Part 2 Anaesthetic considerations during Laparoscopy

Last week we explored the impact laparoscopy has on the pulmonary and cardiovascular systems.

So how can we manage our patients’ anaesthetic to achieve the best possible outcome when performing laparoscopic procedures?

Ventilatory support in the form of intermittent positive pressure ventilation (IPPV), with a mechanical ventilator, is recommended for patients where the procedure is anticipated to last longer than 15 minutes.

 

Mechanical ventilation should be commenced once the patient is stable under general anaesthesia as follows:

1. Monitor ETCO2 – the normal range is 35 mmHg – 45 mmHg and this is crucial for decision making about the ventilation requirements of the patient.

2. Tidal volume 10 – 20ml/kg – set the ventilator at 10 ml/kg and increase as required. In order to avoid barotrauma, it is wise to set tidal volume at no more than 20ml/kg, and to adjust the respiratory rate.

3. Respiratory rate 10 – 12 breaths/min, adjusted to the requirement of the patient. Changing the rate up or down based on the degree of increase or decrease, respectively, in ETCO2 is a sound strategy to manage ventilation. This protects the lung from being damaged by barotrauma due to over ventilation in the face of an expanded abdomen and minimises the decrease in venous return that occurs when the thorax is expanded due to positive pressure ventilation. Blood pressure monitoring is strongly recommended for laparoscopic procedures.

 

While mechanical ventilation is recommended, it is possible to manually or hand ventilate a patient during laparoscopy of longer than 15 minutes duration. If this is the only option available then a dedicated person, or “human ventilator”, is recommended to squeeze the reservoir bag to provide a breath to the patient, during the procedure.

Manual positive pressure ventilation criteria:

1. Monitor ETCO2 – essential to the success of any IPPV whether it is instituted mechanically or manually, because this guides you to successful beginning and end points of ventilation.

2. Use a manometer (pressure gauge) connected to the breathing system so that you know what pressure you are delivering, ideally 10 – 12 cm H20. If you don’t have a manometer then observe the thorax as you deliver a breath and make sure that this looks like a reasonable respiratory excursion. Remember positive pressure ventilation impacts the cardiovascular system by decreasing venous return, lowering cardiac output and blood pressure. Again, blood pressure monitoring is strongly recommended.

3. Respiratory rate see Point 3 above.

 

Laparoscopy is such a valuable skill to utilise in your clinic. Appropriate planning, and vigilant monitoring of ETCO2 and blood pressure during anaesthesia will help achieve an optimal outcome for your patients.

 

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.

 

Other interesting reads:
Part 1: Anaesthetic considerations during Laparoscopy
From Laparoscopy to surgery on large land-based predators (Dr Brenton Chambers)
A peek into Laparoscopy with Dr Peter Delisser
Dr Kathryn Duncan joins the laparoscopy educator team

 

Seeing Things Eye to Eye… Meet Dr Martyn King

Back in the mid 1980’s as a recent graduate, Dr Martyn King didn’t always see “eye to eye” with his senior veterinary associates when they were managing ophthalmic cases. 

He sensed that there must be better ways to treat many of these cases, and began a long journey towards specialisation which initially involved reading, and then moving to the UK. Martyn has worked full time in veterinary ophthalmology since 1994, and has been a specialist ophthalmologist since 2002. 

Martyn now recognises that the best way of learning about ophthalmology is from experience, such as attending a VetPrac ophthalmology workshop, rather than just reading a textbook. He has found that vets often think that the picture in the ophthalmology textbook will show you exactly what glaucoma looks like, or what a corneal ulcer looks like, but that real life is very different. In Martyn’s opinion vets need to get their hands dirty if they ever hope to be an ophthalmic surgeon. 

Attending an ophthalmology workshop will offer an opportunity to learn how to do a thorough ophthalmic examination and to recognise a normal eye, 2 areas which Martyn considers vital to becoming competent enough to be able to accurately diagnose and appropriately manage ophthalmic cases. He suggests that “vets should keep looking at everything to build up a repertoire of normal, and to be thorough, doing every test on every eye. Start with checking for comfort, then do the neuro-ophthalmic testing – any eye that does not have a PLR and you don’t know why needs to be referred. Then start at the front and work towards the back – use magnification – look at everything. Do exactly the same protocol on every eye and don’t get distracted by obvious things when sometimes the more subtle things can give you the diagnosis. Always examine both eyes.” 

Martyn believes that GPs should have a certain skill set to be able to deal with simple lid and lash surgery, or enucleations etc, and be able to cope with some surgeries (e.g. conjunctival grafts) where owners can’t or won’t go for referral. Another valuable lesson GP vets can gain from attending an ophthalmology workshop, according to Martyn, is the ability to recognise the difference between eye conditions that they are able to manage themselves and those that should be referred. 

Practising in the UK offered many opportunities for Martyn to develop a special interest in ophthalmology due to the high rate of insurance, allowing scope to investigate and treat fully, and the large size of practices which tend to be very well equipped. Martyn returned to Australia in 2005, after 19 years of practice in the UK, to be back in his home town. He would encourage all vets to have a stint in the UK – not necessarily the 19 years he spent there but a few years would be good. He was a little worried initially on his return to Australia because insurance was not as common in 2005 and he thought that referral was going to be less commonplace in Australia than in the UK, but this has not been his experience at all. Martyn has found that vets here and their clients are very keen to be referred, insurance or not. 

Martyn’s work in ophthalmology is extremely rewarding, especially when he’s able to restore sight or relieve pain. “The happiness of a pet and their owner when they “see” each other is amazing. You can just see how happy the animal is – and the owners are so grateful. Whether it be cataract surgery or performing laser surgery or gonioshunt surgery for glaucoma, or corneal grafts – all these techniques are very rewarding.”  He’s currently setting up an endolaser unit at Perth Animal Eye Hospital to improve the management of glaucoma and intraocular neoplasia. 

Martyn loves teaching the students at Murdoch University and at the Vetprac courses. “Imparting knowledge is wonderful, and seeing the amazement on student’s faces when they see the fundus for the first time is fantastic! It’s wonderful to know that by helping these people to learn we are not just helping them but also all the patients they will be seeing themselves”. He encourages new graduates to listen to nurses! “They know heaps and are a great source of information! Keep asking your boss for help and if they won’t help then find a new job! Admit things if you are not sure so you can work them up with your colleagues, or to give you time to practice examining the fundus etc. Keep practicing, keep looking” 

Martyn looks forward to opening your eyes to the area of veterinary ophthalmology at the VetPrac Practical Ophthalmology workshop in February at UQ Gatton. Register today or click here to read more information.

Written by Alison Caiafa

 

Contact information:
Dr Martyn King
Perth Animal Eye Hospital
Phone (08) 6110 1616 

 

Join VetPrac on the 15-16th of February 2020 for the popular Practical Ophthalmology Workshop where you’ll develop skills that will build your surgical confidence. With over 7 hours of practical wet labs this hand-on’s stimulating environment will allow you to walk away with skills that can be immediately applied to general practice. Class size is limited with tutelage by specialist ophthalmic surgeons Dr. Mark Billson, Dr Martyn King, and Dr. Edith Hampson. Did we also mention the workshops are super fun?

Part 1 Anaesthetic considerations during Laparoscopy

When planning for laparoscopy, have you ever thought about its impact on your patients’ ability to tolerate general anaesthesia? The key to success, as always, is preparation and vigilant monitoring.

The abdominal insufflation required during laparoscopy will impact on both the pulmonary and cardiovascular systems. Understanding the changes that occur when the abdomen is insufflated will help you plan appropriate ventilation strategies. This, along with considering the primary presenting disease and any co-morbidities, will help set you up for success.

This blog will discuss the impact laparoscopy has on pulmonary physiology. A subsequent blog will discuss some possible ventilation management strategies.

 

Impact on pulmonary physiology during laparoscopy


When laparoscopy is performed gas is used to insufflate the abdomen to a pressure of up to 15 mmHg. The resulting significantly increased abdominal pressure limits normal movement of the diaphragm. Lung tissue becomes less compliant, tidal volume decreases and there is a decreased lung functional residual capacity. This results in a significant decrease in gas exchange throughout the respiratory cycle. Insufflation may also lead to a mismatch in ventilation/perfusion, where deoxygenated blood is carried back to the arterial side of the circulation, causing a reduction in delivery of oxygen to the tissues. Bottom line the greater the insufflation pressure the greater the impact on pulmonary physiology.

In spontaneously breathing patients, the reduction in tidal volume results in significant hypoventilation, and respiratory muscle fatigue can occur when breathing against an expanded abdomen. This leads to an increase in end-tidal carbon dioxide (ETCO2). This increase is further exacerbated by the fact that carbon dioxide (CO2), a highly diffusible gas, is the most commonly used insufflation gas. CO2 will enter the blood stream contributing to the rise in arterial CO2 (PaCO2) and ETCO2.

High ETCO2 leads to a respiratory acidosis, which drives down body pH, leading to an acidaemia and a significant disruption to cellular metabolic processes within the body.  If the patient is already vulnerable due to an established disease process then this will only exacerbate the situation, increasing the risk of anaesthesia and potentially exposing the patient to a poor outcome.

 

Next week we’ll discuss some strategies for managing ventilation of patients during laparoscopy.

 


 

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.

 

 

Other interesting reads:
Part 2: Anaesthetic considerations during Laparoscopy
From Laparoscopy to surgery on large land-based predators (Dr Brenton Chambers)
A peek into Laparoscopy with Dr Peter Delisser
Dr Kathryn Duncan joins the laparoscopy educator team

 

What school did you go to?

Sometimes we come across a question in our careers that influences how we are seen and how we see ourselves. One which I am grappling with at the moment is “What school did you go to?”

As new graduates looking for jobs, or employers looking for staff, it’s a question – an unfair one if you ask me.

Is it fair that we are judged in our ability by what school we went to? And why are we judged by this? After all, our parents’ circumstances often dictated the answer and it wasn’t always our choice (or ability) to have the best possible start in life.

The good thing about being an adult is we become responsible for our own opportunities and investments. We are still limited by some circumstances but usually, with negotiation, these can be managed with sensitivity and sensibility.

What we learn in life to be able to do our job well is important. But how we learn and who teaches us influences the way we practice those things we learn throughout life. It determines the value system under which our performance can be measured and science has shown that the value system of our performance is a better measure for our resilience, success, and happiness than purely performing on the job.

 

 

At VetPrac we have an exceptionally high standard of education and service. We work with specialists who have excelled not only in their chosen field of veterinary practice but also have accolades towards their teaching style. Most have published chapters in textbooks. Many have taught at universities, received awards for their skill, and are invited to speak internationally. Most importantly, all of them are great people with noble values and ethics who are wonderful to spend time with and learn from.

The results we have seen from learning with these people over the last decade is a progression of General Practice Quality by the learners who participate in our training. We go back to work with more confidence. We understand the reasons and decisions for cutting and charging for our care. We have more compassion for our clients and co-workers too. All of this is because we take the time in our workshops to get to know each other, share experiences and form a community.

 

“99.93% of VetPrac participants consider their experience was good value for money, improved their skills and they’d recommend it to their colleagues.”

 

I’m very proud of what VetPrac offers the veterinary profession. Our doors are open to anyone who wants to learn and develop skills to be a better vet. In a decade our statistics on feedback across all our workshop show 99.93% of participants consider their experience was good value for money, improved their skills and they’d recommend it to their colleagues.

So, as you are choosing your training programs for 2020 I’d like to invite you to think about what sort of experience you want to gain and how far you want it to take you. Its your choice, and your opportunity; And I promise VetPrac will do everything we can to help you achieve your goals.

Sincerely,
Dr Ilana Mendels

 

 

JOIN US IN 2020! Registrations are open for these workshops.

 

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.

Dr. Kim Lim inspires with her passion for Canine Rehabilitation

If you’re one of the lucky people that has registered for the Canine Sports Medicine and Rehabilitation Workshop, you’ll meet Dr Kim Lim, who is an educator at the workshop. When I interviewed Kim recently, I was blown away by her passion for veterinary rehabilitation. If Kim can’t demonstrate the benefits of rehabilitation, then I don’t think anyone could!

Read on to learn more about Kim and her inspiring career in rehabilitation.


 

What inspired you to become a veterinarian and then go onto specialise in canine rehabilitation?

“I chose to be a vet by default; looking at a list of university courses in year 9, I had no idea what most of them were. Top of the list was actuary(?) Anyway at the bottom was veterinary science and I knew what that was. Maybe it was a bit of guilt from my rabbit having to be put down with myxo. Luckily for me, I have never regretted it. I loved pulling things apart and trying (mostly unsuccessfully) to put things back together again when young. Surgery was quite similar, but I didn’t enjoy the anaesthetic side of things (back then, I started with an in-breathing Komesaroff, no other monitoring devices etc.).

Discovering biomechanical medicine allowed me to change the biomechanics and function of the body without the anaesthetic or cutting things open. Rehabilitation was a natural extension of the biomechanics training. Sometimes it is like finding pieces of the jigsaw puzzle; you keep looking for better, more elegant ways to help your patients. I remember graduating from vet school and feeling like I never wanted to study again.

So, I did an acupuncture certification a year later because that wasn’t anything like vet school studying. It was more like the stuff my mother used to tell me; a bit of my culture thrown in, not really medicine…How wrong I was; and I have never really stopped learning since.”

 

What would you have done if you hadn’t become a veterinarian?

“Probably an engineer. There is a long history of engineers in the family. I have since found out that my love of fixing things is not just an engineering thing but is shared among many vets.”

 

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

“I first discovered the importance of rehabilitation when a patient was presented to me four weeks after cruciate surgery. I asked the owner what she had been doing since the surgery and she told me she had been walking to the letterbox and back. When asked what else she had been doing, she replied, that’s it. That’s all the surgeon said the dog was allowed to do. I think this was the moment in 2011 when I realised I had a mission to educate my fellow veterinarians out there that just like in human medicine where they get you out of bed the day after surgery and on to a rehabilitation programme, it is not correct to cage rest or severely limit mobility of a dog after a similar type of surgery for six weeks. Another classic example is of the cruciate repair where the surgeon is happy with the surgery, healing rate etc. but the dog’s gait and posture are terrible; hind legs tucked under, kyphotic stance and no engagement and no strength from behind. Changing the biomechanics and adding rehabilitation to engage the hamstrings and release the psoas and the patient can then reap the benefits of the cruciate surgery.”

 

Read Dr. Lim’s article published in Vet Practice Magazine (May, 2019)

 

What procedure, technology, or medication have you used for a dog post-surgery or musculoskeletal injury, and realised that there was a better alternative?

“There is a common misconception that integrative/ alternative/ complementary medicine veterinarians have 2 heads or a chip on their shoulder or are just plain weird. The truth is that many of us started out wanting to be a mixed practice vet like James Herriot. However, there were things that our university taught tools were inadequate for and we kept searching for answers… The first was a Beagle more than 25 years ago. The owner reported that the dog screamed at home. On examination we poked, prodded, pulled the body all ways and got nothing. We took multiple radiographs and got nothing. NSAIDs etc. did nothing. This went on for multiple visits. Then, the owners rang and said they had taken their dog to the veterinary chiropractor down the road, Dr Alex Hauler and the dog was all better now. Apparently, it had been in the neck. A few years later, it was a German Shepherd with a sore back. I treated it with some acupuncture; he was also getting treatment at his local vet, but his back was still sore. At that time, there was a Control and Therapy article (CVE), again by Dr Alex Hauler describing the chiropractic treatment of a German Shepherd that was almost identical to the dog I was treating. It was so frustrating not having the diagnostic or biomechanical medicine skills to help this patient. A month later, I was at a Sydney Postgraduate course on endocrinology (now CVE) and Dr Doug Bryden mentioned that the very first university offered animal chiropractic course was starting at RMIT. The rest is history…”

 

What is the most memorable case you’ve been involved with, that resulted in dramatic improvement to the animal’s quality of life?

“I used to have a miracle a year and now I have lost count. They are not really miracles if you see the same improvement consistently over many years with many patients. There was the 14-year-old Doberman cross that did a disc in his neck and became a quadriplegic; his owner bought a stretcher and brought him in to see me. This dog got better, eventually was able to walk up the mountain/ hill behind his house and died 2 years later of some neoplasia. Another memorable one was a dog that got run over by a 4WD; he was going to die, then he was going to lose his leg… he ended up surviving; was brought in for acupuncture, biomechanical treatment and rehabilitation and after a course of treatment was back chasing the same 4WD. Some of them never learn.

At the moment, I am treating an acute polyradiculoneuritis that was presented to me 7 months after the diagnosis was made. This little dog could only move his head, not his legs…His owner had given up his job to care for his mate. He drove 3 hours to come to me when he found my website. This dog was in a bad way; there had been no useful rehabilitation or therapy for the last 7 months. I was not hopeful. Two weeks later at the second consultation, the dog is now crab crawling with his front legs and able to make weak paddling movements with his back legs; the tail is going 19 to a dozen. There are still no promises, but this is one reason why I do what I do.”

 

Do you have any pets?

“2 cats; a ginger and a tuxedo. The ginger’s wish in life is to be an only child- all about him 24/7. The kids have grown up and left home but there’s still one that needs his mum ALL the time. 5 bantam chickens that are the ultimate freeloaders- too fat to lay properly because they have steadily eaten their way through my orchard for the last 12 months.”

 

What do you like to do for fun?

“I am not a great believer in fun. This doesn’t mean I am miserable but rather that I feel most complete when I am useful to someone or something else. So apart from my paid job helping pets, I have volunteered my time with my children’s schools for many years and then moved on to be a venturer scout leader (still stuck with teenagers; how do high school teachers do it?). I am also involved in the Australian Veterinary Acupuncture Group, the Animal Biomechanical Professionals Association (ABPA) and the teaching of the Graduate Diploma in Animal Biomechanical Medicine. I have come to realise that I am happiest when mildly stressed! My mission in life is to leave the world knowing and hoping that I have made a difference. In my ‘spare time’ I love working in my garden, commuting from A to B by bike or public transport and visiting the local library.”

 

Kim can be contacted at 0478131646 or geelongcreatures@gmail.com
Website: geelongcreatures.com.au

 

At the time of print, there was one spot left in this workshop to be run from August 30 – September 1, 2019. I’m guessing this spot will be snapped up by someone who reads Kim’s down to earth interview responses and is inspired to learn more about the rewarding field of canine rehabilitation!

 

Download the Brochure for this workshop or Register Now for the final spot.

 

 

Vet Education Online Veterinary Conference 2019

Advance your clinical decision-making and take your diagnostic skills to the next level from your couch! Join Vet Education for 2 weeks of LIVE online lectures and expert Q&As delivered by renowned specialists and speakers from around the world.

Topics include medicine, surgery, dentistry, behaviour, anaesthesia and more at the Vet Education Online Veterinary Conference 2019

You can participate live from your couch or afterwards when you have a spare moment to grab a beverage to unwind. Every lecture includes comprehensive notes and video recordings you can watch any time from your webinar library. Join in this digital conference and tell your colleagues about this extraordinary opportunity.

 

     

 

From July 22 – August 1, 2019 – this is an event like no other featuring a virtual conference center, virtual exhibition hall, 16 webinars, a webinar library and so, so much more! You can attend the online live lectures or watch the recording later from your own Vet Education Webinar Library!

 

VetPrac are proud to be supporters of this extraordinary conference
and we recommend you Register Now and lock it in to your calendar.

 

 

 

Proudly supported by:

 

 

 

VetPrac has upcoming practical workshops with limited spots remaining. Register now to avoid missing out!

 

   

 

We’re very proud to support the Vet Education Online Veterinary Conference 2019

What do you want to learn in 2020? Here’s a sneak peek of what’s to come!

We are opening up expressions of interest for the following workshops with dates to be announced later in the year.

VetPrac is a leader in practical skills education for the veterinary community in Australasia. We pride ourselves on innovative educational opportunities for the veterinary community striving to build confidence and competence. With our high-quality training resources and access to ground-breaking technologies, we are passionate about helping the veterinary profession grow and prosper.

 

Enter your details to receive early bird announcements when registrations officially open:

 

 

 

I think this course has transformed my consulting as it has taught me so much about lameness workups that I never learned at Uni or in practice! It has renewed my excitement about veterinary practice (having been in practice for 20 years).
~Anon, Canine Sports Medicine Workshop (September 2019)

 

An excellent workshop. I enjoyed this workshop very much. Stimulating, interesting and challenging. So many take-home points and has re-ignited my passion for ultrasound and diagnosis. Thank you Prof. Denoix and VetPrac.
~Dr Kelly Barrington, Equine Lameness & Ultrasound Workshop (July 2019)

 

These courses continue to exceed my expectations. They are simply awesome! The ratio of tutors to participants is perfect with friendly, practical, knowledgeable and great tutors. The facilities are fantastic and the social interaction and environment great.”  ~Malcolm Anderson, Fiddly Fractures Workshop (February 2019)

 

Check out our current workshops for 2019!

 

 

Can’t Fix the Lameness? The importance of Post-Op Rehab for Canine Patients

Why won’t the dog put its leg down? The radiograph shows that surgery went well. Does this sound familiar? Have you see this after your cruciate or patella surgery?

The importance of post-operative rehabilitation and rehabilitation to complement the pain management plan for your old arthritic dogs cannot be ignored.

Rehabilitation and physical therapy should be a valuable service that you can offer your patients. Post-operatively, healing can be optimized and accelerated if collagen fibres are encouraged to heal to maximize strength. Compensations in associated muscles, soft tissue and associated joints can be addressed. Any restrictions is similar to having your brakes half on while trying to accelerate at the same time.

It is all too common for our non-steroidal anti-inflammatories to be less effective over time. Have you ever wondered why? Do you just switch to another pain killer or increase the dose? The cause could actually be as simple as poor delivery to the intended site due to a compromise in local circulation. Tight muscles and inactivity reduce perfusion. Properly managed physical therapy and rehabilitation can reverse this.

The old saying, “Use it or lost it” is a wise saying. It is no longer acceptable to cage rest for six weeks after cruciate surgery. Human patients are up and about the day after their knee replacements and they want the same for their pets.

 

Dr Kim Lim BVsc (Hons), Cert Vet Ac (IVAS), M Chiro (RMIT)
Educator for Canine Sports Medicine and Rehabilitation
Hosted by VetPrac  |  Aug 30 – Sep 1st 2019 |  Connect with Dr Lim on LinkedIn

 

Join Dr Kim Lim by registering now for one of the final remaining positions in this 3-day practical workshop. More details are available by downloading our brochure.

 

This article proudly features in May 2019 issue of Vet Practice Magazine.