Meet The Hip Dr John Punke

Meet Dr John Punke, who hails from the USA, but has fallen in love with his new home Adelaide. Luckily for VetPrac, John has agreed to join the education team this year, to share his knowledge and enthusiasm for all things surgery at the Hips and Hindlimb Surgery workshop in Gatton on 26 and 27 June 2018.

We recently got to know a little more about John and how his veterinary surgical career and lifestyle has flourished since moving to Australia.

What inspired you to become a veterinarian and then go on to specialise in surgery?

I’ve had a love for animals as long as I can remember.  My dad and I would watch National Geographic movies together.  When I was old enough, during my summer vacation, I would walk to the local library and read every book they had about animals and dinosaurs.  I was fascinated!  I excelled in science in school, then biology in high school.  It was a bit of a natural progression for me, I guess.  I feel that I am very fortunate to have naturally fallen into a career that I love so much and can be so emotionally rewarding.  I entered a small animal rotating internship after veterinary school with 6 other young veterinarians.  I was the only one of us who enjoyed surgery.  So, the other veterinarians would see my scheduled appointments so that I could do surgeries for them (stitch ups, aural hematomas, that sort of thing).  It was an early referral system and I really enjoyed the work.  I love being able to “fix” things.  I didn’t enjoy dermatology or cardiology much at all.  It was a natural progression for me to pursue surgery on a full-time basis and I wanted to practice at the highest level I could, so I accepted a surgical internship at the same practice the next year and pursued residency after that.

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

I really enjoy the problem-solving aspect of fracture repair.  It’s a good combination of veterinary medical care with “shop” work using tools and implants.  Seeing a dog healed two months post-surgery and able to return to full function is very satisfying to me.

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

Hip and hindlimb diseases are very common in dogs; there are a lot of subtleties to their diagnosis and treatment.  I often diagnose ‘grade 2.5 medial patella luxations’ and ‘stable CCL disease’.  I find these subtle findings interesting and I think they enable me to continually improve my surgical skills. These aren’t things that are taught in veterinary school or text books.  I think being able to illustrate and teach these and other subtle findings and differences to general practitioners will help me add an extra level of quality to their clinical practice for their benefit and to the benefit of their patients as well.

Would you like to share any horror or hero stories from any of the procedures we will be addressing to inspire readers to assess and grow their skills?

Some of the most difficult surgeries I have ever had to perform were revision surgeries from failed tibial osteotomies performed in general practice.  To date, I have been able to save the leg in every case.  But, I often warn the owners that I will do my best but can’t guarantee that their dog will have their leg at the end of it.  These cases illustrate to me the importance of education, skill and attention to detail when performing this kind of surgery.  And even though I have been successful so far, I am always nervous that I won’t be able to help.

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

I would stress the importance of gentle soft tissue handling and accuracy with suturing and implant placement.  I think we all enjoy bones and joints, but the success or failure of orthopaedic surgery sometimes hinges on the health of those bones and joints as tissues.  We can’t forget that bones, joint capsule, and cartilage are living cells and need to be cared for like we would muscle, a spleen or the pancreas.

Thinking from a practice standpoint, be careful to always practice within the scope of your expertise.  For example, I do not perform total hip replacements and would not hesitate to refer to the surgery specialist across town with the skills and expertise to perform a total hip replacement well.  Never be afraid to admit and refer to someone who you know can do a better job than you.

What brought you to Australia? Has your lifestyle changed since moving to Australia?

I came to Australia at the end of my surgical residency to interview for a position in a place called Adelaide.  I had to Google it to learn that it’s in South Australia.  I thought it was worth taking a look.  I fell in love almost immediately.  I’ve always had a fascination with the animals of Australia. To see black cockatoos and dolphins on my first day in Oz convinced me to move here more than any job opportunity ever could.  I moved here 6 months later and hope to get citizenship later this year.  My wife and I love living in Adelaide.  It is only a short drive to many different wine regions, the hills for hikes, the beach, and we have many friends in town.  We couldn’t be happier here!

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

My wife and I enjoy hiking, trail running, camping, sailing, and taking our dogs on walks in the woods and to the beach.  There are many fantastic wineries and restaurants to try in Adelaide as well.

Are you working on any projects at the moment?

I’m working on a few projects at the moment.  I have developed a program to organise and teach general practice veterinarians in Adelaide how to screen dogs for hip dysplasia from a young age and what steps to take to treat them along the way.  The program is called the Adelaide Canine Hip Improvement Program (ACHIP).  We are still in the early stages of training our partner clinics, but the uptake has been very good!

I’m also developing a method to use CT and CAD modelling and custom implant design to treat angular limb deformities in dogs much more accurately.  So far, we have used the system to treat common antebrachial deformities, but I can see the system being used for other abnormalities in other bones and even with fracture repair.

We are also doing an experimental study to illustrate how much better our modelling and implant design will be in achieving accurate results and to test if our technique can make ALD surgery more accessible to less experienced surgeons.

What do you enjoy about teaching?

As a surgery specialist in practice, I can only treat and improve the quality of life for the patient in front of me.  But, as a teacher, I can help other veterinarians improve the quality of their care and utilise the skills and lessons I have learned to help many more patients than I could with my own hands.  I find that very satisfying.  Additionally, I really enjoy seeing the “ah ha!” moment on peoples’ faces when I can get them over a mental block they have been having with a concept or principle.  To me, veterinary medicine is about learning principles that we can apply and transfer to multiple cases to help us practice the highest quality of medicine and surgery possible.

For an opportunity to share in some of John’s surgical prowess and his love of his new home town, register for the Hips and Hindlimb workshop at Gatton on June 26-27, 2018.

Dr John Punke can be contacted on johnp@aaerc.com.au

Written by Alison Caiafa