Karl Storz & An Act of Kindness

I want to share an out of the blue act of kindness with you from our wonderful training partner, Karl Storz.

Karl Storz and VetPrac joined forces in February 2020 to host a very successful workshop, Laparoscopy: Principles & Practice. Through a series of unfortunate events, timely ordering of the correct size & type of gas cylinders was not actioned. Without these cylinders, insufflation of the abdomen for laparoscopy is not possible, and therefore our workshop would not have gone ahead.

I solved the problem in an intense few hours the day before the participants were due to use the carbon dioxide for insufflation. Because of the late notice and urgent requirement for supply and delivery, the supply company applied a surcharge which of course I agreed to.

By the time we had wrapped up and debriefed on this workshop, and completed all our tasks for “Laparoscopy” the pandemic had hit, and we were busy organising, designing and coping with the present and future. Therefore, it was mid-April 2020 when I emailed Jayne Thompson, Karl Storz South Pacific Regional Manager, to discuss our plight, and ask for a contribution towards the gas cylinder bill. I had hoped for a contribution that would cover the modest “urgent fee” that had been applied to our bill.

Instead Jayne and Karl Storz offered so much more. Jayne replied with a thoughtful email, which showed that she understood VetPrac’s plight in the face of the pandemic; they appreciated that our core business for now, has stopped. Her email described VetPrac perfectly, and her empathy was tangible. On behalf of Karl Storz Jayne offered to, and has now paid, for the entire cost of the carbon dioxide cylinders that were supplied for the Laparoscopy: Principles & Practice workshop.

 

 

This act of kindness and support was as uplifting as it was unexpected. VetPrac’s responsibility was to supply the carbon dioxide cylinders, as they are “consumables” and this is our agreement with Karl Storz. In writing to Jayne and Karl Storz, I was hoping for a contribution because the communication between our companies had not been pristine, not expecting or asking for the bill to be paid in full. Jayne’s empathy, and appreciation of VetPrac’s postponement of core business for the moment, and her understanding of what that must feel like for our team, was incredible.

These times can be stressful for many who’re facing difficult circumstances. I encourage everyone to participate in a random act of kindness even if it’s only a small gesture to show appreciation for someone doing it tough or even someone who looks like they have it all together. Help us spread gratitude and kindness.

 

Thank you Jayne Thompson. Thank you Karl Storz. The VetPrac Team feels very appreciated and supported. You are amazing.

 

 

Further your surgical skills with Dr Bruce Smith

As vets we all strive to improve the quality of life of our patients. Sometimes in order to achieve this goal, our patients may require surgical procedures which are technically challenging. Surgical procedures involving the patella and stifle are often complex but rewarding. Are you up to the challenge of furthering your skills in this area?

Dr Bruce Smith enjoys the challenges involved with surgery to joints, in particular the stifle and patella. His current roles as Clinical Director, Small Animal Veterinary Teaching Hospital, University of Queensland & Councillor, Australian & New Zealand College of Veterinary Scientists allow Bruce to devote a significant amount of time to help other specialists and clinicians achieve their goals. VetPrac is fortunate to have Bruce as an educator at the upcoming Patella and Stifle workshop.

Let’s get to know Bruce, and his pathway to becoming a specialist surgeon and committed educator.

 

 

What inspired you to become a veterinarian and then go onto specialise in surgery?
“I recall that of all the clinical disciplines (and I was determined to be a clinician) it was surgery that grabbed my attention and imagination as an undergraduate and it grew from there”.

Do you have a favourite surgery or procedure that you like to perform?
“Definitely those procedures that can restore function, reduce pain and allow the animal to express itself in movement – so orthopaedic and spinal. More specifically I have a deep appreciation and respect for engineers and bio mechanists and the implants and procedures that they have made possible”.

What is it about surgery involving the patella and stifle that you enjoy the most?
“The surgical management of a dynamic structure – such as a joint – are intellectually and technically challenging and rewarding. The patella is certainly such a challenge”.

Do you have any advice for general practitioners that wish to pursue further education in orthopaedic surgery?
“Motivation is the key; if you have it you will persist and if you persist you can achieve. There is so much access to informational and skills knowledge these days that a purposeful practitioner can easily self-inform. However, surgery is ultimately a balance of knowledge, technical skill, and good judgement. As such surgery has to be repeatedly & correctly practiced to become a skilled performance. This takes discipline, constant vigilance and good habits, both technical and mental. Developing good habits takes lots of time and hard work – there are no short-cuts, but practical instruction courses are a start”.

Are you working on any projects at the moment?
“Currently my time is primarily taken up with helping other specialists & clinicians achieve their goals. However, I maintain a keen interest in what is new and will cheerfully get involved in intern and resident projects”.

What do you enjoy about teaching?
“Ultimately teaching is learning, and this is a professional habit that I have nurtured over my career and it has rewarded me well. I see younger veterinarians facing the same challenges I did in developing their career, and believe that the exchange of skills, knowledge and experience is one of the true joys of being a professional”.

What do you like to do to wind down? What do you like to do for fun?
“Not a lot these days – slowing down, taking time to “smell the roses” and to catch up on a mountain of reading”.

Dr Bruce Smith can be contacted at basmith@ozemail.com.au

 

Join Dr Bruce Smith, Dr John Punke and Dr Peter Young at Patella & Stifle Surgery in November. This practical hands-on workshop has limited places available. Book your spot now or download the brochure for more information.

 

Vet Tips for Patella & Stifle Surgery

We’re looking forward to VetPrac’s Patella & Stifle Surgery workshop at the University of Queensland, Gatton Campus, in June. Have you booked your place yet?

Join Dr John Punke, Dr Peter Young and Dr Bruce Smith at this practical hands-on workshop to develop your skills and practice modern techniques in cruciate repair.

Dr Punke has kindly developed these tips for us to share with you. Be sure to register to join us in June for more tips and expert advice regarding Patella & Stifle Surgery. We hope to see you there!


Tip 1

Tibial tuberosity transposition (TTT) is the most important and nerve-wracking procedure to perform in the majority of medial patellar luxation cases. Indeed, failure to perform this procedure is the most common cause of surgical failure. Build confidence through our specialist’s practical tips and tricks created from years of experience.

 

Tip 2

Dogs with medial patella luxation (MPL) have been shown to have an INCREASED risk of rupturing their cranial cruciate ligament (CCL).  MPL surgery earlier in life can minimize osteoarthritis and protect the CCL long term resulting in a happier and healthier patient.

 

Tip 3

There is very much an art to performing surgery for MPL. The trochlear wedge recession and a more recent modification, the trochlear block recession technique, both allow elevation of the articular cartilage in the trochlear groove, deepening of the groove, and replacement of the cartilage. As there are no fixations, simply the pressure of the patellar to hold in the newly formed piece of cartilage, the success of the procedure relies upon the surgeons fine carving skills. With the support of highly skilled specialist surgeons and real tissues, you can hone your carving skills for better patient outcomes.

 

Register now to secure your place in the Patella & Stifle Surgery workshop. Dr John Punke, Dr Peter Young & Dr Bruce Smith will be on hand to guide you through the intricacies of this focused arthroplasty workshop. Registrations are limited so we recommend you book now to avoid missing out!

Dr Abbie Tipler: An inspirational surgeon

VetPrac is delighted to welcome back Dr Abbie Tipler as an educator at the Fix the Face workshop at UQ Gatton on 2nd-4th October 2020. When Abbie first joined VetPrac as an educator in 2018, she was working as a surgeon in general practice. Since then, she’s taken a giant leap into a small animal surgical residency at Veterinary Specialist Services (VSS), Brisbane.

Meet Dr Abbie Tipler – surgery resident, passionate educator, charity worker, and last but not least, mother of 2 small children. She appears to have mastered the juggling act of professional life with motherhood and even has something left over to give back to the veterinary and general community.

Let’s find out how Abbie manages life as a resident and a mother of 2 young children, and still has time for charity work!


Tell us a little about your residency at VSS and how you’ve adjusted to life as a resident in a very large referral practice.
“Residency life with two little ones is very busy! But I love my job, so this makes the adjustment a lot easier. There were also many skills I picked up in general practice that prepared me for referral practice, such as teamwork, client communication and history taking, so it was less of an adjustment than if I had started straight from veterinary school.”

You must be a very busy woman having young children and doing a residency. Any advice on how to create a good work life balance, and balancing parenting with work?
“Balancing parenting with working requires you to be highly organised and have a lot of support. I am lucky in that my husband has flexible hours and can work from home, so the kids drop off/pick-ups are made easy. Finding the right balance however is extremely challenging. It is something I think any working mother finds tough and I am certainly no exception to this rule!”

What do you enjoy about teaching?
“I absolutely love the thought that I could make a vets’ life easier or inspire them to try something different or learn a new skill.”


Abbie has been involved in several charities such as Pets in the Park, and Elephants Rhinos People.

For those of you that may be unfamiliar with Pets in the Park, we encourage you to watch this interview Abbie did with the co-founder of Pets in the Park, Dr Mark Westman. We challenge you to be inspired to offer your services in the future.

 

Abbie’s words about the charity:Pets in the Park is a brilliant charity that vets can get involved in, which treats the pets of the homeless. It is a great way to meet other vets in your area that you may not directly work with, and to give back to the less fortunate. I was blown away by how loved these pets are, and how grateful their owners were for our time. It was a great experience.”

 

Abbie truly is passionate about surgery and education of the veterinary profession, and gives back to the profession and indeed the general community in many ways.

Abbie is looking forward to sharing her passion for surgery with you at the Fix the Face workshop. Registrations for Fix the Face: Brachycephalic and Ear Surgery are open. This practical workshop for veterinarians is proving to be very popular and filling quickly so register now to secure your spot.

Dr Abbie Tipler can be contacted at abbietipler@gmail.com or on Facebook.

Register now for this workshop with Dr Abbie Tipler, Dr Charles Kuntz, Dr Tania Banks & Dr Kat Crosse. Registrations are limited and filling. 

Air Liquide saves the day

I’d like to share an amazing customer service experience I had in the lead up to our very first workshop for 2020, Laparoscopy: Principles & Practice.

One of the key features of laparoscopy is being able to insufflate the abdomen with medical grade carbon dioxide (CO2) in order to both visualise abdominal structures and operate within the abdomen. On Friday morning, ahead of the practicals which were commencing on Saturday morning, we discovered that the CO2 supply was not compatible with the equipment we were using for the workshop. Within a very short space of time I realised the full impact of not having CO2 for the laparoscopy workshop; it meant no workshop! We already had people flying in from all over Australia and New Zealand for this workshop, so any thoughts of cancelling or offering a second rate “no abdominal gas” version of laparoscopy was completely out of the question.

So, into action I went!
After searching the web for gas cylinder companies, I started making phone calls. I explained our situation in earnest, to numerous gas companies, and Air Liquide was the only company that heard me and immediately committed to helping me. They began with “yes” answers to all my questions and in the spaces in between they kept asking, “how can we help?”. By close of business on Friday afternoon, they had delivered enough CO2 cylinders to ensure that we would not run out. They had, quite literally, saved the day!

Air Liquide is one of those companies who go above and beyond the call of duty. They pulled their local truck driver back into work after she finished work for the week, so that our precious CO2 cylinders would be delivered. By 4:30pm Friday we were all ready to go!

My very first workshop as Director of VetPrac and our first 2020 workshop, Laparoscopy: Principles to Practice, was a huge success! I thank the whole VetPrac team, including educators, facilitators, volunteers and our training partners, and the can-do attitude of the gas cylinder supply company Air Liquide. Amazing!

 

 

 

REGISTER NOW FOR THESE VETPRAC WORKSHOPS

 

 

Dr Peter Young – A world of experience for younger generations

Dr Peter Young is a private practice surgeon and he’s joining the education team at not one but two VetPrac workshops in 2020. These workshops are an opportunity for veterinarians to get hands-on experience under the tutelage of industry experts, such as Dr Peter Young, who has been working in the industry for almost 40 years!

Peter’s career commenced in dairy work before he moved on to general and referral surgical practice in regional NSW. He spent almost a decade as a surgical educator at Charles Sturt University while working as a referral surgeon for their small animal clinic and completing research. He’s now working a shorter week as a general surgeon in Albury and we’re thankful for the opportunity to have him part of our educator teams.

Dr Young will join us on the 17th-19th April for Practical Skills Bootcamp and again in June for the Patella & Stifle Surgery workshop. We look forward to sharing more about Peter over the coming months. Here’s a glimpse of the legend that is Dr Peter Young.


 

Pete lives life to the full, enjoying competitive karate, trekking in Nepal, and volunteering overseas for Vets Beyond Borders and the Iditarod Dog Sled Race. Last year he travelled to Cape York – I’m sure he’s got plenty of fascinating stories to share from those adventures!

Pete has worked in both private practice and in university settings, as a lecturer, researcher and surgeon. In a university setting he found the case load to be challenging and interesting, however sometimes he found university clinical practice to be frustrating because the bean counters often do not have an appreciation of the clinical needs regarding staff, equipment and the need to do after-hours. He finds private practice to be very rewarding if you are in a supportive well-equipped practice with good professional standards.

When Pete was asked what advice he would give new graduates or those vets are aren’t confident with performing surgery, he cheekily stated “To appreciate that the first 25 chapters of Tobias and Johnson are critical to confidence and success (☹- sorry for that). Work in a supportive practice that will invest in appropriate level of equipment. Don’t let your enthusiasm exceed your ability. Take every opportunity to have mentorship and every case is an opportunity to learn something new.”

 


 

Join Dr Peter Young at Practical Skills Bootcamp this 17th-19th April at UQ Gatton. This workshop is suitable for experienced veterinarians in search of a refresher course, new grads, and veterinarians returning to work after a break.

We’ve crammed a lot of information into this 3-day workshop with topics in surgery, dentistry, animal behaviour, communication, and so much more! Seven other educators are joining forces with Dr Young and class size is limited to ensure participants receive the attention required to have them job-fit and able to immediately implement the skills in practice.

Register now for Practical Skills Bootcamp before the workshop fills or download the brochure for more information.

 

 

Are You Addicted Yet?

Did you know most people who attend one VetPrac workshop, attend two? Ever wondered why?

It might be that the workshop content gives them exactly what they need to treat cases in general practice successfully and with confidence.

It might be because they get to spend time with wonderfully kind and supportive specialists who want them to succeed too.

It might be because the other people at the workshop are just like them. Struggling everyday with GP life where you feel like a Jac of all Trades and a Mistress of none, but loving the variety and challenges.

It might be because we manage to immerse ourselves into something and savour it completely for two full days and it feels amazing.

It might be because we all get to escape our lives for a short time and reflect on what we love and want and that feels amazing.

It might be because the food is always delicious.

It might be because the facilitators are always around to help make it easy and fun.

It might be because vets have high expectations and on trying an alternative no other practical skills education provider in Australia has come close to the quality provided when they come to a VetPrac workshop.

It might be because after you do 3-4 procedures, the money is insignificant and the only thing you are left with is a greater opportunity to treat cases better and have successful outcomes, earning accolades for yourself and the hospital you work for and making you more valuable to the community you are a part of.

 

It might be…. How about you come and see? Check out our 2020 workshops.

 

CLICK HERE TO SUBSCRIBE for announcements about all the workshops we’re planning for 2020

 


 

“Educational, practical, friendly, encouraging, very positive experience. Enthusiasm +++ Great theory & practical components. Great lineup of educators & great support staff who made all aspects run smoothly. All involved adapted to make everything work and be delivered as advised – great course with the amount of content covered and took questions as the workshop progressed.”
Dr Lynne Falconer (RSPCA Qld)  – TPLO Surgery Workshop September 2019

 

“Brian’s instruction is clear, concise and practical. With the lessons from this workshop combined with my background knowledge in orthopedics, I can definitely move forward with confidence in performing TPLOs. Thank you!”
Dr. Waylon Wiseman (Greater Springfield Vets)  – TPLO Surgery Workshop September 2019

 

“This workshop is a wonderful way to help GPs become more confident with procedures that will allow for better standard of care and level of proficiency.”
Kate Story (Peregian Springs Vet Surgery) – Ophthalmology Workshop February 2018

 

“This was a well-targeted surgical workshop revising a series of procedures that can be done in general practice. Labs were great and lecture style enjoyable. Food and social events were really well organised, relaxed and made this a special event. Thank you.”
Anon – VetPrac Workshop 2019

 

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

 

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

 

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.