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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.

Thorn free

17 Jun, 15 | by Assistant Editor


In a recent case report, Marthinus Jacobus Hartman and colleagues report the successful laparoscopic removal of a thorn granuloma from the abdomen of a wild captive cheetah.


Image: Mark Probst

Image: Mark Probst

An 11-year-old cheetah was presented for routine laparoscopic ovariectomy during a cheetah sterilisation project in Namibia. While under anaesthesia, a mid-abdominal mass was palpated and visualised by ultrasonography as a highly vascularised round 6 cm diameter well-vascularised mass, not associated with any specific abdominal organ, in the mid right abdominal cavity (Fig 1). Ultrasound-guided fluid aspiration revealed a cloudy and turbid-appearing fluid, which on centrifugation had a sizeable cellular pellet.

FIG 1: Sagittal transabdominal ultrasound images of the thorn-induced granuloma. (a) The granuloma is seen between the measured callipers with the echogenic exudate caudal to the mass. (b) Image slightly more medially. Colour flow Doppler illustrates the vascularity of the mass

FIG 1: Sagittal transabdominal ultrasound images of the thorn-induced granuloma. (a) The granuloma is seen between the measured callipers with the echogenic exudate caudal to the mass. (b) Image slightly more medially. Colour flow Doppler illustrates the vascularity of the mass


The differential diagnoses considered before surgery were intraomental neoplasia or a foreign body granuloma.

The cheetah was prepared for laparoscopy for ovariectomy and surgical removal of the mass. A single incision laparoscopic surgery (SILS) port was placed immediately caudal to the umbilicus, and the mass embedded in omentum (Fig 2) was found, secured and freed using coagulation without major haemorrhage.

FIG 2: Ometalised granulomatous mass suspended by a Babcock forceps with some free blood in the peritoneal cavity

FIG 2: Ometalised granulomatous mass suspended by a Babcock forceps with some free blood in the peritoneal cavity


After introduction of the extraction bag through the SILS port (Fig 3) and intra-abdominal deployment (Fig 4), the mass was placed into the bag (Fig 5) and retrieved through the port. Ovariectomy was completed and the peritoneal cavity was lavaged before the surgical site was routinely closed.

FIG 3: Introduction of an extraction bag via the 5–12 mm single incision laparoscopic surgery port

FIG 3: Introduction of an extraction bag via the 5–12 mm single incision laparoscopic surgery port


FIG 4: Deployment of the extraction bag inside the peritoneal cavity

FIG 4: Deployment of the extraction bag inside the peritoneal cavity


FIG 5: Resected mass is placed into the extraction bag

FIG 5: Resected mass is placed into the extraction bag


The patient recovered uneventfully.

Subsequent macroscopic examination of the excised mass revealed a firm yellow-white soft tissue mass containing a 25 mm thorn-like structure (Fig 6) resembling that of the Sickle or Chinese lantern bush, a common thorn tree in Northern Namibia.

FIG 6: Thorn foreign body removed from the granuloma

FIG 6: Thorn foreign body removed from the granuloma


This is the first report to describe the laparoscopic removal of a foreign body-induced granuloma from the abdomen of a cheetah. Granuloma formation in this species has not been well described. Similarly, reports on laparoscopic surgery in this species are sparse, particularly those describing the laparoscopic excision of abdominal masses. They have, however, been used for laparoscopy in dogs, horses and tigers using three or four separate ports. The use of these bags or pouches has also not been described with SILS.

Entrance of the thorn into the abdominal cavity remains speculative, but it could have either entered percutaneously or via the gastrointestinal tract

This technique promises to be especially useful in wild carnivores, allowing rapid recovery and lowering the risk of postoperative surgical wound complications.

A much more detailed account with further pictures and a video clip of the procedure can be found here.




Treatment of a case of feline infectious peritonitis with cyclosporin A

1 Jun, 15 | by Assistant Editor

Feline infectious peritonitis (FIP), which is caused by certain strains of feline coronavirus, is a progressive and usually fatal disease for which there is currently no cure or effective treatment. It is a disease which continues to challenge vets and its diagnosis is a crushing blow to owners who will inevitably lose their cherished cats.

There is an important and unique immunological component to the pathology of the disease and there is evidence that some immunosuppressive drugs may offer hope. However, current treatments may induce short-term remission in a small percentage of cats.

Cyclosporin A (CsA) has recently been shown to exert potent antiviral activities in several in vitro systems, including against coronaviruses. However, whether CsA has clinically relevant activity against coronaviruses remains unknown.

Yoshikazu Tanaka and colleagues report a case of effusive FIP in which treatment with CsA resulted in a sustained reduction in viral copy number and pleural fluid volume and was accompanied by clinical improvement.

A 14-year-old female domestic shorthair cat was presented with persistent fever, anorexia and jaundice for a month. A general clinical examination showed a substantial pleural effusion, and laboratory investigation revealed a significant feline coronavirus antibody titre and a low packed-cell volume, as well as signs indicative of liver damage. Pleural fluid was yellowish, viscous and remarkably dense. Coronavirus antigen was demonstrated within macrophages in the pleural fluid and real-time quantitative reverse transcription PCR (RT-qPCR ) revealed 1.6×10 6 copies/ml in pleural fluid, which is higher than that in other cases of effusive FIP that the authors had encountered. The diagnosis of FIP was based on the clinical presentation and clinicopathological, cytological and RT-qPCR findings.

Type-I interferon treatment for two months did not result in improvement in pleural fluid volume and viral copy number and treatment was stopped. Following discussion with the owner, treatment with a daily dose of modified cyclosporin A (CsA) was started. The volume of pleural fluid decreased and became undetectable within four days of starting CsA therapy. The condition of the cat improved, it became more alert and regained a normal appetite, and therefore CsA administration was stopped. However, the pleural fluid accumulated within four days of stopping CsA treatment. Treatment was recommenced and again the pleural fluid levels disappeared and the viral load decreased substantially. Over a two-month period, during which a low dose of CsA was maintained, no clinical abnormalities were detected, the anaemia resolved and biochemical parameters returned to normal.

Unfortunately, about two months after CsA treatment was stopped, viral load gradually increased but no clinical abnormalities were detected until about seven months after treatment was stopped. The cat’s clinical condition deteriorated and it died shortly after.

The study suggests that the potential therapeutic effects of CsA in combination with other therapeutic agents should be evaluated.

Full details of the investigations carried out, treatment and outcome can be found here.

Nominations sought for Veterinary Record Innovation Award

18 May, 15 | by Assistant Editor

VR Innovation

Veterinary Record is launching a new award to recognise innovation in the veterinary sphere.

The Veterinary Record Innovation Award is open to individuals and veterinary teams whose innovation has brought about a change or improvement in any aspect of veterinary practice. This change might relate to a particular aspect of clinical practice or have had a broader impact on veterinary activity.

We welcome a broad range of nominations, which might include, for example, a clinical innovation in medicine or surgery, work that has influenced policymakers, a campaign to improve animal health and welfare, a practice educating owners on responsible ownership, or something that has changed how the business of veterinary practice is conducted.

Nominations can be made on behalf of a candidate but self-nominations will also be considered. Nominations should be between 500 and 800 words, and explain what the innovation is, what the impact has been and why it should be considered for the award. Evidence to substantiate the nomination should be included. In addition, video nominations can also be included. Entries should be entitled ‘Veterinary Record Innovation Award’ and e-mailed to The closing date for nominations is July 1, 2015.

The award will be presented at the BVA Members’ Day in Edinburgh on September 24. The awards ceremony will also include the presentation of the Veterinary Record Impact Award (formerly the William Hunting Award;VR, November 23, 2013, vol 173, pp 497-498), which recognises the research paper published in Veterinary Record in the previous year that is considered to have had the most significant practical impact.

Wombat fatigue: marsupial regains mobility after pioneering surgery

20 Feb, 15 | by Assistant Editor


If you are ever faced with a juvenile hairy-nosed wombat with a limp, the recently published case report by Gail Anderson and colleagues (published in Veterinary Record Case Reports and found here) should contain a salutary lesson.

The authors were presented with a male juvenile hand-raised southern hairy-nosed wombat, which weighed 7.5 kg and was approximately 13 months old. He had been rescued from his dead mother’s pouch about seven months earlier and raised by a carer using southern hairy-nosed wombat milk replacer (yes – it does exist!). His carer had noted he was reluctant to walk and this lameness became progressively worse.



A southern hairy-nosed wombat. Photo: Eva Hejda


Clinical observation showed that he was reluctant to move and, when encouraged to do so, he had severe lameness in both hindlimbs and a ‘shuffling’ gait. The wombat was placed under general anaesthesia and palpation of the stifles elicited crepitus on both sides but no obvious joint effusion. It was not possible to fully extend the stifles. No other abnormalities were found on clinical examination. Stifle radiographs revealed displacement of the distal femoral metaphyses due to bilateral type 1 Salter-Harris epiphyseal fractures.

Distal femoral metaphyses have a mottled, radiolucent, appearance. Proximal femoral epiphyses were flattened and showed delayed development consistent with epiphyseal dysplasia. The right proximal femoral epiphysis was slightly more irregular and flattened compared with the left proximal femoral epiphysis. The lower lumbar spine was normal according to radiographs.



The left (top) and right (bottom) stifle joints of the wombat before surgery.



Radiographs of a normal southern hairy-nosed wombat of the same age were not available for comparison and, to the author’s knowledge, are not available in the literature. This situation is a common problem for veterinarians treating lesser-studied wildlife species.

After discussion with his carer, he was scheduled for surgery to attempt to reduce the epiphyseal fractures. If left untreated, it was unlikely that he would have regained normal mobility and function. The wombat was, however, given a guarded prognosis, partly because the injury appeared to be chronic and other radiographic changes had been observed.

Induction of anaesthesia was somewhat problematic as endotracheal intubation was difficult, probably due to the relatively small diameter of a wombat’s trachea and excessive mucus production.

The surgical procedure was similar to that commonly used for the repair of comparable fractures in dogs. Using a small osteotome and mallet, the cartilaginous and bony epiphyseal piece was elevated and freed from its caudally displaced position and gently levered back into a position more cranially. Once reduced, the epiphyseal piece was secured with two 1.5 mm diameter Kirschner wires.



Radiograph of the right stifle following surgery. The white cross shows the K-wires used to immobilise the fracture. The left side looked the same as this after surgery.


The wombat recovered quickly and uneventfully from general anaesthesia and was given postoperative analgesia. Once he was moving freely and starting to hide in its custom-made pouch (a fleece-lined pillowcase), he was left in a quiet, dimly lit cage and closely supervised.

The wombat was discharged to his carer once he was moving normally in his pouch, with instructions to restrict his activity for two weeks. He continued to eat well, although he showed initial discomfort and limited mobility. However, he continued to improve and by four months after surgery, he was walking with good extension of his hindlimbs and normal action. His carer felt that he had made a complete recovery.

A video of the wombat four months after surgery showing excellent recovery and mobility can be viewed here:

Similar hindlimb injuries in pouch young have been frequently observed by vets working in Australia. It is thought that forcible removal of a juvenile wombat from its dead mother’s pouch is the usual cause. However, this report, adding as it does to the limited resources available for this species, shows that excellent outcomes can be achieved following this type of injury in wombats.

More details, images and discussion about this case can be found at Veterinary Record Case Reports


2014 – a year of One Health

29 Dec, 14 | by Assistant Editor


In 2014, Veterinary Record published a series of articles exploring the links between animal, human and environmental health. While the fundamental idea behind One Health is by no means new, as outlined in an article by Abigail Woods and Michael Bresalier in June, it is beginning to be taken more seriously in the veterinary sector and further afield, due, at least in part, to the increasing complexity of global health problems in both animals and people.

The series seems to have captured imaginations, with the articles being discussed on social media, as well as within the pages of Veterinary Record; the journal has received a large number of letters on the topic this year (for example, here, here and here). In fact, there has been such interest that what was originally conceived as a series lasting 12 months will now be extended into 2015. It was found that there were simply too many interesting and important One Health topics and experts willing to write about them to cram into one year.

All of the articles in the One Health series are, and will continue to be, free to view.

The scene was set in January by Paul Gibbs, in a widely read article charting the recent history of the discipline.

In February, Patrick Wall discussed the role of One Health approaches in maintaining food safety, highlighting the fact that vets play an important part in ensuring human health by safeguarding the health of food-producing animals.

The next article in the series, written by Daniel Mills and Sophie Hall, looked at the human-animal bond, demonstrating that the One Health approach is by no means limited to infectious zoonotic diseases, but that animals can impact on the mental health and broader physical health of people. This article also contained one of the most striking images in the series (below).


A therapy goat being taken to visit residents of a care home. Image: Kristin Streff/AP/Press Association Images

A therapy goat being taken to visit residents of a care home. Image: Kristin Streff/AP/Press Association Images

Chris Oura’s article, published in April, looked at vectorborne pathogens, giving examples of how One Health approaches have been successfully used to control Japanese encephalitis virus in Southeast Asia, West Nile virus in the USA and Rift Valley fever in Saudi Arabia.

In May, Matthew Dixon, Osman Dar and David Heymann discussed emerging infectious diseases, including the One Health lessons learned following the first two pandemics of the 21st Century: SARS and influenza. They argued that the paradigm for One Health interventions needed to shift from a multidisciplinary response to disease outbreaks to the surveillance and prevention of zoonotic diseases.

As already mentioned, Woods and Bresalier’s article on the history of One Health gave an overview of the history of the concept, showing that its roots go much farther back than most people previously thought.

In July, Dilys Morgan gave an example of One Health in action, outlining the work of the Human Animal Infections and Risk Surveillance (HAIRS) group and in particular its response to the emergence of Schmallenberg virus in 2011.

Next, a team of researchers from the University of Glasgow including Sarah Cleaveland looked at whether a One Health approach could be used to tackle rabies. Among their conclusions was that there is compelling evidence that a One Health approach could work to eliminate the disease, but that it remains unclear whether the necessary collaborative partnerships could be built.

Kendra Stauffer and Lisa Conti’s article in October looked at how One Health can play a key role in emergency preparedness plans. Citing One Health issues that arose following Hurricane Katrina and the Fukushima Daiichi disaster, they discussed how some governments are beginning to include One Health considerations when preparing for disasters.

Andy Stringer’s article, published in November, discussed how improving animal health can have positive impacts on the livelihoods and health of poor people, especially those in developing nations.

Finally, in an article published this month, Peter Sandoe and colleagues looked at obesity in companion dogs and cats. They noted that obesity in people is, in some ways, linked with obesity in their pets, stating that a two-way approach is needed to tackle this complex issue. 

The breadth of topics covered in the series shows that the One Health approach is relevant to a wide range of health issues. In 2015, Veterinary Record will continue to publish feature articles on this important topic, with the aim of promoting One Health and stimulating debate.

Shock and awn: two unusual cases of grass seed ingestion in dogs

4 Dec, 14 | by Assistant Editor


It is well known that the common or garden grass seed is the root of many problems in veterinary practice. Two recent articles published in Veterinary Record Case Reports (here and here) describe less common, but serious consequences following the ingestion of a grass awn by dogs.

Case 1

A 15-month-old female mixed-breed hunting dog weighing 16.5 kg was referred with a three-day history of change in bark, progressively worsening dyspnoea, decreased appetite and dullness. The onset of clinical signs was shortly after hunting. On admission, the bitch showed abduction of the forelimbs and inspiratory dyspnoea. Thoracic auscultation revealed muffled heart and dull lung sounds in the caudodorsal part of the thorax, as well as crackles on the caudal lung lobes.

Three litres of air was aspirated from the chest and supplementary oxygen was delivered via a facemask. Thoracic radiography showed elevation of the heart from the sternum and increased thoracic lucency due to the presence of pleural air. The edges of the caudal lung lobes were retracted from the chest wall and an area of soft tissue opacity was evident in the area of the caudal vena cava, the caudal border of the heart and the cupula of the diaphragm.



Radiograph showing elevation of the heart from the sternum, the presence of pleural air and an area of soft tissue opacity between the caudal vena cava, the caudal border of the heart and the cupula of the diaphragm


Soon after radiography the dog developed severe dyspnoea and cyanosis. Thoracentesis was repeated and 2500 cm3 of air was removed while the syringe plunger was forced back, indicating tension pneumothorax.

Tension pneumothorax is an emergency condition in which a flap of tissue acts as a one-way valve so that air entering the pleural space during inspiration cannot be expelled during expiration. This is a rapidly deteriorating state that must be recognised and treated quickly, otherwise it may prove fatal.



The arrow shows a grass awn adhering to the parietal pleura


An emergency exploratory thoracotomy was performed and a grass awn was found adherent to the parietal pleura of the right 10th intercostal space and a 2 mm rupture, covered with fibrin, was identified in the ventral surface of the right caudal lung lobe. A partial lung lobectomy was performed. The dog recovered uneventfully, and was discharged two days after surgery. On re-examination two and six months later, the dog was normal and thoracic radiography revealed no abnormalities.

Case 2

In another case, a six-month-old male neutered crossbred dog presented with a two-week history of pain on opening the mouth and intermittent lethargy. There was also a history of mild blepharospasm of the right eye and pyrexia. On referral, ophthalmic examination revealed mild exophthalmia of the right eye, with a small amount of third eyelid protrusion and decreased retropulsion of the globe. There was marked pain on opening the mouth and palpation over the right temporal region of the skull.

Ocular ultrasound showed increased echogenicity of the tissue within the retrobulbar space and marked diffuse signal on Doppler examination. MRI of the brain and orbit revealed dependent fluid in the right frontal sinus and nasal cavity with mucosal thickening suggesting local rhinitis and sinusitis. There was hyperintense retrobulbar tissue thickening along the lateral aspect of the orbital lamella of the frontal bone, and evidence of regional myositis.


F2.large (1)

MRI images of the brain and orbit. These images show a marked degree of contrast enhancement in the retrobulbar tissue, periorbital tissue and frontal sinus mucosa


Right exophthalmos was present, likely due to diffuse retrobulbar swelling. Despite this, orbital structures were preserved.

Exploratory craniectomy was performed. And three grass seeds and approximately 4 ml of yellow, high viscosity fluid were removed from the surgical site, which was then lavaged with warm saline. Postoperatively the dog was maintained on intravenous amoxicillin and clavulanic acid before being discharged on oral medication.

Four months after the cessation of antibiotic therapy the dog was re-examined and the owner reported no problems when the dog opened its mouth. The dog was also reported to have returned to a normal life and general physical, neurological and ophthalmic examinations were unremarkable.

More details, images and discussion about these cases can be found here and here.

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