In Practice Last 6 Issues

Investigation and management of splenic disease in dogs

Hayes, G., Ladlow, J. — 2012-05-10T07:35:05-07:00

Splenic disorders are a significant cause of morbidity and mortality in middle-aged and older dogs, and a spectrum of presentations is possible, from chronic non-specific clinical signs to a rapidly fatal haemoabdomen. Splenomegaly is commonly recognised during clinical examination or imaging in practice, but it can be difficult to decide whether the primary problem is within the spleen itself (eg, a focal mass, in which case a splenectomy is generally the treatment of choice) or whether the splenomegaly represents systemic disease (eg, a lymphoma or immune-mediated haemolytic anaemia, in which case a biopsy may be useful but a splenectomy may be contraindicated). Splenic surgery requires an appreciation of the vascular anatomy, and adequate monitoring as well as supportive treatment may be critical to the outcome of surgery. This article discusses the anatomy of the spleen and how to investigate splenomegaly, as well as how to perform a (partial) splenectomy and the possible complications involved.

Mastitis control in robotic milking systems

Edmondson, P. — 2012-05-10T07:35:05-07:00

Robotic milking involves the use of automated systems to milk cows as and when they choose. While this has clear benefits in many cases, the use of robots for milking also has some specific disadvantages and does not always represent the best solution for every farm. This article reviews the pros and cons of robotic milking, and discusses its impact on mastitis and milk quality. In addition, it discusses other key factors that need to be considered when using robots or deciding whether to move to robotic milking.

Veterinary care of wild owl casualties

Couper, D., Bexton, S. — 2012-05-10T07:35:05-07:00

Owls are common wildlife casualties seen in veterinary practice, and the basic principles of avian medicine and surgery apply to their treatment. However, unlike birds kept in captivity, free-living owls must be fully fit with unimpaired sensory faculties, especially vision and hearing, in order to survive in the wild. Most owls presented to veterinary practitioners have been injured in traumatic collisions, usually involving road vehicles, and many will have sustained severe injuries as a result. This article covers the principles of dealing with wild owls, including their care and treatment, and the importance of cooperation with rehabilitators in making realistic decisions about their chances of regaining full fitness to avoid unnecessary procedures and suffering.

Update on feline infectious peritonitis

German, A. — 2012-05-10T07:35:05-07:00

Feline infectious peritonitis (FIP) remains one of the most challenging diseases to manage in veterinary practice. It is difficult to diagnose and almost impossible to treat, and can be a source of distress and financial burden for both cat owners and breeders. This article provides an update on recent developments in the pathogenesis and diagnosis of the condition, and discusses treatment options for appropriate cases.

Selection and use of disinfectants

Maillard, J.-Y., McDonnell, G. — 2012-05-10T07:35:05-07:00

Disinfection is an essential means of reducing the number of viable microorganisms on surfaces, devices and the skin. A wide range of disinfectant products are available, which vary in terms of their active ingredients, how they can be applied and their intended use. This article discusses the use of chemical disinfectants and the factors affecting their activity. In particular, it highlights the importance of understanding product labelling, efficacy claims and the regulatory requirements underpinning their application in practice.

Meeting the needs of smallholders

Roberts, V. — 2012-05-10T07:35:05-07:00

Smallholders often keep a range of species with very different needs, and have a responsibility to ensure the welfare of these animals. Victoria Roberts explains how veterinary surgeons can help this growing sector by providing a comprehensive farm health plan and offering guidance and support.

Exit interviews: good practice and good for business

Dingwall, R. — 2012-05-10T07:35:05-07:00

It is good practice for a business to conduct exit interviews when members of staff leave. They provide information that can be useful for business improvement and an opportunity for the transfer of knowledge to replacement staff or other team members. Rita Dingwall offers advice on effective exit interview techniques and gives some sample questions that have been designed to derive the most benefit for the practice as well as the interviewee.

Accommodating cultural differences of opinion

Wells, K. — 2012-05-10T07:35:05-07:00

You work for an animal charity in a developing country. The organisation runs veterinary clinics and neutering programmes with the aim of improving animal welfare. Sometimes you find that differences in religious and cultural beliefs between you and the local staff employed by the charity lead to disagreements over the best course of action to improve animal welfare (eg, concerning handling, pain management or euthanasia). How far should you accommodate these differences when making decisions about individual cases and practice policy?

Comments on the dilemma in the april issue: 'repeat vaccinations'

Mullan, S. — 2012-05-10T07:35:06-07:00

The dilemma in the April issue concerned a client from the medical profession questioning why their dog required repeat vaccinations (In Practice, April 2012, volume 34, pages 246–247). Their understanding was that the immune response had a long memory following vaccination and they implied that yearly vaccinations were only being recommended to provide a regular income stream for vets. David Williams commented that this was a common concern of clients. While the assumption that vaccination should incite long-term immunity against a particular pathogen was correct, the issue was complicated by differences between pathogens, vaccines and the prevalence of the pathogen in the recipient population. Since most companion animal diseases being vaccinated against were no longer circulating in the population, there were no natural boosters for immunity, which meant vaccination was required more frequently. It was also a case of playing it safe for vaccinations with an uncertain duration of immunity. The benefits of vaccination outweighed the side effects. Aside from protection against disease, yearly vaccination encouraged owners to present their pet for examination more frequently, which meant that any conditions were more likely to be diagnosed at an early stage when they were more likely to be treatable. A way forward was to ensure transparent communication with clients so that the vet and the client could come to a rational and amicable decision about the vaccination protocol for the animal. A requirement that some services, such as vaccinations, should not subsidise others, such as the treatment of sick animals, would also be justifiable.

A practitioner ponders

2012-05-10T07:35:06-07:00

I was bitten by a dog last month – quite badly. It was one of those determined, practiced lunges that come without warning. There was even some chewing, and not a glimpse of remorse. It was an elderly dog with a foul mouth brought in by an incompetent owner, and these circumstances only made the situation seem worse.

I was triaged within 10 minutes of arrival at A&E, thus satisfying performance statistics. The decision was eventually made that my wounds merited the attention of a hand trauma specialist at another hospital on the following day.

I began pondering the circumstances of the attack around midnight in bed when the pain relief had begun to subside and I had run out of trial positions for relieving the pressure on my swollen, oozing (and, sadly, dominant) hand.

I was now privy to the knowledge that the dog had previously sent a...

Interpretation and use of BVA/KC hip scores in dogs

Dennis, R. — 2012-04-16T02:16:26-07:00

Hip dysplasia is a potentially debilitating orthopaedic disease in which laxity of the coxofemoral joint often leads to secondary osteoarthritis, a reduction in joint function and pain. It has been recognised for many years as being of particular importance in pedigree dogs, especially in larger breeds, and is known to be partly governed by genetic factors. In order to try to control canine hip dysplasia and to reduce its incidence, a number of radiographic screening programmes have been developed worldwide. In 1983, a scheme was established by the British Veterinary Association and supported by the Kennel Club to examine radiographs of dogs' hips by assessing different anatomical features and giving them a numerical score. This article describes the process of scoring in this scheme, explains how to interpret the score and gives advice on the use of hip scores in the selection of breeding animals.

Influence of genetics and inbreeding on disease

Woolliams, J. — 2012-04-16T02:16:26-07:00

Genetic influences on disease are far more common in epidemiology than those expressed through the phenomenon of inbreeding. However, it is useful to explore the associations between inbreeding and the occurrence of disease before considering the wider role of genetics, as the influence of inbreeding is most overtly seen in simple Mendelian diseases. In such cases, a single locus is responsible for disease manifestation, while in more complex diseases, genetic influences are commonly associated with a number of loci. While this article examines the role of genetics in cattle diseases, with a particular emphasis on inbreeding, all the principles discussed can be extended directly to other livestock, horses and companion animals.

Feline cardiomyopathy

Ferasin, L. — 2012-04-16T02:16:26-07:00

Cardiomyopathy is the most common form of heart disease observed in cats and patients present with a wide spectrum of structural and functional cardiac abnormalities. Although several attempts have been made to standardise the classification of the various forms of cardiomyopathy, substantial disagreement still exists among cardiologists since classification criteria are often subjective and are continuously evolving as the aetiology of myocardial disease becomes better understood. This article describes the current classification of cardiomyopathies, as well as the pathophysiology, clinical findings and treatment of the disease in feline patients.

Backyard poultry 2. Veterinary care and disease control

Lister, S., Houghton-Wallace, J. — 2012-04-16T02:16:26-07:00

As the keeping of backyard poultry becomes ever more popular, it is important that practitioners develop an understanding of disease management and control in these birds, particularly given the free-ranging nature of many of these flocks and the fact that some products will be destined for human consumption. This article describes the conditions affecting backyard poultry, highlighting the options for the treatment and prevention of those problems most likely to be seen in practice. An article published in the March issue of In Practice (volume 34, pages 136–145) described the husbandry and general management of small flocks.

Medical support for cattle and small ruminant surgical patients

Hallowell, G., Potter, T., Aldridge, B. — 2012-04-16T02:16:26-07:00

While the initial assessment of cattle and small ruminants presented for surgery is similar to that in other species, it can be more challenging because farm animals are often sicker than they appear to be. This article outlines how to identify and manage potential medical problems in large animal surgical patients, including practical fluid therapy, analgesia, sedation, anaesthesia and rational antimicrobial use.

Advertising your business: entering the digital arena

Johnson, J. — 2012-04-16T02:16:26-07:00

As the internet becomes an integral part of life for businesses and consumers alike, veterinary practices need to consider how it can be used to their advantage. Setting up a practice website and using social networking sites and search engine optimisation tools to promote the practice can be either a very effective way of advertising your business and attracting new clients or a waste of time and money. Jeremy Johnson explains how to keep up with the competition while avoiding the potential pitfalls of advertising legislation.

Planning for redundancy: legal and practical considerations

Lea, N. — 2012-04-16T02:16:26-07:00

In the March issue of In Practice, Peter Gripper recommended undertaking a thorough organisational and strategic review of a business to identify alternatives to making redundancies. Here, assuming that the business has already done this and is left with no other option, Nigel Lea explains legal and practical aspects of implementing redundancy.

Clinical audit: application in small animal practice

Dunn, F., Dunn, J. — 2012-04-16T02:16:26-07:00

In an article in the March issue of In Practice, James Dunn outlined a stepwise process for conducting clinical audits in first-opinion small animal practice. In this article, he and Frances Dunn describe how this process might be applied to a specific aspect of small animal practice, using the prescription of fluoroquinolones as an example.

Repeat vaccinations

Williams, D. — 2012-04-16T02:16:26-07:00

An owner presents her one-year-old dog for its repeat vaccinations. She is a lecturer in immunology at the local university and asks you why her dog needs to be vaccinated again. The whole idea of an immune response is that it has a long-lasting memory, she says. As an example, she points out that children do not need to be vaccinated yearly against measles, mumps or rubella. She suggests that yearly vaccinations are only recommended to provide veterinary surgeons with a regular income stream and that she considers this to be unethical. How should you respond?

Comments on the dilemma in the March issue: 'Genetic testing for coat colour in cats'

Mullan, S. — 2012-04-16T02:16:26-07:00

The dilemma in the March issue concerned whether it was ethically acceptable for genetic testing to be carried out to determine coat colour in cats (In Practice, March 2012, volume 34, pages 174–175). Sean Wensley noted that some people were uncomfortable with the use of genetic testing to select for aesthetic preferences, but that, in effect, it merely accelerated the process of selective breeding to comply with phenotypic requirements, which had been carried out for many years. Just because someone selected for aesthetics did not mean that they would be unable to provide positive welfare outcomes for the animal. In fact, it could also be argued that selecting for phenotype would mean that those who were tempted to disregard kittens that did not meet their approval would euthanase fewer animals. On the other hand, the cat genome had been sequenced to facilitate research into inherited diseases – not for the purpose of selecting for aesthetics. Selective breeding had also been linked to welfare problems in some companion species, including cats. Selecting for coat colour would be less ethically justifiable if it was found to be associated with deleterious mutations, and it might distract breeders from health testing. Diagnostic laboratories could help by using market strategies to raise awareness of the availability of DNA tests to screen for diseases.

A practitioner ponders

2012-04-16T02:16:26-07:00

The question ‘What makes a good vet?’ is one I ask myself often. It came up recently in discussion with a final-year veterinary student.

As an undergraduate I would have listed traits like excellent surgical skills, an ability to communicate well with clients, encyclopaedic medical knowledge, the ability to deal calmly and efficiently with stomach-churning, adrenal-gland milking emergencies, and so forth.

The student's concept of the good vet was similarly focused on clinical prowess – essentially, the ability to perform, confidently and competently, a series of diagnostic and therapeutic tasks, with a smattering of ‘good communication’ thrown in because we are taught that good clinicians are good communicators.

However, experience has taught me that this picture is incomplete. Bradley Viner, in his book ‘Success in Veterinary Practice: Maximising Clinical Outcomes and Personal Well-being’, cites a study in which general practitioners list the hallmarks of medical excellence in their postgraduate...

A modern approach to equine dentistry 3. Imaging

Tremaine, H. — 2012-03-13T02:26:52-07:00

This article, the third in a series of four to review recent developments in equine dentistry, describes the use of imaging to aid the diagnosis of dental and oral lesions in horses, and provides a pictorial guide to features that might be seen radiographically. Part 1, published in the January issue of In Practice (volume 34, pages 2–10), described the procedure for a routine dental examination in horses, while Part 2, published in the February issue (volume 34, pages 78–89), highlighted the common dental and oral lesions that may be seen in this species. Part 4 will consider the techniques available for the prevention and treatment of equine dental disease.

Surgical diseases of the genital tract in male dogs 2. Penis and prepuce

de la Puerta, B., Baines, S. — 2012-03-13T02:26:52-07:00

An article in the February issue of In Practice (volume 34, pages 58–65) described the diseases of the scrotum, testes and epididymides of dogs, and their surgical treatment. This article discusses the most common conditions affecting the penis and prepuce of dogs, and describes the surgical techniques used to manage these disorders. Diseases affecting the penis and prepuce are rare, and the surgical techniques used to treat them are more complicated than those outlined in Part 1 for the management of testicular or scrotal disease.

Backyard poultry 1. Husbandry and general management

Houghton-Wallace, J., Lister, S. — 2012-03-13T02:26:52-07:00

‘Backyard poultry’ can cover anything from pampered exhibition birds to small egg-laying flocks, as well as pet chickens, and is an expanding area of veterinary medicine. Clients will range from experienced keepers to complete novices, many of whom will not be served by commercial poultry veterinary surgeons and, hence, will turn to their local practitioner for help and advice about caring for their birds. This article, the first of two discussing the veterinary approach to backyard poultry, describes the key elements of husbandry and general management of small flocks. Part 2, to be published in the April issue of In Practice, will focus on the specifics of veterinary care and disease control of poultry, with particular emphasis on the management of those conditions most likely to be seen in practice.

Mycoplasma wenyonii infection in cattle

Strugnell, B., McAuliffe, L. — 2012-03-13T02:26:52-07:00

In recent years, the number of reports describing a combination of clinical signs in cattle comprising pyrexia, hindlimb and/or udder oedema and prefemoral lymphadenopathy, consistently associated with Mycoplasma wenyonii infection, has increased. However, infection does not always appear to result in these typical clinical signs, and the factors leading to their manifestation have still to be fully elucidated. This article analyses the available evidence and suggests some options for diagnosis and management.

Gastrointestinal disease in rabbits 2. Intestinal diseases

Lord, B. — 2012-03-13T02:26:52-07:00

Intestinal diseases in rabbits can develop as a result of many causes. Dietrelated problems are a common aetiology of intestinal disorders but infectious (bacterial, viral, parasitic), idiopathic and neoplastic diseases are also seen with relative frequency. This article describes the diagnosis and approach to treatment of intestinal diseases in rabbits. An article in the February issue of In Practice (volume 34, pages 90–96) considered gastric diseases in this species.

Redundancy: when is it the right decision for a business?

Gripper, P. — 2012-03-13T02:26:52-07:00

Making redundancies may seem like the best option for a practice that is struggling financially. Peter Gripper recommends considering other options, and undertaking a thorough organisational and strategic review, before going ahead.

Clinical audit: a tool in the defence of clinical standards

Dunn, J. — 2012-03-13T02:26:52-07:00

James Dunn outlines the process of clinical audit, arguing that regular clinical audit, at local level, empowers clinicians, improves patient care and provides robust grounds for defence against complaints. In a second article, to be published in the April issue of In Practice, he will use antimicrobial prescription as an example to illustrate the application of clinical audit in veterinary practice.

Supporting older people with pets in sheltered housing

Ormerod, E. — 2012-03-13T02:26:52-07:00

While recent research demonstrates a plethora of health and social benefits associated with pet ownership, many older people in the UK are still denied the opportunity to keep a companion animal. Rules pertaining to pet keeping are often illogical, impermanent and inconsistently applied. Elizabeth Ormerod believes that veterinary practices can be influential in advising housing providers about the benefits of pets and offers advice on how to encourage them to adopt positive pet policies.

Genetic testing for coat colour in cats

Wensley, S. — 2012-03-13T02:26:52-07:00

You recently attended a cat show where a company was offering genetic testing for coat colour in cats. The test is performed on cells collected using a mouth swab. Is this an ethically acceptable scientific advancement?

Comments on the dilemma in the February issue: 'Shortcomings in locum practice procedures'

Mullan, S. — 2012-03-13T02:26:52-07:00

The dilemma in the February issue questioned what you should do if you disagreed with practice procedures while working as a locum (In Practice, February 2012, volume 34, pages 110–111). In the example discussed, a client asked for a repeat prescription for acepromazine tablets for a dog in the run up to bonfire night. You knew that it was not the ideal treatment from a behavioural point of view, but other clients' records showed that acepromazine was widely prescribed by the practice for firework phobias. Richard Green commented that locum vets had obligations to the animal, client, practice, colleagues and themselves, and that it was useful to use an ethical matrix to allow due consideration of each of these stakeholders' interests. It was inevitable that there would be differences of opinion on how to do things between the locum and the practice, but very few of these would impact on patient welfare. In instances where the practice was falling short of best practice, locums could use their influence to change things for the better. Many practices were willing to change but did not do so because of inertia or lack of awareness. Best practice changed all the time, and it should be possible to tactfully discuss alternative treatments to the customary ones without overtly criticising colleagues.

A practitioner ponders

2012-03-13T02:26:52-07:00

It was when two of my nurses turned up for work one Friday last year wearing foam-rubber red noses that I felt prompted to ponder just how many ‘special days’ we now have in the annual calendar, and if they're worth all the effort. Actually, I don't have any problem with Red Nose Day – it raises a huge amount of money for worthwhile charities and nearly all our clients that day happily contributed to the collection box on the reception desk – but you'll not catch me sporting a fake proboscis! It's not that I’m against the idea, more that I find it difficult to breathe when it's on my nose, and it makes wearing a mask during operating a bit of a challenge.

But what if a staff member wants to participate in every novelty day that comes around? Wrong Trousers Day, perhaps? Yes, we can cope...

Surgical diseases of the genital tract in male dogs 1. Scrotum, testes and epididymides

de la Puerta, B., Baines, S. — 2012-02-13T06:11:40-08:00

While castration is the most common surgery carried out on the genitals of male dogs in first-opinion practice, there are several other, less common, surgical procedures that are performed to treat various conditions affecting the male reproductive tract. This article discusses the surgical diseases and treatment of the scrotum, testes and epididymides of dogs. A second article, to be published in the March issue of In Practice, will cover the surgical techniques used to manage disorders of the penis and prepuce.

Abdominal ultrasonography as an adjunct to clinical examination 2. Cattle

Scott, P. — 2012-02-13T06:11:40-08:00

This article, the second of two discussing the use of abdominal ultrasonography as an adjunct to a thorough clinical examination in farm animal practice, describes ultrasonographic findings that might be visualised in the abdomen of cattle, with particular focus on the common problems encountered in the species. Part 1, published in the January issue of In Practice (volume 34, pages 12–21), considered ultrasonography of the abdomen in small ruminants.

Muscle and tendon disorders in small animals 2. Conditions affecting the hindlimb and digital flexor tendons

Moores, A. — 2012-02-13T06:11:40-08:00

A wide range of muscle and tendon conditions are seen in small animals. An article in the January issue of In Practice (volume 34, pages 22–26) reviewed some general aspects of managing tendon and muscle disorders together with conditions affecting the forelimb. This article describes conditions affecting the hindlimb as well as digital flexor tendon injuries that affect both the fore- and hindlimbs.

A modern approach to equine dentistry 2. Identifying lesions

Tremaine, H., Casey, M. — 2012-02-13T06:11:40-08:00

This article, the second in a series of four to review recent developments equine dentistry, describes the common dental and oral lesions that may be seen during a routine dental examination in horses, the procedure for which was published in the January issue of In Practice (volume 34, pages 2 to 10). Part 3, to be published in the March issue, will consider how these lesions may be investigated further using appropriate imaging techniques, while Part 4, to be published in the April issue, will consider the techniques available for the prevention and treatment of equine dental disease.

Gastrointestinal disease in rabbits 1. Gastric diseases

Lord, B. — 2012-02-13T06:11:40-08:00

Gastrointestinal diseases in rabbits are being recognised with increasing frequency. A pet rabbit presented with anorexia, weight loss, changes in defecation and depression can present a diagnostic and therapeutic challenge for the clinician. Diet- and stress-related problems predominate, and preventive treatment plays a large role in managing these conditions. However, gastric ulceration and bacterial, viral, parasitic, idiopathic and neoplastic diseases are also seen frequently in pet rabbits. This article provides an overview of the common gastric conditions seen in rabbits, including their diagnosis and the options for treatment. The common causes, diagnosis and approach to the management of intestinal diseases will be discussed in an article to be published in the March issue of In Practice.

Laying your cards on the consulting table

Everitt, S. — 2012-02-13T06:11:41-08:00

Consultations are central to veterinary practice. They allow the veterinary surgeon to discuss options with the client to establish what is in the best interests of the animal patient. This requires effective communication through openness, transparency and an evidence-based approach. In this article, Sally Everitt describes some of the techniques that can be used during consultations to achieve the best results for all involved.

Trouble with snow: preparing your vehicle for winter conditions

Richards, I. — 2012-02-13T06:11:41-08:00

Snow may be an opportunity for many people to have some fun, but it represents quite a different prospect for anyone who has to work in it. Practice managers have a duty to ensure that their staff remain safe when they are on farm visits or house calls. In this article, Iain Richards describes the hazards associated with bad weather and recommends some useful equipment to keep in the boot of your vehicle in case problems arise.

Branching out: a guide to practice expansion

Terry, J. — 2012-02-13T06:11:41-08:00

The extension of practice services through the development of a branch network can boost practice profits significantly. Conversely, it can also be a considerable drain on the resources of an otherwise profitable business. Getting it right requires a strategic approach that is planned and executed carefully to minimise loss and to optimise profitability. Jane Terry describes some factors to consider.

Shortcomings in locum practice procedures

Green, R. — 2012-02-13T06:11:41-08:00

While working as a short-term locum, a client asks for a repeat prescription for acepromazine tablets for a dog in the run up to bonfire night. You know that it is not the ideal treatment from a behavioural point of view, but other clients' records show that acepromazine is widely prescribed by the practice for firework phobias. It would be difficult to refuse the repeat prescription without upsetting the client and the practice, and it seems unfair to cause problems for this particular client when she could come in a week later and be given the tablets without any hassle. As a short-term locum, you feel that it is important to fit in with normal practice procedures as much as possible, and the RCVS requires you not to criticise colleagues. However, your client is likely to know other clients who are being prescribed acepromazine tablets by the practice at the same time as you are refusing to prescribe them. With this in mind, if you refuse to prescribe the tablets, how should you explain to the client that they're not an appropriate treatment?

Comments on the dilemma in the January issue: 'Promoting personal views in practice'

Mullan, S. — 2012-02-13T06:11:41-08:00

The dilemma in the January issue questioned whether it was ethical for a practice owner to provide literature in the practice waiting room sympathetic to their own personal views on farm animal welfare issues (In Practice, January 2012, volume 34, page 54). While promoting animal welfare was admirable, the question of whether it was morally or professionally acceptable to promote personal views to clients on which animal-derived products to reject was less clear. Paul Roger commented that it was fine for practice owners to promote what they saw as beneficial practices as long as no negative pressure was put on the alternative view. In fact, they had a duty to publicise their stance, while ensuring that the information they provided was accurate and reviewed regularly. This would help to maintain the focus of the public on important animal welfare issues, leading to an improvement in standards. A possible way forward was to consider using an ethical framework to help inform views on different farming methods and to evaluate each method based on how well they applied the Five Freedoms concept.

A practitioner ponders

2012-02-13T06:11:41-08:00

It's time for me to get a new wallet. Not, regretfully, because the old one is so full of money that it can hold no more, but rather because the current one is crammed with all sorts of detritus and is basically worn out. It's stuffed full of faded till receipts, long-forgotten shopping lists, dog-eared business cards, and the all-essential credit and debit cards, with the odd wrinkled five-pound note hidden among it all. It's done the job but can do no more. On closer inspection, I realise that it bulges for one reason more than any other – because I have so many so-called loyalty cards in it.

Are these a curse or a blessing of the 21st century? I have loyalty cards for hotels, coffee bars, supermarkets, petrol stations and clothing shops, and not just one but several for each type of business. If I stop for...

A modern approach to equine dentistry 1. Oral examination

Tremaine, H., Casey, M. — 2012-01-11T08:21:53-08:00

Recent developments in our understanding of dental anatomy, pathology and the effects of specific dental techniques have advanced the current status of equine dental care. This article, the first in a series of four to review these developments, describes how to carry out a thorough oral examination in horses. Subsequent articles, to be published in consecutive issues of In Practice from February to April, will describe the different lesions that might be seen in equine patients (Part 2) and how these might be investigated further using appropriate imaging techniques (Part 3). Part 4 will consider the techniques available for the prevention and treatment of equine dental disease.

Abdominal ultrasonography as an adjunct to clinical examination 1. Small ruminants

Scott, P. — 2012-01-11T08:21:53-08:00

Abdominal ultrasonography is a diagnostic technique that can be used in farm animal practice as a complementary adjunct to a thorough clinical examination. This article describes the ultrasonographic findings that can be visualised in the abdomen of small ruminants and outlines some of the common indications for ultrasonography. It illustrates how this modality can be readily incorporated into a clinical examination on farm to provide an accurate demonstration of underlying pathology. A second article, to be published in the February issue of In Practice, will discuss the use of abdominal ultrasonography in cattle.

Muscle and tendon disorders in small animals 1. General management and conditions affecting the forelimb

Moores, A. — 2012-01-11T08:21:53-08:00

Muscle and tendon injuries and diseases are common causes of lameness in dogs and occasional causes of lameness in cats. This article reviews the general management of these disorders and provides an overview of specific conditions affecting the forelimb (thoracic limb). A second article, to be published in the February issue of In Practice, will consider conditions affecting the hindlimb (pelvic limb) and digital flexor tendon injuries.

Management of tail pull injuries in cats

Davies, E., Walmsley, G. — 2012-01-11T08:21:53-08:00

Feline tail pull injury is a challenging condition that is commonly encountered in first-opinion practice. This article discusses the key factors in the diagnosis, prognosis and management of tail pull injuries, including the use of radiography to confirm sacrocaudal luxation, and the identification and appropriate treatment of associated urinary and faecal dysfunction. It also highlights the importance of good owner communication, as currently the best prognostic indicators at the time of presentation for the return of continence (the conscious perception of noxious stimuli applied to the perineum or tail base) are not infallible and recovery can take weeks.

Anaesthesia and analgesia in chinchillas

Saunders, R., Harvey, L. — 2012-01-11T08:21:53-08:00

Chinchillas are becoming increasingly popular as pets, and so are being presented more often for veterinary care. The most common indications for anaesthesia of chinchillas include the diagnosis and treatment of dental disease, neutering, caesarean section, fracture repair and the collection of diagnostic samples. For successful anaesthesia of chinchillas, an understanding of their particular anatomy and physiology, and a sound knowledge of anaesthesia, is important. This article discusses the perianaesthetic and anaesthetic management of these animals.

Minimum monitoring for financial health

Gripper, P. — 2012-01-11T08:21:53-08:00

Maintaining financial success is important for every business, and a good manager should track its performance at a number of levels. These parameters may be interlinked and complex, so it is vital to be able to interpret the data collected. In this article, Peter Gripper describes some useful measures of financial performance and explains the importance of internal and external benchmarks.

Embracing the social media revolution

Samuel, S. — 2012-01-11T08:21:53-08:00

Over recent years, the use of social media has increased dramatically. If your veterinary practice chooses not to engage itself with the online community, it is missing a valuable opportunity to encourage recommendations, increase footfall and cement bonds with existing clients. Here, Susie Samuel describes how to set up profiles with some of the most popular social media platforms to facilitate practice marketing.

Keeping it legal: delegation to veterinary nurses

Branscombe, L. — 2012-01-11T08:21:53-08:00

Last year marked the 50th anniversary of veterinary nursing and, with non-statutory regulation of the profession being sought by the majority of its members, it is timely to consider the veterinary nurse's role. In this article, Liz Branscombe explains the procedures that can legally be delegated to veterinary nurses within the veterinary practice, as covered by Schedule 3 of the Veterinary Surgeons Act 1966.

Promoting personal views in practice

Roger, P. — 2012-01-11T08:21:53-08:00

You own a successful small animal practice and have a good relationship with your clients. You are also keen to do what you can to promote all aspects of animal welfare. Your knowledge of farm animal welfare issues leads you to reject certain animal-derived products when buying for yourself. Is it morally or professionally ethical for you to provide literature sympathetic to your viewpoint about farm animal welfare issues in your waiting room?

Comments on the dilemma in the November/December issue: 'Owner access to isolation facility webcam images'

Hopper, D. — 2012-01-11T08:21:53-08:00

The dilemma in the November/December issue concerned a practice that had recently installed webcams to monitor its patients in an isolation facility where human and animal contact had to be kept to a minimum (In Practice, November/December 2011, volume 33, pages 558–559). Susana Silva discussed the issue of whether or not owners should be allowed access to such images. She argued that the relationship between humans and their animals had changed greatly over the past few decades and that, now, they were usually regarded as family members. As such, people tended to be very concerned about the welfare and quality of life of their pet when it was in an isolation facility. It was good practice to discuss with the owners what type of care was going to be provided so as not to give them false expectations, and to allow them to visit the facility before their pet was admitted. Allowing owners to view video footage of their pet in isolation could have variable outcomes. Some would feel reassured while others might become anxious about their pet's altered behaviour or about protocols that might be in place to keep human contact with the animal to a minimum. A compromise might be to allow the owner to see a short video of a couple of minutes per day, rather than a live stream, thus allowing the vet to decide which footage was most appropriate for which client. Although partial access had the potential for the owner to accuse the vet of censoring, vets were not currently legally obliged to allow access to such images.

A practitioner ponders

2012-01-11T08:21:53-08:00

I've been thinking lately about customer service.

I'll give a couple of examples. There is a very small Italian restaurant in London that I go to three or four times a year. The food is perfectly good though nothing outstanding, but the patron always recognises me and greets me like a long-lost cousin. Nearby, in a London club, a young maître d’ used to insult his guests with such cheerfulness as to charm them and never troubled them for their room number for the bill; instead, he memorised their faces and kept print outs showing who was staying in which room. In both instances, the chef might think that customers are buying his food, but we are actually buying customer service – the atmosphere created by the front-of-house people. What can we learn from this and apply in our surgeries?

Complaint handling is another area that we all know...

Diagnostic testing for the detection of feline retroviruses

Adam, F., Dandrieux, J. — 2011-12-21T04:02:10-08:00

Since the discovery of feline leukaemia virus (FeLV) in 1964 and feline immunodeficiency virus (FIV) in 1986, knowledge of viral epidemiology and disease pathogenesis has developed greatly. Diagnostic tests demonstrating antigen, whole virus and the presence of virus-specific antibody titres have allowed the identification of retrovirus-infected cats. More recently, molecular testing methods have been developed for use in the diagnosis of FIV and FeLV. This article discusses the commercial diagnostic tests available for the detection of these viruses and outlines how such tests may be applied in clinical practice.

Welfare assessment in sheep

Goddard, P. — 2011-12-21T04:02:10-08:00

Protocols for the assessment of welfare in sheep are not as well developed or validated as in other livestock species. However, it is possible to use a number of animal- and resource-based measures to indicate the standard of animal welfare in sheep flocks. This article considers the potential indices that can be implemented when assessing welfare in sheep, and reflects on what difference this might make to the animals themselves. In addition, it highlights how these might be tailored to individual production units in order to make them more relevant and, hence, maximise welfare.

Investigation of pelvic problems in horses

Powell, S. — 2011-12-21T04:02:10-08:00

Despite the advanced diagnostic techniques that are currently available, diagnosing equine pelvic injuries and pain can be challenging for even the most experienced equine diagnostician. Due in part to its size and complexity, the equine pelvis is rather daunting to investigate as a site of pain. Localising diagnostic anaesthesia – required for the assessment of pelvic and thoracic limbs in horses – is restricted in the back and pelvis, leading to a degree of subjective assessment, which is obviously not ideal. The introduction of scintigraphic imaging has revolutionised the diagnostic potential of bone injuries of the pelvis but has contributed to a far lesser degree to the understanding of soft tissue pain. This article describes an approach to the investigation of pelvic pain in horses and outlines a number of pathological conditions that can be encountered.

Pleural effusions in dogs and cats 2. Placement of tubes and treatment

Murphy, K., Papasouliotis, K. — 2011-12-21T04:02:10-08:00

It is not uncommon for dogs and cats to present with a pleural effusion, which often requires emergency management involving the placement of a thoracic drain. This article describes a step-by-step guide to placing traditional wide-bore tubes and small-bore drains in practice. It also focuses on the general management of specific conditions that can cause pleural effusions. The diagnostic investigation of dogs and cats with pleural effusions was discussed in an article published in the October issue of In Practice (volume 33, pp 462–469).

Veterinary care of snakes

Rowland, M. — 2011-12-21T04:02:10-08:00

Snakes are becoming increasingly popular pets and are hence seen more frequently in general veterinary practice. It is therefore important that clinicians have a working understanding of the species presented, as well as the steps required to accurately diagnose and manage health issues. This article reviews the commonly presented species and outlines the husbandry requirements of each. In addition, it discusses the unique anatomy and physiology of snakes and highlights commonly seen conditions, their diagnosis and treatment.

Oestrus detection in dairy cattle

Gordon, P. — 2011-12-21T04:02:10-08:00

Achieving reproductive targets in artificially inseminated cattle herds relies on oestrus (heat) detection, which can be identified directly and indirectly from behavioural changes in cows. Increased herd size and reduced oestrus expression have been linked to suboptimal detection. This article reviews current knowledge of oestrus detection and highlights the opportunities for veterinary surgeons to become further involved in its management through training, monitoring and the identification of appropriate aids for oestrus detection.

Back to black: a five-point plan to boost practice profits

Wright, M. — 2011-12-21T04:02:10-08:00

With rising costs, reducing client numbers and increasing competition, the current economic climate is making it more and more difficult for veterinary practices to stay in the black. In this article, Malcolm Wright describes a five-point plan to improve practice performance and management, and help boost practice profits.

Media training for vets in the limelight

Walter, D. — 2011-12-21T04:02:10-08:00

The phrase ‘prevention is better than cure’ crops up frequently in the veterinary world and, when it comes to media appearances, it is far better to be prepared in advance than to have to repair the damage caused by a bad interview. In this article, David Walter explains how a short course in media training could prepare vets for defending the profession against criticism and might even present an opportunity for them to promote it proactively.

In the director's chair: understanding your responsibilities

Miller, J. — 2011-12-21T04:02:10-08:00

A director's responsibility is to manage a company's resources to deliver profitability. This requires specific personality traits, continuous learning and an understanding of the legislation governing employment and directorship. In this article, Julie Miller describes the role of limited company directors, including their responsibilities as both employers and employees.

Owner access to isolation facility webcam images

Silva, S. — 2011-12-21T04:02:11-08:00

You have recently installed webcams to monitor your patients in an isolation facility where human and animal contact must be kept to a minimum. It would be technically possible to allow owners to have access to the webcam images. Would this be a good thing to do?

Comments on the dilemma in the October issue: 'Mammary mass in an overweight dog'

Mullan, S. — 2011-12-21T04:02:11-08:00

The dilemma in the October issue concerned an overweight labrador with a mammary mass (In Practice, October 2011, volume 33, pages 493–494), which required biopsy and removal of the mass. However, when the client was advised that the dog would need to lose weight before surgery, they become aggressive, said ‘the dog is on a diet and the weight problem is under control’ and refused to discuss attending weight clinics or changing the animal's food. Practice records showed that the client had previously taken the dog to two weight loss clinics and, at the last visit, it had weighed 27 kg. It was now 33 kg. Rachel Casey commented that there were three options for dealing with this scenario: to ignore the problem until the client returned; to report the owner to the RSPCA; or to contact the owner and try to convince them to reconsider weight loss options. By not taking action, the weight issue would probably not be addressed by the owner and the mass would inevitably grow bigger over time, resulting in a decline in the dog's welfare, while reporting the client to the RSPCA might breach client confidentiality. Consideration also needed to be given to whether the welfare of the dog would be better in kennels or with its owner. She suggested that the best option was to contact the owner and to take the time to consider why the owner was reluctant to address the dog's weight problem. In addition, focusing on the mass and the requirement for surgery rather than the weight of the animal, or suggesting alternative weight-loss options, such as a balanced home-made diet, might achieve good welfare outcomes for the dog.

A practitioner ponders

2011-12-21T04:02:11-08:00

The current emphasis on evidence-based veterinary practice in veterinary schools and journals is very necessary, but an unacknowledged victim of this progress is the humble case report. I thought it was just my imagination, until a friend sent me an editorial from the recently launched Journal of Medical Case Reports, which stated that ‘case reports have become a casualty of the pursuit of the impact factor’ (Kidd and Hubbard 2007).

In other words, case reports have low citation value and may therefore negatively affect a journal's impact factor – so it is no surprise that the prevalence of case reports in high-impact journals is decreasing.

Don't get me wrong – large studies are critically important to the future of veterinary medicine. Systematic reviews and meta-analyses, particularly in human medicine but increasingly in the veterinary field, have demonstrated that some treatments that we have relied upon for decades...