Friends Newsletter Spring Summer 2018

Better Together fr iends

SPRING/SUMMER2018 MEET THE TEAM OLD FACES & NEW CASE STUDY LEMMY’S STORY INTHE SPOTLIGHT LIMB SPARING & SALVAGE SURGERY REGENERATIVE MEDICINE SERVICE OSTEOARTHRITIS CLINIC REGULAR FEATURES CLIENT COLUMN & FITZ & PIECES

World-ClassVeterinary Medicine, Hope and Healing

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We are also welcoming back some well-known faces at Eashing as we celebrate a number of accomplishments in the orthopaedics team. James Guthrie is returning as a Senior Surgeon in Orthopaedics, after passing his board exams first time in February and becoming a European specialist in small animal surgery. Pádraig Egan and Susan Murphy have both accepted positions as Surgical Registrars in Orthopaedics, after completing a three-year ECVS approved residency programme in small animal surgery. F itzpatrick Referrals is delighted to introduce Dr Iain Grant, who is heading up the medical oncology service as our Oncology and Soft Tissue hospital in Guildford continues to grow. Introducing old faces & new... Iain qualified from the University of Bristol in 1990 and since then has worked in New Zealand, Sydney and California where, in 2004, he began his residency training in medical oncology at the University of California. He became a Diplomate of the American College of Veterinary Internal Medicine in the subspecialty of oncology at Ohio State University in 2007. Following Iain’s return to the UK, he was a Clinician Teacher at the University of Liverpool (2008 - 2012) and University of Glasgow (2012 – 2014). Iain worked at a private speciality practice in north-west England from 2016, before joining Fitzpatrick Referrals in January to widen the scope of our oncology service and adding extensive experience in advanced medical oncology treatment. Iain is currently the vice president of the European Society of Veterinary Oncology and is Director of Chemopet LLP, a service that provides case advice and chemotherapy medications to vets in practice treating cancer patients. Iain is passionate about his speciality and has been lucky to work with some of the best oncologists in the UK and abroad. His interests are in palliative care of the cancer patient, the gastrointestinal microbiota of cancer patients and effective and compassionate multimodal therapy for the management of small animal cancer. Iain Grant BVSc DipACVIMMRCVS Lead Clinician inMedical Oncology

Nick Bacon& IainGrant

This is a genuine opportunity for me to continue to growas a clinician and as a person in a supportive, forward-thinking teamof like-minded specialists and I am thrilled. I amalso excited about what future possibilities wewill be able to offer not just for our patients, but also for animals as awhole. As someonewho cares deeply about my profession, I also look forward to supporting the learning of veterinary colleagues, support staff and junior colleagues in training. I believe that nomatter what our level of expertise is, we are all working towards a common goal and that is to bond centred veterinary practicewith personal growth and development.

IainGrant

James Guthrie BVM&S CertAVP (GSAS) DipECVS MRCVS Senior Surgeon inOrthopaedics

I love seeing the team grow. It brings a constant improvement to the complexity and standard of care we can deliver and expands the level of service we can offer to you by shortening waiting times and increasing emergency capacity.

A welcome note from Pádraig Egan I feel the winter brings out my Looking at the year ahead, the preparations for this summer’sVET Festival are also in full swing.The festival has grown so much over

JamesGuthrie,SusanMurphyandPádraigEgan

James graduated from the University of Edinburgh in 2010 and was awarded the best student of his class in veterinary orthopaedics. He then completed a one-year rotating internship at Northwest Surgeons; a specialist veterinary referral hospital in Cheshire. Following this, he spent two years working in a small animal hospital in Berkshire where he obtained the RCVS AdvancedVeterinary Practice Certificate in Small Animal Surgery. In 2013, James joined Fitzpatrick Referrals as a duty vet and completed a one-year surgical internship. Following this, James stayed at Fitzpatrick Referrals to pursue his goal of becoming a specialist surgeon and completed a three-year residency programme in small animal surgery. James became a Diplomate of the European College of Veterinary Surgeons in February 2018. He has published multiple research papers and presented his findings at national conferences.

melancholy side! The short days, dark mornings, rubbish weather! However, as spring begins to peep its head into view, I feel that the year ahead is full of promise. After three years, my time as a Surgical Resident has come to an end and I am proud to be joining my colleagues in the orthopaedic team as Surgical Registrar. United failed to do! Dr Iain Grant has recently joined our Oncology and Soft Tissue centre; adding a wealth of experience to our medical oncology team.The orthopaedic team has also been further bolstered by the addition of Susan Murphy and James Guthrie to its ranks. Huge congratulations to James who passed his board exams in February, and is now a European specialist in small animal surgery. This is a great achievement for James and I hope you will join me in congratulating him. We have exploited the transfer window very well this year; something my dear Leeds

the last three years and the breadth and complexity of the lecture programme this year blows me away. I am so happy to see a Wellness & Practice Development stream at this year’s festival.The profession is, at last, realising it is important we look after ourselves and each other and not just our patients – personally, I shall be grabbing a front row seat at ‘Batch cooking like a badass’! This coming year also sees the advent of our regenerative medicine service, which will open up new avenues of treatment for a plethora of orthopaedic diseases. It is an exciting time at Fitzpatrick Referrals, many new beginnings to celebrate and a fun packed year ahead. Keep safe, keep well and keep the cases coming… preferably before 8pm – I am trying to get back into EastEnders after a three-year hiatus due to my residency!

Pádraig Egan BVM&S CertAVP (GSAS) MRCVS Surgical Registrar inOrthopaedics

Pádraig graduated from the Royal (Dick) School of Veterinary Studies, Edinburgh, in 2007. He began his career working in his hometown of Leeds at a PDSA clinic, followed by three years working as a mixed vet in rural Scotland and a year working as an emergency and critical care vet at a busy clinic in Glasgow. In 2010, Pádraig joined Fitzpatrick Referrals as a duty vet and completed a one-year surgical internship.After completing his internship, he fulfilled the role of Clinical Services Coordinator followed by a period as Operations Manager. Pádraig returned to full-time clinical work in October 2014 to pursue his ambition of becoming a European boarded specialist surgeon and completed a three-year European College ofVeterinary Surgeons approved residency program in small animal surgery.While Pádraig enjoys all aspects of small animal surgery, his particular areas of clinical interest are management of the feline trauma patient and management of osteochondral defects.

Even before I graduated from vet school, my goal was to become a specialist surgeon. That goal became a reality after passing my final set of examinations. I am hugely grateful to Fitzpatrick Referrals for providing me with the opportunity over the last five years to make a dream come true.

Susan Murphy MVB MRCVS Surgical Registrar inOrthopaedics

Susan graduated from University College Dublin (Ireland) in 2006 and spent five years working in general practice before enrolling in a surgical internship at Fitzpatrick Referrals in 2012.After completing her internship, she fulfilled the role of Clinical Services Coordinator for two years. Susan returned to full-time clinical work in January 2015 to pursue her ambition of becoming a European boarded specialist surgeon and completed a three year European College of Veterinary Surgeons approved residency program in small animal surgery.While Susan enjoys all aspects of small animal surgery, her particular areas of clinical interest include fracture management and synthetic osteochondral resurfacing techniques.

James Guthrie

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Case Study Lemmy’s Story L emmy is an affectionate two-year-old Lurcher who lives with the Dunn family. His family believes that Lemmy was hit by a motor vehicle after they found him unable to weight bear on his left thoracic limb. His family vet referred Lemmy to Fitzpatrick Referrals Orthopaedics and Neurology in August 2017 after their radiographs of Lemmy’s limb confirmed a complex fracture. Lemmy was admitted by Dr James Guthrie, Senior Surgeon in Orthopaedics.

On clinical examination, a fracture through the distal left antebrachium was palpable.A few small puncture wounds were present through the skin overlying the fracture, and multiple superficial skin wounds were present on all four paws. Lemmy was anaesthetised and transferred to the imaging team for X-rays. Fortunately, thoracic and abdominal radiographs did not reveal any internal injuries. Radiographs of the injured limb confirmed a complete, displaced, transverse fracture to the left distal radius and ulna. James recommended open reduction and internal fixation of the fracture and Lemmy was prepared for surgery the same day.A craniomedial approach was made to the distal radius. The fracture was reduced and stabilised with a cranially applied 2.7mm Synthes TM locking compression plate (LCP) in a locking- compression mode.A separate caudolateral approach was made to the distal ulna.The ulna fracture was reduced and stabilised with a laterally applied 2.0mm Synthes TM LCP. Closure of both incisions was routine and finished with skin staples.Two skin

staples were also placed in the small skin wound on the caudal aspect of the distal left antebrachium.Two days later, Lemmy showed satisfactory progress and was discharged back to the care of his family at home. Six weeks postoperatively, Lemmy was ambulating well and comfortable on palpation over the surgical sites. Orthogonal radiographs were performed under a routine sedation, which documented no disruption to the implants and radiographic evidence of osseous healing at the fracture site. Lemmy was re-presented for his final assessment in November 2017, approximately eleven weeks after the surgical repair. He was comfortable and ambulating very well, and orthogonal radiographs confirmed osseous union. Lemmy was then free to return to off-lead exercise. Lemmy has recovered remarkably well and is enjoying exercising again in the great outdoors thanks to the dedication from Lemmy’s care team.

“Lemmywas such a sweet boy; very brave andwell behaved throughout his treatment. Witnessing howhappy and emotional Ms Dunnwas when shewas reunitedwith Lemmy just showed how strong their bond is and it was a pleasure to help them.” James Guthrie

X-rays confirmed a complete,displaced, transverse fracture to Lemmy’s left distal radius and ulna

Post-op x-rays following surgery

LIVINGWELLWITH METASTATIC CANCER To markWorld Cancer Day on 4th February, Professor Nick Bacon reflected on the changes to cancer care for small companion animals

and how our cancer hospital is helping patients to live well with cancer. He also shared the stories of two brave and inspiring dogs, Monty and Casey. These dogs are wonderful ambassadors for living well with metastatic cancer and champion the greatest message that life after diagnosis is still rich and happy. Monty and Casey are living their lives at home with their families as we continue to manage their symptoms as part of a wide care team who is with them for life. Read Nick’s message on fitzpatrickreferrals.co.uk/blog.

Seven months post operatively Lemmy is continuing to enjoy life to the fullest, thanks to the dedication of Lemmy’s patient care team comprising his family vet, the Dunn family and the team at Fitzpatrick Referrals.

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In the spotlight

L aunching in April, the Osteoarthritis Clinic at Fitzpatrick Referrals will provide you with an innovative clinical service for the medical treatment of osteoarthritis in dogs. Regenerative Medicine Service Osteoarthritis Clinic

Through the dedication of our orthopaedic surgeons and extended patient care team,we are able to treat a variety of clinical conditions that requiremore bespoke intervention.We asked the clinical teamsome frequently asked questions about limb sparing and limb salvage surgery at Fitzpatrick Referrals, led by Professor Noel Fitzpatrickwho has innovated these techniques in companion animals and developed a number of world-first veterinary initiatives such as limb salvage prostheses and custom joint replacement implants.

Brought together by Professor Noel Fitzpatrick, this service will sit alongside and complement our Orthopaedic and Neurology referral practice in Eashing, therefore benefiting from the support of our highly specialised facilities, world-class specialists and extensive patient care team.The Osteoarthritis Clinic will champion a comprehensive and multi-modal approach to osteoarthritis by integrating medical, physiotherapy and rehabilitation disciplines with our state-of-the-art regenerative medicine and biotherapeutic service. Our dedicated experts in stem cell regenerative medicine and bone tissue engineering are available to offer platelet and fibrin derived preparations alongside enriched autologous Skeletal Stem Cells (SSCs) applied as intra- articular injections to alleviate the clinical symptoms associated with osteoarthritis. Our dedicated cell laboratory ensures a degree of quality control and standardisation rare to stem cell treatment in veterinary medicine and is unique to us. Our client and patient bonded approach also enables us to collect clinically relevant data, helping each patient and to shape

the future in this important treatment area. Patients and their families will also benefit from rigorous patient tracking via validated osteoarthritis and quality of life scoring systems and computer-based kinetic data. Our emphasis is on ethics, efficacy and evidence- based medicine to benefit each individual patient whilst providing comprehensive data to optimise the outcome for future patients. At Fitzpatrick Referrals, we hope that by launching our Osteoarthritis Clinic we will further expand the options available to patients and their families affected by osteoarthritis, whether that be with surgery or comprehensive medical management.All treatment plans and follow ups will be on an assessed needs basis and may consist any or all of the elements of the medical, surgical, regenerative and rehabilitation services. We are accepting all dogs with osteoarthritis of any joint, where primary medical management has been ongoing and further amelioration of clinical signs is sought.

Limb sparing & limb salvage surgery

For further information, please contact our Orthopaedics andNeurology practice on 01483 423 761 or enquiries@fitzpatrickreferrals.co.uk

for a patient.We would recommend that tru-cut or punch biopsies are NOT taken prior to referral, as this may contribute to the spread of cancer cells within the surrounding tissue, negating the possibility of an endoprosthesis. Our goal is to always act in the best interests of each and every patient to provide optimal pain-free and functional quality of life. PerFiTS may be appropriate for patients with osteosarcoma but an endoprosthesis is usually a better alternative. 4.What is the typical recovery time? Our goal is that patients will be able to enjoy long periods of exercise at home after 8-12 weeks of recovery depending on the implant. 5.What are the risks? The main risks associated with an endoprosthesis are implant failure, infection and local or distant reoccurrence of the cancer, where applicable. Careful postoperative management will reduce the risk of early implant failure and with new generation implants, implant breakage is rare.We aim to prevent infection by adhering to strict postoperative management protocols during the recovery phase. Infection remains the biggest risk for PerFiTS patients, but other complications include failure or breakage of the implant (though this has massively decreased in more recent generations of the PerFiTS design) and failure of the skin to adhere to the dome meaning that the wound is exposed. It is extremely rare for the implant to break, but the potential risk should be noted. Every precaution is taken to prevent infection and other complications of the device both during surgery and post operatively. 6. Can you perform limb sparing and limb salvage surgery on cats? We have placed custom-designed endoprostheses and PerFiTS implants for a few feline patients, though it is rare. We are here to help you advise your client about all of the options available.We are more than happy to discuss patients over the phone with you and assess their suitability for the treatment through our Radiograph Reporting Service. For more information, please visit: fitzpatrickreferrals.co.uk/orthopaedic/ limb-sparing-surgery/

1.What is limb sparing and limb salvage surgery? Limb sparing and limb salvage surgery reduces the need for full amputation of a limb in the presence of a tumour, a limb deformity or major trauma, and allows the animal to retain normal function of the limb. Fitzpatrick Referrals offers two options; endoprostheses and PerFiTS (Percutaneous Fixation To the Skeleton).An endoprosthesis, most commonly performed on dogs with distal radial or distal tibial tumours, involves the surgical removal of the area of bone affected by the tumour, which is subsequently replaced by a metal spacer and attached to the surrounding bones of the limb.The PerFiTS is a custom designed implant that replaces the end of a limb that may be missing due to cancer, trauma or deformity. It has internal plates which attach to the remaining bone, a mesh to which the skin attaches and ends with a small peg protruding from the skin onto which a replacement ‘foot’ can be attached. This type of surgery is an excellent option for giant and large breed dogs, heavy dogs, or those whose lifestyle would be impaired by amputation, those animals already living with three legs and animals with orthopaedic or neurological problems affecting their other limbs. The most common application of an endoprosthesis is in the distal radius of medium to large breed dogs with an osteosarcoma.The most common injury treated with PerFiTS is major trauma of the distal limb. 3.Are there any considerations to make before referring a patient? Not every patient is a suitable candidate, but submitting radiographs and photographs of the patient and the affected limb is usually the best way for us to assess their initial suitability. For patients with cancer, we work as part of a multidisciplinary team with our cancer specialists at our Oncology and Soft Tissue hospital in specifically dedicated conferences designed to discuss these cases.We will always comprehensively stage their disease at the initial consultation.We will not carry out surgery if there is any evidence of metastatic disease affecting the lungs, abdomen or other bones, as mean survival time is not considered sufficient to justify surgical intervention, in our view, although full limb amputation may still be considered. Every patient is assessed on a completely individual basis and there are situations where we would consider full limb amputation to be the best option 2.What are the most common cases referred for limb sparing and limb salvage surgery?

Archienow livesafullyfunctionalandhappy lifewithhis familyfollowingsurgerywithaforelimbPerFiTS implant toreplacetheulceratedcanceroussectionofhisfoot

Peanutwithhisnewfeetathome

APerFitS implantfollowingamputationof thedistalmanusandcarpusbilaterally in felinepatientPeanut

Anendoprosthesisfor anosteosarcoma ina distalradius

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Fitz & Pieces

Join our team We are always looking to strengthen our teamwith skilled and passionate professionals, andwe have a number of vacancies available as we experience a period of continued expansion and growth. For a full list of job opportunities, please visit fitzpatrickreferrals.co.uk/jobs.

By Ellie Swinyard

Client Column | Our Stan

S tan, aka Stanley Panley, is our handsome 12-year-old Staffordshire BullTerrier. He has been a much-loved member of our family since he first came home with us at a teeny, tiny but super cute 7 weeks old.We had no idea how big a part of our lives that mischievous puppy would become! In November, we discovered a lump under his jaw and in early January, after some tests and a biopsy, he was diagnosed with cancer. Our worst nightmare. The biopsy results revealed adenocarcinoma. This didn’t mean a great deal to us.We were worried and confused.We were told things didn’t look good and that the cancer looked to be quite aggressive and was possibly spreading. We felt we needed to know more in order to make the best decision for Stan, so Stan’s lovely local vet offered to refer us to Fitzpatrick Referrals.We wanted to find out as much as possible regarding end-of-life care to help Stan remain pain-free.At the time, he was enjoying a good quality of life and showed no signs of being uncomfortable.We didn’t really feel surgery was an option and was also wary about the journey due to Stan’s car anxiety! Upon arrival, we were made to feel so welcome and relaxed.The staff were absolutely fantastic.We met Senior Surgeon, Dr Jon Bray who examined Stan along with two lovely nurses who made us feel very at ease. Jon took the time to explain everything clearly and honestly. He explained that there was a chance the cancer could be contained in the salivary gland and that if this were the case, surgery could be an option. If it had spread, however, the outcome would be much bleaker.We would have to see what the CT scan revealed. It was 50/50. Thankfully and much to our surprise, the scan revealed the cancer was contained in the salivary gland with no sign of having spread.We drove home without Stan that evening. It was scary but we trusted the team 100%. He stayed overnight

and underwent surgery the following morning. During this time, we received several phone calls with updates on how he was doing.‘Super-Stan’ was home within 24 hours after surgery. He bounced back to normal at home remarkably quickly. Since then, he’s had 20 stitches removed all in one sitting and has been doing well in general. He continues to surprise and amaze us with his resilience.We are so proud of him.We can’t thank the staff at Fitzpatrick Referrals Oncology and SoftTissue enough, especially Stan’s surgeon Jon, Client Services Manager Hattie for her help and advice prior to our visit and upon arrival, as well as everyone else we encountered during our visit including the reception team and nurses who looked after Stan during his visit. Everyone does a superb job. We are so pleased that we decided tomake the journey that day.A big part of this decisionwas down to the several conversations I hadwith the teamprior to our visit.Stanwill continue to be spoiled and loved,snoozing happily across the laps of hisMumEllie,Dad Craig&Nanny Lesley.Thank you somuch fromus and of course,fromStan.

One of the most anticipated events in the veterinary CPD calendar,VET Festival, will return to the field at Loseley Park in Surrey on Friday 8th and Saturday 9th June 2018 to continue its mission to break the mould for the delivery of veterinary education. We are delighted that twelve members of the Fitzpatrick Referrals team are lecturing at the event, and are ready and waiting to share their skills, knowledge and passion with delegates. Friends of Fitzpatrick Referrals receive a 20% discount on all tickets. Book today using the code FR20 For further information and to book tickets, please visit vetfestival.co.uk One group of nursing students received a behind- the-scenes tour of the Oncology and SoftTissue hospital and attended lectures by Sarah Holliday RVN and Jen O’Keefe RVN.An additional group of dog training students visited our Orthopaedics and Neurology practice to tour the custom-built patient wards and observe a hydrotherapy session. Professor Nick Bacon said,“Wewere delighted to host a keen and enthusiastic group of students from Japan.We remain committed to sharing our ethos of care as widely as possible.” Japanese students experience UK veterinary compassion and care In December, we once again welcomed a group of veterinary students from Japan during their visit to the UK.The visit marks the third year that the cohort from the RenaissanceAcademy of PetWorld were invited by Professor Nick Bacon, and this year they met Fiona Doubleday at our Rehabilitation Centre too.

Fitzpatrick Referrals to fund RSA Insurance Group fee for clients All clients who have a pet insurance policy underwritten by the RSA Insurance Group will be reimbursed the £200 additional excess fee, to ensure clients are not penalised unfairly by RSA for having their pet treated at a referral hospital of their choice. Fitzpatrick Referrals are not part of the RSA Referral Vet Network and are committed to ensuring that clients have the freedom of choice when making their referral decision. Read more on fitzpatrickreferrals.co.uk/news.

OPEN OVER EASTER | We are open 24/7, 365 days a year and are available for emergency referrals throughout the Easter holidays at both of our hospitals.

IN AN EMERGENCY To discuss a case or for any urgent or emergency referrals, please call us

For oncological and soft tissue emergencies 01483 668100 For orthopaedic and neurological emergencies 01483 423761

Fitzpatrick Referrals Orthopaedics & Neurology Halfway Lane, Eashing, Surrey GU7 2QQ Tel: 01483 423761 | Fax: 01483 527590 enquiries@fitzpatrickreferrals.co.uk

Fitzpatrick Referrals Oncology & Soft Tissue 70 Priestley Road, Guildford, Surrey GU2 7AJ Tel: 01483 668100 | Fax: 01483 454724 guildford@fitzpatrickreferrals.co.uk

For more information visit fitzpatrickreferrals.co.uk

Fitzpatrick Referrals Oncology and Soft Tissue Limited 08627448

Company Registration: Fitzpatrick Referrals Limited 5287667

World-Class Veterinary Medicine, Hope and Healing

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