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A new differential for canine pneumothorax

6 Dec, 16 | by gmills

By Cameron Knight

An article recently published in Veterinary Record Case Reports describes a case of fatal pneumothorax in a dog secondary to malformation of a single lung lobe. Within the published literature, most canine cases with a similar presentation are diagnosed as congenital lobar emphysema (CLE). However, in this particular dog, CLE was ruled out by a panel of veterinary and human paediatric pathologists. Histological lesions closely resembled congenital pulmonary airway malformation (CPAM), a disease that is well recognised in children, but that has never been reported previously in any veterinary species. This report proposes that CPAM be considered in the differential diagnosis for canine spontaneous pneumothorax, and clarifies the distinction between CLE and CPAM.

The case describes an eight-month-old female boxer dog with progressive respiratory distress and no previous history of disease, trauma or toxin exposure. Pneumothorax was diagnosed and repeat thoracentesis and oxygen supplementation were performed for three days. CT confirmed bilateral pneumothorax and showed variably sized bullae in the right middle lung lobe, leading to a presumptive diagnosis of CLE.

During anaesthetic induction for lung lobectomy, the dog developed cardiopulmonary arrest and died. A postmortem examination was performed, which confirmed severe bilateral pneumothorax with atelectasis of all lung lobes, and revealed a small, pale and flaccid right middle lobe with several ruptured bullae (Fig 1). The primary bronchus supplying this lobe was flattened, with a slit-like, rather than circular lumen. In addition, the right subclavian artery had an aberrant origin from the left subclavian artery, rather than from the brachiocephalic trunk.

Fig 1: Right lung of a dog that died from spontaneous pneumothorax. (A) The right pleural cavity, with the cranial (RCr), middle (RMd) and caudal (RCd) lobes of the right lung labelled. The caudal lobe has been reflected dorsally to better expose the middle lobe. All lobes are severely atelectatic. In addition, the middle lobe is pale and flaccid. (B) The right middle lung lobe at higher magnification. Several collapsed bullae (yellow arrowheads) are present along its ventral and ventrocaudal margins

Histological sections of the right middle lobe were difficult to recognise as lung tissue. They consisted predominantly of thick fibrovascular trabecular networks outlining collapsed, empty cavities lined by a simple cuboidal to simple squamous epithelium. All other lung lobes in the dog had normal histological architecture.

A diagnosis of CLE was ruled out histologically. CLE requires overinflated alveoli or hyperplastic alveoli, whereas the affected lobe in this dog lacked alveoli. Instead, after consultation with seven human paediatric pathologists, a diagnosis of CPAM-like disease was reached. The term CPAM refers to a spectrum of human airway malformations characterised by abnormal development of various portions of the tracheobronchial tree. CPAMs are well recognised and relatively common in people, and are characterised by multiple irregular pulmonary cystic structures lined by varying types of epithelium. The distinction between CLE and CPAM in humans is not merely academic. Importantly, CPAM may progress to malignant neoplasia, while CLE does not. Lobectomy is generally indicated for CPAM lesions, while CLE may resolve spontaneously and can often be managed conservatively.

While CPAM-like disease has never been reported in the veterinary literature, there are 11 reports of CLE in dogs. After reviewing these, it is possible that some reported canine cases of CLE may, in fact, represent CPAM-like disease. This case highlights the necessity for histological distinction between these two diseases, and describes a novel condition that may result in spontaneous pneumothorax in dogs.

More details, images and discussion about this case can be found here:

Working with Guide Dogs

21 Sep, 16 | by Kristy Ebanks

By Dr Mary Fraser

As vets and veterinary nurses we’re taught how to work with animals and clients. However, when working in practice I noticed that some colleagues found it awkward talking to owners of guide dogs or hearing dogs as they didn’t know what was expected of them, and were worried about offending someone by saying the wrong thing. So with this in mind I set about designing a study where we talked to owners of guide dogs to find out more about their experiences, identify what worked well in practice and why, and also discover what went wrong. I hoped that from this, we would be able to design some training for current students and practitioners in how to work with owners of assistance dogs.

So, what were the findings? Well, the first thing to mention is that overall the findings were very positive with many good experiences. Everyone had something good to say about their vets. This often focussed on consistency and routine: meeting familiar staff, including reception, nurses and vets who knew the dog and owner. Difficulties arose where new staff were present who didn’t know that the owner would weigh the dog before going into the consultation, that the dog shouldn’t be given treats or that it shouldn’t be distracted as it was working.

Good communication is essential to vet practice

Do you remember older vets talking about the ‘art’ of veterinary practice? This also applied to working with guide dog owners. Some owners found that if nothing was said in the consultation and they couldn’t see what was happening to the dog they felt isolated. They also worried about their dog as they didn’t know that it was only jumping because it was having its temperature taken – warning the owner about what was going to happen would have been helpful.

Sometimes vets didn’t fully appreciate the bond between owners and their dog. Every owner worries about their pet and many will treat them as part of the family. For guide dog owners though there is an even stronger bond. People rely on their dogs to go about their daily life and they spend all of their time with them. From this, owners were able to pick up subtle differences in their dog’s behaviour, or detect changes in movement through the harness (things that showed the dog was ill, sometimes before even the vet could pick it up on clinical examination). This, however, led to difficulties, as owners felt that sometimes vets didn’t believe them when they said there was something wrong with their dog.

Like any other dog, guide dogs need preventive healthcare and may need to be given medication at home. Many guide dog owners will be perfectly happy to apply drops or flea medication or give tablets, but they might not. So just take the time to ask if they are OK with the format the medication comes in. If not, do you have a different preparation that might be more suitable? We came across some ingenious methods of adapting syringes or droppers to make them more user friendly to both the owner and the dog. Where dogs were receiving multiple medications, then think about ways that they can be differentiated. If sending owners home with instructions then what format would suit best; emails or MP3s might be worth thinking about, although most owners were happy to remember instructions and knew they could phone the practice if they had any queries.

So where do we go from here? I hope that some practitioners/students out there will read the research and find it helpful in practice. I would be delighted if the vet schools could incorporate some of this into their communication training, but I know their curriculum is already full! Training staff in sighted guiding would also be beneficial to practices, so if you want to find out more please go to Guide Dogs website. I was recently asked what was the most important point to take from this research and my answer was ‘just ask if you can help.’

Acknowledgements: Thanks to Pamela Munro, Emma Brown, Julie Millar of Guide Dogs Scotland and all the owners and dogs who gave up their time to take part in the research.

Photograph: Shona Black with guide dog Woody. Photograph courtesy of Pamela Munro, Guide Dogs Scotland.


The women in leadership discourse

17 Aug, 16 | by Kristy Ebanks

By Elizabeth Chan

It is fantastic to have this opportunity to talk about the research I have been involved in (Career aspiration in UK veterinary students: the influences of gender, self-esteem and year of study), although I feel the need to start with a disclaimer: until Sabrina Castro approached me to ask her to supervise her student project, I lacked enthusiasm. I felt I lacked the skills that were needed to contribute to the women in leadership discourse and was a reluctant role model.

Initially we carried out our research in order to explore whether the disproportionate representation of female vets in leadership positions arose from a lack of interest, or whether female students demonstrated equal career aspirations to male students, but subsequently become less successful in their pursuit of leadership roles. Although an overly simplistic question, we indeed identified a gender difference in leadership experience and ambition in veterinary students: not only were the female students less likely to aspire to owning a practice, they were also less likely to have previously held a leadership role, such as in the Students’ Union (SU). Particularly in a female-dominated course, we would have expected male and female students to have similar experiences and ambitions, and we concluded that the gender imbalance in veterinary leadership was not simply caused by women tending to work part-time or eschew senior positions because of family commitments, but instead is a consequence of factors exerting their influence before women enter the workforce.

Does this matter? We have had female RCVS and BVA presidents and will soon have a female BVA president this year, as well as female heads of several UK veterinary schools. One could argue that these positions are available for those women who want them, and the gender-discrepant career aspirations could be interpreted as female students simply choosing to pursue other roles. However, that would ignore our findings in that the female students surveyed had lower confidence and self-esteem than the male students, not to mention the surprising finding (at least to me) that knowing a female practice owner had no effect on the female students’ career aspirations. Given that one of our initial arguments for supporting women into leadership roles was to provide role models, this is a significant issue and one to which I will return.

I might buy the ‘female students want other roles so it’s not an issue’ argument if this was accompanied by comparable confidence and self-esteem to the male students. Gender bias is not simply the way an individual analyses someone’s attributes and character traits as a consequence of their gender – being surprised that a female colleague isn’t nicer to work with (‘too bossy’), or considering it to be more acceptable for a male employee to be ‘tough’ – the phrase ‘too aggressive’ appears three times more frequently in women’s performance appraisals than those of men according to research in a recent Harvard Business Review1. More important here is the way an individual feels about his or herself, as a function of their gender. It is a woman thinking ‘I couldn’t take on that line manager role – I don’t like conflict’, ‘I can’t sit on that committee – I’m not assertive enough’ or ‘I can’t apply for that position – I don’t have sufficient confidence in my decision-making’. Confidence and self-esteem have high context stability – in a particular environment, these will remain consistent. Therefore, aiming to improve female students’ confidence and self-esteem as a way to bolster their leadership aspiration would be a demanding task. An alternative strategy would be to demonstrate to women and girls the plausibility of taking on leadership roles, despite having less confidence in the attributes they perceive as being essential for these positions. Which brings me to the issue of female role models.

I was initially surprised and disappointed that when I discovered seeing female practice owners did not seem to encourage female students to consider similar careers (and interestingly this actually appeared to increase male students’ aspirations to own a practice; at the time we overlooked the significance of this finding and it was left unreported). However, review of the literature reveals female leaders can inadvertently dissuade other women from considering similar roles. There is a tendency for women to view other women in leadership positions as ‘not like me’. We assume they have the ‘other’ character traits (assertiveness, decisiveness, able to take criticism), which we consider that we ourselves lack. It was only when a senior colleague told me she hated conflict and had been dreading a potential argument that I began to wonder if most women leaders achieve these roles without feeling they have strengths in these presumed leadership traits. In gender studies, women are typically found to favour relational leadership styles and a more connected approach to working relationships. Veterinary practice increasingly emphasises client relations, shared decision-making and communication; it therefore makes sense that those who excel in these attributes would form the profession’s leaders. If this is the case, we need to think how we role model leadership, particularly to female students. Maybe being an uncomfortable decision-maker, conflict-avoider and reluctant task delegator is not incompatible with having a voice on female leadership, and it may even represent better role modelling to advertise these (seemingly lacked) attributes!

So what now? Our findings included some reasons for optimism. Our observed gender differences in leadership aspiration are smaller than the leadership representation currently seen in the profession. Also, the proportion of male students who would consider reducing their hours for childcare reasons is larger than the proportion of male vets who work part time. Career aspiration was significantly associated with SU experience, and it was great to see all of the SU positions being filled by women at the RVC this year. Hypothetically, these findings could translate to a more balanced gender representation in the profession’s future, both in terms of leadership roles and work hours; work is needed to follow these trends and to explore the support mechanisms needed, such that those who are inclined towards leadership feel empowered to pursue their ambitions.

1 CORREL, S. & SIMARD, C. (2016) Research: Vague Feedback Is Holding Woman Back. August 8, 2016

The full article is available here

Intubation complication in a rabbit

15 Apr, 16 | by gmills

By Daniel Pang

A report of an unexpected and novel anaesthetic complication in a rabbit, the presence of faecal matter in the oropharynx impeding attempts at intubation, was recently published in Veterinary Record Case Reports.

The incidence of anaesthetic-­ and sedation-­related mortality in apparently healthy rabbits is 1.4 per cent, six to eight times greater than in dogs or cats, and respiratory complications represent a substantial fraction of these deaths.

Unfortunately, undiagnosed respiratory disease and hypoventilation due to anaesthetic agents can cause significant respiratory depression. Endotracheal intubation provides a secure airway, facilitating positive pressure ventilation, reducing the risk of fluid aspiration and limits workplace pollution with anaesthetic gases. However, many rabbits are maintained anaesthetised with a face mask, rather than secure airway, because they are challenging to intubate. They have a relatively large tongue, narrow oral cavity and small glottis, which combine to limit visibility of, and access to, the larynyx. Simpler, novel methods of securing an airway such as supraglottic airway devices (eg, Laryngeal Mask Airway, V­Gel) have shown promise in clinical use.

A healthy, adult New Zealand white rabbit was anaesthetised for a CT scan as part of a larger study evaluating different methods of providing a secure airway to facilitate ventilation. Following induction of general anaesthesia (intramuscular dexmedetomidine and midazolam, followed by intravenous alfaxalone), the rabbit was positioned in sternal recumbency and orotracheal intubation with an endotracheal tube was attempted with a blind technique. Initial attempts at intubation by an experienced anaesthetist were unsuccessful, with intubation finally achieved after five minutes. This contrasted with an average of two minutes to perform intubation in similar rabbits by the same anaesthetist.

The study protocol required CT scans of the oropharynx to be performed before and after intubation. These ‘pre’ and ‘post’ scans allowed us to identify the cause of the difficult intubation: faecal matter present in the oropharynx before intubation, which was pushed caudally to cause a physical obstruction during attempted intubation (Fig 1). This was also confirmed at postmortem examination.

pang pic

FIG 1: CT images (sagittal plane) of a three-month-old New Zealand White rabbit pre-intubation (top) and post-intubation (bottom) with a 2.5 mm ID endotracheal tube. The pre-intubation image shows two areas containing material of mixed gas and soft tissue attenuation. These were confirmed as faecal material at necropsy examination – a discrete faecal pellet in the oral cavity (orange arrow) and dispersed faecal material in the caudal oropharynx, immediately rostral to the larynx (orange arrowheads). The endotracheal tube (green arrowheads) is visible in the post-intubation scan (bottom) passing dorsal to the faecal pellet (orange arrow). The pellet visible in the pre-intubation scan in the oral cavity has migrated caudally to merge with, and compress, the dispersed faecal material in the laryngopharynx

The source(s) of failed orotracheal intubation attempts in rabbits are usually unknown, although there is a tendency to blame anaesthetist inexperience or anatomical impediments. This report identifies a previously undocumented source of a difficult intubation. A pre­anaesthetic examination of the oral cavity in rabbits may be warranted, but is unlikely to rule out the presence of foreign material in the oropharynx.

The full article is available here:

Immaculate contraception

15 Feb, 16 | by gmills

By Marie Kubiak

Meerkats are a charismatic and popular exhibit in zoo collections and they are typically maintained in their natural family groups. One dominant pair in each group is responsible for breeding and can produce up to four litters of one to six pups a year. As such, successful breeding can quickly result in overpopulation of an animal with IUCN conservation status of ‘Least concern’, with limited opportunities to relocate animals within the zoo community. Additionally, if social structure of a group breaks down and the dominant pair are displaced then inbreeding between younger members of the group can result. In either scenario, contraception is useful in managing unwanted breeding. Deslorelin acetate implants are advocated for contraception in many mammalian species, including meerkats (Suricata suricatta) but recommendations are based entirely on anecdotal reports with no objective data to demonstrate efficacy or safety.


This study followed two groups of meerkats: one group with contraception, using deslorelin 4.7 mg implants every 12 months to prevent inbreeding following social structure breakdown; and one group without contraception, to assess the efficacy of this treatment on breeding cessation. The group that used contraception produced no further litters for the entire 600-day observation period, while the control group continued to breed. Following control group expansion, the control group was also given deslorelin implants after 12 months for population management reasons, resulting in suppression of further conception, although one female successfully carried her litter to term. This litter was exceptionally large at seven pups and conception may have occurred in the hyperstimulatory stage in the two weeks following implantation.

No adverse effects on health or behaviour were associated during daily observation and annual clinical examination of all animals. Effective contraception appeared to result from implant placement in both sexes. As the meerkats were kept under the same dietary and management conditions, it would be expected that if environmental factors alone were responsible for the cessation in breeding in the group that received contraception, then a similar failure to reproduce would be seen in the group that did not receive contraception during the same time period. No disruption to the social hierarchy was noted following contraception and, interestingly, it appeared that the dominant pair in each group maintained their social status even when one received contraception and breeding was not occurring.

It was noted in this study that implanted males had a notable reduction in testicular size and this may be a useful criterion for assessing implant efficacy and monitoring duration of action. A duration of action of at least 12 months is expected based on the findings from this study.

More details about this case can be found here:


CSI North Yorkshire

17 Dec, 15 | by gmills

By Tim Hopkins

Raptor persecution is an emotive issue in Britain. In an attempt to increase the population of gamebirds, some unscrupulous gamekeepers (sometimes directed by managers and employers) continue to illegally kill raptors. For conservationists and welfare groups, the shooting, trapping and poisoning of these wild birds represents the worst of the gamebird industry. Aside from the welfare concerns (for both game and raptor) and the disease risks from the release of many millions of captive birds annually, persecution continues to have a significant conservation impact on a number of species, in particular the hen harrier (Circus cyaneus) and golden eagle (Aquila chrysaetos). Historically, some British species were pushed to extinction due to such pressure, although all have since returned to breeding. Parts of the gamebird industry continue to dispute the scale and impact of raptor persecution and believe that the conservationists and welfare bodies are attempting to piecemeal outlaw their traditional hunting sport. For any given incident, the reliability and transparency of a postmortem investigation is paramount.

Veterinary pathologists, police and NGOs are hindered in confirming shooting by decomposition, scavenging and concealment of the carcase by the perpetrator. Furthermore, the identification of ballistic objects within a carcase is rarely enough to prove cause of death – it is often an incidental finding. An article published recently in Veterinary Record Case Reports details a confirmed shooting in an otherwise ambiguous postmortem examination of a hen harrier using advanced imaging techniques.

The bird was fitted with a tracking device as part of Natural England’s Hen Harrier Recovery Project, which enabled its recovery after death. Despite the advanced state of decomposition, a postmortem examination was performed at the Zoological Society of London’s Institute of Zoology. The bird had a broken tibiotarsus, which was radiographed, and minute metallic radio-opacities noted. Without an obvious gross ballistic remnant, the authors needed a diagnostic tool that would determine the composition of the foreign object and its effect on the surrounding tissue. Several modalities were considered but ultimately rejected as they failed to preserve both the foreign body and the microscopic structure of the bone. Histology, for instance, would have provided accurate descriptions of the bony trauma but no information about the chemistry of the object. Conversely, many spectroscopic techniques would have provided accurate descriptions of the metallic object atomic makeup but destroyed the surrounding bone in the process. Scanning Electron Microscopy with x-ray Dispersive Spectroscopy (SEM-EDX) was the only tool that fitted the bill.


Fig 1: Plain craniocaudal radiograph of the left tibiotarsus and tarsometatarsus showing three radiodense objects (white and black arrowheads)

Fig 1: Plain craniocaudal radiograph of the left tibiotarsus and tarsometatarsus showing three radiodense objects (white and black arrowheads)


SEM-EDX was carried out at the University College London’s Institute of Orthopaedic and Musculoskeletal Science. With great care, the bone was prepared for imaging, which included a thin coat of gold palladium to reduce scatter during scanning. The images were spectacular and conclusive. The fragment had tunnelled into the cortex of the tibiotarsus, fracturing the bone and trabeculae. On its way, it had disintegrated. The fragment was predominantly lead on EDX. The lack of any significant bone resorption or remodelling suggested this injury had resulted in rapid death. Case closed.

That was until we noticed that there were minute amounts of niobium on the spectrum. Niobium is not used in ammunition or firearms manufacture, so where had it come from? The explanation took several months. EDX, like any diagnostic tool, is subject to artefacts, operator error and sensitivity and specificity constraints. After consulting with the University of Bristol’s Department of Earth Sciences, the authors ran the scan data through third party software – DTSA II (Desktop Spectrum Analyser, National Institute for Standards and Technology). DTSA was able to discriminate the spectral peaks and showed that the aforementioned niobium was a misread of the peaks caused by the gold palladium coating. Additionally, it revealed the presence of arsenic and antimony, common additives in lead ammunition manufacture.

This case demonstrates the application of a novel forensic modality to the veterinary field. SEM-EDX has also been used in human forensic science to demonstrate gun shot residue (GSR) – microscopic remnants of the ammunition primer and propellant – on victims, shooters and firearms. This information often forms a vital piece of the investigative puzzle. In the future, it may be possible to determine that an animal was shot by a particular firearm or person by matching the GSR EDX data.

Novel modalities are increasingly important for NGOs and police seeking to stamp out illegal persecution. Confirmation of shooting in such ambiguous cases may increase pressure on the game industry to reform its practices. The imminent use of GSR EDX to match individuals with shooting incidents may be enough to dissuade gamekeepers too.

More details about this case can be found here




What is interprofessional working and how does it affect your working veterinary life?

30 Nov, 15 | by Kristy Ebanks

By Tierney Kinnison

Veterinary Record has recently published a number of papers that can give the detail; here I draw the strands together. Two papers (the practice effect and the personal effect) used Social Network Analysis (SNA) to map interactions between veterinary practice team members and to identify trends across practices in England. This formed the starting point of the empirical research for my PhD. The SNA produced a vast amount of data, which could be analysed in a number of different ways depending on the focus and questions being asked. This, I think, highlights the usefulness of SNA – relatively unheard of in many fields of work and study – in studying team interactions.

With all these data, we chose to focus the first paper on ‘the practice effect’ and the second on ‘the personal effect’. The practice effect deals with how interactions between staff are affected by the size of a practice and the presence of branches. Small practices were relatively cohesive, with interactions between most individuals, while the density of interactions tended to decrease with increasing team size. However, even in smaller practices, everyone was not connected to everyone else; hence, decisions about whom to interact with were made. In practices that do not rotate staff between branches there tended to be a lack of information/knowledge flow across branch sites, creating sub-teams. These results have implications for practices aiming to grow in size.

The second paper focused on ‘the personal effect’; the concepts of key people, interprofessional interactions and the links between social and work interactions. Key people were identified individuals through whom information/knowledge travels and who tend to link other groups together, as often they were appointed leaders, such as directors, practice managers and head nurses, but they could also be emergent and situational leaders. Analysis of interactions between professions identified a hierarchy with veterinary surgeons at the top. In order to create a well-functioning and informed team, we tentatively suggested that interactions should instead be based primarily on experience and knowledge, as opposed to purely what profession someone is. Social and work interactions were linked, suggesting that we interact at work with those people who we like (rather than on their expertise), or we become friends with those people whose work interactions we value. Crucially, higher order interactions were much more likely between those who socialised than those who did not.

The third paper (errors in veterinary practice) evolved from the second part of my research, case studies, which aimed to explore the trends identified through the SNA in more depth. During the case studies I spent several weeks with two practices and observed the teams as a whole, as well as observing and interviewing selected individuals, who were representatives of each profession. I was looking for good interprofessional working and learning and found many examples of this. However, on occasion, I also saw errors, defined in the most encompassing sense, to mean any behaviour that could lead to any potentially negative consequence for patients, clients, the practice or the team. These errors were primarily, though not exclusively, communication based and involved, for example, mistakes on records, missing information given face-to-face and mistakes in face-to-face communication. Identifying the systems nature of these errors (rather than placing blame on an individual) and using potential solutions may reduce error in veterinary practices, and is likely to be important in large organisations where information flows less easily as a function of their size.

We have had a very positive response from members of the veterinary professions towards these articles, as well as our Veterinary Record letter (VR 2015 177, 345). I hope through this brief piece that the background to the research will be better understood, and that the veterinary community will use this type of research to create a workplace where all professions and occupations are valued for their individual expertise, which when brought together, can form a complementary skills set, best placed to suit the evolving needs of our patients and clients in the 21st century.

Professor Stephen May from the Royal Veterinary College and Professor David Guile from the Institute of Education, University College London are co-authors in these series of articles.

We need to talk about error

3 Nov, 15 | by Kristy Ebanks

By Catherine Oxtoby

A paper that has recently appeared in Veterinary Record exploring the causes and types of error in veterinary practice is the first phase of a three year PhD into mistakes in veterinary practice – a hugely neglected area of research in our profession. It wasn’t until I started researching the background to errors and mistakes in other industries that I realised how little attention our profession has shown to a topic which is the driving force of policy and procedures in other sectors.

What we found, was that vets are no different to anyone else. Our brains are wired the same way – we make mistakes for the same reasons, it’s just that when a vet makes a slip during surgery the consequences are serious. It’s all about context, rarely about competence and almost never about a lack of care. Psychological limitations, system failures in the form of poor communication, poor teamwork and badly designed equipment or packaging were major causes of error, not simply a vet having a bad day. It is vital that we understand that mistakes don’t happen because someone was being careless – it’s much more complicated than that, and blaming the clinician does nothing to prevent it happening again. What we need are simple tools to support clinicians, and training in non-technical skills to help reduce mistakes.

Patient safety influences many areas of practice – not just the obvious example of ‘why things go wrong’. Reporting and discussing error, the reactions of our piers and seniors in the aftermath of mistakes and the way we look at our systems to prevent recurrences, all reflect the culture and ethos of a practice, its visons, values and leadership. Actively engaging with the concepts of patient safety drives quality, empowers staff and increases efficiency as well as saving lives and law suits. The final two years of the PhD study will be spent investigating safety culture in veterinary practice – the force which drives attitudes and behaviours. I believe that this is where efforts to improve should be targeted, as it is the culture of the place which determines its willingness to embrace the changes which may be required for interventions such as surgery checklists and reporting systems to really work.

I hope the paper will shine some light on a difficult and sensitive subject in the profession. The vast majority of veterinary surgeons and nurses are dedicated, compassionate people who care deeply about both their patients and their clients, but they are also human beings. We need to recognise the things which impair their performance and build resilience into our personnel and systems to ensure consistent quality of care, through a better understanding of the true causes of veterinary medical error.

More details can be found here


Dog gets a raw deal

21 Jul, 15 | by gmills

An article recently published in Veterinary Record Case Reports describes a case of small intestinal segmental volvulus in a dog secondary to dietary obstruction. Small intestinal volvulus is an infrequently encountered condition in small animal practice. Within the published literature, there are notable contrasts in the clinical history and examination findings described as well as the success of the surgical intervention itself. This cases serves to propose both a cause for the volvulus and also describe its successful management.

The case describes a four-year-old golden retriever that had been vomiting intermittently and had been lethargic for a few days. The owners described the diet which the dog was being fed as consisting of a chicken bones and raw food (BARF) diet along with boiled potatoes and pasta. There was no history of foreign bodies having been consumed.

On clinical examination, there was an area of mid-abdominal intestinal thickening within the abdomen, but no discrete foreign body was palpated. Biochemistry, electrolyte and haematology blood samples were unremarkable, while abdominal radiographs were consistent with an intestinal foreign body (Fig 1).

At exploratory coeliotomy, segmental small intestinal volvulus was identified, and successfully excised by enterectomy without previous derotation. The patient made a smooth recovery from anaesthesia and surgery. Upon dissection of the excised portion of intestine, bones that were anatomically typical of those contained in chicken legs were found.

BARF diets have been recently increasing in popularity among dog owners. This is not currently mirrored by the profession where the vast majority are still cautious on their use especially in regard to the food hygiene and nutritional imbalance risks. This having been said, there are increasing numbers of the profession now considering whether BARF diets can be used in dogs, and if so how they can be nutritionally balanced.

This case demonstrates that intestinal volvulus, which is often considered to have an acute onset, may have a more delayed presentation, and still be successfully surgically managed. Additionally, it demonstrates that intestinal obstruction with secondary volvulus can occur due to dietary obstruction when a dog is fed a BARF diet.

More details, images and discussion about this case can be found here

Fig 1: (a and b) Right lateral and dorsoventral abdominal radiographs showed gastric as well as intestinal dilation, increasing the suspicion of gastrointestinal obstruction

Fig 1: (a and b) Right lateral and dorsoventral abdominal radiographs showed gastric as well as intestinal dilation, increasing the suspicion of gastrointestinal obstruction

Lumbar pain presenting as praying position-like posture in a dog and a cat

30 Jun, 15 | by Assistant Editor


An article recently published in Veterinary Record Case Reports describes the case of a 10-year-old, male, intact Border collie presented with a 12-month history of progressive paraparesis and lumbar discomfort and a 5-year-old male neutered, domestic short-hair cat presented with a one-week rapid progressive history of unusual stance and gait. Both pets adopted a ‘praying position’-like posture and a gait characterised by raising the pelvis while keeping the elbows flexed.

Neurological examination indicated lumbosacral localisation in both patients. The dog adopted this unusual posture only intermittently and thus it was challenging to attribute the lumbosacral discomfort to the presenting posture. However, this unusual posture could be elicited later in the disease process by applying pressure on the lumbosacral junction. The cat presented acutely and continuously in this posture in addition to lumbosacral pain, plantigrade gait and a flaccid tail.

Advanced diagnostic imaging of the lumbar spine revealed caudal lumbar disc disease in both animals. MRI in the dog showed a focal bulging of the annulus fibrosus at the dorsal aspect of the L7-S1 intervertebral disc, which was causing compression of approximately 50% of the spinal canal. Both the left and right intervertebral foraminae of L7-S1 were filled with intermediate to low signal T2 weighted images (T2WI) and T1 after contrast (T1+C) material above the intervertebral disc. A CT scan of the cat revealed a large amount of hyperattentuated material within the spinal canal extending from the endplate of L6 vertebrae to the cranial third of L7 vertebra and occluding most of the vertebral canal.


Lateral and ventrodorsal radiographs (a and c, respectively) and sagittal and dorsal CT images (b and d, respectively) of the lumbar spine of case two. Lateral radiographs (a) show a subjectively narrowed L6-7 intervertebral disc space. Radiodense material is visible within the vertebral canal above the cranial third of L7 vertebrae (a, d, arrow). A large amount of hyperattenuated material within the spinal canal is located midline and ventrally occluding 80% of the height and 75% of the width of the vertebral canal extending from the caudal endplate of L6 vertebrae to the cranial third of L7 vertebra leaving only a rim of normal signal dorsally (b, d, arrow). L, left; R, right

Lateral and ventrodorsal radiographs (a and c, respectively) and sagittal and dorsal CT images (b and d, respectively) of the lumbar spine of case two. Lateral radiographs (a) show a subjectively narrowed L6-7 intervertebral disc space. Radiodense material is visible within the vertebral canal above the cranial third of L7 vertebrae (a, d, arrow). A large amount of hyperattenuated material within the spinal canal is located midline and ventrally occluding 80% of the height and 75% of the width of the vertebral canal extending from the caudal endplate of L6 vertebrae to the cranial third of L7 vertebra leaving only a rim of normal signal dorsally (b, d, arrow). L, left; R, right


The praying-position like posture and gait vanished with suitable treatment in both pets. The owner of the dog elected conservative treatment of exercise restriction and oral steroids leading to it being only mildly paraparetic. The cat underwent a L6-L7 dorsal laminectomy removing calcified intervertebral disc material resulting in resolution of nearly all neurological deficits.

It is suspected that the praying position-like posture resulted in greater pain relief for the dog and cat. Adopting a praying position-like posture results in ventroflexion of the caudal lumbar spine and decreased impingement of the nervous structures due to an increased distance between the dorsal aspects of the vertebral bodies of the adjacent vertebrae. A praying position-like posture has been previously described in different pathologies. For instance, acute abdominal pain can present with a prayer-type posture, abdominal distension, restlessness, vomiting, diarrhoea and collapse. Another report described severe cervical pain and an intermittent praying position-like posture and gait in a bulldog with C4-5 ventral cervical disc extrusion.

The two cases raise the importance of considering a praying position-like posture as clinical presentation for caudal lumbar disc disease in dogs and cats.

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