From Laparoscopy to surgery on large land-based predators

What do you get when you cross a veterinary surgeon with a fine dose of good humour?  Dr Brenton Chambers!

Dr Chambers is a UQ graduate with a mixture of general, emergency and referral practice experience, a stint as a lecturer at the University of Melbourne in Small Animal Surgery, and he’s a Fellow of the Australian and New Zealand College of Veterinary Scientists.

Brenton will lead the education team in the 2020 Laparoscopy Workshop at Gatton on February 7-9th 2020. We spent a little time getting to know Brenton a little better and hope you enjoy his insight as much as we do:


What do you like to do for fun?
I enjoy photography, woodwork, music and reading.

 

How do you spend your days off?
Trying not to worry about surgery.

 

In you own words, what is it about Laparoscopy that you find interesting and that you believe general practitioners would benefit from learning from and performing better?
Laparoscopy and laparoscopic -assisted procedures provide an avenue to access the peritoneal space via a minimally invasive approach with unparalleled visualization and illumination whilst minimizing the morbidity inflicted on our patients. It has a learning curve like any other procedure and some capital expenditure is required, but once the basic techniques are learned, the principles (and also the equipment) can be applied to many situations.

 

What have you learned from experience that you didn’t learn from a textbook? What practical advice would you offer fellow vets?
Surgery, more than most disciplines has a significant manual component. Whilst the concepts and cerebral component can be learnt from a textbook, the fine nuance of any surgical procedures are learned from doing and watching others doing the same procedure. Practical courses provide a good introduction, but finding an experienced and skilled mentor is invaluable and will allow you to fine tune your techniques and troubleshoot your complications.

 

What procedure/technology/medication have you used and realized that there was a better alternative?
Intra-corpeal suturing without needle drivers.

 

What practical surgical tips you’ve learned from experience would you share with general practitioners?
When performing surgery on large, land-based predators which have been anaesthetized by some-one else, know where the exits are and don’t be the slowest person in the room.

 

What advice would you give new graduates?
Find a supportive environment in which to work, ideally with a mentor. Keep in touch with your peers to help support each other. Don’t stay in a situation that doesn’t suit you.

 

 

If you want to learn more about Laparoscopy this is the workshop you don’t want to miss! Dr Brenton Chambers, Dr Peter Delisser & Dr Kathryn Duncan are combining their expertise and we’re keen to share it with you. This workshop is proving to be very popular so don’t delay! Register HERE for the Laparoscopy: Principles and Practice Workshop at Gatton on February 7-9, 2020.

 

Dr Brenton Chambers can be contacted at
Centre for Animal Referral & Emergency
Email: bchambers@carevet.com.au

 

Other interesting reads:
Dr Brenton Chambers’ experience, publications and awards
A peek into Laparoscopy with Dr Peter Delisser
Brochure: Laparoscopy Workshop 2020

 

A peek into Laparoscopy with Dr Peter Delisser

Dr Peter Delisser is a formidable specialist in Small Animal Surgery. From his undergraduate degree at the University of Queensland to his surgical residency at the University of Bristol, Dr Delisser has completed his PhD studying the effects of mechanical loading on bone tissue and its relevance to osteoporosis in people.

In his ‘spare time’ he’s published an impressive collection of scientific papers and presented at conferences on various topics from urinary incontinence in bitches to fracture repair techniques, and bone mechanobiology to name a few.

Pete returns to the VetPrac education team in 2020 for the Laparoscopy Workshop at Gatton on February 7-9 2020. He last joined us at our Perineal & Urogenital Surgery Workshop in 2018 so we’re thrilled to be in his fine company again.

We took some time out with Pete to get to know him a little better:


What do you like to do for fun? 
Skiing, beach holidays, camping, or golf. I spend my time off with my children mostly which is far less adventurous than it used to be.

 

What is it about Laparoscopy you find interesting and believe general practitioners would benefit from learning from and performing better?
Laparoscopy is fun, challenging and beneficial for the patient from a comfort and recovery point of view.

 

Can you share any horror or hero stories from procedures we’ll be addressing in the workshop that may inspire others to assess and grow their skills?
My supervisor lacerated a spleen and required a conversion and splenectomy when doing a laparoscopic spay.

This week I had to convert a lap-assisted cystoscopy for the first time. The bladder didn’t inflate very well so I couldn’t visualize the stones and suction made it harder rather than easier.

The best advice I can share with general practitioners is to “Practice, practice, practice…”

 

What have you learned from experience that you didn’t learn from a textbook?
Tilt the dog more than you think you can. It makes it easier!!

Suture the camera portal closed around the port if you are getting air leakage or the port keeps slipping out when changing instruments.

 

What procedure/technology/medication have you used and realized there was a better alternative?
Open cryptorchid – laparoscopic removal is so much nicer!

 

What have you tried that may be a surprising tip to other vets?
A metal reusable straw works for bladder stone suctioning and allows bigger stones to be vacuumed up.

 

Do you have any advice for new graduates?
Keep learning!!!

 

If you want to learn more about Laparoscopy this is the workshop you don’t want to miss! Dr Brenton Chambers, Dr Peter Delisser & Dr Kathryn Duncan are combining their expertise and we’re keen to share it with you. This workshop is proving to be very popular so don’t delay! Register HERE for the Laparoscopy: Principles and Practice Workshop at Gatton on February 7-9, 2020.

 

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

 

Other interesting reads:
Struggling with rear end encounters? Dr Peter Delisser can help! (August 01, 2018)
Brochure: Laparoscopy Workshop 2020
Dr Peter Delisser’s experience, publications and awards

Guest Blog: Pulmonary Contusions in the Small Animal Trauma Patient

Trauma in dogs and cats can cause a range of potentially serious conditions and our friends at Vet Education have developed a 4-week course addressing emergency management of trauma patients. More details about the Vet Education course are available below.

We are proud to support our friends at Vet Education and this guest blog has been kindly provided by Dr. Philip R Judge BVSc MVS PG Cert Vet Stud MACVSc (VECC; Medicine of Dogs).

 


 

 

Trauma in dogs and cats can cause a range of potentially serious conditions, from obvious injuries, such as fractures, open wounds, and external haemorrhage, to serious head trauma, internal haemorrhage, and life-threatening injuries of the chest cavity.

Despite advances in the management of trauma patients over recent decades, the morbidity and mortality that occur secondary to trauma remain remarkably high1. In fact, in a study evaluating causes of death in more than 74,000 dogs, trauma was the second-most common cause of death in juvenile and adult dogs2.

Thoracic injuries are one of the most common causes of mortality in the trauma patient3. Among thoracic injuries, pulmonary contusions remain one of the more challenging conditions to manage.

Pulmonary contusion occurs following non-penetrative, compression-decompression injury to the chest wall. The disruption of alveolar-endothelial integrity results in haemorrhage and oedema4. Interestingly, 80% of humans with pulmonary contusions also suffer non-thoracic injuries5 necessitating the clinician conduct a thorough patient evaluation and consideration of pulmonary contusions in patients presenting with injuries following trauma.

 

Lung ultrasound image showing evidence of pulmonary fluid in a patient suspected of having pulmonary contusions following chest trauma.

 

The pulmonary injury suffered in contusions, results in a secondary inflammatory reaction that leads to massive extravasation of fluid and inflammatory cells into pulmonary interstitial and alveolar spaces that results in progressive impairment in gas exchange for up to 12-18 hours following trauma. Concurrent myocardial contusion, rib fracture, or diaphragmatic hernia may also be present, further complicating patient management.

 

Radiograph of a cat that was attacked by a dog, showing a diaphragmatic hernia. Pulmonary contusions are common with this type of injury and are one of the major contributing factors to mortality.

 

Treatment of pulmonary contusions can be challenging. Oxygen therapy should be provided – ideally by intranasal cannula. Pleural space disorders, such as haemothorax or pneumothorax, should be managed to provide for maximal lung expansion during inhalation. Additionally, local anaesthesia and/or stabilisation of rib fractures, along with appropriate and timely management of diaphragmatic hernia are also indicated.

Some patients with pulmonary contusions require ventilation assistance, and careful patient monitoring is essential to identify such patients.

 

ECG tracing showing paroxysmal ventricular tachycardia, in a dog with pulmonary and myocardial contusions following trauma.

 

Administration of appropriate intravenous fluid therapy to patients with pulmonary contusions has long been an area of controversy, owing to concerns about excessive fluid administration contributing to pulmonary oedema. Scientific studies offer conflicting evidence regarding appropriate fluid administration. As a result, clinicians must therefore achieve a balance between limiting pulmonary pressures and providing adequate fluid resuscitation to avoid hypoperfusion complications of other organ systems.

Administration of large volumes of isotonic crystalloids, e.g., lactated Ringer’s solution should be avoided, as they are associated with excessive lung water accumulation and a deterioration of respiratory function and gas exchange.

A study6 in 2009 explored the concept of biphasic (early and late) fluid management of patients suffering septic shock complicated by acute lung injury – which has many facets similar to those observed in pulmonary contusions – including the presence of high pulmonary capillary permeability and inflammation. The study evaluated the relationship between adequate initial fluid resuscitation (AIFR), where patients received an initial fluid bolus corresponding to a positive fluid balance, and conservative late fluid management (CLFM), defined as an even-to-negative fluid balance measurement during the 7 days after lung injury. Mortality rates were lowest if used in combination, suggesting an additive effect of both fluid strategies (Murphy el al., 2009).

Given many patients with pulmonary contusions have traumatic injury to other organ systems (such as head trauma, fractures, open wounds, etc.) – all of which require positive initial fluid balance to ensure adequate tissue oxygen delivery, a strategy of fluid resuscitation to restore cardiac output and tissue oxygen delivery in acute resuscitation, followed by a more conservative fluid administration protocol seems appropriate for most patients with pulmonary contusions.

Frequent patient monitoring is essential and should be coupled with adequate analgesia and other supportive care in order to achieve optimal outcome.

 

Vet Education offers a comprehensive, RACE-approved 4-week online course on acute trauma management in the dog and cat, covering in detail, many aspects of the treatment of trauma, including respiratory complications. For more information, visit the Vet Education website, or email info@veteducation.com.au.

 

References:

  1. Hall, KE; Sharp, CR; Adams, CR; Beilman, G. A Novel Trauma Model: Naturally Occurring Canine Trauma. Shock 41 (1) 2014
  2. Fleming JM, Creevy KE, Promislow DE: Mortality in north American dogs from 1984 to 2004: an investigation into age-, size-, and breed-related causes of death. J Vet Intern Med 25 (2): 187–198, 2011.
  3. Simpson SA, Syring R, Otto CM: Severe blunt trauma in dogs: 235 cases (1997–2003). J Vet Emerg Crit Care 19 (6): 588–602, 2009.
  4. Roch A., Guervilly C. and Papazian L. (2011). Fluid management in acute lung injury and ARDS. Annals of intensive care, 19(16).
  5. Fulton R., Peter E. and Wilson J. (1970). The pathophysiology and treatment of pulmonary contusions. J Trauma. 10, 719-730.
  6. Murphy C., Schramm G., Doherty J., Reichley R., Gajic O., Afessa B., Micek S. and Kollef M. (2009). The importance of fluid management in acute lung injury secondary to septic shock. Chest. 136(1), 102-109.

 

 

Want to be a High Achiever in the veterinary industry? This is your opportunity

The on-line course How High Achievers Succeed and Keep Succeeding is starting again soon, over 6 weeks on Thursdays from October 17 to November 21, 2019.This course has run ten times so far with close to 100 people being a part of the small group format.

So why might you want to take some time out of your busy life to join the course?

Let’s go straight to the horses’ mouth to find the answer as this is a question that Cathy asks each participant in order to personalise the course to their needs. Detailed data analysis revealed 4 key themes in the vets, nurses, practice managers, and others that have attended.

 

Improving work-life balance.

Far and away the biggest reason for joining the course relates to improving work-life balance and building skills to achieve this improvement; better manage stress, burnout or life in general, dial down an overactive mind, grow self-awareness, set boundaries and have perspective. This is no surprise given that high workloads are relatively common in our industry and Australian research (Dinh et al 2017) identifies that productivity and mental health start to decline when we work more than 39 hours a week on average.

Exploring passion, purpose and career direction.

Others come on the course to think about what it is they love and don’t love about their work and how they might craft their jobs to create more enjoyment and satisfaction along with the sense that they are making a contribution to a better world. A drive to explore “where to next” makes sense when you consider that 19% of respondents to the 2018 AVA Workforce survey were considering not working as a veterinarian in a years time.

Growing self-confidence.

Low self-confidence coupled with high expectations of ourselves are common in the veterinary world and many people came to the course looking for (and finding) suggestions to manage this.  

Working well with others.

The people we encounter in the veterinary world, clients and colleagues alike, can challenge us. Sometimes they can feel like an obstacle getting in the way of us providing effective veterinary care. Course participants found that gaining greater understanding of themselves and their motivations, whilst also learning to better take the perspective of the other, was a beneficial outcome in their day to day lives.

 

 

Getting information that relates to these key themes is easy. The difficult part is finding the motivation and identifying and breaking down the barriers to behavioural change.

High Achievers have appreciated the safe space and dedicated time that the course creates that allows them to talk, and to reflect on their lives and their habits. They learn both from other people and their experiences, and the science of positive psychology, to personalise that learning and set step-by-step goals to improve their lives.

So what about you? How would you rate your current work-life satisfaction and enjoyment? If you are less than a 7/10, then now could be a good time to join the course!

OR – you might have completed a Mental Health First Aid course and want to play an active role in supporting the teams’ mental health within your practice. High Achievers provides a great summary of the literature on leading a fulfilling life which will be very helpful in your important role.

Either way, Cathy and VetPrac would love to see you in the course starting soon.

If you’d like to learn a little more about Cathy, and missed my articles about her over recent years, click here to find out about how she followed her passions which lead to her current role as Veterinary Well-Being Consultant and Coach.

 

Download the brochure for High Achievers or Click Here to Register.