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SMALL ANIMAL
Cryosurgery
in veterinary
ophthalmology
page 32
THE UK’S LEADING MONTHLY VETERINARY PUBLICATION DECEMBER/JANUARY 2019/20
OFFICIAL VET
Pets, passports
and problems
page 52
EQUINE
Modern equine
cheek tooth
extraction
page 60
PRACTICE MANAGEMENT
Growing through
innovation: what
can vets learn
from start-ups?
page 70
OPINION
“Young solo vets
carrying a bag
Cardiology
of drugs into an
urban housing
Managing feline arterial estate: what
thromboembolism could go wrong?”
page 72
Plus
IN FOCUS Approaching cases of congestive heart failure in cats / EXOTICS Cardiac M facebook.com/vetpracticeonline
disease in small mammals / SMALL ANIMAL Exocrine pancreatic insufficiency in dogs /
LARGE ANIMAL Antimicrobial use in agriculture / EQUINE Achieving high-quality care / N @VetPractice_Mag
OFFICIAL VET Do vets understand biosecurity? WWW.VETERINARY-PRACTICE.COM
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1. FACCO survey, 2016. 2. AIEMV, Dry pet food sales of lifestage diets in France, Veterinary channel only, Jan-Dec 2018.
3. Sparkes AH. Feeding old cats-an update on new nutritional therapies. Top Companion Anim Med 2011; 26: 37-42.
B
EDITOR’S WELCOME
“This month, the focus
is on cardiology”
H
appy holidays to those who Vivash Jones delving into the history of
celebrate and welcome to the the profession as we know it.
December and January double Reports from two insightful confer-
issue of Veterinary Practice magazine. ences form our large animal section this
This month, the focus is on cardiology, month – one outlining the proceedings
with articles on the management of at the BCVA annual congress 2019 and
congestive heart failure and arterial one reporting on the Responsible Use of
thromboembolisms in cats. You can Medicines in Agriculture (RUMA) confer-
also read about cardiac disease in small ence held at the end of October.
mammals in the exotics column. The Official Vet section is back this
The small animal section has features month, with two pertinent articles. Nick
ranging from an overview of the use Perkins highlights common certification
of cryosurgery in ophthalmology to a problems in small animal practice and
report of a case of pemphigus foliaceus Alasdair MacNab discusses biosecurity an overview of holiday entitlements and
in the dermatology column. Part two of within the veterinary world. what to do when you're "ghosted" by an
the feline medicine mini-series on early BEVA President Tim Mair reviews the employee to ideas of what vet practices
chronic kidney disease is an interesting implementation of "high-quality" care in can learn from tech start-ups. Sandeep
read, focusing on nutritional manage- equine practice. An in-depth overview of Dattani provides insights of how you can
ment of the disease. Make sure to check modern extraction techniques in equine start to prepare your practice for Brexit.
out part one in last month's issue. dentistry is provided by Tim Barnett,
Two interesting articles on the veteri- in which he discusses the diagnosis of
nary profession, past, present and future diseased teeth, the indications for extrac-
are also in this issue – from Gudrun tion and the different extraction methods
Ravetz discussing shared challenges available.
and solutions vets may share with other The practice management section this
healthcare professionals and Bruce month is full of useful information: from AMELIA POWELL EDITOR
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Veterinary Practice December/January 2019/20 1
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CONTENTS
IN FOCUS
40 Feline arterial thromboembolism
Current trends in the diagnosis and management
of the condition, both in hospital and at home.
44 Congestive heart failure in cats
Teamwork, client communication and a good
understanding of available treatments are key.
47 A look through the latest literature
The latest academic publications providing further
insight into this month’s “In focus” topic.
REGULARS 20 Outreach
Livestock health training workshop in Kenya.
4 News 23 Education
A snapshot of the topics currently hitting industry Creating engaging and informative CPD online.
headlines.
24 Exotics
12 The profession
Cardiac disease in small exotic mammals.
Veterinary and medical professions share parallel
challenges, so can we benefit from parallel
solutions? SMALL ANIMAL
14 History 26 Nutrition
We should recognise the individuals who have An overview of canine exocrine pancreatic
carved the veterinary profession as we know it. insufficiency and Purina’s new approach to
managing sensitivities to cat allergens.
16 RCVS Knowledge
Do daily probiotic supplements improve clinical 29 Dermatology
outcomes in cases of canine acute diarrhoea?
Approaching cases of pemphigus foliaceus in cats.
17 Insurance 32 Ophthalmology
Neutering in dogs: a health and behavioural debate.
Cryotherapy in cases seen on a regular basis.
18 Mental health
Non-judgement is accepting your thoughts and
35 Feline medicine
feelings. Managing early chronic kidney disease.
19 Sustainability 38 Rare diseases
Implementing the three Rs in veterinary practice. An insight into exercise-induced collapse in dogs.
EDITORIAL ADVERTISING ENQUIRIES
Nic Catterall
EDITOR 07730 762136
Amelia Powell nic.catterall@improveinternational.com
DESIGN
Improve International EDITORIAL ENQUIRIES
Veterinary Practice (ISSN: 0042-4897) is an independent Amelia Powell Improve International,
monthly publication, free to members of the veterinary PRINTING 07704 306843 Alexandra House,
profession in the UK. Buxton Press amelia.powell@improveinternational.com Whittingham Drive,
Swindon,
Volume 51, number 10 SN4 0QJ
M facebook.com/vetpracticeonline N @VetPractice_Mag
© Improve International (2019): no part of this publication may be reproduced in any form (except for review purposes) without the express permission of the editor.
2
the ultimate microchip solution
OFFICIAL VET
48 News and updates
The latest news and updates for OVs.
50 Do vets understand biosecurity?
Are our biosecurity standards up to scratch?
52 Pets, passports and problems
Certification pitfalls in small animal practice.
LARGE ANIMAL
54 BCVA
What was discussed at the British Cattle Veterinary
Pet-ID Microchips
www.pet-idmicrochips.com tel +44 (0)1273 837676
Association Congress 2019?
57 Antimicrobial use in agriculture 66 Employment
An update from the RUMA 2019 conference. Understanding holiday entitlements.
EQUINE 68 Marketing
Making sure your website is optimised for use.
58 Achieving high-quality care
69 Finance
How can “quality improvement” be applied to
Business protection and making sure you are
equine practice?
adequately covered.
60 Dentistry 70 Business
Teeth can be extracted quickly and efficiently, but Growing through innovation: what can vets learn
thorough workups are still vital. from start-ups?
PRACTICE MANAGEMENT OPINION
64 Brexit 22 Clifford Warwick
How should practices prepare for Brexit? “It is important to recognise the formal
responsibility of a veterinarian”
65 Legal
What to do when faced with an employee who 72 Gareth Cross
resigns with immediate effect. “Young solo vets carrying a bag of drugs into an
urban housing estate: what could go wrong?”
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Veterinary Practice December/January 2019/20 3
NEWS
Europe’s first oral vaccine for dogs
launched by Zoetis
Zoetis announced on 31 October 2019 vaccination compliance and ultimately a organisms. CIRDC is not just a cough
the launch of Versican Plus Bb Oral – healthier dog population. picked up in kennels. It can be spread
the first oral vaccine for dogs in Europe. “Nearly all dogs are at risk of CIRDC, in any space occupied by multiple dogs,
It will provide robust, long-lasting and Bordetella is a common, but pre- including grooming parlours, dog day
protection against Bordetella bron- ventable, pathogen. Adding Versican care establishments or dog parks. The
chiseptica, a primary component of the Plus Bb Oral to vaccination protocols pathogens have not disappeared over
canine infectious respiratory disease offers CIRDC protection for dogs. Vets time and CIRDC is prevalent throughout
complex (CIRDC), with new easy oral can propose this new vaccination to pet Europe, with Bordetella bronchiseptica
administration. owners at an annual wellness visit in remaining a commonly identified agent
Versican Plus Bb Oral offers the knowledge that they will be creating in infected dogs.
increased comfort for dogs and a a less stressful experience for the pet “I think it is exciting for European vet-
smooth consultation room experience and owner.” erinarians now to have another option
for both dog owners and veterinarians. Zoetis established the European in the way they deliver non-core Borde-
The single-dose liquid vaccine is easily Canine Infectious Respiratory Disease tella protection. There will be different
administered into the mouth and has a Advisory Board – made up of veterinary situations depending on circumstances
12-month duration of immunity. specialists from across Europe – to in which either an oral, intranasal or
Eileen Ball, Global Veterinary Medical provide guidance and advice on the injectable route of administration will
Lead for Companion Animal Infectious product’s launch. be most appropriate.”
Diseases for Zoetis, said: “The new oral Member of the board, Professor Emer-
delivery brings a more positive expe- itus Michael J Day, University of Bristol,
rience for dogs, owners and vets. We spoke at the launch and said: “The Versican Plus Bb Oral is being
expect this new option for vaccination CIRDC has a multifactorial pathogenesis, launched in Europe from November
will lead to an increase in recommenda- involving environmental and lifestyle fac- 2019 with rollout across the conti-
tions for Bordetella prevention, better tors and numerous potentially causative nent continuing until October 2020
Programme for Vets South 2020 announced in
association with lead sponsor, Bayer Animal Health
Tickets are selling fast for Vets South
2020, the only veterinary congress
In total, Vets South will offer 27 hours
of CPD for delegates to choose from SOUTH
to take place in the south-west of the through its two veterinary streams and
UK. It offers a comprehensive clinical a veterinary nursing stream. Speakers stream. A keynote panel discussion will
programme for both vets and veterinary include Dr Kieran Borgeat, an Ameri- take place at the end of the first day.
nurses and has become a popular fixture can, European and RCVS Recognised Early Bird rates start at £90.00 + VAT
in the veterinary congress calendar. Specialist in Veterinary Cardiology; Dr per day, available until 31 December 2019.
During the two days, 16 world-class Ian Ramsey, Professor of Small Animal Delegates can also sign up for a free
speakers will discuss best practice in Medicine at the University of Glasgow; six-month subscription to Improve’s On-
small animal medicine, surgery and vet- and Dr Owen Davies, an American Spe- line Bitesize CPD, an online educational
erinary nursing under the over-arching cialist in Veterinary Oncology. platform. It offers veterinary surgeons
theme of “treating patients on a limited Dr Andrew Carrington, an Official an additional 18 hours of free CPD and
budget”. Topics covered will include Veterinarian working in practice in an additional nine to veterinary nurses.
cardiology, oncology, ophthalmology, Wiltshire, will chair the small animal
orthopaedics, emergency and critical medicine stream, while Dr Jon King,
care and infectious diseases. Vets South manager of the Wales Veterinary Sci- Vets South will be taking place on
is organised by global veterinary CPD ence Centre in Aberystwyth, will chair 4 and 5 March 2020 in Sandy Park,
specialist Improve International and, for the small animal surgery stream. Ms Exeter. For more information about
the first time, is held in association with Wendy Nevins, RVN and Past President the event and the programme visit
lead sponsor Bayer Animal Health. of the BVNA, will chair the nursing vetssouth.com or call 01793 20805
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Veterinary Practice December/January 2019/20 5
NEWS
SUPERB checklist poster produced to assist
vets when delegating tasks to vet nurses
under Schedule 3
The RCVS has produced a checklist production of a number of case studies ρ Person – can you delegate to this
poster for use in the practice setting to and a reference poster to assist veteri- person?
help veterinary surgeons remember the nary surgeons in making those everyday
ρ Experience – does the RVN/SVN
key things they need to consider when decisions on delegation in practice.
feel capable and have sufficient
delegating work to veterinary nurses. Ian Holloway, RCVS Director of Com-
munications, who helped develop the competence and expertise?
Schedule 3 to the Veterinary Surgeons
Act provides that vets may delegate poster with the Standards Committee ρ Risks – have you considered the
medical treatment and minor surgery and the College’s Standards and Advice risks specific to this case?
(not involving entry into a body cavity) to Team, explains: “It was clear from the
survey results that we could do more
ρ Be there – are you available to
registered veterinary nurses (RVNs) and
to help vets and vet nurses understand direct or supervise as necessary?
student veterinary nurses (SVNs) under
certain circumstances. and remember the principles of delega- Only if veterinary surgeons can answer
Following an RCVS survey to gauge tion under Schedule 3, so hopefully our all six questions in the affirmative, can
how well both vets and vet nurses six-point checklist, using the memorable they delegate accordingly.
understood the provisions of Schedule mnemonic ‘SUPERB’, will do just that.”
3, it was clear that both groups could The mnemonic SUPERB stands for: The poster is available to download
benefit from some additional guidance from rcvs.org.uk/schedule3 where
and greater clarity around some of the
ρ Specific procedure – is the proce-
dure medical treatment or minor further resources about delegation
terms and language in the Schedule. are available, including links to the
surgery not involving entry into a
After the publication of the survey relevant chapter of the RCVS Code
body cavity?
report, the RCVS Veterinary Nursing of Professional Conduct and the
Schedule 3 Working Party made a num- ρ Under care – is the animal under Schedule 3 case studies
ber of recommendations, including the your care?
Applications for joining the RCVS Shape the future of the veterinary
2020 Fellowship are now open professions as an RCVS or VN
The Fellowship is the learned society of the RCVS aimed at Councils candidate in 2020
veterinary surgeons whose activities demonstrate excel-
lence in veterinary endeavour and who have distinguished Veterinary surgeons and veterinary nurses are being
themselves on account of their ongoing commitment to encouraged to help shape the future of their professions by
using their experience and knowledge to enhance the pro- standing as candidates for the RCVS Council and Veterinary
fession further. There are three routes to entry, recognising Nurses (VN) Council, respectively, in their 2020 elections.
meritorious contributions to: veterinary knowledge; clinical In next year’s RCVS Council election, there are three
practice; and the profession. elected veterinary surgeon member places available with
successful candidates serving four-year terms.
The Fellowship has been given additional impetus with
In the VN Council election, there are two elected vet-
the development of a three-pronged strategy to help it
erinary nurse member places available with successful
reach its aim of becoming a learned society. The three key
candidates serving three-year terms.
aims are: promoting scientific excellence; harnessing the ex-
Nominations are open until 5pm on 31 January 2020.
pertise of Fellows to further professional skills and practice
and to invigorate a curiosity for innovation; and undertaking
activities that enrich public discourse about the impact of Further information, including nomination forms,
veterinary science to everyone. guidance notes and frequently asked questions for
prospective RCVS Council candidates can be found at
rcvs.org.uk/rcvscouncil20.
The deadline for applying to join the 2020 tranche of the
Fellowship is Monday 3 February 2020. All the details on The equivalent documents for VN Council candidates
how to apply can be found at rcvs.org.uk/fellowship are available at rcvs.org.uk/vncouncil20
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Veterinary Practice December/January 2019/20 7
NEWS
Veterinary antibiotic sales BEVA provides practical
halved over past four years support to encourage further
Sales of antibiotics for use in food-producing animals have
reduced by 53 percent from 2014 to 2018, the Veterinary
reduction in antibiotic use
Medicines Directorate (VMD) confirmed on 29 October 2019. BEVA is running a survey to find out more about antimicrobial
This demonstrates the strong and committed approach use and antimicrobial resistance in practice and has added
taken by the UK’s food, farming and veterinary sectors to further elements to its PROTECT ME Toolkit online resources.
tackle antimicrobial resistance (AMR). The figure comes from The survey, launched at BEVA Congress in September,
the annual Veterinary Antibiotic Resistance Sales and Sur- aims to assess any changes in prescribing of antimicrobials
veillance (UK-VARSS) report published in November 2019. in equine practice since the last survey in 2009. The results
The UK’s Chief Veterinary Officer Christine Middlemiss said will also provide an insight on the current frequency and
that this is a testament to the improvements industry and types of antimicrobial-resistant infections seen by clinicians
the veterinary profession have made in antibiotic steward- and what infection control and audit practices are in place.
ship, training and disease control. “This is a great example BEVA’s PROTECT ME toolkit is a free resource for BEVA
of how real change can be achieved when government and members, to help facilitate compliance and educate horse
industry work together including through initiatives such as owners about the importance of antimicrobial awareness.
the Targets Task Force chaired by RUMA (Responsible Use of “While antimicrobials remain essential for the health and
Medicines in Agriculture Alliance). The focus on infection pre- welfare of horses suffering from bacterial infection, it’s
vention and control is key to reducing the need to treat with imperative for vets to protect their usage to maintain their
antibiotics and maintaining the UK’s world-leading standards effectiveness for the future,” said BEVA President Tim Mair.
in protecting animal health and biosecurity.” “The equine veterinary sector is committed to responsible
This success in reducing antibiotic use in food-producing stewardship; sales surveillance data shows that sales of
animals is also highlighted in the recently published Ninth horse-only antibiotics has fallen by 4.3 tonnes (64 percent)
European Surveillance of Veterinary Antimicrobial Con- since 2017 and 13.6 tonnes (85 percent) since 2014. We
sumption report which shows that the UK now has one of hope the results of the BEVA survey will provide further
the lowest levels of veterinary antibiotic sales in Europe. optimistic data.”
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NEWS
Evidence-based veterinary medicine at
forefront of new veterinary group
In a first for the profession, 15 of the impact that evidence can have – and lems, new methods to reduce seizures
major UK member organisations, vet has had – on animal health and in dogs with epilepsy and faster means
schools and policy-making bodies have welfare. It also provides a convincing of detecting antimicrobial resistance,
come together to affirm their commit- rationale for all veterinary profession- among many other valuable advances.
ment to veterinary medicine based on als to contribute to the evidence base In their commitment, the signato-
sound scientific principles, in a new and put evidence into practice, to the ries state: “When rigorous research
landmark publication produced by benefit of animals, owners and veteri- underpins medical decisions, adverse
RCVS Knowledge and the charity nary teams themselves. events can be minimised, and patient
Sense about Science. The commitment is set in the context outcomes can be improved. We believe
Evidence-Based Veterinary Medicine of 14 case studies showcasing that evidence-based veterinary medicine re-
Matters: Our Commitment to the Future different types of evidence have been inforces the sound scientific principles
represents the first time this broad and vital to significant steps forward in vet- of the profession and strengthens the
influential group have formally united in erinary medicine. Evidence has been at commitment to put animal health and
support of a single issue. This unprece- the heart of the eradication of the cattle welfare at the forefront of all we do.”
dented collaboration is testament to the disease rinderpest, successful strate-
importance that veterinary organisations gies to prevent bird flu and the rapid
The full commitment and portfolio
across the profession place on the use of and accurate diagnosis of colic – one
of case studies can be read
evidence to enhance all types of veteri- of the most common causes of death in
in Evidence-Based Veterinary
nary medicine. horses. Evidence has also been core to
Medicine Matters, available for free
The publication serves to demon- the development of new techniques to
online: bit.ly/EBVMMatters
strate the profound and wide-ranging treat bulldogs with breathing prob-
Latest small animal neutering complication
rates released by vetAUDIT
The latest small animal neutering ρ 75 percent of neuters were Pam Mosedale, Chair of the Quality
complication rates were released in complication-free Improvement Advisory Board at RCVS
November 2019, alongside the first ever Knowledge, said:
ρ In cats and dogs, spays suffered a
benchmarks for rabbit neutering, on “These benchmarks are of importance
higher incidence of complications
RCVS Knowledge’s vetAUDIT website. to all small animal practices and offer
than castrates. However, the
The baseline figures in dogs and invaluable insight into the current
reverse was seen in rabbits
cats are remarkably similar to last levels of patient safety associated
year’s benchmarks, indicating neither ρ Spayed and castrated cats with routine neutering procedures…
improvement nor deterioration in suffered fewer complications We are also heartened to see a 10
treatment quality across the practices than dogs percent increase in data submitted
included in the audit. Rabbit data was to the audit in 2019, which not only
recorded for the first time, although the
ρ At least 25 percent of dog makes the national benchmarks more
small sample size limits the inference spays resulted in some form of accurate, but demonstrates the growing
that can be taken. complication importance the professions are placing
ρ More than 95 percent of castrated on quality improvement methods.”
In total, just under 40,000 cases were cats suffered no abnormality
included. Standout benchmarks include:
ρ 35 animals died as a result of a Practices can anonymously submit
ρ Over 15 percent of animals neutering procedure, including their data to the audit and compare
suffered an abnormality related to one rabbit their figures to the national bench-
the operation, with around half of marks on the vetAUDIT website:
these requiring medical treatment ρ Over 3,000 cases were lost to
vetaudit.rcvsk.org/nasan
or surgical intervention follow-up
10Veterinary Practice December/January 2019/20 11
THE PROFESSION
What can we learn from medical
professionals?
Veterinary and medical professions role. Performance related pay is a controversial area in the
veterinary sector, beyond the scope of this article. We know
share parallel challenges, so can we that pay is an important hygiene factor, but the relationship
benefit from parallel solutions? is not linear and beyond a certain point higher pay does not
continue to boost motivation. However, the knowledge that
as a vet we’re paid on average 20 to 25 percent less than
GUDRUN RAVETZ our doctor and dentist colleagues may be demotivating.
Gudrun Ravetz is Head Veterinary Officer for Simply- The move towards larger medical practices and
health Professionals and a BVA past president. Gudrun
has worked in companion animal practice as well as in
corporatisation in the dental and veterinary professions is
industry and management. Gudrun joined the Society of also increasing. In dentistry, large pan-European groups are
Practising Veterinary Surgeons and went on to be their
President in 2012. forming, with the recent acquisition of one of the largest UK
dental groups by a Swiss firm. NHS England stated that 85.7
A
s veterinary professionals, it’s a natural comparison percent of dentists in England were now performer-only (ie
to look at the working life of doctors and dentists. We hold no share of NHS contracts or facilities), compared with
often labour under the impression that the human 62.4 percent between 2006 and 2007, and similarly general
medics benefit from higher salaries and more defined practitioners are increasingly opting for salaried GMP
career options. There can be a hint of envy as we look at our roles. In the Doctors and Dentists Remuneration Report the
medical colleagues if we find ourselves financially stretched reasons for the shift towards lower-paid performer-only
or stagnating in our careers. However, a recent government or salaried roles are not clear, but were thought to relate
review on remuneration of the medical professions reveals to the desire for work–life balance, flexibility and fewer
truisms remarkably similar to our own experiences responsibilities. Work–life balance and flexibility are also
and mirrored challenges to those facing the veterinary common themes for the veterinary profession.
profession. Can we benefit from parallel solutions? Interestingly, while dentists earned more on average as
With guaranteed jobs on graduation and public perception young graduates, career progression did not always mate-
of being valued and held in high regard, it’s still an attractive rialise as expected. The BDA’s view was that dentists were
prospect to be a vet, doctor or dentist, although there has almost at the tipping point where the balance between pay
been a recent decline in the number of applicants across the and workload would push them to leave. If a number left
three professions. With parallel challenges with recruitment or retired and Brexit had an impact, there could be a crisis.
and retention we need to focus on creating good workplaces Again, many similarities with the veterinary profession...
to safeguard the future of these professional workforces. There are signs of a clear trend in the medical workforce
Starting salaries for new graduates are certainly towards salaried employment and away from the part-
respectable and very comparable for the three professions. nership model. All generations are showing an increased
The 2018 Society of Practising Veterinary Surgeons Salary desire for flexibility and a better work–life balance, and this
Survey showed the average salary for new graduate vets appears to be translating into salaried employment, locum
was £32,175. Foundation trainee salary for dentists is a work and part-time working patterns (sound familiar?).
comparable £31,992, while the foundation doctor year 1 Interestingly, the RCVS Survey of the Profession in 2014
(FY1) salary is lower at £27,146. found that although women are more likely to work part-
The small salary advantage vets see as new graduates time than men (26 percent compared with 11 percent), the
soon reverses. The median annual salary for a full-time biggest growth in part-time working in the last four years
salaried general medical practitioner (GMP) was £63,493 was from men (5 percent in 2010 to 11 percent in 2014).
in 2016. Compare this to the results of the SPVS Salary Reports from all the professions have noted that employers
Survey 2018, with a median salary of £47,800 (excluding and planners will need to react to the different work prefer-
additional benefits) and the difference in salary progression ences in order to recruit and retain and ensure the effective
is stark. The British Dental Association (BDA) stated that delivery of healthcare/veterinary care.
there had been a deterioration in dentists’ pay since 2008, This leads us on to the gender pay gap which is prevalent
from a median FTE net of £67,880 to £60,200 in 2016 for per- in all three professions. These are often accounted for by
former-only dentists (equivalent to a salaried assistant vet). structural factors such as fewer working hours or more jun-
An interesting comment is the idea that pay progression ior roles (which in themselves can often have a discrimina-
should be linked to performance and competence in the tory basis), versus a more obvious discriminatory gap where
12equal work is not rewarded with equal pay. The independent
report from the Review Body on Doctors and Dentists Re-
muneration noted that the prevalence of women as perform-
er-only dentists (ie not partners) or salaried GMPs may entail
a correspondingly lower income for these individuals. We
have heard similar things in the veterinary profession.
Here’s where others may learn from vets. The BVA’s
gender discrimination report based on an experimental study
highlights obvious discrimination and indicates attitudes as
key in addressing the issue. Maybe doctors and dentists can
also learn from the BVA report to help them shape a thriving,
motivated and sustainable workforce for the future.
In May 2016, the King’s Fund published research on the
pressures in general medical practice, which found that in-
creasing demands including a heavier workload and increas-
ing complexity and intensity of work had led to a feeling of
crisis. It added that the NHS was finding it difficult to recruit
and retain GMPs who wanted full-time, patient-facing work.
On the positive side, peer support was reportedly increas-
ing. With the advent of similar veterinary peer support
networks including veterinary social media groups focused
on everything from career support, parenting and chronic
illness, this is a clear, unmeasured trend for our profession.
Changes are afoot for doctors to increase retention of
the groups where the pipeline has the biggest leaks. The
NHS GP Retention Scheme is aimed at doctors who are
seriously considering leaving or have left general practice
due to personal reasons (caring responsibilities or personal
illness), or requiring greater flexibility. It provides financial
support for both the retained GP and the employing prac- Upgrading your CR Image Processor has never been easier
tice, providing working hours are limited. Crucially, it also
demands CPD and educational support are provided. While
the veterinary profession may lack a pot of funds, a similar
scheme could reap long-term benefits.
Early retirees are the second key group, with a loss of Lightweight yet robust, the
skills and experience of doctors over 55 years of age – a DR-14e Digital Detector offers
general radiography facilities all
similar phenomenon to the buy-out of independent vet the advantages of Direct
practice partners by corporate groups, leading to career Radiography, while maximising
divergence or early retirement for vets. The NHS GP Career the use of their existing
Plus pilot scheme encourages the retention of this expe- equipment.
rienced group through vaccine clinics, cover of practice
The wireless (or wired)
holiday or sickness, mentoring and clinical coaching, and technology and lighter weight
specialist clinics or home visit services to augment local offers operator comfort and
practice offerings. In this modern era of innovative recruit- improve exam flexibility and
ment start-ups, a matching service for those in the twilight convenience, even in challenging
imaging situations. The modern
of their veterinary careers would be an interesting prospect. design of the detector combines
In summary, the challenges around workforce retention ergonomics with aesthetics, with
and satisfaction which will impact the future shape of all the sides sealed to prevent liquid
three medical professions are similar. By comparing and ingress, making cleaning and
disinfection easier.
contrasting proposed solutions we can learn from each
other how best to adapt working practices to ensure con-
tinued provision of excellent care. The bottom line from the TALK TO US ABOUT OUR
BVA study suggests that if the profession can facilitate its EASY UPGRADE PROGRAM
members feeling valued, fitting in and having role models,
this is likely to have multiple benefits in terms of cultivating
a cohort of vets who are strongly motivated in their careers
and keen to stay within the profession. VP
Veterinary Practice December/January 2019/20 13HISTORY
Who made our profession?
We should recognise the individuals who The baton was taken by his colleague George Fleming,
elected RCVS President in 1880. At once he drafted a Bill to
have carved the veterinary profession as obtain protection of the veterinary surgeon title. By incredi-
we know it ble persistence, and funded by his own money, he was able
to get the Veterinary Surgeons Act 1881 entered on to the
Statute Book. The profession was now legalised and the
BRUCE VIVASH JONES members listed in the RCVS Register.
Bruce Vivash Jones, BVetSts, MRCVS, graduated from These two men, Francis Wellington John Fitzwygram
the RVC in 1951. After retiring from his consultancy
business in 2003, he began studying and writing on the
and George Fleming, had saved the profession. They were
history of the profession and veterinary medicine. known as “Fitzwygram the Charter and Fleming the Act”.
Following the First World War, the profession fell to a low
O
ebb: horses were being replaced by motor vehicles, farming
ur Royal College is celebrating its 175th anniversary
was in a desperate situation and veterinary work was in
this year. Established by Charter on 8 March 1844,
little demand. The veterinary schools were underfunded
the objective was to create a professional body of
and research was negligible.
those trained in veterinary medicine and to govern them
In 1938, the Loveday Committee was tasked to report on
with both educational and ethical standards to serve the
veterinary education. Recalled in 1943 to look into wartime
needs of both animals and the public.
food shortages, the committee now included Reginald Wool-
The question in the title echoes the succinct words of
dridge, who was able to ensure that the final report recom-
Ralph Waldo Emerson (1803–82): “There is properly no his-
mended veterinary schools to be in the university system
tory; only biography.” Therefore, as a profession, we should
and receive funding to encourage research. These recom-
recognise the individuals who have enabled the creation of
mendations were incorporated into the Veterinary Surgeons
our present working environment.
Act 1948, and veterinary colleges were also created at Bris-
The story begins when Granville Penn, a member of the
tol and Cambridge universities (adding to those in London,
Odiham Agricultural Society, and philanthropist, saw the
Edinburgh, Glasgow and Liverpool). This was almost solely
need for proper veterinary education. In 1789, he happened
due to Reginald Wooldridge, who also founded the Animal
to meet Charles Vial de Saint Bel, a French veterinary Health Trust.
graduate who wanted to open a school in England. Granville There can be little doubt that without the initiative of the
soon drafted a plan with the objectives of creating both “sci- Mayers, Fitzwygram, Fleming and Wooldridge, we would
entific veterinary education” and a “veterinary profession”. not have the veterinary profession that we have today. The
It came to fruition in 1791 with the opening of the London Mayers had the initiative and perseverance to start the
College, but Charles Vial de Saint Bel died in 1793 and his process; Fitzwygram and Fleming were the key men who
successor had little interest in founding a profession. It took put into place the legislative structure and Wooldridge had
Thomas Mayer and Thomas Walton Mayer, a veterinary the foresight and drive to bring veterinary medicine into a
father and son, to determine the way forward. They over- university and research-focused environment.
came opposition, drafted a petition and obtained the Royal Two other people showed the direction veterinary medi-
Charter in 1844. cine would take: Aleen Cust, who in the late 1800s was the
This Charter enabled the RCVS to be established and first British woman veterinarian, and Brian Singleton, who
was designed to “afford us the same privileges and was leader in the founding of the BSAVA in 1957.
exemptions which other professional bodies possess”. A At the time of both of these events, no one could foresee
president, officers and a system to oversee new entrants the consequences. Today, veterinary student intake borders
were created. But it did not confer legal powers to protect on 80 percent female and small animal work dominates all
the title “veterinary surgeon”. A Bill had to be presented to other veterinary activity. Singleton also went on to lead the
Parliament to confirm the Charter and enforce legislation. creation of the World Small Animal Veterinary Association
In 1875, the RCVS Council elected Sir Francis Wellington in 1959 – now with more than 200,000 members in its 110
John Fitzwygram (later both a Major General and a baronet) member associations.
as president. Because of his status he possessed influence Mayer, Fitzwygram, Fleming, Wooldridge, Cust and
– he could open doors and twist arms with elegance and Singleton. Remember these six names; they made today’s
grace. Almost single-handedly, he drew up a supplementary profession. We can be sure of only one thing for the vet-
charter to protect the veterinary name, create a registrar erinary future: veterinary medicine changes as the needs
and maintain a register of members from both the London of human society alter. Maybe the forerunners of the next
and Edinburgh colleges. It was granted in 1876. Now, the change have already shown themselves. It will not always
Act of Parliament was needed. He passed the baton. be as it is today.
VP
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Veterinary Practice December/January 2019/20 15RCVS KNOWLEDGE
Use of daily probiotic supplements
in canine acute diarrhoea
Does a daily probiotic supplement in the
diet provide better clinical outcomes in
cases of canine acute diarrhoea?
A
dog suffering from acute diarrhoea (under 14 days) has Severity Index”. Given that clinicians and owners may
been brought to your clinic and no cause is identified. have different standards when they evaluate the costs and
The owners suggest the feeding of a probiotic to benefits of a one day improvement, the clinical relevance of
shorten the recovery time, based on their findings on this study is unclear.
the internet. You have no experience in recommending a The probiotic group in the first of these two studies present-
probiotic supplement as diarrhoea management. What ed a greater decrease of faecal C. perfringens on day seven,
evidence exists to support this approach? while the probiotic group in the second study presented a
lower abundance of faecal C. perfringens. The clinical rele-
The evidence vance of these findings is affected by the undefined relation-
Five placebo-controlled studies were identified that have ship between C. perfringens and acute diarrhoea.
assessed the clinical outcomes of administering a daily oral It is unclear whether a reduction of C. perfringens in
probiotic supplement in dogs that have acute diarrhoea faecal samples can be regarded as a clinical benefit, given
with no identifiable cause. that one study reported an association between increased
Significant findings were reported for various outcome C. perfringens in faeces and acute diarrhoea, while another
measures: the time to diarrhoea resolution; improvement was unable to find an association between the two.
in diarrhoea severity; change in the microbiota; and the Two studies showed a lower percentage of dogs in the
percentage of dogs that required additional treatment. probiotic group received additional treatment than the
Three studies presented a shorter time to diarrhoea placebo group, and a large sample size of 118 was included
resolution in the probiotic group, ranging from 15 hours to in one of these.
2.7 days. However, detailed investigations of the underlying In conclusion, the participating dogs in all the studies
aetiology of the diarrhoea were either incomplete or presented a better clinical improvement in the probiotic
patients with identified causes were included. group than the placebo. This suggests a daily supplement
The studies may not be sufficiently strong to support of oral probiotic may provide better clinical outcomes to
a faster clinical recovery by the probiotic supplement, dogs experiencing acute diarrhoea without an identifiable
because baseline variations between the probiotic and cause. One study offered fairly strong evidence for a
placebo group were not evaluated, a standardised definition reduced requirement of additional treatment in dogs
of abnormal stool was not given to owners and clinicians, administered a probiotic.
there was an unexplained mismatch between the number The clinical relevance of the reduction in faecal C. perfrin-
of dogs that completed one study and the number of dogs gens and improvement in diarrhoea severity was uncertain,
included in the analysis of diarrhoea resolution and a and the strength of the studies supporting a shorter time to
validated stool scoring system was not used. diarrhoea resolution was limited.
Two studies measured improvement in diarrhoea severity Additional studies would be beneficial to validate the bet-
in the probiotic group. One reported a greater improvement ter clinical outcomes brought by probiotic supplementation,
in stool consistency score in the probiotic group than the given there were variations in several factors, which can
placebo on day seven. However, the improvement differed lead to different clinical outcomes. VP
from the placebo group by such a small degree that it was
questionable whether there was an observable difference in Read the full Knowledge Summary:
stool quality, and whether the improvement in consistency bit.ly/JacquelineOiPingTong
score was clinically relevant. Also, this study did not
evaluate baseline variations between the probiotic and The full Knowledge Summary was written by an under-
placebo group. graduate student, who was one of the winners of the
The second study that measured improvement in 2019 RCVS Knowledge Veterinary Evidence Student
diarrhoea severity reported that the probiotic group Awards. The 2020 awards are now open. Find out more:
took one day less to achieve a statistically significant bit.ly/VEstudentawards
improvement in the “Canine Haemorrhagic Diarrhoea
16INSURANCE
SPONSORED CONTENT
Neutering in dogs: a health and
behavioural debate
How can we help our clients make an Dog behaviour
informed decision?
Carolyn: Looking at dog
N
behaviour, thoughts are
eutering is a complex topic for dog owners, made even
very much the same – it
more so by conflicting advice, advances in research
is a case-by-case decision. People used to think if you take
and almost endless folklore of how it will affect dogs.
testosterone away from male dogs they would be easier to
To help owners to make an informed choice about what to
live with, but that’s not always the case. Aggression can have
do, we asked Carolyn Menteith, dog behaviourist and trainer,
its roots in fear or anxiety, so by taking away testosterone,
and Robin Hargreaves, director, veterinary surgeon and
which may be giving the dog some confidence, you could end
former BVA president, both members of the Agria Specialist
up with a more fearful dog, that in turn becomes more ag-
Health Team, to discuss neutering and its impact on health
gressive. There is also evidence of similar results in female
and behaviour.
dogs. In the same way, there can be an increase in other pho-
bias and touch sensitivities as well – so neutering to improve
Dog health
behaviour isn’t as clear cut as we previously thought.
It’s true that it will prevent or reduce most sexually driven
Robin: When it comes to health, the two main reasons to
behaviours, such as running off after a bitch in season or
neuter female dogs are the dramatic reduction in mammary
excessive territory marking, and it may prevent some dog-
cancer in animals neutered at a young enough age and the
to-dog aggression and male competitiveness – but it isn’t
absolute prevention of the potentially fatal pyometra.
the panacea that people always thought it was to calm dogs
In male dogs, neutering can reduce the incidence of pros-
down; in fact, there are some studies that show increased ex-
tatic disease. While we see fewer cases of benign prostatic
citability in neutered dogs. We’re simply finding out more and
disease in neutered males, it isn’t so clear in prostatic cancer
more all the time about how hormones affect our dogs and
that neutering makes a difference. Compared with females,
about what happens when you alter that hormone balance.
the health drivers for neutering males are not so strong.
Where population control is not an issue, owners should talk
Are there negatives for health in respect of neutering? Yes.
to their vets – and if they are hoping to improve behaviour,
Most insidiously across animals that have been neutered
their behaviourist – and make their decision on a case-by-
is the serious potential for weight gain – they simply find it
case basis based on what is right for them and their dog.
easier to put weight on. And if this is not addressed it can
complicate every other health problem as life goes on.
Conclusion
For females specifically, there is an increased incidence of
urinary incontinence. While manageable in most cases, medi-
Robin: We wouldn’t just book male dogs in to be neutered
cation will probably be required forever. There also continues
these days, there’s always a discussion about why. In the sig-
a debate on the timing of neutering and whether it is respon-
nificant minority of cases, we realise that client expectations
sible for an increased rate of urinary incontinence in females.
are completely awry and we would be disappointing people
It appears that spaying after the first season can reduce this.
enormously if we carried out the operation.
Neutering male dogs under the age of 12 months, or before
With females, we’re confident that it’s the right course of
the dog has reached skeletal maturity, is not advised. This is
action but it’s still important that people realise what the
due to the increased length of time growth plates will take to
downsides might be: the potential for weight gain, for example.
fuse following a reduction in testosterone, creating a statis-
The only certainty with neutering is that that animal will
tical increase in the incidence of injuries among animals that
have no further part in the breeding process. Any other
have been neutered at a younger age.
changes cannot be guaranteed, so it’s a risk–benefit analysis.
I suspect over the next five years we will see a lot more
data and will have greater clarity over the ancillary risks and
benefits. But at the moment with male dogs it’s a case-by- To find out more about how your practice could benefit
case decision, whereas for female dogs, with the health risks from working with Agria and offering your clients five
being so much more significant, I think we can be clear that a weeks of free insurance, get in touch with the Agria Vet
non-breeding female is better off spayed. Team by calling 03330 30 83 90
Veterinary Practice December/January 2019/20 17MENTAL HEALTH
Non-judgement is accepting
your thoughts and feelings
No one ever healed a blow to the head Does that mean that I’m allowing them to win? Or, in choos-
ing to suffer less, am I indeed being responsibly selfish
by hitting themselves there again enough to be the winner?
If your motivation is to feel less hate, less hypertension
and less pain, then maybe you will choose to simply feel
LAURA WOODWARD
LAURA WOODWARD COUNSELLING less angry when the stimulus occurs next time. It is genu-
inely a choice. Or maybe the cause of the anger is gone, in
Laura Woodward has been the surgeon at Village Vet
Hampstead for over 10 years. Laura is also a qualified which case it’s even easier to simply feel less anger about
therapeutic counsellor and is affiliated with the ACPNL the past from now on. No matter how justified your anger
and the ISPC. She runs laurawoodward.co.uk – a coun-
selling service for vets and nurses. is, if you choose to let the feelings of rage go, then you may
feel more empowered and more free than the perpetrator if
M
editation sessions are a perfect time to allow our you choose to defuse it.
emotions to envelop us. It takes discipline and inner Once the internal reaction has been chosen, what do I want
strength to allow the emotions which have previously my external reaction to be? Again that’s your choice. Maybe
been overwhelming to come to the forefront of our mind. you want to send an eloquent email. Maybe you feel like
Self-awareness means being acutely alert and aware of throwing furniture. Maybe you want to try (dare I suggest it)
what you’re feeling. This is not about burying emotions in showing compassion towards an adversary?
a box and ignoring them. In mindful meditation, it is about It may be that, once the internal rage has become so weak
being actively aware of your emotions, however distressing that it’s way down your list of priorities, your external reac-
or otherwise they may be, and feeling them one by one, so tion is naturally one of calmness and physical non-reactivity
that the full force of the emotion is there. Then, and only in the face of what would have previously enraged you.
then, can we defuse it, if we wish. Holding on to distressing and painful emotions disem-
Give one emotion a name, look it in the face, allow it to powers you. Letting go of them, if that’s what you choose,
envelop you and accept that you are feeling what you are relieves the stress and burden on you to feel responsible for
feeling. The more you accept and embrace that emotion, the everything, especially those things that you cannot change.
more you defuse it and decrease its power over you. Anger is just one emotion which can be looked at in this
Now the non-judgement... This begins with awareness of way. Anxiety is a great emotion to work with in a similar
your own thoughts and stopping yourself from labelling any step-by-step fashion. Fear, grief and regret may be on your
of them as good or bad. They just are. list also. When embracing anxiety and feeling it to its full
Accept your thoughts and feelings as natural and allow extent, it can be quite nauseating and stressful. You may
them to come. Non-reacting is allowing your thoughts and find your stomach sinking, your pulse increasing, your
feelings to be, without resorting to the need to behave reac- breaths becoming gasps. “Letting go” of anxiety is simply
tively in the same way you have reacted before. too difficult and impractical for most people due to the bio-
Pause for a moment to reflect on your inner experience. chemical aspects of it as well as the external causes.
Don’t act hastily and emotionally. So now, you can make Spending extended periods of time focusing on nothing-
this space as large as you like. And you can literally choose ness can help with anxiety, as can focusing on your breaths
how you want to react to this emotion internally as well as and nothing else for as long as possible (ideally 20 minutes
externally. What you choose to do in your morning medita- at a time). It’s hard but it’s very effective.
tion, you will do subconsciously later in the day. However, probably the most powerful tool I have used with
For example, if I feel angry, I feel angry. Having the emotion my clients, along with the above, is learning to accept that
is not good nor bad. It is what it is. There may be many rea- anxiety is not going to go away anytime soon. Acceptance of
sons I am angry and the causative effects of how I’m feeling anxiety as a part of your life (if it is), which contrasts so pro-
right now are in the past. Maybe the causes will never stop. foundly with trying to make it go away or cure it, can feel like
But the way I feel right now is a result of what has happened laying down passively and succumbing to the horrors of it all.
up to this point, and the past cannot be changed or undone. However, if fighting against anxiety hasn’t worked this
Right now, while allowing the anger to envelop me, I have far, and “letting go” of anxiety is simply too difficult, maybe
a choice to make. Would I like the internal reaction to be allowing it to just be, to play along in the background and
“to feel less angry”? Is it a sign of weakness that the same be accepted for what it is, will decrease its hold over you.
things or people which caused the anger will remain the Hans Selye said “It’s not stress that kills us. It’s our reac-
same and I am changing to be less reactive? tion to it” and this is true of every emotion you feel. VP
18You can also read
