causes a transfusion reaction but this is typically clinically less severe and is still accompanied by the lysis of the transfused erythrocytes.

TransfusionsThe normal feline erythrocyte half-life is approximately 40 days. Autologous and allogenic matched transfusions of both type A and type B blood are well tolerated, with an erythrocyte half-life of approximately 29 days. However in the case of mismatched transfusions, type B erythrocytes infused into a type A cat have a mean half-life of only approximately 2 days whereas type A erythrocytes transfused into a type B cat have a half-life of minutes to hours. Given that a transfusion is often given to maintain a patient’s PCV, transfusion of unmatched

Jo Arthur of Petsavers Grant Awarding Committee looks at the importance of blood typing for blood transfusions and in kittening queens, highlighting how a Petsavers funded study has advanced veterinary knowledge

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

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PETSAVERS

If a practice wishes to be able to provide blood transfusions, when required, to its feline patients, a list of appropriate

donors needs to be established. Criteria for potential donors include being in good health, aged one to eight years, weighing at least 5kg, FeLV/FIV negative, and the cat must not have travelled outside the UK.

The written consent of their owners is required. When my own cat, Prue, required an emergency blood transfusion, she was fortunate enough to be Type A and to be at a referral practice where one of the nurses’ cats was a Type A registered blood donor.

The reason practices are dependent on setting up their own list of potential feline blood donors is because whilst the pet blood bank is able to provide a range of canine blood products, at the moment it is not able to provide feline blood products. However, the pet blood bank is already identifying potential feline blood donors, and it is hoped that feline blood

TRANSFUSIONS IN PRACTICE AND THE PET BLOOD BANKJo Arthur gives a brief overview of the available options and issues for canine and feline blood transfusions

products will be available in the future.At the ‘PETS or pests?’ lecture on

3 April at BSAVA Congress, Dr Susan Shaw of the University of Bristol reported that of the 183 dogs diagnosed positive for Leishmania at her lab in the UK, three had no travel history, but all had been obtained from UK rescue societies. There are also concerns that in the future Leishmania may be transmitted to dogs that have not travelled abroad, either due to the northern migration of the sandfly vector due to climate change, or by direct transmission. Therefore, ideally, 100% of the donated blood would be sent for a Travel Screen, but this would make the cost of the blood products prohibitively expensive.

At present, the pet blood bank sends aliquots from 10% of the donated canine blood for a Travel Screen. To date, none of the donated blood has tested positive – dogs that have travelled abroad are excluded from donating blood, and at present the number of cases of vector-borne disease in dogs without a history of travelling abroad is very small.

This is yet another issue that highlights the importance of maintaining the derogation, to avoid vector-borne disease becoming endemic in the UK. ■

BLOOD TYPING IN CATS

blood not only exposed the patient to the risk of a potentially fatal transfusion reaction but also may only raise PCV for a few days.

Kittening queensThe other situation where the blood type of the feline patient is important is in kittening queens. Type A or AB kittens born to type B queens are at risk of neonatal isoerythrolysis due to anti-A antibodies in the mother’s colostrum ingested within 24 hours of birth. Not all type A or AB kittens in the queen’s first litter would necessarily be severely affected, as 40% of the type B cats in Claire’s study had relatively low anti-A antibody titres.

TestingClaire’s work also validated the Rapid Vet-H (Feline) desk top blood typing kit, which enabled vets in practice to have a simple and accurate method of blood typing cats.

Petsavers funds projects which do not involve the use of experimental animals and improve the diagnosis and/or management of disease in small animals, Claire’s research enabled vets in practice to give blood transfusions to anaemic cats much more rapidly and safely. ■

The written consent of their owners is required. When my own cat, Prue, required an emergency blood transfusion, she was fortunate enough to be Type A and to be at a referral practice where one of the nurses’ cats was a Type A registered blood donor.

on setting up their own list of potential feline blood donors is because whilst the pet blood bank is able to provide a range of canine blood products, at the moment it is not able to provide feline blood products. However, the pet blood bank is already identifying potential feline blood donors, and it is hoped that feline blood

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WSAVA NEWS

Did you know?■ The largest number of visitors to the

website were from the USA, around 36% of the total, with the rest of the top 10 being: UK, Canada, Australia, Italy, Spain, China, France, Mexico, and Germany

■ 91% of visitors came directly to the www.wsava.org site

■ Google was the most common referral search engine

■ The most common search phrases used to reach our website included ‘WSAVA’, ‘tail docking’, ‘small animals’ and ‘veterinary associations’

■ The most popular pages viewed included those on microchip identification, tail docking, congresses, news, and member association pages.

The WSAVA website continues to be popular, with more than 2 million hits last year, up 10% on 2007 – that’s an average of around 175,000

per month or 5,800 per day. Page views were up by 20% compared to 2007, at over half a million. All in all, these numbers indicate a continued and growing interest in the WSAVA and its various initiatives. Our member associations continue to be busy implementing CE and a variety of other association initiatives, and many have provided annual reports that can be read on the ‘member associations’ pages on our website.

A few facts and figures about our website

www.wsava.org

The most common search phrases used to reach our website included

with more than 2 million hits last year, up 10% on 2007 – that’s an average of around 175,000

A few facts and figures about our

.org

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The most common search phrases used to reach our website included The most common search phrases used to reach our website included

24 | companion

WSAVA NEWS

WSAVA NEWSWSAVA NEWS

World Rabies Day is just around the corner and we’d like to take this opportunity

to inform you about some new resources and utilities available via our website (www.worldrabiesday.org). We also invite you to submit information about any events you are planning for this year’s campaign! We will be updating our website throughout the coming months and we encourage you to check back regularly for new and helpful planning materials.

WORLD RABIES DAY 20 09The WRD team highlights some of the events surrounding World Rabies day on 28 September

What are you doing?We want to hear about your events! Please send event information to: peter.costa@worldrabiesday.org .

Attention: Shelters and human associationsWe’ve recently initiated a web page just for you, where you will find educational materials that are freely downloadable. The web page is available at: www.worldrabiesday.org/EN/Get_Involved/Shelters.html . For more information, please contact Mylissia Stukey (Shelter Outreach Coordinator) at mylissia.stukey@worldrabiesday.org .

Get tweeting!Follow World Rabies Day on Twitter (twitter.com/worldrabiesday) and post event stories/pictures on Facebook (www.facebook.com/group.php?gid=35575735236). View/download/submit video at our

YouTube site (www.youtube.com/user/worldrabiesday) and join the WRD Flickr Group (www.flickr.com/groups/wrd/)!

Educational materialsResources from around the world are available from the World Rabies Day Education Bank (www.worldrabiesday.org/EN/Education-Bank/english.html). Logos in over 25 languages can be found at: worldrabiesday.org/EN/Logo_Downloads .html. Please contact us for specific languages or to help create new logos.

Fundraising and advocacySee what our global health advocates are saying about World Rabies Day at www.worldrabiesday.org/EN/Media_Center/Perspectives.html . Read about some of the fundraising projects currently underway at www.rabiescontrol.net/EN/Programs/Projects-Overview.html . Funds donated to this initiative are used to support

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WSAVA NEWS

WORLD RABIES DAY 20 09Honouring the contribution of Anna Worth, past AAHA president and WSAVA representative

We are sad to report that on Saturday 16 May, Dr Anna Elizabeth Worth, past

president of the American Animal Hospital Association (AAHA) and WSAVA representative, passed away peacefully at home surrounded by her family, following a valiant fight with cancer. Her accomplishments and far-reaching influence mean that she will be greatly missed by members of our profession around the world.

Anna was actively involved in veterinary medicine at many levels. Locally, she served on the Board of the Bennington County Humane Society. She also served as president of the Vermont Veterinary Medical Association (VVMA), where she founded and edited the VVMA newsletter. She served as the Vermont delegate to the American Veterinary Medical Association from 1992 to 1999. In 1992 she received the Massachusetts SPCA Veterinarian of the Year Award, and in 1997 the David Walker Award. She served as chairperson for the Vermont Cruelty Task Force and the Vermont Animal Welfare Committee.

Across the past 12 years, Anna became passionately involved with AAHA. She served on numerous committees and acted as the AAHA

representative for the CATalyst Council, National Council on Pet Population Study and Policy, and the WSAVA. In 2005 she helped found the AAHA Helping Pets Fund, which provides funds to pets and clients in need. From 2008 to 2009, during her illness, she served as AAHA president where she championed student advocacy and mentoring guidelines, and had numerous speaking engagements at veterinary colleges in the USA and Canada. Despite all of this, she continued to find time for other activities, including a veterinary management group, the AAHA Veterinary Management Institute, and being president of the Society for Veterinary Medical Ethics.

Anna grew up in a home where she was allowed to bring her treasured donkeys into her parents’ living room. Her love for the outside world was evident in her vocation and hobbies, which included gardening, astronomy, motorbikes, cycling, tennis, camping, and boating. Anna was a voracious reader and loved trying new things, travelling and meeting new people. She was actively involved in the community, participating in the Parent Teacher Association, the MAU High School Curriculum Committee, and the Vermont Women’s Fund. She will be sadly missed. ■

A LIFE REMEMBEREDcommunity level

rabies control and education programmes throughout the world, with a specific focus on regions with high human rabies cases and uncontrolled rabies in dogs.

Partner with us!World Rabies Day is supported by partnering organisations throughout the world – if you are interested in becoming a partner, please contact peter.costa@worldrabiesday.org . A list of our current partners can be found at: www.worldrabiesday.org/EN/Our_Partners/Our_Partners.html .

RITA 2009The 20th International Conference on Rabies in the Americas (RITA) will be held 19–23 October 2009 in Quebec City, Quebec, Canada. For more information see www.rita2009.org . ■

community level rabies control and

6

Photos 1 and 2: WRD 2008, Serengeti. Tendeka Maiaiu and Suzanne McNabb; Photo 3: WRD 2007, Zambia. Dr Perfecto Buyamba Kabanshi; Photo 4: WRD 2008, Swaziland. Dr Sihle Mdluli; Photo 5: WRD 2007, University of Manchester. Emm Barnes; Photo 6: WRD 2007, Thailand. Molecular Biology Center for Neurological Diseases, Chulalongkorn University Hospital

26 | companion

companion INTERVIEW

Maggie Fisher was born in 1963 near Warrington in Cheshire and grew up on a small market garden as the eldest of three sisters. Her maternal grandfather was a Ministry vet and the challenge of his career appealed, so she applied to RVC and after five years graduated as a vet in 1986. After a short period in mixed practice she returned to the RVC as an intern and lecturer in parasitology. In 1993 she moved with her husband and two small daughters to a small animal practice in Worcester, and since 1997 has developed a consultancy in parasitology

You are known for your work in parasitology; what drew you to this specialism?

As recent graduates working in practices in the Midlands, my husband and I realised that on our combined income we couldn’t afford even the smallest house in the village where I was working, so we decided to move back towards London to make some money. I was also struggling to smile at clients 5 or 7 days a week (and I wholly admire those of you who are doing that day on day). I was interested in everything and anything and Dennis Jacobs at the RVC happened to have a vacancy and so when we returned to London I began the internship with him.

How did your work with the European Scientific Counsel for Companion Animal Parasites come about?

Ruedi Schenker of Novartis had set up an American group, CAPC – and he wanted to set up a European group. He approached me to be the moderator. In coming together as a group, the parasitological challenges that face us in Europe became far more apparent than they were to us as individuals. Plus, as a group we were in a better position to suggest what could be done about them than we were as individuals. There was a sense too, best described by Jim Duncan our present chair, that parasitological expertise has somehow failed to get out of the ivory tower in a user-friendly way. And ESCCAP was an opportunity to address this.

What are ESCCAP’s main aims?The long term goal for ESCCAP is that parasites are no longer a health issue for pets or humans across Europe. This is obviously some way off, and indeed when preparing an abstract for the WAAVP (World Association for the Advancement of Veterinary Parasitology) conference later this summer, I realised that probably, over the past 3 years, parasites have become a greater health issue. Having established ESCCAP our ongoing challenge at both European and national level is defining priorities and fulfilling on these as we work towards this goal.

What do you consider to be your most important professional achievement so far?

There is a distinction that I have only now overcome: for many years I haven’t considered myself a ‘real’ vet as I don’t work in practice. Thus, my most important professional achievement in practice was an aural resection. Now I often develop leadership skills in others or work within a team and so in some senses achievements are never all my own doing. I am proud of having created and held a symposium at a world conference to consider how the 3Rs (reduction, replacement and refinement) can be implemented into parasitology research for regulatory purposes. I’m also proud to have played a part in raising awareness of the value of the tick and tapeworm treatment derogation within the Pet Travel Scheme.

What has been your main interest outside work?

I have tended to disappear into work as an escape route, so outside interests are not perhaps very well developed. Without doubt, my main occupation is bringing up my two daughters. And I love my mountain bike.

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

In the UK probably Lord Soulsby. I was privileged a few years ago to launch the book (created as the final project of the Allan White Educational Trust) that John McGarry and I had written at a reception in the House of Lords hosted by Lord Soulsby.

What would you have done if you hadn’t chosen to be a vet?

I remember as I cycled on the way to collect my A level results I concluded that if they didn’t get me into vet school then I would try again. So there was no plan B.

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

That each of us is powerful and it is only possible to use it if we define what we want to do clearly and are willing to let go of the concerns and other constraints that we place upon ourselves.

What is your most important possession?

My Swiss army knife that’s kept in my handbag and I have to post to myself when I discover it in my hand luggage at customs! n

THEcompanionINTERVIEW

CPD DIARY

companion | 27

CPDDIARY

3 SeptemberThursday

AngiostongylusSpeaker Sheila BrennanThe VSSCo, Lisburn. Northern Irish RegionDetails from Shane Murray, shane@braemarvetclinic.co.uk, or VetNI, 028 25898543, info@vetni.co.uk

EVENINGMEEtING

2 SeptemberWednesday

Cardiology: The Quest Study, when not to use pimobendan, and ACE inhibitors are not deadSpeaker Mark PatessonThe Park Inn Hotel, Llanedeyrn, Cardiff CF23 9XF. South Wales RegionDetails from the Chairman or secretary,southwalesregion@bsava.com

EVENINGMEEtING

9 SeptemberWednesday

Orthopaedics: the diagnosis and management of carpal and tarsal problemsSpeaker Hamish DennyThe University of Bristol, Langford House, Langford, North Somerset BS40 5DU. South West RegionDetails from Kate Rew, kate@linhayvet.co.uk

EVENINGMEEtING

10 SeptemberThursday

Preparing for bonfire night special. Drugs used to treat behaviour/phobiasSpeaker Danny MillsThe Acorn House Veterinary Surgery, Linnet Way, Brickhill, Bedford MK41 7HN. East Anglia Region.Details from Graham Bilbrough, graham-bilbrough@idexx.com

EVENINGMEEtING

1SeptemberTuesday

Sending your dog to rehabSpeaker Fiona DoubledayThe Potters Heron Hotel, Ampfield, Romsey, Hampshire S051 9ZF. Southern RegionDetails from Michelle Stead, 01722 321185, mmstead@btinternet.com

EVENINGMEEtING

10 SeptemberThursday

Practical haematology: detective work for nursesSpeaker Kostas Papasouliotis BSAVA, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley GL2 2AB. Organised by BSAVA.Details from the Membership andCustomer Service Team, 01452 726700, administration@bsava.com

DAYMEEtING

13 SeptemberSunday

Considering behaviour in veterinary medicineSpeaker Sarah HeathThe Pavilions of Harrogate, Great Yorkshire Showground, Harrogate HG2 8QZ. North East RegionDetails from Karen Goff, 01924 275249, northeastregion@bsava.com

DAYMEEtING

15 SeptemberTuesday

EndoscopySpeaker P.J. NobleThe Swallow Hotel, Preston New Road, Preston PR5 0UL. North West RegionDetails from Simone der Weduwen, 01254 885248, beestenhof@ ntlworld.com

EVENINGMEEtING

25 AugustTuesday

Oncology: medical treatment for mast cell tumours and assessment of the quality of life of a cancer patientSpeakers Tom Cave and Rob HarperThe Holiday Inn Bristol Airport, Brunel Room, A38 Bridgwater Road, Redhill, Bristol BS40 5RB. South West RegionDetails from Lennon Foo, lennonvet@hotmail.com

EVENINGMEEtING

10 SeptemberThursday

‘ECGs for dummies like me’Speaker Geoff CulshawThe L.A Lecture Theatre R(D)SVS, Edinburgh. Scottish RegionDetails from Claire Robertson, 07792 251003, claireadriennelamb@hotmail.com

EVENINGMEEtING

9 SeptemberWednesday

Haematology Road ShowSpeakers Guillermo Couto and Michael DayDay meeting at the Daventry Hotel, Sedgemoor Way, Daventry, Northamptonshire NN11 0SG. Organised by BSAVADetails from the Membership andCustomer Service Team, 01452 726700, administration@bsava.com

11SeptemberFriday

Haematology Road ShowSpeakers Guillermo Couto and Michael DayDay meeting at Mottram Hall, Wilmslow Road, Mottram St Andrew, Cheshire SK10 4QT. Organised by BSAVADetails from the Membership andCustomer Service Team, 01452 726700, administration@bsava.com

14 SeptemberMonday

Haematology Road ShowSpeakers Guillermo Couto and Michael DayDay meeting at the Marriott Hotel, Kingfisher Way, Hinchingbrooke Business Park, Huntingdon PE29 6FL. Organised by BSAVADetails from the Membership andCustomer Service Team, 01452 726700, administration@bsava.com

16 SeptemberWednesday

Haematology Road ShowSpeakers Guillermo Couto and Michael DayDay meeting at the De Vere Hotel, Hook Heath Road, Gorse Hill, Woking GU22 0QH. Organised by BSAVADetails from the Membership andCustomer Service Team, 01452 726700, administration@bsava.com

For further details of CPD courses in your area, please visit www.bsava.com

British Small Animal Veterinary AssociationWoodrow House, 1 Telford Way, Waterwells Business Park,

Quedgeley, Gloucester GL2 2ABTel: 01452 726700 Fax: 01452 726701

Email: administration@bsava.comWeb: www.bsava.com

For more information or to order visit www.bsava.com, email administration@bsava.com or call 01452 726700

Special offers on BSAVA Manuals

£26

BSAVA Manual of Canine and Feline

Oncology, 2nd editionEdited by Jane Dobson and Duncan Lascelles

■ Focus on the clinical approach to care■ Tumour biology, pathology, diagnostic

techniques and clinical staging■ Ethical issues, emerging therapies

and nutrition

Member price £52 £26

BSAVA Manual of Canine and FelineBSAVA Manual of Canine and Feline

£26

BSAVA Manual of Small Animal

Cardiorespiratory Medicine and SurgeryEdited by Virginia Luis Fuentes and Simon Swift

■ Problem-oriented approach■ Diagnosis and treatment of disorders from

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New editions of both manuals will be published during 2010