VetTips: Practical Veterinary Skills

Tip 1: In tick toxicity, respiratory failure can occur with or without the administration of tick antiserum

In tick toxicity, respiratory failure can occur with or without administration of tick antiserum. Aspiration pneumonia is frequently encountered in patients with lung disease related to tick paralysis. Aspiration pneumonia is attributed to oesophageal, pharyngeal and laryngeal dysfunction, all of which frequently occur in patients with tick paralysis.

Despite its importance, physical examination of the respiratory system in patients with tick paralysis may not clearly identify the underlying abnormalities. Respiratory failure is usually multi-factorial and the clinical signs of respiratory disease are masked by generalised weakness and central respiratory depression. Arterial blood gas analysis and thoracic radiography improve clinical diagnostics.

Tip 2: Careful when Bandaging Limbs

Any bandage that creates more than 30cm of water pressure under it will stop capillary blood flow, cause ischaemia and tissue death. Remember that distal extremities should be bandaged more loosely than higher on the limb because pressure under a bandage is inversely proportional to the diameter so the smaller the diameter of the limb, the greater the pressure created by a bandage.

Tip 3: Doctor – Know your ABCD’s and do you have A CRASH PLAN?

After Airway, Breathing, Circulation, Disability – Check Airway Cardiovascular, Respiratory, Abdomen, Spine, Head, Pelvis, Limbs, Arteries, and Nerves.

Dealing with emergencies requires the astute clinician to be able to multi-task. While all of the above is going on we also need to be getting baseline diagnostics (ideally before fluid resuscitation starts but not essential). The laboratory trends will be essential to implementing the best supportive care for the patient.

Packed Cell Volume (PCV), Total Protein or Total Solids (TP or TS), Blood Urea Nitrogen (BUN) levels and Urine Specific Gravity (USG) are simple tests that can be rapidly performed yet yield valuable information about the patient’s physiological status (particularly hydration and renal/prerenal dysfunction) while waiting for full laboratory results. The only instrumentation needed is a centrifuge with hematocrit capabilities, a refractometer, and a bottle of Azostix reagent strips.

If you’d like to learn skills in abdominal surgery, emergency and critical care, and dentistry, join us for the Practical Skills Bootcamp. Register NOW! Be quick as the workshop is already filling fast! For more information check out the brochure. 

Undercover Superhero.. Meet Dr Anne Fawcett

Dr Anne Fawcett didn’t always intend to be a vet or a superhero. Her academic path through university started with an honours degree in philosophy! Many of you might wonder why Anne eventually decided to study veterinary science, or whether she actually uses her philosophy degree when practising veterinary science! Read further to find the answers to these questions, and learn more about the multi-faceted and highly talented Dr Anne Fawcett.. the veterinary world’s real-life Clark Kent.

Your path to studying veterinary science was not a common one, having graduated with a Bachelor of Arts majoring in Philosophy before studying Veterinary Science. What inspired you to become a veterinarian and then go onto specialise in ethics and animal welfare?

“Quite honestly it went like this: I did honours in philosophy and planned to be a career philosopher. Graduated, went to the careers centre and they told me with a smile that I was now qualified to be an ANZ Bank Teller. No offence to ANZ, but I hadn’t studied philosophy with that end in mind. And teaching seemed a bit circular. I could have done a philosophy PhD, but sitting in a library for four years didn’t appeal. I spoke to a counsellor who asked me what was the smallest, most finite unit of happiness in my life? “Animals”, I replied. “How do you build that up?” they asked. “Become a vet” was my answer.

Of course, when I was a kid I had wanted to be a vet. But I also had wanted to be a zoologist, a spy, a fireperson, a police officer, and Cher. None of which transpired (not yet, anyway).

It wasn’t easy transitioning from arts to veterinary science. We were taught to question everything in philosophy, then in the first week of vet school we were being told to rote learn key points about cytology. It took me until fourth year to get over the shock of it all.

But having the philosophy degree comes in handy. From justifying ethical decisions, to understanding the origin of dog and cat names. As a vet, I’ve treated Plato, Socrates, Zeno, Sartre and Kant.”

You recently co-authored a book titled “Veterinary Ethics-Navigating tough cases”. Please share your journey leading to the decision to write this book; how long did it take from initial concept to publishing?

“The decision was very easy. Dr Siobhan Mullan was the founding editor of Everyday Ethics in the British Veterinary Association’s journal, In Practice. She’s a specialist in Animal Welfare Science, Ethics and Law and has made a huge contribution to the field. When she asked me to be co-author I was thrilled.

That was the easy bit. There was also three years of work, including a lot of liaising with contributors, writing scenarios and commentary, reading, awkwardly timed international skype meetings, early mornings, late nights and Endnote dramas.

The book was twice as big as we’d anticipated, so it took a while to typeset, design and print. I was at the AVA conference in 2017 when I went to get changed in my hotel room. I noticed there was a box sitting in my hotel room and I opened it and there was 1.4kg of our book which the publishers had couriered to the hotel. A tear might have been shed.”

You are currently a lecturer in the School of Veterinary Sciences and one of your subjects is “The Veterinary Professional”. Tell us a little about this subject. I suspect some of our older readers may not have had the benefit of this subject in their curriculum.

“I really hope all veterinary schools teach this stuff because its critical to what we do. Communication skills, ethics, clinical skills like consultation skills, the so-called “soft skills” that actually make or break most vet’s careers. It evolved from Professional Practice, a subject introduced to our University’s veterinary curriculum by a visionary parasitologist, Dr Henry Collins. I was in the first intake of students to undertake the course and I was fascinated by it. Others loathed it because they saw it as wishy-washy, when compared to subjects like anatomy. Yet when we catch up at conferences and swap notes about stressors in practice, communication is the number one issue.

I work with a team of amazing academics, including Dr Sanaa Zaki and Ingrid van Gelderen, to deliver this program.

I also teach into other areas including small animal practice, and I run the mentoring program for our DVM students. I work closely with the AVA’s mentoring program. Every vet – newly minted or experienced – should have the benefit of mentorship. Often we do but its informal, so we don’t always know it’s happening. I’ve been lucky to have some brilliant mentors over my career.”

What do you enjoy about teaching?

“Teaching works best when students and teachers recognise it’s a two-way street. When they do, it’s magical. There is a genuine discussion, the big questions are asked fearlessly, there is swapping of notes and key references, there is meaningful learning and you walk away feeling pumped. Clinical teaching is great because students often see things that experienced practitioners do not, and they bring their enthusiasm which lifts everyone.

Every now and then I get an email or a phone call from a former student, or we run into each other at a veterinary conference, and they tell me I gave them a piece of advice that was useful. That is one of the best feelings EVER.”

What advice would you give to new graduates?

“Attend as much face to face CPD as you can. There is a lot of online material delivered but honestly, networking and making friends is one of the most important outcomes of learning and you won’t do it if you don’t get out there.

Consider how you can improve the welfare of animals. It might be reviewing your analgesia protocols or quality of life scoring, or discussing environmental enrichment with clients, but there are lots of little changes we can make that improve animal welfare and this will always give you something to think about.

Cultivate your curiosity. About animals, about people, about the environment, about diseases. This is where the satisfaction comes from. One of my colleagues said to me she knows she is feeling burnt out when she notices she is less curious about her cases.

Don’t be afraid to get support. Even without being a vet, life has inevitably dark patches. Loved ones are lost (humans and otherwise), relationships stall or break down, you disappoint yourself or it gets too much. Go to the GP. Go to the psychologist. Phone the AVA’s free counselling hotline. Been there, done all that, more than once. It not just okay, I think its an ethical obligation. If we’re in the business of caring, we should be practicing self-care so we’re in the best position to help animals and the people who live with them.

Get involved in your professional organisation and play a role in shaping the future of the profession. You really do get out what you put in and being involved in organisations like the AVA is a brilliant way to make your voice heard (e.g. through contributing to development of animal welfare policy) and meet other people who are not only keen to make a difference but taking positive action.”

Who are the biggest influences in your life?

An ever-changing cast of amazing people, from colleagues I work with to animal welfare gurus like John Webster, David Mellor, Bernard Rollin and Donald Broom to philosophers long gone like Benedict Spinoza. There are so many people in our profession who I look up to and who inspire me to be a better vet. To give an example that springs to mind simply because it relates to the eyeballs staring at me from across the room this very second: ophthalmologist Kelly Caruso. She phacofragmented my dog Phil’s cataracts and restored his vision. Despite being an anxious client, she even allowed me to watch the procedure. It was like a beautiful ballet. Dr Caruso oozes competence, compassion, enthusiasm and a sense of humour. (Just to be clear, its Phil’s eyeballs across the room right now, not Kelly’s!). It’s easy to understand why clients travel from all over to see her. I’ve met them in her waiting room – I know they’ve driven up from Parkes for the recheck. Being around colleagues like that inspires and energises me.

It would be remiss of me not to include Dolly Parton, Cyndi Lauper and Cher in the mix (or mixtape, as it were). My dad encouraged me to watch Countdown as a kid, and while I know he would have loved me to become a Van Halen fan, I’ve grown up a bit more Bananarama. “

Do you have any pets?

“I am not a fan of the word pets but not sure I love the alternatives either. I live with several non-human animals: one tiny hound (1.8kg) with glistening refurbed eyeballs, one three-legged cat (Hero), and three budgies (Mandy, Candy and Cheeky though I did not name them, nor did I intend to adopt them – they were passively acquired through work). Hero is sitting on my desk as I type this and swishing his magnificent tail across my keyboard.”

I’m sure you’ll agree that Anne has had a fascinating career to date!

At VetPrac’s workshop on Navigating Difficult Clinical Encounters Conference on October 15-17, 2018, Anne will be sharing her approach to being a successful and sustainable “Veterinary Professional”. Why not join her for what promises to be an enriching experience, with no doubt a bit of Bananarama style music thrown into the mix! Register HERE.

Contact information:
Website:  www.smallanimaltalk.com
Twitter: @fawcettanne

Written by Alison Caiafa

VetTips: Feline Surgery and Denistry

Can you say you know everything about cats? Have a read of our vettips to discover some facts you may not know!

Tip 1: FORL Update

In an Australian study, feline tooth resorption lesions was a common finding in all breeds of domestic cats. The overall prevalence was 52%, with 74% of cats over the age of six years having at least one lesion.

Tip 2: Avoid Confusion

Diagnostic confusion between lymphocytic plasmacytic gingivostomatitis and other inflammatory oral conditions such as periodontal disease, tooth resorption, oral neoplasia and eosinophilic granuloma complex is common. Differentiating between these disorders can help provide specific direction for treatment, increasing the chances of a positive outcome for the patient.

Tip 3: Thyroid Surgery

Thyroidectomy can range from a straightforward procedure to one that is fairly complex. Benign, well-encapsulated tumors, such as those found in most cats, are easily resectable with minimal complications. Malignant, invasive tumors require extensive, careful dissection around many important and vital structures such as the trachea, esophagus, carotid arteries, jugular veins, and recurrent laryngeal nerves.

Tip 4: SCC Surgery

Nasal planum resection is a procedure that is most commonly performed on cats with squamous cell carcinomas of the nasal planum. All or a portion of the nasal planum is excised. The procedure may need to be combined with a rostral maxillectomy if the tumour invades or originates from the oral cavity. Quite often in this case the patient will need a full thickness labial flap and reconstruction of the lip.

Tip 5: Do you look for inflammatory polyps?

The surgical removal of Inflammatory polyps can be done in a number of ways. However, the best results are seen when a ventral bulla osteotomy is performed. With this procedure the recurrence rate is less than 2%.

If you’d like to learn more so you can DO more, join us 7-9th of February 2019 in Wagga Wagga for a three day cat extravaganza at the Feline Surgery and Dentistry Workshop. Book NOW for to secure your place in this unique workshop, or click to read the brochure. Be quick!

Setting Clear Expectations

How do you maximise the best return on your education? Both culturally AND financially…
What key leadership principles are required to successfully implement lasting change?
What changes do YOU need to make in order for your practice to reach its full potential??

Dr Gary Turnbull from Lincoln Institute, a boutique leadership company, is here with Vlog 2 to discuss how to set expectations and apply the skills you’ve learnt to your advantage. Curious about how you can succeed? Click below to watch Vlog 2! If you missed out on the first one, head here to catch up.

Education Investment Lincoln Institute

Money Talks and So Should We

“Like it or not (mostly not) talking money is the vet care team’s responsibility – from the estimate of costs of care through to the actual payment.  The discussion can vary and be fraught with guilt, awkwardness and no eye contact, to being too clinical and abrupt about the whole thing.

It’s easy to talk about set-price services, like a vaccination, and more difficult when there’s a case in hospital where the care has had to increase or change. Then you need to communicate the health information to the owner, as well as why the invoice is blowing out and they need to rejig their budget this month.

Charging for what we do doesn’t mean we don’t care, and yet it astonishes me how guilty we, as in the vet care health team, feel about it. If we don’t charge for what we do, the practice where we work won’t exist, we won’t have jobs, and the next set of patients that need us won’t have us.

I’ve worked in places where the veterinarian isn’t allowed to touch the bill – we apparently couldn’t be trusted to charge appropriately.  Nurses did the entire invoice. If you wanted something taken off the bill (and it was a service/treatment that had been provided) then you had to go to head-honcho and ask for it to be removed. With very good reasons. For the most part you learnt to talk to owners about money pretty rapidly.

Talking money should just be like another procedure really. My husband had his cruciate surgery appointment with a private orthopaedic specialist. After the doctor examined him, declared that he would fix the knee better than God had made it in the first place (eye roll: surgeons) we were sent out to see his PA. The PA gave us the handout about the surgery, the run down on the days in hospital/rehab expected, and then the costs to us, when payment was expected, and how payment could be made.  It was just another thing in the list of things we needed to know.

Rehab weekly: check, payment fortnightly: cheque!

We absolutely should be mindful of costs and our client’s expectations. After all, you and I know money doesn’t grow on trees. But if we don’t have these conversations, then we don’t know what our client’s expectations or budgets are, and cannot possibly hope to serve them the best way that we can.

Money talks, and so should we.” – Dr Sandra Ngyuen 

If you’d like to learn how to navigate difficult clinical encounters with confidence, please join us for the Navigating Difficult Clinical Encounters Training Seminar on October 15th – 17th, 2018 in Sydney with three of the most supportive, intelligent and experienced veterinarians – Dr Sandra Nguyen, Dr Cathy Warburton, and Dr Anne Fawcett. Register HERE! For more information check out the brochure.

Ilana Mendels: I was a participant at a VetPrac workshop!

Dear Colleagues,

I just had the most invigorating week!

For a change, I was the one in the learning seat at the Introduction to Canine Rehabilitation VetPrac Workshop.

Having graduated 15 years ago and been out of practice for two while moving home, having a baby and managing the business I was surprised by how much I remembered! The content of the Rehabilitation Workshop I went to was very different to how we learned at university and the way all the information was consolidated and able to be put into context for clinical practice got me excited. I actually felt like I could go back into a clinic and be useful to the employer and help their business grow as a result of my extra training.

You might be thinking, I’m just saying this, after all it’s my business – why wouldn’t I say it was good? Most people know we are usually our biggest critics! That’s true for me, for sure! But this year, VetPrac has a superb team of facilitators on board who are even better at organising than I am!!! I am so proud of the people who work with me every day building these workshops for our community. It was a pleasure to be on the receiving end of it for a change.

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Also, if I’m being honest, I wasn’t sure of my faith in myself as a clinician. I was a little scared. Like so many of us, I have that little subconscious driver telling me I might not be good enough or have the memory or the skill to absorb and use the content on offer was whispering in my ear in the lead up to the workshop. In retrospect I can laugh, because the VetPrac workshops were actually always designed for vets like you and me. People who want to do a good job, and don’t want to do it for the first time on a patient after reading it in a book or on the web.

Take for example, the Perineal and Urogenital Surgery Workshop. This is a splendid mix of soft tissue surgery skills with a focus on the Caudal aspect of the body. In it we get to practice fine tissue dissections, muscular flaps, advanced suture techniques, work with mesh, organ surgeries, biopsies, anastomosis procedures and more! So many people have commented that these are soft tissue skills that can alleviate the struggle we face when presented with challenging cases.

If you haven’t organised your CPD for this year yet – check out the schedule HERE. This workshop ran for the first time in 2010 and has been improved on year after year to make it ever more interesting and relevant for our general practice environments. To register click HERE or to ask us more about any of our workshops please email or call us at your leisure. Don’t wait and don’t miss out!

Warm Regards,

Ilana

Have You Ever Had A Colleague Trash Talk A Client?

“Have you ever worked in a setting where staff would act one way towards clients, yet bag them out as soon as they leave? Telling them one thing to their face: “you’re doing your best for Fluffy”, but turning around and telling colleagues “I can’t believe Mr Bloggs isn’t going to pursue treatment, people like that really shouldn’t have a dog.” Or worse.

You might feel like you’re taking the moral high ground, but toxic trash talking has major implications, none of which are good.

First, it creates and reinforces and us and them divide, where clients are seen as unknowing, irrational people who don’t deserve to care for animals, as opposed to the all-knowing, all-deserving veterinary team.

Second, it feels like a short-term score – by judging a client, we feel better about ourselves. But the judgement is based on a false-premise, and ultimately hurts the staff member doing it. Their interaction with clients is experienced as increasingly negative, yet interactions with clients can be the most rewarding aspect of our job.

Third, it sends a strong signal to your staff that it is acceptable to behave unprofessionally. Toxic trash talking is never limited to clients.

Finally, trash talking is a way of eschewing responsibility for cases. If Mr Bloggs isn’t doing his best for Fluffy, why did we tell him he was? If you know something Mr Bloggs doesn’t, why aren’t you sharing it with him? And what about Fluffy – can you really improve the welfare of a patient if you’re actively disrespecting the client, the person who cares for that animal 24/7 and will be in charge of implementing treatment?

Trash talking in the short term can represent a brief bonding over a common woe, but longer term it compromises our ability to help animals, and erodes our career satisfaction.” – Dr Anne Fawcett

Have you experienced an awkward encounter like this where you might like to speak up but feel you can’t? There are tools and ways of understanding colleagues, clients and your relationships to better under people and situations. If you’d like learn how to navigate these difficult clinical encounters with confidence, please join us this October 15th – 17th for the Navigating Difficult Clinical Encounters training Seminar in Sydney with three of the most supportive, intelligent and experienced veterinarians Dr Sandra Nguyen, Dr Cathy Warburton, and Dr Anne Fawcett.

 

Struggling with rear end encounters? Dr Peter Delisser Can Help!

Dr Peter Delisser has always been interested in using his hands to make and fix things, so it wasn’t surprising that within a few years of graduating, his interest in veterinary science quickly turned to all things surgical. He particularly likes the surgeries he can do and immediately see a difference, like urogenital surgery.

Pete is joining the VetPrac education team this year at the Perineal and Urogenital Surgery Workshop at Gatton on August 24-25th August, and we can’t wait to share his passion for urogenital surgery.

In the meantime, let’s get to know Pete a little better:

What inspired you to become a veterinarian and then go onto specialize in surgery?

I have always been interested in the ability to use my hands to make things and fix things. My initial interest in veterinary science has always been based on my interest in the surgical side of things. Ever since seeing a radius/ulnar fracture repair at a family friend’s veterinary practice and watching this dog go from non-ambulatory to ambulatory the following day, I knew I wanted a large part of my working life to be doing something similar. General practice did not provide the surgical caseload I was after, so this is why I pursued surgical specialisation.

Do you have a favourite surgery or procedure that you like to perform?

Like everyone, I like the surgeries I can do and immediately see a difference. For example, performing surgery on an incontinent dog with ectopic ureters and seeing an immediate improvement in the level of continence. Similarly, I also love a nice challenging fracture repair where the dog can quickly use its leg postoperatively, where it was non-weight bearing preoperatively.

In your own words, what is it about perineal and urogenital surgery that you find interesting and that you believe general practitioners would benefit from learning from and performing better?

The perineal region is an area with clear and important anatomy and understanding this underlying anatomy is key to achieving successful outcomes with all urogenital and perineal surgery. General practitioners should hopefully leave this course with a greater understanding of the perineal and urogenital anatomy, including neurovascular supply and functional relevance and contribution to the diseases we commonly see.

What practical surgical tips that you learned from experience would you share with general practitioners?

Be gentle. Remember Halsted’s principles. Use atraumatic forceps (Debakey’s) or stay sutures when handling urothelium.

Tell us a little about your PhD project.

I studied the response of bone cells to mechanical loading and how that response is adversely affected in bone of old animals. It was primarily a research topic aimed at characterising the deficient response to mechanical loading in elderly people, in efforts to control the incidence of osteoporosis and improve treatment options by providing better/additional therapeutic targets.

In your opinion, what makes a great workplace?

The people. You can have excellent facilities, but without people who you work well with and enjoy being around, these facilities mean little. (Having the toys is also somewhat essential for a surgeon…)

What do you like to do for fun? How do you spend your days off?

Back in the day, my days off involved outdoor pursuits (e.g. hiking and skiing) and catching up with mates at the pub. Now I have kids, most of my spare time is spent playing with them! When they’re a bit older, I hope I can convert them to the wonders of hiking and skiing.

To learn more about perineal surgery from Pete and maybe even share an ale with him at the workshop dinner (for old times’ sake) why not register HERE for the Perineal and Urogenital Workshop at Gatton on August 24-25, 2018.

Dr Peter Delisser can be contacted at
Veterinary Specialist Services – Underwood
Email: pdelisser@vss.net.au
Phone: (07) 3841 7011
Fax: (07) 3841 7022

Written by Alison Caiafa