Companion May2012

Celebrating CongressIn picturesP4

Notifi able DiseasesA useful guide

P8

Clinical ConundrumA tachypnoeic Labrador retrieverP12

The essential publication for BSAVA membersThe essential publication for BSAVA members

companionMAY 2012

Feline blood donation: how to

select donors and collect blood

Celebrating Congress

Notifi able DiseasesA useful guide

Clinical ConundrumA tachypnoeic

Feline blood donation: how to

select donors and collect blood

01 OFC May.indd 1 23/04/2012 08:52

2 | companion

Im really looking forward to the challenge and am very proud to be representing the Association. The BSAVA is a huge organisation of more than 7,000 vets, nurses

and students so there is a leadership role, a figurehead in a sense, and for me it is about guidance and working with the Officer team to ensure the profession moves forward.

There is no doubt the economic situation is challenging to vets at the moment, but we are a unique and hard-working profession. We have to be good business people as well as good vets, so Im very pleased to see our Vet Schools are improving business education every year and Congress has now introduced an excellent business stream, plus there is the new management manual on its way.

Over the past year Ive been learning a lot more about One Health. As vets we have always learned about the risks of diseases spreading from viruses jumping species, but Im concerned that doctors dont fully understand the risks. Rarely do doctors ask if people have pets, but they should it is a good soft opening question to build a good relationship with patients and it can establish if there is a reason for disease. It would be useful for the two professions to work together.

companion is published monthly by the British Small Animal Veterinary Association, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB. This magazine is a member-only benefi t. Veterinary schools interested in receiving companion should email [email protected]. We welcome all comments and ideas for future articles.

Tel: 01452 726700Email: [email protected]

Web: www.bsava.com

ISSN: 2041-2487

Editorial BoardEditor Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVSPast President Grant Petrie MA VetMB CertSAC CertSAM MRCVS

CPD Editorial TeamIan Battersby BVSc DSAM DipECVIM-CA MRCVSSimon Tappin MA VetMB CertSAM DipECVIM-CA MRCVSPatricia Ibarrola DVM DSAM DipECVIM-CA MRCVS

Features Editorial TeamCaroline Bower BVM&S MRCVSAndrew Fullerton BVSc (Hons) MRCVSMathew Hennessey BVSc MRCVS

Design and ProductionBSAVA Headquarters, Woodrow House

No part of this publication may be reproduced in any form without written permission of the publisher. Views expressed within this publication do not necessarily represent those of the Editor or the British Small Animal Veterinary Association.

For future issues, unsolicited features, particularly Clinical Conundrums, are welcomed and guidelines for authors are available on request; while the publishers will take every care of material received no responsibility can be accepted for any loss or damage incurred.

BSAVA is committed to reducing the environmental impact of its publications wherever possible and companion is printed on paper made from sustainable resources and can be recycled. When you have finished with this edition please recycle it in your kerbside collection or local recycling point. Members can access the online archive of companion at www.bsava.com .

3 BSAVA NewsLatest from your Association

47 Congress in PicturesAn update and photos from World Congress 2012

811 Notifiable and Zoonotic Disease for Companion Animal PractitionersGuidance on the obligations we face as a profession

1215 Clinical ConundrumConsider the approach to a tachypnoeic older Labrador retriever

1620 How ToSelect and collect: feline blood donation

21 Scottish Congress 2012Now head north for a Summer Congress

2223 What Joness has to OfferThe latest edition of the BSAVA Textbook of Veterinary Nursing

2425 Nursing HistoryEarly proposals for the qualities required in a veterinary nurse

2627 Chronic Kidney Disease in DogsHow PetSavers funding has helped vital research

2829 WSAVA NewsThe World Small Animal Veterinary Association

3031 The companion InterviewAndrew Trawford

33 Focus OnEast Anglia region

3435 CPD DiaryWhats on in your area

Additional stock photography Dreamstime.com Alexandru Vladoiu; Bogdan Carstina; Isselee; Jagodka; Matthewgore; Pavel Hodorogea

Your new PresidentMark Johnston qualified from the RVC and runs a three vet

practice in South-East England. companion caught up with him for a few minutes

at Congress as he took the helm as President of BSAVA

Your new

helm as President of BSAVA

02 Page 02 May.indd 2 23/04/2012 08:51

companion | 3

Researchers at Liverpool University have shown it is possible to extract priceless epidemiological data on companion animal diseases from practice computer records. Now it is up the profession as a whole to make sure that the process continues and that the data produced is

effectively and ethically used. This is why BSAVA made increasing awareness of SAVSNET a priority at Congress.

Delegates were told by Dr Alan Radford, principal investigator, how the original pilot study had considered gastrointestinal diseases using data from both commercial laboratories and private first opinion practices. Now SAVSNET plans to collect information on a much broader range of conditions including dermatological, respiratory, neurological, oncological and endocrine diseases, Dr Noble told the meeting.

Initially, SAVSNET gathered data from a limited number of practices and only those using a particular practice management system from Vet Solutions. Now the organisers hope to collect information on routine consultations from as many practices as possible, all around the country. If you are using that system already in your practice, then you can sign up immediately. If not, then please join us as we encourage other providers to produce the software that will allow it to be embedded in the SAVSNET system, said Dr Radford.

The ambition is to make data available at different levels for the public to learn about the prevalence of their pets condition, for practitioners to find out how their practice compares with others (anonymously), and for researchers to use the raw data in further studies.

I would find it incomprehensible for any member of the profession not to want to contribute to this project, suggested one interested observer, Professor David Church of the Royal Veterinary College. For more information about becoming part of the project email [email protected].

Surveillance now is the time

With BSAVA joining the team at University of Liverpool for the SAVSNET project, now is the time for the profession to get ambitious about data gathering so we began by taking that message to Congress

One of the key themes running through BSAVA Congress was One Health with BSAVAs Junior Vice-President Michael Day leading the call for the

veterinary profession to take the lead and work with human health and environment agencies.

At a series of lectures, and in the press conference, leaders from WSAVA, FECAVA and BSAVA discussed how global collaboration is essential if we are to meet the key objectives set by the One Health ideal.

For the ambitious WSAVA One Health initiative this means rabies it is one of the first focus areas and the team believe now is the time to address the fact that an estimated 55,000 rabies-related deaths occur every year mostly in children in the developing world. Jolle Kirpensteijn of WSAVA, Simon Orr of FECAVA and Michael Day, who chairs the One Health project all agree it is possible to eradicate this disease, and we have both the ability and responsibility to do so.

Vets lead on One Health

POISONS PICK-UP

The loyalty bene t for 2012 (available to renewing members) was a big hit at Congress. Eligible members were keen to be the rst to collect their BSAVA/VPIS Guide to Common Canine and Feline Poisons on the BSAVA Balcony. All those members who did not collect at Congress will be sent their copy during May and June.

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The BSAVA was proud to welcome its WSAVA and FECAVA colleagues and visitors from around 70 nations to Congress 2012, with a particularly strong Scandinavian contingent

and many professionals from the USA, Australia, and the rest of Europe.

The diversity of delegates was celebrated in fine fashion with a Welcome Reception and Opening Ceremony at the ICC, featuring speeches from the Presidents of all three Associations Andrew Ash, BSAVA; Jolle Kirpensteijn, WSAVA; Simon Orr, FECAVA. The Opening Ceremony also included a moving talk from BSAVA founding father Brian Singleton, who celebrated the rich history of innovation of BSAVA Congress.

The Taste of Britain event that followed was a massive success, where delegates from all over the world were heard to comment on why BSAVA Congress was such a draw Dr Marge Chandler, who has worked in California, Colorado, New Zealand, Liverpool and Edinburgh said, BSAVA Congress has an excellent international presence, especially amongst the guest speakers so lots of expertise. And it is really nice meeting people at both the CPD and social occasions and just running into them around the event.

Congress opened its exhibition doors on Thursday when the lectures also began in earnest. With so many additional delegates there was always a buzz in both the NIA and ICC. The usual social events had sold out weeks before the event the Banquet had to be expanded to 950 all eating restaurant-quality food and enjoying great live music. Party Night tickets were hot property and thousands packed in to see superb comedy and enjoy Olly Murs X-factor performance.

All three lecture programmes vet, nurse and management were described as fresh, challenging, and inspiring. The How To (inspired by the companion feature of the same name) and Controversy lectures really sparked delegates imaginations.

Record breaker

The veterinary world converged on Birmingham in April, with a record number of international delegates representing six continents. With more than 7000 visitors joining the 3000-plus exhibitors, this was another record breaking year

04-07 Congress In Pictures.indd 4 23/04/2012 08:48

companion | 5

ceLeBrItY congreSS. Several exhibitors brought in some well-known faces to help tell their story including athlete Steve cram for petplan and adventurer ray Mears for Merial. everyone said that the exhibition was bigger and brighter and better this year and that the number of new launches was incredible.

SAVSnet. At the press conference Dr Alan radford gave an enlightening demonstration of how the Small Animal Surveillance network could help the profession take a view on its use of antimicrobial products.

FounDIng FAtHer. BSAVA welcomed the world to congress at its opening ceremony on Wednesday afternoon, where our friends from WSAVA and FecAVA joined us to celebrate the start of a very special international event. Brian Singleton, involved in the foundation of both BSAVA and WSAVA, and a past-president of both Associations gave an inspiring speech.

LorD roBert WInSton delivered an inspiring talk on thursday afternoon. An enthralled audience packed out Hall 1. He talked about how veterinary research was responsible for many of the developments in his own area of Medicine, and that government needs to place a much higher priority on scientific research in the future.

Robert Winston

Brian Singleton

Alan Radford

WeLcoMIng tHe WorLD. Festivities began a day earlier than usual with an evening of great British goodies and entertainment at the taste of Britain party on Wednesday. Award winning Welsh choir, only Men Aloud, put on a stirring performance and the mini Yorkshire puddings went down well with Brits and international revellers alike.

Only Men Aloud

Taste of Britain

Ray Mears

Steve Cram


6 | companion

Record breaker

BSAVA BAnquet. this year we managed to serve restaurant quality food to more 950 diners 300 more than usual. International guests included the BSAVA sponsored Bulgarian delegation, hosted on the evening by Wolfgang Dohne and his wife Silke.

Congress Banquet

BSAVA Awards are an important opportunity for us to honour our colleagues full details about 2012 winners and nominating for next year are online at www.bsava.com.Award Ceremony

SuperB ScIence. there is always loads of choice at congress when it comes to science and this year some of the most popular talks were the How to lectures, the controversy stream, and FecAVAs Symposium on animal assisted facilities. the clinical research Abstracts are increasing their audience and anyone who wants to get away from the mainstream is encouraged to sit-in on crAs next year.

LIFeLong DeLegAteS. trevor and Jean turner have only missed one congress since trevor acted as a steward at the first 55 years ago. Jean won the entire BSAVA manual collection in the Big Booking Bonanza by registering online before christmas. She donated her old library copies to the World Veterinary Service who had a stand in the Icc.


companion | 7

pArtY nIgHt. packed out more than ever before tickets for party night became hot property after selling out weeks in advance of the event. comedians greg Davies and Simon evans went down a storm and olly Murs, the chart-topping brother of a vet nurse, really stole the show proving he actually does have the X-factor.

BSAVA BALconY. Delegates packed out the BSAVA Balcony to see the latest Manual titles and find out how to make the best of their cpD. While there, many used the free internet facilities and eligible members collected their loyalty bonus the BSAVA/VPIS Guide to Common Canine and Feline Poisons. qualifying members who didnt collect at congress will be sent the book in April/May.

neW preSIDent. Mark Johnston with his wife theresa, as he begins his year in charge of BSAVA.

Party Night

BSAVA Balcony

preSIDentIAL FAreWeLL. At the closing ceremony on Sunday all three presidents were delighted to have hosted a record breaking event for the small animal profession.


8 | companion

Dr Sally Everitt, BSAVAs Scientific Policy Officer, offers guidance on notifiable diseases and the obligations we face as a profession

Dr Sally Everitt, BSAVAs

offers guidance on notifiable diseases and the

Notifiable and zoonotic disease for companion animal practitioners

A notifiable disease is any disease that is required, by law, to be reported to government authorities. Animal diseases may

be notifiable because they are of significant economic importance or because they pose a risk to human health. The primary purpose of the notification system is to identify possible outbreaks and epidemics to allow rapid initiation of appropriate action.

In the UK notification of diseases in animals is regulated by the Animal Health Act 1981, as well as the Specified Diseases (Notification and Slaughter) Order 1992 (as amended) and Specified Diseases (Notification) Order 1996 (as amended) which enacts European Union Legislation. Certain pathogens also have to be reported under the Specific Animal Pathogens Order (SAPO) 2008.

The 1981 Act states that any person having in their possession or under their charge an animal affected or suspected of having one of these diseases must, with all practicable speed, notify that fact to a police constable. However, in practice a veterinary surgeon who suspects a notifiable disease should contact the appropriate Animal Health and Veterinary Laboratories Agency (AHVLA) office (www.animalhealth.defra.gov.uk) who will investigate the disease.

Endemic, exotic and zoonoticThe current list of notifiable diseases (which can be found at www.defra.gov.

At world level, the World Organisation for Animal Health (OIE) places a formal obligation on each member to report the animal diseases (including zoonoses) that it detects on its territory in order to: ensure transparency about the global animal disease situation; enable the collection, analysis and dissemination of veterinary scientific information; encourage international solidarity for the control of animal diseases; and safeguard animal health and welfare. The OIE list of diseases of importance is available online, along with more detailed information about the diseases (www.oie.int). The OIE list includes diseases of fish, bees and amphibians as well farm animals and birds.

Defining the conceptThe concept of notifiable disease is also used in human medicine under the Public Health (Control of Disease) Act 1984 and the Health Protection (Notification) Regulations 2010. The current list of notifiable diseases includes a number of zoonoses. A comparison of the notification status of zoonotic diseases in humans and animals is provided in Table 1 (from HPA Guidelines for the investigation of zoonotic disease).

Companion animals and zoonotic diseaseAlthough the concept of One Health has been gaining ground in recent years, the importance of companion animals in the transmission of zoonotic disease has been somewhat neglected*. However, there are a number of reasons why it is appropriate to examine the role of companion animals in diseases of public health importance.

uk/animal-diseases/notifiable) includes diseases which are endemic (such as Bovine TB), exotic (those that are not normally present in the UK, but can be introduced, for example via illegal imports or by wild birds), and/or zoonotic (such as rabies).

To date, the notifiable disease system has largely concentrated on diseases of economic importance and public health as applied to food-producing animals, and Defra only specifically mentions one notifiable disease of dogs and cats (rabies). It should be remembered, however, that dogs and cats may also be affected by a number of notifiable diseases which normally affect farm animals, horses and birds. Exotic pets and wildlife can also become infected or be implicated in the transmission of notifiable diseases.

Beyond the UKThe European Animal Disease Notification System (ADNS) collects information about outbreaks of certain important infectious animal diseases. This system is supported by Council directive 82/894/EEC (last amended by 2008/650/EC) which makes it compulsory for Member States to notify primary and secondary outbreaks of listed infectious animal diseases. The primary purpose of this system is to provide information and to ensure that trade in live animals and animal products is not affected unnecessarily (http://ec.europa.eu/food/animal/diseases/adns/index_en.htm).

08-11 Notifiable Diseases.indd 8 23/04/2012 08:39

companion | 9

Disease Requirements for humans Requirements for animals

Noti ablea Reportable to HSE under RIDDOR

Noti able (to Animal Health)

Reportableb Noti able under SAPOf

Anthrax

Avian in uenza (highly pathogenic strains only) (All H5 and H7 strains)

Bovine spongiform encephalopathy

Brucellosis

Brucella abortus, B. melitensis Brucella ovis (contagious epididymiti s, sheep)

Brucella suis (pigs) and all other Brucella species

Chlamydiosis

Chlamydophila abortus C. psitt aci ()c d

Diptheria (includes toxigenic C. ulcerans)

Encephaliti s (all causes)g

Equine viral encephalomyeliti s

Echinococcus multi locularis and granulosus

Equine morbillivirus (Hendra)

Food poisoning (all causes)

Glanders and Farcy (Burkholderia mallei)

Leptospirosis

Lyme disease

Meningiti s (all causes)g

Newcastle disease and paramyxovirus infecti on

Plague (Yersinia pesti s)

Q fever (Coxiella burneti i)

Rabies Classical rabies virus (genotype 1) Other rabies virus genotypes

(e.g. European Bat Lyssavirus)

Relapsing fever

Rift valley fever

Salmonella spp. Streptococcus suis Trichinella spiralis Tuberculosis e

Vesicular stomati ti s

Viral haemorrhagic fevers (all)

Viral hepati ti s (Hepati ti s E)

West Nile fever

Table 1: Notifiablea and reportableb zoonotic diseases and organisms in humans and animals in England and Walesa Notifiable diseases are those where there is a statutory requirement to report clinical cases of disease. b Reportable diseases (in animals) are those where there is a statutory requirement to report laboratory confirmed isolation of organisms of the genera Salmonella and Brucella under the Zoonoses Order 1989. The report is to be made by the laboratory which isolated the organism from an animal derived sample. c A local anomaly exists in Cambridgeshire where psittacosis is reportable to the local CCDC under a local bylaw. d Legislative veterinary powers under The Psittacosis or Ornithosis Order 1953 (S.I. 1953 No. 38) give discretionary powers to serve notices to impose movement restrictions and require cleansing and disinfection of affected premises, and so Animal Health may be involved in the control of Psittacosis, even though it is not actually a notifiable disease in animals or birds. e Under the Tuberculosis (England) Order 2007, the Tuberculosis (Wales) Order 2006, and the Tuberculosis (Scotland) Order 2007, there is a statutory requirement to notify the suspected presence of TB in the carcase of any bovine, deer, farmed or companion (pet) mammal to nearest Animal Health Divisional Veterinary Manager (DVM). Furthermore, identification of M. bovis in samples taken from any mammal (other than man) is also notifiable to Animal Health unless the organism was present in the sample as a result of an agreed research procedure. Notifying the suspicion of TB in a living domestic animal in the course of clinical examination, surgery, by radiography or in biopsy material is not mandatory (except for cattle or deer), but submission of clinical samples from such cases to VLA is encouraged. f Under the Specified Animal Pathogens Order 1998 anyone with reasonable grounds for suspecting the presence of these specific zoonoses should notify a veterinary inspector forthwith, unless they are held under licence made under this legislation. This requirement only relates to avian influenza viruses and Newcastle Disease viruses which are either uncharacterised or have been found to be of higher pathogenicity (set out in the legislation), or for avian influenza type A viruses H5 or H7 subtypes with specified nucleotide sequences. Echinococcus and Trichinella are only notifiable under this Order. g These are syndromes that are notifiable in human medicine.


10 | companion

More than half of households keep pets, and even among those who do not own companion animals the majority will have direct (animal) or indirect (e.g. faecal) contact with a companion animal at some time*.

Animals share our homes, and often our kitchens and bedrooms, increasing the risk of disease transmission*.

The introduction of the Pet Travel Scheme has led to a significant increase in pet travel. This is likely to increase

further following the reduction in regulation and quarantine after 1st January 2012. The increase in movement of companion animals increases the risk of introduction of exotic and potentially zoonotic disease.

The increasing tendency to keep exotic pets also carries implications for the spread of zoonotic disease*.

There are a wide range of diseases which can theoretically be transmitted from animals to humans; further details can be obtained from the Health Protection Agency website (http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Zoonoses/TableZoonoticDiseases).

Examples of zoonotic diseaseSalmonellosisInfection may occur in all animals and is usually acquired through contact with contaminated food or water or from exposure to infected faecal material. It should be noted that Salmonella spp. have been isolated from a wide range of species kept as pets, possibly as components of the natural flora, from rodents, reptiles and birds. While acute gastroenteritis is the most common manifestation of infection, septicaemia may also develop. Enteric salmonellosis is self-limiting and antibiotics are not indicated in uncomplicated cases. Animals with septicaemia will require intensive care including fluid therapy and appropriate antibiotic therapy. Of particular

note in guinea pigs, salmonellosis typically manifests as septicaemia and death rather than enteritis and diarrhoea.

Lymphocytic choriomeningitisLymphocytic choriomeningitis virus (LCM) is an RNA Arenavirus that causes a chronic fatal wasting of young hamsters. Wild mice are a common primary reservoir of infection but hamsters and guinea pigs can also act as reservoirs. The disease may also be seen in chinchillas and chipmunks. Diagnosis is by PCR, serological detection of anti-LCMV antibodies or virus isolation. Humans may become infected by exposure to urine and faeces or from a bite. In most human cases symptoms are flu-like: headaches, fever, myalgia or arthritis. Rarely a fatal aseptic meningitis or meningoencephalitis develops.

As well as considering disease in animals we have to consider the health implications for ourselves, and our staff, of contact with zoonotic diseases which may require reporting under the Reporting of Injuries, Diseases, and Dangerous Occurrences Regulations, 1995 (RIDDOR). These include:

Anthrax Brucellosis Chlamydiosis Leptospirosis Lyme disease Q fever Rabies Tuberculosis.

Further information can be obtained from http://www.hpa.org.uk.

Companion animal notifiable diseaseRabiesClassical rabies was eradicated from the UK in 1922. It is thought that our island status makes it unlikely that terrestrial rabies will be re-introduced through wildlife and that the largest risk for rabies entering the UK would be through an infected

animal imported into the country illegally. The last case of rabies in an animal outside of quarantine in the UK was a dog in Camberley in 1970 and the last case of rabies in quarantine was reported in 2008.

The Pet Travel Scheme (PETS) was launched in 2000 to allow people to travel with their pets while ensuring the UK remains free from rabies and certain other exotic diseases. In total, 752,945 pet animals have entered the UK under PETS since 2000 (ferrets have only been able to enter under the scheme since July 2004), and there have been no cases of rabies in any of these animals (Defra, 2010).

However, since 2001 nine rabid dogs have been illegally introduced into France; all but one of these was imported from Morocco through Spain. Rabies has also been reported in individual animals in Norway and The Netherlands, indicating that illegally imported dogs continue to pose a risk of rabies in otherwise rabies-free regions.

Defra have admitted that the changes to the pet travel regulations that came into effect on 1st January 2012 do increase the risk of rabies being introduced to the UK. However their risk assessment suggests that the risk is still very small, calculated to be one rabies introduction every 211 years, or one rabies case for 9,809,601 animals imported, although these figures assume 100% compliance with the regulations (VLA 2010).

EBLVCases of bats infected with one of the two European Bat Lyssavirus (EBLV) subtypes have been confirmed in the UK as recently as 2009. One of these cases resulted in the death of a bat worker in Scotland in November 2002. EBLV is transmitted through contact with an infected bat, for example through bites, scratches or saliva. All reported cases in the UK have so far occurred in Daubentons bats (Myotis daubentonii), a common species which often comes into human contact as it roosts in houses.

Notifiable and zoonotic disease for companion animal practitioners


companion | 11

Up to 8% of Daubentons bats carry antibodies to the virus. A novel lyssavirus has recently been reported in a Natterers bat in Germany. It is very rare for EBLVs to cross the species barrier; however EBLV-1 has infected other animals, including five sheep in Denmark, a stone marten in Germany, and two cats in France. Classical rabies has never been recorded in a native European bat species.

Defra takes a precautionary approach to possible contacts with bats by bat workers and others handling bats on a routine basis, as well as any incident where a member of the public has come into contact with a bat.

The Health Protection Agency (HPA) has detailed guidance, which includes recommended pre-exposure vaccination for those handling bats, and immediate precautionary administration of rabies vaccine for anyone bitten or scratched by a bat. In light of the HPA guidance, it is not automatically necessary to euthanase a healthy bat for rabies testing involved in a biting or scratching incident. However, any bat suspected of being infected with EBLV must, by law, be reported to the AHVLA. Readers are directed to the How to handle bats article in companion June 2009 for more information.

Notifiable diseases of other animals that may affect petsAlthough rabies is the only notifiable disease which normally affects dogs and cats, it should be remembered that dogs and cats can sometimes become infected with other notifiable diseases.

Avian influenzaThere have been no cases of avian influenza reported in dogs, but there are a small number of confirmed cases in cats. It is thought that cases of H5N1 infection in cats have resulted from prior consumption of infected bird carcasses when wild birds have died from avian influenza H5N1. Experimental research has also shown that ferrets and other mustelids are potentially

susceptible to highly pathogenic avian influenza. However natural infections in carnivores appear to be self-limiting.

Tuberculosis (Bovine TB)Pets can be exposed to TB from a variety of sources including infected cattle, badgers and other wildlife. Dogs and cats are variably susceptible to infection caused by Mycobacterium tuberculosis, M. bovis, M. microti and M. avium. Cats appear to have an innate resistance to M. tuberculosis. Tuberculosis has also been recorded in ferrets*.

Clinical signs reflect the site of granuloma formation, but whether the infection remains at this site or disseminates systemically is determined by host immunity. Respiratory infection is more common in the dog, whereas the cat is more likely to develop cutaneous or intestinal disease.

Granuloma formation in the lungs and mediastinal lymph nodes leads to cough, weight loss and pyrexia, while granuloma in the oropharynx may cause dysphagia, hypersalivation and retching. Generalized mycobacteriosis presents with splenomegaly, pleural or pericardial effusions, generalized lymphadenopathy, weight loss and fever*.

A definitive diagnosis depends on demonstrating acid-fast bacilli. For classic tuberculosis the prognosis is grave. The decision to treat should be carefully considered in view of the zoonotic potential as well as the complexity and costs of treatment.

Bovine TB is a zoonotic disease; therefore, where bTB in pets is disclosed, Animal Health or the private veterinary surgeon must inform the Consultant in Communicable Disease Control (CCDC) of the Local Health Authority so that any risks to human contacts can be investigated. If TB is reported in a farm cat or dog, the AHVLA will instigate TB testing of any cattle on the farm and other, potentially exposed cattle, on neighbouring premises.

AnthraxBoth dogs and cats are relatively resistant to infection with Bacillus anthracis. When it does occur it is usually through the ingestion of contaminated carcasses or animal by-products. Local inflammation of the upper gastrointestinal tract is followed by local and mesenteric lymphadenopathy. Diagnosis is made by the examination of Gram-stained blood smears or fine-needle aspirates, which show the characteristic Gram-positive rods.

Aujeszkys disease (pseudorabies)In dogs and cats pseudorabies usually presents as a per-acute rapidly fatal disease. Before death the animal may show ptyalism, pruritus, restlessness and aimless wandering, as well as depression. The disease is usually contracted through the ingestion of contaminated meat or offal.

BrucellosisBrucella canis is prevalent in many areas of the world although it is believed to be absent from the UK*. Infected bitches may suffer abortion, most commonly between days 45 and 55 of pregnancy, although early resorption or stillborn puppies can also occur. In male dogs Brucella spp. may cause granulomatous epididymitis and prostatitis. B. canis can also affect other tissues, such as the eye (recurrent anterior uveitis) and skin (nodular and diffuse pyogranulomatous dermatitis), as well as being implicated in disco-spondylitis*.

Serology for brucellosis should be undertaken in dogs that have been imported into the UK or in areas where Brucella canis is endemic; serological titres of 1:200 or greater are diagnostic for the disease. The isolation of the bacterium from blood or aborted tissues is diagnostic but as there are prolonged periods when a bitch is not bacteraemic, negative blood cultures do not rule out disease. The most common route of infection is venereal.

*For a useful list of links and references see the Advice section of www.bsava.com.


12 | companion

Clinical conundrum

Create a problem list for this patient Tachypnoea and increased effort Lethargy Decreased appetite Caudally displaced heart sounds Dull thoracic percussion

Create a list of likely differential diagnoses for this caseTachypnoea and increased effort could have a multitude of aetiologies. They can be considered in light of the anatomical area of the airway involved.

Small airway disease Foreign body

Pulmonary parenchymal disease Neoplasia Haemorrhage Pulmonary fibrosis Infectious disease, eg: Bordetella bronchiseptica Pulmonary oedema Thromboembolism Parasitic eg: Angiostrongylus vasorum

Thoracic tracheal disease Extra-luminal compression Tracheal collapse Neoplasia

Pleural (restrictive) disease: Neoplasia: mediastinal, thoracic wall Pleural effusion pyo-, chylo-, haemo-thorax Diaphragmatic hernia or rupture

The differential diagnosis list can be further refined on the basis of the pattern of respiration observed. Upper respiratory tract disease (nasal passages, pharynx, larynx and trachea) was less likely as the dog was showing no clinical signs of stertor or stridor and the dyspnoea was not primarily inspiratory. This was considered an important rule out as laryngeal paralysis would be a common differential for respiratory distress in an older Labrador retriever. Parenchymal lung diseases were considered less likely as these are often associated with a mixed pattern with both inspiratory and expiratory effort, which was not seen in this case. Similarly small airway disease was unlikely as it is typified by a short inspiratory and prolonged expiratory phase. This patients respiratory pattern could be described as restrictive, an increased respiratory rate with reduced depth of inspiration, which is most consistent with pleural space disease. However, these signs might be attributable to anaemia and this possibility cannot be excluded at this stage.

In support of this suspicion the caudally displaced heart sounds suggests a space occupying lesion in the cranial thorax displacing the heart and this would also be consistent with dull thoracic percussion.

Lethargy could be attributed to the tachypnoea, increased respiratory effort and reduced respiratory capacity. Decreased appetite is a fairly non specific clinical sign, particularly in this case which has evidence of other disease and was not considered further in isolation.

In summary the patients respiratory pattern suggests a pleural space disease, supported by apparent displacement of the heart on auscultation and dull thoracic percusion. As such the most likely differential would be a large space occupying thoracic mass.

Rebecca Thorne, intern at Davies Veterinary Specialists invites companion readers to consider the approach to a tachypnoeic older Labrador retriever

Case presentationAn 11-year-old, male neutered, Labrador retriever presented with a reduced appetite and lethargy of several weeks duration. Clinical examination was mostly unremarkable, but the dog was tachypnoeic (RR 50 breaths pm) with increased effort but reduced depth of inspiration. On thoracic auscultation cardiac sounds were noted in a more caudal location than normal and the cranial thorax seemed dull on percussion.

12-15 CLINICAL CONUNDRUM.indd 12 23/04/2012 08:38

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Figure 1: Right lateral thoracic radiograph

What initial investigations would you consider?A blood sample was taken for routine haematology and biochemistry as it was anticipated that the further investigation would require sedation or anaesthesia and the patient was geriatric. This also allowed checking of a PCV, in light of the possibility of anaemia. The blood results were unremarkable apart from a mild normocytic normochromic anaemia (PCV = 29) which was of insufficient severity to account for the tachypnoea.

Investigation of thoracic disease commenced with radiographs of the thorax to investigate the respiratory signs. As a single diagnostic procedure this was most likely to direct further appropriate investigation, based on the findings. Other investigations that might have been informative, such as pulse oximetry or performing an arterial blood gas analysis, might be indicated based on the findings of thoracic radiography.

What is your interpretation of the right lateral thoracic radiograph (Figure 1)?The thoracic image shows a large cranial thoracic mass of soft tissue or fluid radiopacity which is displacing and compressing the trachea dorsally and the lung lobes to the caudo-dorsal thorax. The mass extends from the thoracic inlet to the 5th intercostal space and displaces the cardiac silhouette, which is somewhat more upright than usual, caudally. An orthogonal view (eg a DV thoracic radiograph) would have been required to definitively locate the mass but based on the presence of tracheal elevation a mediastinal origin seemed most likely.

In light of the radiographic findings refine your differential diagnosis listMediastinal mass Mediastinal cyst Non-neoplastic mediastinal masses (abscess,

lymphadenopathy, haematoma) Mediastinal neoplasia

Lymphoma Thymoma Heart base tumour Metastatic neoplasia

How would you narrow you differential diagnoses?Further diagnostically useful information is likely to be gained from ultrasonographic evaluation of the mass, and this would also allow decision making regarding sampling strategy. For example masses may be seen to be highly vascular, precluding a Tru-cut biopsy, or cystic, allowing directed sampling by fine needle aspiration.

In this case a large heterogeneous mass of variable echotexture and echogenicity was visualised arising from, and obliterating, the cranial mediastinum. There were numerous vacuolations throughout the mass. Fine needle aspirates under ultrasound guidance were performed from the solid portions of the mass and these were examined.

Figure 2: Cytology from mediastinal mass (x200)Courtesy of PTDS


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Clinical conundrum

What is your interpretation of the cytology? (Figure 2)Within a background of fresh blood there is a scattered heterogenous population of lymphoid cells, dominated by small lymphocytes and a single cluster of larger atypical epithelial cells. Diagnosis Thymoma.

Differentiation between thymoma and lymphoma cytologically is challenging as both will display prominent lymphoid populations, normal and heterogenous in the former, homogenous and neoplastic in the latter. The neoplastic component of a thymoma is epithelial and only when this is identified, as in this case, can a cytologist be confident of a diagnosis of thymoma. Mast cells can be identified in upto 85% of cytological samples from thymomas, and this may also aid differentiation. Often histological examination is required to obtain a definitive diagnosis, sometimes even immunohistochemistry. In this case Tru-cut biopsy had been planned had cytological examination not immediately yielded a definitive diagnosis.

Are there any clinical signs of any of the paraneoplastic syndromes associated with canine thymoma in this case?The paraneoplastic syndromes associated with thymoma are listed below. In this case, there were no clinical signs which were not immediately attributable to the mass effect of the neoplasia. This is of relevance as, for example, the presence of megaoesophagus due to myasthenia gravis, is a strong negative prognostic indicator and such patients may be poor treatment candidates.

Myaesthenia gravis Paraneoplastic dermatitis Paraneoplastic hypercalcaemia Cranial vena cava syndrome Horners Syndrome

What treatment options are available for canine thymoma?

Chemotherapy Thymoma are poorly responsive to cytotoxic agents, although some reduction in size may be seen. However it is unclear if size reduction is due to an anti-neoplastic effect or solely because the cytotoxic and/or corticosteroid protocols reduce the non neoplastic lymphoid content of the thymoma.

Chemotherapy is indicated if other treatment modalities are unsuitable or unavailable and may offer some symptomatic relief associated with mass effect.

Surgery Surgical excision, if feasible, can be curative and the clinical signs associated with the mass effect will be relieved. However the feasibility of the surgery depends on the invasiveness of the mass, its association with the phrenic nerves and adhesions to vascular structures. When full excision is achieved recurrence is uncommon and survival times in excess of 2 years are expected.

Radiotherapy If surgical excision is not possible due to the invasiveness of the thymoma, radiotherapy can be considered. Three quarters of thymoma treated in this way can be expected to shrink to some degree, occasionally completely. Survival times typically average nine months.

As is implied by the above discussion, whether the thymoma is invasive or not determines the treatment strategy employed. Typically half of cases will be classed as non invasive (well encapsulated) and further information regarding this distinction is gained using advanced imaging. CT provides information on the definitive margins of the mass, its size and extent of the mass effect as well as allowing evaluation of invasion into surrounding structures such as the cranial vena cava, thoracic wall and pericardium. CT offers considerable advantages over thoracic radiography allowing better distinction between solid, lipid, cystic, mineralisation and vascular structures. CT is also more sensitive in identifying pulmonary metastases in the rare cases of thymic carcinoma.

However it can be easy to overestimate invasion into associated structures on CT alone and often the true extent of invasion or local adhesions is only apparent during surgery. As such, images should be evaluated by a surgeon and a radiologist and a consensus of opinion reached. In short, whilst CT evaluation can identify those patients in which excision is clearly indicated or those in which it appears impossible, there will still be a proportion of individuals in which it will only become clear at exploratory thoracotomy if resection is feasible.

Should resection not be possible then the information gained at CT will be useful in the planning of radiotherapy.


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Evaluate the CT (Figure 3). Are there obvious signs of invasion into the pleura, thoracic vasculature or pericardium?There is a large mass (12 x 7 x 14 cm) occupying the majority of the cranioventral aspect of the thoracic cavity. The mass extends caudally and ventrally to the immediate surroundings of the cardiac silhouette. The heterogenous appearance, particularly evident on the dorsal plane, indicates internal areas of fluid, most likely necrosis. The cranial vena cava is dorsally displaced and compressed. There are fascial planes between the mass and surrounding structures (pleura, thoracic vasculature and pericardium).

As such, with a mass of this size excision would be challenging but possible. Based on the mass effect observed it was likely that development of cranial vena cava syndrome would be imminent. Based on the likelyhood of development of other clinical signs and that it was possible that excision might be achieved, the owners opted for a surgical approach.

Surgical reportAt exploratory sternotomy a large mediastinal mass was identified cranial to the heart. The mass was adhered to the surrounding structures including the phrenic nerves. These nerves and other structures were dissected free from the mass resulting in mild to moderate intraoperative haemorrhage. An intraoperative typed blood transfusion was performed and the thorax was closed routinely. A thoracostomy tube was placed to manage the pleural space, provide intra-pleural analgesia and to allow monitoring of any haemorrhage.

Figure 3: Sagittal (A), dorsal (B) and transverse (C) plane MPR constructions (soft tissue window of cranial thoracic CT at the level of the mass)

A CB

Patient outcomeFollowing an initial smooth recovery from anaesthesia, low grade haemorrhage into the thoracic cavity continued. Further mild haemorrhage could be seen in subcutaneous locations along the thoracostomy tube tunnel. A coagulation profile revealed marked prolongation of clotting times in association with thrombocytopenia and a consumptive coagulopathy was suspected. A plasma transfusion was administered as a source of clotting factors in addition to intravenous colloid and crystalloid support. Following a normalised coagulation profile, a further unit of blood was given to account for the blood loss overnight, however total protein remained low. The patient then went on to make a steady recovery, although there was a constant battle between providing adequate intravascular volume support, maintaining urine output and the development of generalised oedema. The thoracotomy tube was removed after 5 days, when total protein had improved, and the patient discharged after a total post-surgery hospitalisation stay of 8 days.

SummaryAlthough advanced imaging modalities allow for more pre-surgery decision making, in cases of thymoma, there are some patients for whom exploratory thoractomy is necessary to determine whether excision is achievable. As such, CT images must be carefully evaluated before surgery is excluded as a treatment option for large thymomas or those with evidence of invasion.

The author would like to thank all her colleagues, both vets and nurses, for their assistance with this case.


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How to select and collect: feline blood donation

Blood transfusions may be carried out for a variety of conditions, including those associated with anaemia (haemorrhage, haemolysis, or reduced erythropoiesis),

coagulopathies, sepsis, disseminated intravascular coagulation and specific factor deficiencies.

Unfortunately the methods of collection for feline blood do not make it suitable for storage nor, at present, is feline blood available from external blood banks. Therefore, when presented with a case requiring a transfusion it is best practice to collect blood at the time of need specifically for that case.

Feline blood typesThe feline blood AB type system is quite different to that of the dog. There are three blood types; type A, type B and type AB (which is rare). Most cats (~95%) in the UK are type A.

The prevalence of feline blood types varies with breed but type B seems to be seen in higher prevalence (upto 50%) in breeds such as British Shorthair, Birman, Devon Rex and Persian, whilst the majority of domestic shorthair/longhair and Siamese cats tend to be type A (Figure 1).

Unlike dogs, cats tend to develop antibodies directed against the opposite blood type antigens A or B. These antibodies can cause destruction of transfused erythrocytes of the opposite blood type. Typically type B cats develop anti-A antibodies earlier than type A cats develop anti-B antibodies but all cats should be assumed to possess alloantibodies.

Most type B cats have high titres of anti-A antibodies and should a type B cat receive type A blood a potentially fatal transfusion reaction can occur.

Danielle Banks, Diagnostic Supervisor at Davies Veterinary Specialists, describes the practicalities of feline blood donation

Figure 1: An increased proportion, but not all, of the individuals of the illustrated breeds will be of the blood type shown here

TYpe A

TYpe B

Type A cats will generally have a lower titre of anti-B antibodies and so should a type A cat receive type B blood, although accelerated destruction may occur, a transfusion reaction is unlikely to be as severe as the other way around.

Type AB cats have neither alloantibody and should ideally receive AB blood, although obtaining an AB

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donor can be difficult. Practically type A donor blood would be an appropriate choice for AB cats as it contains low levels of anti-B antibodies to react with the recipients AB erythrocytes. As is clearly apparent from this discussion, administering compatible type-specific blood is mandatory in feline transfusion. See Table 1.

Despite using type-specific blood and performing a cross-match, it is still possible for transfusion reactions to occur, even when donor and recipient appear compatible, and close monitoring is vital during any transfusion. Similarly, warning clients of the possibility of transfusion reactions inspite of compatibility testing, is mandatory before any feline transfusion.

Feline blood typingThe principle of all veterinary blood typing methods is a visible haemagglutination reaction between patient RBC surface antigens and known reagent monoclonal or polyclonal antisera. There are several different typing kits available.

Feline donors and recipients must always be blood-typed due to the naturally occurring antibodies and this can be achieved using simple in-house test kits (for example Alvedia Quick Test A+B) which will type for A, B and AB blood types (Figure 2). It is worth noting that profound autoagglutination, as might be seen with IMHA, will prevent blood typing by in-house methods. Furthermore when an AB result is received it should be checked by an external laboratory for confirmation.

Table 1: Reactions produced between donor and recipient blood types

RecipienT BLOOD GROUp

A B AB

DOnOR BLOOD GROUp

A OK Maybe fatal Possible reaction

B Reaction OK Reaction

AB Reaction Maybe fatal OK

BOX 1: ABBreviAted slide crOssmAtch pROceDURe

1. Collect blood into an EDTA tube from recipient and donor.

2. Centrifuge tubes to settle the RBCs, remove the supernatant and transfer to a clean, labelled glass or plastic tube.

3. For each donor prepare 3 slides labelled as major, minor and recipient control.

4. Place 1 drop of RBCs and 2 drops of plasma on to each slide according to the following:

Major cross-match = donor RBCs + recipient plasma Minor cross-match = recipient RBCs + donor plasma Recipient control = recipient RBCs + recipient

plasma

5. Gently rock the slides to mix the plasma and red cells and examine for haemagglutination after 15 minutes (presence of agglutination indicates incompatibility); recipient control agglutination will invalidate results.Mik antigen

Recently a blood group antigen, and clinically relevant alloantibody, distinct from the AB blood group system has been discovered. Researchers have named this Mik. The absence of Mik can be associated with naturally occurring anti-Mik alloantibodies. In light of this knowledge, and given that more blood group antigens are likely to become known in the future, it is clear that the AB blood group system is simplistic. Therefore, ideally all cats should be cross-matched prior to transfusion, particularly if multiple transfusions are likely.

Cross-matchingCross-matching is the gold standard laboratory test used to determine the serological compatibility between the donor and recipient red blood cells and is recommended in all cases. Practically however, cross-matching can not always be performed and its use is typically restricted to animals likely to receive more than one transfusion or before a second transfusion.

From a pragmatic point of view, use of typed rather than cross-matched blood is likely to be suitable in most general practice situations. A brief guide to cross-matching, from a previous How to article (companion April 2011) is reproduced in Box 1.

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Red blood cell substitutesOxyglobin (a polymerized bovine haemoglobin solution) was available until recently as an alternative to feline blood for improving the oxygen carrying capacity. Currently out of production, the manufacturers (OPK Biotech) are applying for a licence and production is hoped to re-commence shortly. Prior to cessation of production this product was not authorized for use in cats but had been used off-licence in cats with few reported complications.

The main advantages of Oxyglobin are that its use avoids the possibility of incompatibility reactions and it is has a greater ability to deliver oxygen to the tissues than erythrocytes. Therefore Oxyglobin is principally useful in cases where type-specific blood is not available or, particularly relevant to cats, when oxygen carrying capacity is needed immediately and the patient cannot wait for the time taken to collect feline blood. The main disadvantage is its short duration of effect (1182 hours); compared with erythrocytes (maximum circulating lifespan of transfused cells is 46 weeks).

Furthermore Oxyglobin acts as a plasma volume expander as it is a potent colloid and causes vasoconstriction. Patients, particularly those which are volume-replete, must therefore be carefully monitored to prevent fluid overload. Conversely, Oxyglobin is an excellent choice in patients in which rapid volume expansion is required.

Recruiting blood donorsDespite there being animal blood banks in the UK, the author is not aware of any currently supplying feline blood. At Pet Blood Bank a pilot project, funded by the Waltham Foundation, has been underway looking into various collection methods, with a conclusion to this project due for publication in 2012. It is hoped that in the future Pet Blood Bank may be able to provide feline blood products.

However, at present, veterinary practices must rely on recruiting their own donors. There are two principle sources. The Animal Blood Register can be used to obtain a list of possible donors in your area (www.animalbloodregister.com). This online register allows owners to register their pets and contact details and allows vets to access them via a secure registration system.

Alternatively, practices may choose to use staff pets for convenience or to recruit clients pets. If feline transfusions are regularly carried out, creating a database of donors will be useful when a transfusion is required in an emergency. The donors should be pre-typed and have had an initial pre-screening of biochemistry and haematology, as well as being tested for feline leukaemia virus, feline immunodeficiency virus and haemotropic Mycoplasma sp.

The ideal donorCareful selection of potential donors minimizes both the risk to the donor of the blood collection and to the recipient of the blood transfusion. The owner of the donor should be made aware of the risks associated with sedation and donating blood. All donors should:

Be in good general health. The sedation and collection of blood from the donor can result in hypotension and can exacerbate pre-existing conditions such as cardiac and renal disease.

Undergo initial pre-screening for biochemistry and haematology. They should also have tested negative for feline leukaemia virus, feline immunodeficiency virus and haemotropic Mycoplasma sp. Ideal donors maintain a lifestyle which limits exposure to the viruses, i.e. indoor-only cats. It is recommended that these blood tests are carried out on a yearly basis, whilst the cat is a donor. The owner of the recipient cat should be

Figure 2: A variety of methods exist for feline blood typing including immunomigration assays (such as the Alvedia kit (A and result Type A) and blood typing cards (B and result Type B). possible results are Type A, B or ABFigure 2a courtesy of pet Blood Bank

A

B

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made aware that despite testing for infections such as feline leukaemia virus, false negatives are possible and there is a chance that the recipient cat could become affected with one of these disorders.

Be regularly vaccinated and regularly treated for endo- and ecto-parasites.

Not have travelled abroad, therefore preventing the need for testing for foreign diseases.

Not have received a previous transfusion because of the risk of development of antibodies to other blood types which would complicate a future transfusion.

Be between 18 years of age. Over 8 years old, sub-clinical diseases will be more likely.

Weigh over 4.5 kg with good body condition. Be of calm temperament. Not be pregnant, nor have had previous

pregnancies. Ideally have a packed cell volume greater than

35%. This should be checked prior to each collection. In practice cats with a PCV in the normal range meeting all other criteria are suitable donors.

Restraint during collectionIn the authors experience all cats will require sedation for blood collection, unless the cat undergoes substantial and adequate training and is very calm. Ethically, it is vital that the procedure is as stress-free as possible, as the donor cat is undergoing a procedure which is not of any personal benefit. The drugs used for sedation are dependent on operator preference. The staff handling the collection should be familiar with the drugs to ensure the sedation can be managed safely. The drugs should be short acting, dosed to effect or be reversible. It is advisable to avoid acepromazine due to the hypotension it causes and the difficulties this may cause during collection.

Sedative drug combinations which are commonly used in the authors practice for blood collection are:

Medetomidine 20 g/kg and butorphanol 0.2 mg/kg i.m. reverse with atipamezole 50 g/kg i.m.

Ketamine 35 mg/kg, midazolam 0.2 mg/kg and butorphanol 0.2 mg/kg i.m.

These provide up to 30 minutes of sedation, commencing 5 minutes after intramuscular administration.

The feline blood donationThe acceptable donation volume in cats is 1012 ml/kg and this typically results in a total donation of ~50 ml. Donations should not be more frequent than every 3 months. With frequent donors it is advisable to alternate between the left and right jugular veins.

It is important to keep accurate records of the donors and of each donation. From these records it can be ensured that regular health checks are carried out and that any reasons why the cat should not donate are identified. Notes on the donors reaction to dosages of drugs used for sedation can be made which will aid future donations.

Aseptically prepare the equipment (Box 2) by flushing though the butterfly needle and three-way tap with CPDA and drawing up 2.5 ml CPDA into the 20 ml syringes and 1.25 ml CPDA into the 10 ml syringe (a 1:7 ratio). Set up the fluids ready for administering post donation.

Once the donor checks are successfully completed, place an intravenous catheter and sedate the donor.

The assistant should restrain the donor in lateral or sternal recumbency, with the head extended to expose the jugular vein. If the patient is in lateral recumbency then placing padding under the patients neck may aid visualisation and access to the jugular vein.

The hair is clipped and the skin surgically prepared.

BOX 2

The following is required for the donation:

Suitable sedative drugs Clippers Surgical scrub and spirit Sterile gloves Equipment for intravenous catheter placement 19 G butterfly needle and three-way tap Citrate phosphate dextrose acid (CPDA) anticoagulant

obtained from standard human blood collection bag 20 ml syringe x 2, 10 ml syringe x 1 19 G needles to cap the filled syringes 100 ml blood collection bag and 19 G needle (optional) Hartmanns fluids and giving set The phlebotomist and two assistants

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Figure 4: Use of an inline filter (such as a hemo-Nate) is essential during blood transfusion in cats for removal of any clots

The phlebotomist raises the vein and inserts the butterfly needle into the jugular vein; this can be directed caudally or cranially.

The needle is attached to the three-way tap and the syringe. The second assistant draws back on the syringe to collect the blood. The syringe should be regularly inverted to mix the blood thoroughly with the CPDA (Figure 3).

Once the first syringe is filled the three-way tap is closed and the syringe disconnected before being capped with a sterile needle.

The second assistant then repeats the process with the second and third syringes.

Once complete, the butterfly needle is removed and gentle pressure with a dry swab is applied over the jugular vein. Any sedation is reversed as necessary.

If desired, the blood can then be transferred aseptically into the blood collection bag.

The donor should be kept warm and carefully monitored whilst they recover. Hartmanns fluid is administered intravenously typically 23 times the amount of blood that has been collected. This should be administered as a 510 ml/kg bolus over 20 minutes and then the remainder at 4 ml/kg/h over the next 23 hours. Food should be offered to the donor as soon as possible.

Figure 3: Blood is withdrawn into a 20 ml syringe containing 2.5 ml of cpDA, and regularly mixed during collection. Use of a three-way tap is highly recommended, although not seen in this photograph

Other options for collectionOther options are available for the collection of feline blood, such as the use of a 50 ml syringe with integrated blood collection bag. Although these may be easier from the point of view that syringes do not need to be changed, in the authors opinion they pose a number of difficulties. The use of a 50 ml syringe results in increased pressure in comparison to a smaller syringe and this can cause the vein to collapse making blood collection very difficult.

Secondly, if for whatever reason it was not possible to obtain the full 50 ml of blood, that which is collected would be over-anticoagulated (in a 50 ml syringe) and its use would risk complications for the recipient (such as hypocalcaemia). By using two 20 ml and a 10 ml syringe the pheblotomist is minimising the risk that any collected blood would need to be discarded.

Once the blood is collected it should be used as soon as possible, as the feline blood collection technique is not closed and there is a risk of bacterial contamination and growth. For further details on feline blood administration and transfusion reactions the reader is directed to How to utilise blood products in small animals companion April 2011 and is reminded that use of an inline filter is essential (Figure 4).

Feline blood collection and transfusion is achievable in general practice. It requires minimal equipment and can often be a life-saving procedure for the recipient. It is, however, important to follow an established protocols to protect both the donor and the recipient.

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Scottish Congress 31 AUGUST 2 SEPTEMBER 2012

Now head north for a Summer Congress

From their stand in the NIA, members of the BSAVA Scottish Congress team urged vets and nurses in Birmingham to stretch their minds further without putting a big dent in their CPD

budgets by attending the Edinburgh event 31 August 2 September.

The main topics for vets are ophthalmology and orthopaedics, while nurses can strengthen their knowledge in nutrition and neutraceuticals, peri/post partum conditions and neonatology.

Accessible CPDAnyone who has been to Scottish Congress before knows they can expect to experience a warm and friendly welcome in Edinburgh. Congress Co-ordinator Barbara-Ann Innes said: We are very much looking forward to hosting this great event, which makes veterinary expertise, CPD hours and the strong social aspect more accessible for those who live in Scotland and the north of England, though we do have visitors flying in from outside the UK too.

There is a lot of expertise in Scotland and this is a great place for them to share their experiences. For some delegates it will be about cementing knowledge they may have lost and for others it will be about providing them with new information or refreshing clinical skills.

It is always a very lively, friendly and interactive occasion and the social aspect is still a very big part in a great city.

Nutrition expertiseDr Marge Chandler is a senior lecturer in internal medicine and clinical nutrition at the University of Edinburgh. She will be speaking on the growing importance of nutrition and her ultimate goal is to see a nutritional assessment added to the vital signs assessment.

Every pet, every time thats the mantra I want to see implemented on every visit to first opinion and referral vets, she said. Nutrition is the cornerstone of management for a lot of disease causes and as vets and nurses are the go-betweens to pet owners, it is important to educate them about good nutrition.

I am really looking forward to the Congress. It is an accessible event for Scottish vets and draws international visitors too due to the high quality of speakers.

Opthalmology focusNeil Geddes works at the 10-vet St Clair Practice in Fife and will be speaking about the ophthalmology exam and how to get the most out of it.

It is one of those things that there is not enough time to teach at vet school but there should be for example, in the US they have three weeks dedicated to it.

I will try to explain the finer points and teach the techniques of ophthalmology so that it is more productive, because so much is from recognition, such as retinal blood vessels as a marker for high blood pressure, especially in cats.

He added: It has always been a great Congress and this year looks really good, and remarkably good value.

For more information visit www.bsava.com/scottishcongress. n

BSAVA Congress welcomed its Celtic siblings with a dedicated stand to promote the Northern Ireland and Scottish conferences in the NIA

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What Joness has to offer

The new Occupational Standards and the RCVS Level 3 VN syllabus in September 2010 determined that students study the veterinary nursing of both horses and small animals

(including exotic pets) at a core level and then opt for either the small animal or equine pathway. To meet this requirement, the latest edition of the BSAVA Textbook of Veterinary Nursing covers the core syllabus for small animals and horses, plus the syllabus content for those students choosing the small animal pathway.

The textbook has been written by clinicians and veterinary nurses with expertise in their field, under the direction of the new editorial team of Barbara Cooper, Elizabeth Mullineaux and Lynn Turner. Authors with specialist equine knowledge and experience have contributed to this new edition and the consulting equine editor, Tim Greet, has ensured that the horse content is accurate and up to date.

Establishing the formatEach of the 27 chapters is clearly set out and easy to read. Learning objectives are stated at the beginning of each chapter, outlining what the student should be able to do

after reviewing the information. The colour photos, specially commissioned line drawings, tinted tables and highlighted boxes not only aid students in preparation for exams but also act as a reference source for both students and qualified veterinary nurses in their work, whether in a practice or educational setting. Useful bullet points, selfassessment questions and additional reference sources are also provided for those readers that wish to undertake further research.

The chapters in the textbook are organised so that they can be read independently; however, some do make reference to other sections of the book, reflecting the connection between subject areas. Thus, a greater understanding of the role of the veterinary nurse can be acquired by reading the textbook in its entirety.

Chapter highlightsAll of the chapters in the 5th edition of the BSAVA Textbook of Veterinary Nursing have been revised or rewritten. In addition, although not specified in the new syllabus, the material on small animal behaviour, kennel management and dentistry has been retained and updated, as these areas are of practical importance for veterinary nurses. Some of the highlights of the new edition are summarized here.

Professional responsibilities, regulation and the ethics of veterinary nursingThis new chapter provides worked examples which allow the reader to consider a range of scenarios that a veterinary nurse may encounter during their professional life. Given the increasing focus on veterinary nurses being accountable for their own actions, this chapter is essential reading.

Anatomy and physiologyThis chapter has brought together a range of species commonly encountered in veterinary practice, including dogs, cats, horses, small mammals, birds and reptiles. In each section the generic anatomy is discussed, followed by consideration of the major anatomical differences between the species or groups. The theory is skilfully brought together with excellent line drawings to complement the text (Figure 1).

Client communication and practice organizationThis chapter considers the application of communication skills in veterinary nursing. Communication techniques to deal with cultural differences, facilitation, informed consent, aggression and health promotion are discussed.

Barbara Cooper, Principal of the College of Animal Welfare, introduces companion readers to the latest edition of the BSAVA Textbook of Veterinary Nursing

Figure 1: Skeleton of

the horseIllustration drawn by

S.J. Elmhurst BA Hons (www.livingart.org.uk)

and printed with her permission

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The nursing process, nursing models and care plansThis chapter covers nursing theories such as the Roper, Logan and Tierney Model of the nursepatient relationship, and discusses how models can be adapted in a clinical environment. Worked examples are provided for the reader to review.

Diagnostic imagingThe use of diagnostic imaging modalities such as magnetic resonance imaging and ultrasonography has become increasingly commonplace in veterinary practice and is considered in this chapter. The text is written with the presumption that the reader has no former experience in this field and is ideal for those wishing to gain or increase their knowledge in this area. A practical definition of each diagnostic imaging method is provided, along with information on how images are obtained. The positioning of small animal and equine patients for imaging is also reviewed (Figure 2).

ORDER YOUR COPY TODAY

BSAVA member price: 49.00Non-member price 60.00

Buy online at www.bsava.com or call our Customer Services Team on 01452 726700.

BOOKSHOP SELLS OUT AT CONGRESS

With an increasing reputati on around the world, BSAVA Manuals clearly bene tt ed from the increase in internati onal delegates who joined their UK colleagues to browse and buy from the Balcony stand in the NIA at Congress. Sales were up 20% on the same period last year and the most popular ti tles were the new Dermatology and Endocrinology manuals in fact a number of ti tles sold out due to popular demand before the exhibiti on closed on Sunday aft ernoon. There was a huge amount of interest in the Practi ce Management book due out soon.

Surgical nursingThis chapter considers surgical wound management, including the healing process, principles of care and the use of dressings. The revised and updated text incorporates information on reconstructive surgery, oncological surgery and the use of endoscopy for minimally invasive surgery. With the increasing care needs of surgical patients, veterinary nurses are challenged more than ever to deliver safe, quality, patient care.

Perfect endingA number of useful appendices can be found at the back of the textbook, which provide:

Illustrated guides to common dog, cat, horse and rabbit breeds

Normal physiological parameters for dogs, cats, horses and rabbits

Study skills Reflective insight into personal and professional

development.

The BSAVA Textbook of Veterinary Nursing, 5th edition is an invaluable resource for veterinary nurses seeking guidance and affirmation of their understanding and learning.

Figure 2: Positioning for a dorsoproximal-dorsodistal oblique view of the carpus. The beam should be centred to the middle of the joint (X). The foot is placed vertically under the upper limb and restrained at the toe. The assistant stands to the side

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these are some of the words that frequently occur in early proposals for the qualities required in a veterinary nurse. A story that pre-dates the 1961 introduction of the RCVS training scheme by Bruce Jones author of the original BSAVA veterinary nursing textbook and Senior Vice Chairman of the Veterinary History Society

Patience, gentleness, forbe arance, the ability to observe...

Ever since animals have been kept, the value of veterinary nursing has been known, but until recent years the practice was erratic. Invariably, the value of the animal or the wealth

of the owner were the deciding factors. While there was a growing realisation that nursing was an invaluable part of animal care and treatment, little was done in an organised fashion.

Early careAs far back as 1824 Delabere Blaine, in the first substantive book on canine diseases, wrote that sick dogs, require great attention and care to ensure their recovery their minds should be soothed by every means in the power of those around them.

By 1881 the value of nursing was recognised. John Woodroffe Hill wrote, the health of the patient is in the majority of cases as much in the hands of the nurse as of the professional attendant, adding that a dog was endued with imagination, instincts, and thought, has a language of its own, is sensible of neglect, harshness, yea, even cross looks on the part of those ministering to it

Dedicated care was finally becoming recognised. In 1888 J.H. Steele wrote that veterinary nursing required strict attention to the animals comfort and well-being in matters of warmth, quietude, cleanliness, pure air and diet.

Recognition of sortsBy 1925 matters had advanced much further and Louis Sewell (veterinary surgeon to Queen Alexandria) was writing of specially trained canine nurses, costing from 2.10s to 3.0s per week live-in, and of a Distemper Hospital in Montpelier Place, Knightsbridge. The hospital had four wards and, an ample staff of day and night nurses. At that time distemper was the major canine infectious disease problem, with invariably a fatal outcome.

In 1934 F.W. Cousens (veterinary surgeon to King George V) described his Nursing Home, with a medically qualified Hospital Matron in charge and nurses under her for training, claiming that this was the first attempt at training women nurses for dogs in this or any other country. He also noted that he had tried to get the RCVS to recognise the title Canine

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Patience, gentleness, forbe arance, the ability to observe...

Nurse, after passing a suitable examination and being granted a certificate of efficiency.

He recorded, the Council would not entertain the idea, adding of course the Council will come round to my views, probably sooner than later; and the profession of canine nursing will then have not only a properly disciplined training but that recognition which it deserves and which is a necessary safeguard for the public. Little did he realise that it would be nearly 30 years before his dream would come true.

Suggestion of regulationProgress was slow and hindered by the 193945 war, but in 1947 a new edition of Hobdays Surgical Diseases of the Dog and Cat included a chapter on veterinary nursing written by Phyllis Peake, who (probably uniquely) was qualified both SRN and MRCVS. She discussed her subject competently, adding that, to be a good animal nurse needed a strong vocational call for self-sacrifice, tenderness and the ability to consider the patient as an individual a good nurse has a way with dogs and cats there seems to be a bond of sympathy and trust between themkind words and an occasional caress are of more value than medicine. At last cats get a mention!

Presciently, Peak also wrote, There is scope for a registration system whereby the veterinary surgeon can regulate these activities, and the certificate of registration could be a sign of competence which would be of great value to the prospective employer.

Hamilton Kirk, a leading small animal veterinarian wrote in 1948 that nursing is an important part of the successful treatment of pets. He noted that for all treatment, the first consideration is the provision of a capable and conscientious nurse; she should have limitless patience exercise gentleness and forbearance and possess the ability to observe.

At last recognitionFinally, in 1961, the RANA scheme was approved and veterinary (animal) nursing became an officially recognised professional qualification, and the rest, as they say, is history.

Today vet nurses are an integral part of the practice team and their contribution increasingly

recognised. As BSAVA President Andrew Ash reports, Veterinary nurses are key opinion leaders in my own veterinary practice. I know that after every BSAVA Congress I am going to have them beating my door down about the new equipment that they have seen and is suddenly absolutely essential. Nine times out of ten, if my nurses have been convinced that we need something then it will be adopted by the practice. This isnt just my experience, I know it is echoed around the country, which is why BSAVA considers VNs a priority when putting together the Congress programme, creating relevant manuals and producing practical CPD, and now offers a membership option too. Nurses arent just influential in the practice they are vital to the future of the profession.

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Chronic kidney disease in dogs

Research into chronic kidney disease in dogs was motivated by awareness from our routine diagnostic work that increasing numbers of older dogs and cats were being

referred for CKD.With current laboratory tests CKD is not always

diagnosed at the early stages where intervention and treatment would be most effective. This is partly due to the problems of not having widely available sensitive tests and not knowing which animals with changed tests values will progress to chronic disease. Before there are increases in the blood levels of urea, creatinine and phosphorus there is usually a marked loss of kidney function.

Testing and monitoringUrine tests are more sensitive but many are affected by conditions other than CKD and also by sample handling. Urine specific gravity is a sensitive test of loss of urine concentrating ability but is dependent on many variables, including the hydration status of the patient and other constituents in the urine (e.g. blood). A more widely used moderately sensitive urine test is the measurement of the urine protein:creatinine ratio. If this is > 0.4 in dogs and > 0.2 in cats there is a strong suggestion that the animal may be developing CKD.

Likewise animals with persistent albuminuria should also be monitored for progression to CKD. There is an automated method for measuring albumin in urine but it is not widely used and the available dipsticks for canine and feline microalbumin are expensive and no longer widely used in practice. The most sensitive and specific method available is the measurement of changes in GFR (glomerular filtration rate) by clearance of endogenous or exogenous creatinine or iohexol.

However, these are expensive, time-consuming methods which involve numerous timed blood and urine sample collections. In human medicine, measurement of endogenous cystatin C in plasma

(Left) Cambridge Resident Paola Monti who worked on the PetSavers and RCVS Trust funded project and (right) Dr Joy Arthur

Dr Joy Archer of the University of Cambridge describes how PetSavers funding has helped carry out research into chronic kidney disease in dogs

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and/or urine is a preferred method. Measurement of cystatin C in the plasma of dogs has been validated by several veterinary laboratories but is not currently widely used. Measurement of urinary cystatin C has recently been validated in our laboratory, and cystatin C:creatinine ratios generated. These have been shown to distinguish between dogs with no kidney disease and dogs with CKD.

Funding and the futureThis work was carried out with the help of a PetSavers research grant and a residency scholarship from RCVS trust to Paola Monti. This work was presented at ECVIMCA in 2011, and will be published in the Journal of Small Animal Practice*.

Work is now continuing on measuring microalbumin and cystatin C in urine from dogs with CKD, dogs with no obvious disease and dogs with other (non-kidney) diseases. When this stage of the work is completed we would like to set up a prospective trial and follow the progression of CKD, and the effects of treatments in a group of dogs over a longer period.

We are also setting up similar studies with cats, and have been able to confirm that special non-absorbent litter which can be used for urine collection from cats does not interfere with these tests. In this way it is hoped to provide non invasive urine tests for both dogs and cats with early CKD.

We are also investigating other biomarkers for glomerular and tubular injury by the use of ELISA methods. Unfortunately many available test kits were developed for human samples using monoclonal antibodies, and this causes many technical difficulties when they are used for cats and dogs. Many of the biomarker peptides are also unstable in urine so we are evaluating best methods for collection and storage of samples. The next step will be a longitudinal study. We hope to recruit dogs and cats with CKD that can donate urine at regular intervals over a 12 year period.

As the gateway stand to the BSAVA Balcony, PetSavers gets to meet delegates from all areas of the profession. Which is perfect for this ambitious charity, which knows that the support of vets, VNs and practice managers is vital if it wants to continue to

achieve its aims.PetSavers relationship with the profession is very much two-way. On the

one hand, appealing for donations and financial support and on the other, the Charity provides funding for vital veterinary research as well as offering a range of products and resources for use in the Practice. So there was plenty to talk about with the 7000+ crowd at Congress.

There was a lot going on off the stand too with two gala events offering more fundraising opportunities.

On Thursday night the popular Petplan awards took place, where guests generously donated more than 1200 to PetSavers.

The winners of the awards were Zaila Dunbar, Queens Park Veterinary Clinic (Vet of the Year), Lucy Kells, Wildlife Aid Foundation (Vet Nurse of the Year) and Eastcott Veterinary Hospital (Vet Practice of the Year). The PetSavers Achievement Award was presented to Barnfield Vets.

Then on Friday the guests at the Banquet had the opportunity to support PetSavers and win a piece of art. The Banquet raffle has raised many thousands over the years, thanks to the continued support of Castle Fine Art Gallery in the ICC who donate a picture. This year it raised nearly 4000, and the winner of the artwork was BEVA President, Ben Mayes.

PetSavers would like to thank all those who took the time to visit the stand at Congress and for all the generous donations it received.

BSAVA ON CKD

The Manual of Canine and Feline Nephrology and Urology has a chapter on the management of chronic kidney disease by Scott A. Brown.

For details or to order the manual visit www.bsava.com or call 01452 726700.

Please visit www.petsavers.org.uk for more information on PetSavers grants and how you can help support studies such as Joys.

A fruitful CongressPetSavers owes a huge thanks to Congress delegates and exhibitors who helped raise funds for the charity during the event

*Editors note: Readers are directed to this paper which has just been published online by the JSAP.

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been flooded out. They worked so well together, taking turns to sort out their homes and practices before coming back to the front line. They came from all six vet schools in the country, the Veterinary Practitioner Association of Thailand (VPAT) and the Department of Livestock Development. They worked long hours for three months to deal with the immediate aftermath. It was wonderful to see how they came to the rescue of so many animals and helped each other through difficult times.

Dr Kaywalee Chatdarong, VPAT President and task force member, acknowledged VPATs partners, including Pfizer, Hills, Virbac, Bayer, Novartis, Royal Canin, CP and DKSH which donated 30,000 kg of pet food, medicine, veterinary supplies and equipment. n

Volunteer task force helps stranded animals

Vets pulled together to help stranded and injured animals during floods in Bangkok last year

Following severe flooding in Bangkok, Thailand, between September and December last year, 500 vets formed a volunteer task force to help stranded and injured animals and their owners.

Working together, they operated rescue missions on foot, by boat and by military truck, caring for animals taken into shelters and running free vet clinics to treat affected pets, livestock and wildlife. They also delivered survival bags, containing pet food, poop bags, collars and other basic equipment to help owners forced out of their homes and into shelters to care for their animals.

Inspired by t

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Companion May2012