Vet Tips for TPLO Surgery

TIP 1. Did you know that TPLO can be performed in small breed dogs and cats?

If your client asks, “What is the best technique for my miniature poodle’s CCL rupture?” you can say TPLO with confidence. Our Vet Prac instructors routinely perform TPLO on small breed dogs and cats with excellent results. In fact, we feel that small breed dogs and cats recover faster and with better function following TPLO than extracapsular techniques.

TIP 2. TPLO has been shown to allow for healing of partial CCL tears.

Dr. Beale is one of the coauthors on a paper (Hulse et al., Vet Surg 2010) where second look arthroscopy was performed on dogs that had TPLO for partial CCL tears. Reevaluation found that partial CCL tears are protected and can heal when we perform TPLO before the CCL completely ruptures.

TIP 3. TPLO is a very versatile technique.

TPLO can be performed on animals from very small dogs with 1.5mm screws, and has been performed on a young male alpaca! It can be used in cases of medial patella luxation and excessive tibial plateau slope. The technique is very stable due to its biomechanics and more so with modern locking plate technology. There is a very low major complication rate (3.1%). And, once the tibia is healed, the implants can be easily removed (but is rarely required), without decreasing the efficacy or stability of the repair.

Ultrasound – A Sound ROI for Equine Vets

Don’t you wish you had a machine in your practice that printed money? Well – you do!

An Ultrasound machine used on every equine lameness case will increase the cash flow of your business by $150-600 per case depending on how you decide to price it.

If you do 4 call-outs per day you’ll earn an extra $600-$2400 per day. Which means, if you perform 20 lameness exams per week, you have the potential to make an extra $10,000 per week – just by using what you already have in the practice… Ultrasound! There’s also the added information you’ll have available to you from the diagnostics. It’s a win-win situation.

Let’s take a more conservative approach of 10 lameness exams per fortnight. This can still equate to an extra $2500 per week you were not earning before. Of course, this is conservative but imaging if your practice was seeing a high caseload of lameness exams with 10 scans a day?!… Wouldn’t that be dreamy?

Why would someone charge $150 for the scan when another person would charge $600? It’s a bit like tooth extractions. Here are three reasons:

 

Firstly – How do you value yourself as a professional service provider?
Do you have the skills to use your money maker and are those skills at a novice level? Or have you practiced them with a specialist under controlled conditions so you are confident they are strong, efficient and diagnostic?

 

Secondly – What are you scanning?
We all know there are laypersons out there offering all sorts of services. Anyone can buy an ultrasound machine and make it work for them. The machine might be good or not. They might have the skills, they might not. It’s an annoying reality of animal care these days. Lots of people spruiking without acceptable credentials. However, very few people have the training to scan accurately, to achieve better diagnostic results. But you can. You are a vet. You have the greatest and broadest capacity to give the best results for horse owners. Don’t doubt yourself. Others may know how to perform a direct perpendicular scan of the Suspensory Ligament. But they will not know what they are looking at with an oblique approach. They probably won’t scan the whole structure either. Nor would they have the background knowledge in anatomy and physiology which vets have to make good clinical judgments and provide prognostic and treatment advice for recovery. Others certainly don’t have the medical knowledge either. And those vet skills and techniques are worth charging for. But you can’t use all those skills if you haven’t got good diagnostics. And it’s well known that ultrasound, when applied properly, can give almost good results as MRI in a lot of common cases, AND it requires less anaesthesia and stuffing around (transport) of the patient. That’s worth paying for. Ultrasound is also a great monitoring tool for healing and can be used on repeat consultations to immediately judge the progress of a patient.
On top of that – Scanning a spine or Shoulder or Hip or even parts of the foot is a bucket load harder than scanning the superficial digital flexor tendon. So those anatomical differences might carry a loading fee to accommodate the time and skills required.

 

Thirdly – Do you have clientele and live in a demographic where price matters?
Realistically some of us can make bigger margins on our services because the demographics of our market allows for it.

 

So if you have an ultrasound machine sitting in your hospital and you aren’t using it on every lameness case you might be selling yourself short. Don’t sell yourself short! VetPrac has organised the worlds best lameness ultrasound workshop for equine practitioners this year on July 4-5 and 6-7th.

Register HERE for ‘Distal Limbs‘ July 4-5.

Register HERE for  ‘Proximal Limbs and Spine‘ July 6-7.

CLICK HERE to download the brochure about these workshops.

 

This article has kindly been written by our friends at

 

Proudly supported by:

vPOP is a Surgeon’s Best Friend designed by Vets for Vets

vPOP-pro is the veterinary Preoperative Orthopaedic Planner vets have been waiting for.

If you’re a busy surgeon, needing precise planning tools that are always at your fingertips  in your pocket or at your nearest device , or if you’ve had enough of never finding the  out-of-date  fading slippery disappearing acetates  , just maybe you can’t afford an overpriced software licence with pixelated implant templates restricted to one pc that’s never near when you need it .

Well, the solution is downloadable in 5 minutes at vPOP-pro. 
Just click ‘get vPOP’.

Every surgeon and their patients deserve the best portable precise and accessible planning tools to facilitate better patient outcomes.

You’ll have one account across all your devices for seamless cloud syncing. Want to upload a radiograph you’ve been sent on your iPhone?…Done!

Want the convenience of being able to plan on your office laptop with your colleagues over a coffee?… Just login!

You can then take the plan into theatre to visualise your calculations. Simply prop your iPad on the trolley or stream it via Apple TV for the big screen experience!

“I believe as vets we deserve peerless resolution for precision implant templating. Every implant has been painstakingly digitally redrawn in vector graphic format – no more pixels!

For less than the price of a cup of coffee every week, a surgeon can have these precision planning tools in their pocket. Not only that, we can inform owners efficiently in the consultation room too. Orthopaedic consultations can be very stressful. Vets are always under time pressure because we want to ensure our clients understand everything, and it’s all too easy to overrun simply because we care. If you have your iPhone and an internet connection, you can use vPOP.  I now save so much precious time every day,  I can efficiently  inform owners and leave them with a lasting image of the solution, not the problem that they have entrusted their pet to me for.”  ~ Dr Rory Paton BVSc CertAVP MRCVS (founder of vPOP)

At only £125 per surgeon per year, or £12.50 GBP per month, you really can now plan and template a TTA, TPLO, CBLO, angular limb deformity, even a THR on your iPhone.

Take a mini tour to the vPOP mini instructional YouTube video channel. Watch a virtual  TPLO, CBLO, and TTA being performed and planned with efficiency and precision.

Designed by Vets for Vets, vPOP is helping surgeons in universities, referral centers, training course providers and first opinion practices around the world. Let vPOP help you and come see what people are talking about at vpop-pro.com and just click ‘ get vPOP’.

More details are available on the vPOP pro website. You can also join them on Facebook and Instagram.

Dr Alex Young – From UC Davis to the University of Queensland

Dr. Alex Young always imagined she’d be a horse vet. What started as a large animal ultrasound fellowship at UC Davis to hone her skills as a lameness diagnostician ended up in a specialist radiology qualification. It was the “exposure” to many different imaging modalities at UC Davis that morphed Alex from an equine vet into a specialist radiologist. Let’s hear more about Alex’s career and her passion for education.


What inspired you to become a veterinarian and then go onto specialise in radiology, in particular equine musculoskeletal imaging?
“My family owned a small thoroughbred breeding business when I was young and I always wanted to work with horses. At vet school, I was convinced that if I wasn’t a horse vet, I wouldn’t be a vet at all. I wanted to be out on the road, in my truck looking at horses in the fresh air and sunshine…these days I sit in a dark room and sometimes look at cat/dog radiographs thinking “How did this happen??” I never planned to become a radiologist. I liked lameness workups and began the UC Davis Large Animal ultrasound fellowship thinking that it would round out my capabilities as a lameness diagnostician…but with the exposure I received to all the other imaging modalities while I was there I couldn’t help but become interested in those also.”

Who were the biggest influences in your training at UC Davis?
“Dr. Sarah Puchalski, Dr. Mary Beth Whitcom and Dr. Mathieu Spriet”

Any advice for new grads or general practitioners that wish to pursue further education in the use of ultrasound for lameness assessments?
“There are some great ultrasound workshops around and the EVA generally has an imaging person presenting at the Bain Fallon conference every couple of years. Try to keep an eye out for these as there are often associated wet labs that offer great hands on experience.”

What have you learned from experience that you didn’t learn from a textbook?
“Ultrasound is all about practice and hands on repetition. The more you scan, the more you develop your hand-eye coordination and the more skilled an ultra sonographer you become. The more you see, the more you realise the mistakes you have made in the past and the better diagnostician you become.”

What do you enjoy about teaching?
“I really enjoy contributing to what I believe is a lingering deficit in our equine veterinary training. Most equine vets were never taught how to operate an ultrasound machine let alone place a transducer on a horse in vet school so there is a huge population of “self taught” vets doing their best but also feeling quite lost with this modality (I was one of these vets before I went overseas!) I enjoy helping my colleagues fill this deficit and sharing the skills and knowledge I gained in the USA.”

What do you like to do in your spare time?
“Spare time? What is that? I’m embarrassed to admit that prior to having kids, most of my life was my work. Now I’m loving being a mum and spending time with my family. My work might keep me in a dark room but family time is spent outdoors in the fresh air as much as possible!”

If you’re one of the many vets that feel lost with using ultrasound in lameness assessments of horses, why not register for the Equine Lameness Ultrasound workshop with Dr. Denoix at Gatton on July 4-7, 2019.  At this workshop, you’ll also meet Alex and have an opportunity to share much of her vast knowledge of all things imaging.

Download the brochure HERE.

Register HERE for Distal Limbs on July 4-5th 2019.

Register HERE for Proximal Limbs and Spine on July 6-7th 2019.

Video: CRI Canine Sports Medicine Course

Canine Rehabilitation Institute (CRI) is coming back to Australia!

Join us at the Canine Sports Medicine and Rehabilitation workshop. This is your opportunity to learn from the world’s best. Enrolments are open to Veterinarians, Physiotherapists and Vet nurses who work with a veterinarian certified in canine rehabilitation in their practice.

Canine Sports Medicine & Rehabilitation, 30th August – 1st September, 2019
This 3-day workshop contributes to the CCRT program. You can find out more by downloading the brochure on this link. This workshop will fill quickly so register now to avoid missing out.

 

Meet Dr Jones, “Horses flow in the blood of the Irish.”

Meet the widely travelled Irish equine veterinarian who now calls Australia home, and whose preference for a “quiet one” has adapted to her new home’s climate and viticultural products! VetPrac is excited to welcome Dr Sue Jones to our team of educators; let’s find out a little more about Sue’s journey from Ireland to Australia.

What inspired you to become a veterinarian and then go onto further study in large animal ultrasonography and equine sports medicine and rehabilitation?
“I have wanted to be a vet since I can remember, and I guess was inspired by my Dad’s love of horses to specifically pursue equine practice. I would be remiss to not acknowledge the James Herriot books as also being somewhat responsible for my choice of career. As for pursuing ultrasonography it was twofold. One was how alarmed I was by the presence of the ultrasound machine in my car in my first job. The second was my genuine belief that the more precise you can be with the diagnosis the better the management can be.”

You’ve worked in your home country of Ireland, and then the U.K., many states of Australia and then the USA before returning to Australia. What are your favourite things about each of these countries?
“A difficult question to answer briefly! Ireland will never cease to amaze me in its beauty, but also the depth of love for the equine industry. Melbourne certainly comes close in that regard, but horses flow in the blood of the Irish in a very traditional sense. The standard of equine practice in the UK really set the bar for me and encouraged me along the lines I have followed to expect more of myself and deliver more to clients. Also, it’s difficult to beat an open fire with a hot toddy after a walk in your wellies in the streaming rain. I have come to love and adopt Australia largely because of the people, their love of the outdoors, their relaxed nature and the vineyards may have had something to do with it! California was a spectacular place to live and UC Davis was truly inspirational as an institution.”

What do you consider is the most significant advancement in equine ultrasonography for lameness in the last 5 years or so?
“The ease of access to reasonable priced highly efficient and multi-purpose machines. Equine vets are increasingly looking to make the most out of their investment and as such seeking on-going training to support their performance clients”.

Are you working on any research projects at the moment?
“I have recently submitted a paper on the evaluation of the larynx in horses during swimming. We scoped them while they were swimming which had a few logistical challenges but was pretty fun.”

What do you enjoy about teaching? Who has been your biggest influence when developing your own teaching style?
“I particularly enjoy identifying various ways to adapt my teaching for the individual student. I love when someone has a particular aim and I am able to assist them to reach that. I did the fellowship as my ability to scan was so far below where I wanted it to be and I feel so strongly that sharing what I have learnt will advance equine practice. Dr Mary-Beth Whitcomb (UC Davis) has one of the most individual and innovative teaching techniques I have ever come across and I do attempt to channel this into my own teaching”.

What do you like to do to wind down? What do you like to do for fun?
“I really enjoy sitting outside after a day’s work with a glass of wine (specifically a South Australian Shiraz!), a few friends and a cheese board. I play field hockey for the local Werribee Tigers who have welcomed me in as part of their family (it’s been a slow start to this season however with many injuries!).”

 

To enhance your expertise in using ultrasound as a diagnostic tool in equine lameness, and experience Sue’s teaching style, register for the VetPrac Equine Lameness Ultrasound workshops:

Register HERE for Distal Limbs on July 4-5th 2019.

Register HERE for Proximal Limbs and Spine on July 6-7th 2019.

CLICK HERE to download the brochure for more information about these workshops. Dr Sue Jones can be contacted at susan.jones1@unimelb.edu.au or 0405 955 703.

Vet Tips for Brachycephalic and Ear Surgery

Tip 1
Post-operative monitoring, especially keeping the patient very calm, is extremely important when performing brachycephalic airway surgery.

Look to recover these patients in a quiet area, however a nurse cage-side is essential in the recovery period. Avoid stress and consider low doses of sedatives to keep them calm, for example medetomidine at low doses IV. Supplemental oxygen may be required. If significant airway distress occurs whilst the patient is oxygenated and calm, they may require endotracheal intubation while the swelling resolves or a temporary tracheostomy.

 

Tip 2
Treating gastro-intestinal signs medical improves the prognosis with brachycephalic airway syndrome.

Medical management primarily focuses on reduction in gastric acid secretion (consider omeprazole 1mg/kg BID) but may also include increasing the rate of gastric emptying with drugs such as cisapride, dietary management and antacid therapy in dogs with overt digestive clinical signs e.g regurgitation or vomiting.

 

Tip 3
You should aim to address as many factors as possible when performing brachycephalic airway surgery.

Some factors to address include aberrant nasal turbinates, everted laryngeal saccules, laryngeal collapse, elongated soft palate, everted tonsils, and stenotic nares.

 

Tip 4
Maropitant, omeprazole and medetomidine can all be useful medications to consider pre-operatively on the day of airway surgery.

Medetomidine can be a useful addition to the premedication at low doses of around 3-5ug/kg. Again, keeping the patient calm is a priority. Maropitant given subcutaneously on the morning of surgery is thought to help by reducing the risk of regurgitation post-operatively. Omeprazole is recommended by some surgeons a few days prior to surgery to reduce gastric acid secretion. This is then generally continued on the day of surgery and post-operatively for a few weeks. This may be more important in dogs showing concurrent gastro-intestinal signs.

 

To learn more about these surgical techniques, treatment plans, and post-operative care – join the VetPrac Fix The Face: Brachycephalic And Ear Surgery Workshop September 13th – 15th.

There are 4 places remaining so Register Today!

A Discussion With Dr. Jean Marie Denoix

VetPrac is excited to welcome Professor Jean-Marie Denoix to Australia in July 2019; he will lead the equine lameness ultrasound workshop at UQ. Dr. Denoix is considered to be the world’s foremost equine musculoskeletal system anatomist. Let’s get to know how Dr. Denoix became the guru he is, and learn about the wonderful facility in Normandy, France, CIRALE, that is his workplace.

 

What inspired you to become a veterinarian and then go onto specialise in equine locomotor pathology?
“I was interested in sports and horses, so I have made this synthesis: equine athletes!”

Who was your most influential mentor when you were training to become an equine specialist?
“Professor Robert Barone, famous French anatomist who asked me to stay at university for teaching”

What advice would you give recent graduates who are interested in furthering their knowledge in equine locomotor pathology?
“To learn anatomy and biomechanics!”

What do you enjoy about teaching?
“To demonstrate the link between anatomy, biomechanics, the cause of lesions, clinical manifestations and rehabilitation exercises.”

How is your time spent working in the field of equine locomotor pathology?
“I spend 60% of my time seeing clinical cases and 20% of my time doing research (on clinical cases); the remaining 20% is spent teaching postgraduate (15%) and undergraduate (5%) students.”

CIRALE (Centre of Imaging and Research on Equine Locomotor Affections) is a world-class facility that has been your workplace since its establishment in 1999. What type of horses are referred to CIRALE? Do you accept referrals from veterinarians or owners outside of France? How has CIRALE expanded over recent years?
“We accept only referred cases, from everywhere: 50% from Normandy; 30% from elsewhere in France 30%, and 20% from abroad. Many disciplines of horses are referred to CIRALE, including Showjumpers, Eventers, Dressage, Trotters, and Thoroughbreds; CIRALE sees 1100 cases per year. New facilities for internal medicine and surgery and a campus with more undergraduate students will open in 2023 on the same site as CIRALE. This will bring new cases. Recently a new building has been constructed providing 3D imaging (CT scan + MRI under general anaesthesia); I will personally be involved in a new rehabilitation unit for race and sport horses (with outside track and arena, swimming pool, and water treadmill). Research that I am currently undertaking at CIRALE includes ultrasound diagnosis of musculoskeletal system injuries, and rehabilitation protocols based on controlled exercises.”

What is your favourite or most memorable case at CIRALE?
“A case with a fracture of the first rib creating stenosis of the subclavian artery and lameness at work because of lack of blood perfusion of the shoulder muscles.”

What are your favourite leisure activities you enjoy on days when you are not working?
“Doing sculptures, training horses, looking at nature”

 

No doubt Jean-Marie’s superior knowledge of anatomy is an asset for doing sculptures!

 

Register for Distal Limbs July 4-5th &/or Register for Proximal Limbs and Spine July 6-7th.
Download the Brochure for more information about these exciting opportunities.

Case Study: Bilateral fractures a common complication in toy breeds

Meet Merlin, the Chihuahua cross whose magical skills weren’t enough to prevent injury when he jumped out of a car!

Merlin was referred to Dr Peter Young for management of bilateral non-union fractures of the distal radius and ulna; a not uncommon complication of such fractures in toy breed dogs.

Merlin, an 8-year-old male Chihuahua cross presented with a history of jumping out of a car 2 months prior. Immediately after the incident, he was taken to a local clinic, where bilateral radiographs of radius and ulna were taken. They showed fractured bilateral tibia and ulna in the distal 1/3 of the diaphysis. Both legs were splinted at the local clinic.

2 months after the incident Merlin presented to the referral vet with bandages on both front legs. Merlin was unable to bear weight on either front leg. When palpated both front legs felt unstable. Radiographs of the tibia and ulna were taken of both legs in lateral and dorsopalmar position. These showed signs of delayed bone healing and malalignment. There were signs of decalcification of the ulna and radius distal to the fractures.

Clinical and radiographic examination showed that the fractures had not healed, the fracture ends had not been retracted to normal position and there was still instability around the fractures.

The left radius and ulna were hypertrophic with a fragment overriding, and the right radius and ulna were atrophic, also with a fragment overriding. Surgery was recommended in order to obtain complete bone healing.

The surgical procedure chosen was external fixation of the atrophic non-union mid shaft fracture of the left radius.

The dog was placed in dorsal recumbency. The intercarpal joint was located by inserting 2 needles in the medial and the dorsal joint space and detecting joint fluid. A k-wire was drilled through the distal radius in a lateromedial direction just proximal to the joint space. A ring fixator was applied on the wire and another k-wire was applied in a dorsopalmar direction. The carpal joint was manipulated to confirm that there was no accidental articular insertion of wires. A 2 cm incision was made over the dorsomedial part of the fracture. The cephalic vein was identified and protected at all times. A transverse osteotomy was made at the location of the chronic fracture and the distal and proximal parts were aligned. The distal part was rotated 30 degrees so the supination was neutralised. 2 positive threaded pins were applied 11 and 40 mm proximal to the osteotomy in a lateromedial direction and 2 pins were applied 7 and 27 mm proximal to the osteotomy. Each pin was locked on to a bar with clamps connecting the two pins and the fixation ring. Alignment was checked. A 10-degree medial angle at the osteotomy site is detected and an adjustment on the fixating configuration was made to correct that. All bolts were tightened, and the skin was sutured with Premilin 3-0.

A soft dressing was applied to control swelling.

Radiographs were planned for 3-4 weeks post op; these will determine when the external fixation can be removed.

The right leg went on to heal spontaneously once Merlin could ambulate on the left.
With the increasing popularity of toy breed dogs in our densely populated cities, cases like Merlin are not uncommon.

VetPrac is excited to offer a workshop that will equip you to appropriately manage cases like Merlin and hopefully reduce the risk of complications such as non-union fractures.

The Fine and Fiddly Fracture Workshop will be held at UQ Gatton on April 12-13, 2019. To register for this amazing workshop, click here. For more information, check out the brochure.

Nurture Your Self-Confidence & Increase Performance

Dear Colleagues,

VetPrac contributes to helping veterinarians prepare for their technical roles by offering a lot of opportunities. It’s exciting to hear about these success stories as you grow in your professional roles but confidence is an area that seems to hold us back. As high achievers we look to our exceptionally talented and trained peers or predecessors and often think – “Oh, I can’t do that. I’ll never be that good. I haven’t the time to get those skills” We do this because it’s easier to stay in our comfort
zone and more often than not, lack the confidence.

“With the realization of one’s own potential and self-confidence one can build a better world”
~ The Dalai Lama

But what is self-confidence and how do we know we have it? Or how do we bet more of it? It requires trust and self-belief. It permeates our thoughts and feelings defining our actions and the outcomes of those actions. Low self-confidence limits us. The Online Psychology Dictionary defines self-confidence “Our self-assurance in trusting our abilities, capacities, and judgments; the belief that we can meet the demands of a task.”  Self-confidence is clinically determined by “The Self-Esteem Formula”, “The Self-Efficacy Theory”, and “The Self-determination Theory”.

While it has never been the scope of VetPrac to advance what the veterinary community knows about psychology, I find it fascinating that we are only limited as a community by our self-belief and confidence. We are intelligent and capable. I don’t think many clients look at us collectively as a group and think anything less. If there was a zombie apocalypse I know I’d feel much safer in a group of vets (preferably mixed practice) than any other contingency in society. So, where’s the gap?

I read constantly about the personal gripes we have about how we are perceived by clients, business partners, managers and family members across all forms of media. This bothers me. I have never met a veterinarian under 40 who isn’t disappointed with some part of their life because they played it safe.

In 2018 I learned to ride a bike. I’d never tried something others explore in their childhood because of my self-confidence and I didn’t trust my balance. It turns out I actually have great balance. I also didn’t trust I could steer, break and pedal at the same time or when required. It turns out, it’s actually not that hard once a good teacher explains the fundamentals and supports you. Once someone I trusted showed me and showed me I could do it, I believed it and I did it.

Confidence is a shareable trait. It’s a communicable condition that can be nurtured. It permeates everything we do and its potential is exponential and shareable.

We would like to help the veterinary community build self-confidence in 2019. Dr Cathy Warburton is a coveted speaker and trainer on this topic. In 2019 She will be leading small classes online about “How High Achievers Succeed” as well as a special ‘VetTalk Communication Workshop‘ with Dr Sandra Nguyen. No one is born with excellent communication skills, we develop them along with all our other talents. The theory behind good communication can be learnt and practised.

Regardless of what you hope for yourself in 2019 if you have healthy levels of self-confidence you will be better equipped to succeed. Check out our workshops that offer training and understanding about self-confidence HERE.