0900 - 1040 - Hall 9
How far is too far in the treatment and surgery of animals?
Daniel J. Brockman
Roger Clarke
Jolle Kirpensteijn
‘I am continually frustrated by people in practice referring hopeless cases where the welfare of the animal is ignored by people trying to fulfil an owner’s unrealistic expectation. I feel vets should always be advocates for the animal’s welfare and should promote this to the owners rather than performing heroic procedures to buy them a few days or months of a life that is less than satisfactory.’
Wrapped up in these words is something that speaks to the heart of what being a veterinary surgeon is. Although these words could be considered harsh, judgemental and potentially unfair, the questions they raise are multiple and complex. We would all like to know the answers to these questions before we embark on a medical or surgical treatment plan for any given patient.
Any disease state has a negative impact on the welfare of the affected individual. Any surgical procedure has a negative impact on the welfare of the animal undergoing an operation. Many medical therapies carry with them the risk of side effects that could be detrimental to an animal’s quality of life.
What compromise in welfare is acceptable in the short term, during an attempt to improve health and welfare in the long term? Who makes that judgement and how is such a judgement reached? Who should be the strongest advocate for the animal and its welfare, and what criteria should such individuals use? To whom does the veterinary surgeon have the greatest responsibility: the animal or the owner? How do we determine an animal’s quality of life? What represents a ‘good life’ and how do we tell a ‘good life’ from a life simply ‘worth living’ and a life ‘not worth living’? What additional privileges in the decision-making cascade for any given animal does specialist status confer? Are there any cultural differences? What motivates practitioners and specialists to ‘push the envelope’ when it comes to animal treatment? Is ‘pushing the envelope’ ever the right course?
The outcome of a treatment course or action for any individual animal is always unknown, at the outset of treatment. What probability of success is acceptable? How do we generate this information?
This open discussion, led by highly opinionated specialists with disparate views, will explore these questions as we try to gain further insight into appropriate case-based decision making and the roles of owners, general practitioners and specialists in the pursuit of improved animal health, wellbeing and welfare.
1145 - 1230 - Hall 9
How can you ignore the cascade?
Steve Dean
The veterinary medicines cascade was incorporated into EU legislation in 2005 in recognition of the veterinary surgeon’s challenge in treating minor species and rare diseases where there is no authorized veterinary medicine available. The cascade provides a veterinary surgeon with the ability to reach a clinical judgement on the best therapy to deploy where authorized medicines are not available. Without the cascade, any use of an unauthorized medicine would not be within the legal framework.
Animal owners and the public justifiably demand assurance about the safety of veterinary medicines for human health, animal health and the environment. The regulatory process provides an independent assurance of product quality, safety and efficacy. This level of assurance declines once the cascade is employed and as the use of a medicine descends the steps of the cascade. A veterinary surgeon has the appropriate professional and scientific experience to be responsible for the application of the cascade and, as it is a safeguard for the client and their animal, it is difficult to understand how it can be ignored as a useful regulatory tool.
Some veterinary surgeons complain that the cascade restricts their choice of medicine but correctly applied this is not the case, especially where evidence-based medicine is applied. Nevertheless, a review of the EU Veterinary Medicines Directive, due in 2012, provides an opportunity to address areas of the cascade that can be improved.
1400 - 1540 - Hall 5
Early neutering: how young is too young?
David Yates
Gerry Polton
Alasdair Hotston-Moore
Kersti Seksel
In many developed countries, surgical neutering of dogs and cats has become a standard management procedure for all animals not intended for breeding use. Suggested benefits of neutering include behavioural modification, control of disease transmission and population control. The latter two are of particular relevance in countries and cities with significant street animal populations. However, there are adverse effects of early neutering.
Traditionally in the UK, bitches are neutered after one or more oestral events and male dogs are neutered when they become sexually mature. Cats of both sexes are usually neutered before sexual maturity. Some veterinary surgeons advise neutering before puberty in dogs of both sexes, and some caution against neutering cats until after puberty.
Animals neutered pre-pubertally may express different anatomical, physiological and behavioural phenotypes as a result. These alterations in phenotypes may be beneficial or detrimental to the animal’s welfare and to the client’s relationship with the animal. Postulated benefits include reduced incidence of mammary neoplasia in females and improved bonding with owners. Postulated negative effects include increased risk of bone and prostate cancer, risk of long bone fracture and impaired learning of complex behaviours.
It is accepted that there are different morbidities associated with neutering before or after puberty. Surgical morbidity of pre-pubertal gonadectomy is reduced compared to conventional neutering. By contrast, the physiological impact of anaesthesia and the risks associated with exposure to hospital pathogens may be greater in young animals.
The panel also recognizes that in charity practice, where client compliance may be sub-optimal, early neutering provides an additional opportunity to improve animal welfare, both for individual animals and for the animal population. The panel will review the evidence behind these assertions, allowing veterinary surgeons to counsel clients so that neutering is scheduled to optimize the benefits for each individual case.
1550 - 1635 - Hall 5
Breeding dogs: how many caesareans is too many?
Harvey Locke
Steve Dean
Harvey Locke - Irresponsible dog breeding has been the subject of much debate both within and outside the veterinary profession for many years. The question that vets need to ask themselves is ‘are we doing enough to tackle the problems of breeding for extreme, fashion and commercial gain?’ Both the BVA and BSAVA have looked at the issue of bitches that have repeated caesarean sections. Discussions have been held with the Kennel Club on the number of litters born by caesarean section that may be registered from an individual bitch.
The BVA’s Ethics and Welfare Group and BSAVA Scientific Committee both agreed that the maximum number of caesarean procedures undertaken on a bitch before her puppies could no longer be registered should be one, with no exceptions. The Kennel Club has announced that from January 2012 it will no longer register any puppies born by caesarean section from a bitch that has had two previous caesarean operations except for ‘scientifically proven reasons’. This is an ill-defined term that could be open to abuse. Whilst welcoming this move by the Kennel Club, it is disappointing that the rule change does not go far enough.
As a profession, our first priority must be the health and welfare of dogs and no bitch should be expected to go through the trauma of a caesarean section more than once. We should be doing all in our power to prevent the perpetuation of breeding lines in which the conformation is such that bitches cannot give birth naturally.
Steve Dean - A caesarean section is life-saving surgery. Where foetal oversize is the issue in a breed associated with frequent elective caesareans, there is justification in considering how to limit the number of times surgery is performed. For caesareans arising from a mal-presentation, secondary inertia or human impatience (by owner or vet), evidence is available to inform the decision to breed the bitch again.
The risk and stress of a caesarean is arguably no greater for the mother or puppies than that of a natural birth. Adhesions arising from abdominal surgery may complicate subsequent intervention and this is an increasing risk with the number of caesareans performed. The age, health status and breed (of the bitch and intended sire) are also factors to be considered.
Consultation with dog breeders resulted in the view that a second caesarean is generally justifiable taking these factors into account, but no more than two should be undertaken. The veterinary profession was offered the opportunity to play a formal role in considering the risk of a second caesarean in registered pedigree dogs but professional bodies rejected the concept. This leaves the responsibility with the individual breeder who voluntarily takes advice from their veterinary surgeon. The profession should have taken a proactive stance in support of their dedicated dog breeding clients.
A veterinary surgeon should be certain that a caesarean is necessary if dog breeding is to see breeding restrictions applied effectively. A proactive engagement with higher risk breeds is essential before elective surgery is agreed and the profession must report caesareans to the Kennel Club if the registration limit is to be effective. The issue should not be limited simply to the number of caesareans but should take account of the clinical evidence available.