Saturday, May 30, 2015

Do power breaks increase productivity and mental health?

Have you ever wondered what kind of instruments a horse dentist might use? As a small animal vet I am not called upon to perform equine dentistry, but these gents were happy to share their wisdom. 
It’s difficult to sum up the feeling of spending over a week with over 1000 colleagues from Australia and New Zealand. My mind is buzzing with so much new information and some insights into where our profession is headed. Since this is the weekend I thought it would be a bit easier to summarise in pictures, although here’s an interesting gem I wanted to discuss.

Towards the end of the conference delegates can choose workshops to attend. There were so many choices, and I wanted to go to about ten of these…animal behaviour (this group got to go to the RSPCA and clicker train shelter dogs, and donate treat-filled Kong’s to them), backyard chooks (I see more and more of these in the clinic), wound management (you would be amazed at the sort of wounds vets can treat) and dentistry (I always get something out of a dental workshop). But I chose the First International Symposium on Veterinary Mental Health.

The First International Symposium for Veterinary Mental Health & Suicide Prevention was held in Brisbane.
The organisers were worried around 12 people would turn up. They needn't have worried. The room was full – and people were watching the livestream from around the world.

When Dr David Bartram just happened to sit next to me at lunch, I had to get a fan pic. He politely obliged. It is always a bit of a thrill meeting someone whose papers you have read, and nicer still when they practice what they preach. (And more so when they don't run screaming when you tell them you've read all your papers and want a fan pic!!!) I asked him which afternoon sessions he was going to and he said he was going to enjoy some fresh air and sunshine. Ahhh. Something in that for all of us! (I should clarify that he wasn't wagging lectures - he had come early).
My impression from the day, which was very educational, is that the rate of suicide is higher in vets not so much because of inherently vetty things, but because of access to the means. As mental health campaigner Brian McErlean says, “vets have a gun in the house”. We absolutely don’t have a monopoly on depression, anxiety, relationship issues, interpersonal conflict etc.

Looking after vets: Dr Randall Lemin, Dr Brian McErlean and Dr Helen Fairnie-Jones promoting the Australian Veterinary Association's benevolent fund.
So much of the advice about promoting mental health applies to everyone. And one of the tips is the concept of a strategic break. Overworking is carried like a badge of honour in our society. But it’s counter-productive. Studies (and since it’s the weekend, no, I don’t have these to hand!) have shown that taking a 10-15 minute “power-break” or “strategic break” every 90-200 minutes increased productivity and mental health. But which margin I know not. Although the organisers suggested why not run some controlled trials in vet clinics and see what happens?

Dr Peter Hatch, veterinary mental health researcher, discussed reported workplace stressors for vets.
The rule is this: the break has to involve ENTIRELY work-unrelated stuff. You could play darts, go for a walk, eat, drink or talk to someone but not about work. Nice idea!!!

The best conference shoes award goes to Dr Karen Teasdale, of whom I am now a fan. Not only did she have the shoes, she had the dress and hair and makeup down pat. Every single day.
We will be back to our regular posting schedule next week. 

The AVA Wellness stand displayed books written by Australian vets. I've read Dr Kirkham's excellent book (for review and not personal purposes), but the others are now on the list.
Congratulations to the Australian Veterinary Association and the New Zealand Veterinary Association for what, in my experience, was the best national conference to date.

Thursday, May 28, 2015

More things I learned from the AVA conference

Laser goggles for dogs and cats. To protect them from therapeutic lasers. Spotted at the dlc stand.

Conference world is a weird parallel universe. At the 2015 AVA/NZVA Pan Pacific Veterinary Conference this week, lectures begin at 6.45am and carry right through to 6pm. Sure, one is fed three times a day, but it is a totally immersive experience and I can’t blog as fast as I am learning new information. 

Today is the final day of lectures, and tomorrow we break for workshops which are a bit more interactive/hands on.

There are eight concurrent streams, so one can’t attend everything at once as much as one would like to.

For me yesterday’s highlights included a talk by Professor David Mellor on promoting positive welfare states. For years our thinking at welfare has been dominated by the “five freedoms” model – animals should be free from hunger, pain, fear and distress etc. But Professor Mellor is one scientists who has pushed for a model of welfare and measures of quality of life that incorporate positive welfare states. He has worked on the “five domains” model which is discussed elsewhere.

Dr Magdoline Awad from the RSPCA chaired the session with Professor David Mellor.
He put forward a five-tier system for assessing quality of life in animals.
  1. Animals that have a life not worth living – these animals should be euthanased in the interests of their welfare.
  2. Animals that have a life worth avoiding – these animals may have their quality of life improved by veterinary or husbandry interventions, at least to ensure the negative experiences are alleviated so they live a theoretically neutral level
  3. The theoretical point of balance – where the negative and positive welfare states produce a neutral quality of life.
  4. A life worth living – meeting all minimum standards of codes of welfare.
  5. A good life – meeting all of the best practice recommendations in codes of welfare. Animals that have an overall positive existence.

The behaviour stream produced some heated discussion yesterday when US veterinary behaviourist Meghan Herron discussed the “top ten behaviour tips”. One of these was the myth that dogs that behave aggressively are dominant.

There was some colourful discussion when Dr Herron stated that “The idea that there is a dominance hierarchy between humans and dogs is no longer scientifically accepted. Social ranks do not cross species lines. Most human directed aggression is based in fear (perception of threat) or protection of resources.”

Wherever you sit on the fence (and the fence keeps moving if you look at the literature), our beliefs about the motivation of canine behaviour do change the way we approach and treat dogs and they have massive welfare implications.

Veterinarian and coach Dr Natasha Wilks gave a great talk on “understanding clients to increase compliance.”

Veterinarians and doctors often use the term “compliance”. But a lot of non-medicos find the term offensive and I get it. I did an arts degree before I studied vet science so the term “compliance” to me was about following a rule, or doing something that some authority tells you because they said so. I remember once reading a letter to an editor from a veterinary client saying “I heard my vet talking about my compliance. How dare they!”.

In a medical context, we mean how closely the patient or client stuck to the treatment recommendations.

But the above example really does speak to one reason why clients don’t always follow our recommendations. It’s that “us vs them” type thinking which is rapidly becoming old school. We’ve not yet found a better word for compliance but we need to find something that reflects shared decision making (happy to take suggestions).

What happens “out the back?” Dr Wilks described how veterinarians are rapidly desensitised – we tend not to notice the noise or smells in our clinic (a poor sense of smell is a definite career attribute in this field, I have to say). But we don’t see the same things clients do.

She stressed the need to SHOW clients what the problem is – point it out, demonstrate it (if possible), take a photo, show the x-rays, show them the blood results. Use models, give a handout, draw a picture, use videos, refer to a blog or website.

The important thing is to then inform the client HOW this affects their pet. Does it cause pain and if so, is it mild, moderate or severe? Is it likely to worsen? What are short and long term effects? What do they need to look for and what do they need to do?

Yesterday at lunch when I was feeling a bit fatigued along came Dr Ilana Mendels from VetPrac who managed to eat lunch, set up her personal boom box (she funked it up with Shake Your Booty) and trialing a canine massage bed (she's sitting on it) at the same time. 
There have also been oodles of meetings, the Australian Veterinary Orchestra's second ever concert, university reunions and free health checks for vets. 

Wednesday, May 27, 2015

A few things I learned about rabbit desexing

Animal cakes at the AVA conference. I made sure I had my blood glucose checked at the wellness stand before sampling these carb-tastic beauties.
Have you ever desexed a rabbit? In some States in this country where rabbits are illegal to keep as pets (such as Queensland), it’s unlikely. But interestingly, between 150 and 200 vets rocked up to a session on rabbit desexing. It felt like everyone in the conference flocked to one room (which is a semi-accurate estimate, it was about 20 per cent). Some had over forty years’ experience. Which gives you an indication of how challenging it can be.

Exotics veterinarian Dr Brendan Carmel shared his techniques with the eager crowd. For males he recommends an open technique via a pre-scrotal incision. He doesn’t worry about subcutaneous sutures as there is barely any subcutaneous tissue, and uses tissue glue to close the wound.

He does advocate speying female rabbits because of the high incidence of uterine neoplasia. Depending on the study you read it’s between 40 and 80 per cent in rabbits over 3 years. Ovariectomy can be considered in rabbits at 2-3 months old.

Reassuringly, Dr Carmel advised that the mesometrium is a major fat storage area in rabbits. Thus speying an adult female rabbit who is a bit on the plus-size side is the lagomorph equivalent of desexing a bit fat Labrador. He advocates sending off any uterus that looks hyperaemic, lumpy or bumpy in case there is uterine neoplasia. Often in females with uterine adenocarcinoma, the fat has atrophied somewhat. If he palpates a very large uterus in an adult rabbit, run some bloods and do chest radiographs before you do surgery.

The risk of anaesthetic mortality remains high in rabbits (0.7-7.4% compared with 0.1-1.4% in cats and 0.05-1.3% in dogs). Owners need to be informed about this.

Airway control is challenging to achieve in rabbits but Dr Carmel uses a supraglottid device or V-gel, or uses a rigid endoscope to intubate. These are very nifty, I popped along to the V-gel stand to check them out and they’re really easy to place.

A V-gel used to maintain airway in a rabbit (nb this is a model).
A close up of the V-gel. You can autoclave and reuse these 40 times.
Dr Carmel advocates plenty of analgesia and higher than standard doses of non-steroidals in rabbits, up to twice per day. He does not discharge rabbits until they are eating. If they don’t eat, he assist-feeds them Critical Care formula. The details of course are in the proceedings, but it was an excellent talk.

Tuesday, May 26, 2015

Managing feline aggression and urination

Michael is pictured here going nuts over a "catnip kicker" made by a client who grows her own catnip. Judicious use of herbs, cat toys and indoor cat gardens is a great source of environmental enrichment for cats.
Veterinary behaviourist Dr Gabrielle Carter gave a compelling lecture this morning about aggression between cats, and I found it fascinating. This is a problem seen commonly in clients with multi-cat households, but I’ve also seen it in my own household. On one occasion, Mike and the late Lil Puss Fawcett were sitting at the front door when a strange cat walked past. Neither liked the look of the stranger and the growling and hissing escalated…but they couldn’t open the door (nor was I going to unleash them, worked up as they were, as cat fights are a nasty business). But I was not prepared for what happened next – they went for each other instead.

It was like all the aggression needed an outlet. For the next week they did their best to convince me that they could no longer live together. Some environmental tweaking, feline facial pheromone and cat herbs later and things settled down but they were never 100 per cent the same.

On another occasion, Hero returned from the clinic having had surgery, and Michael decided he stank like a vet and chased him out of the lounge room.
So it was reassuring that Dr Carter mentioned these two types of events as common triggers for intercat aggression.

She discussed her management of intercat aggression.
  • Don’t try to force cats to be friends. Provide each cat with a core area where they can have all their needs met without walking past the other cat/other cats. This core area should contain food, water, a scratch pad and a litter tray OR a cat door to get outside. Dr Cartner is not backwards about recommending multiple cat doors in a household. And if you do provide a scratching post, make sure its tall enough that the cat can really stretch up vertically.
  • Use vertical spaces. Dr Carter is also a fan of thosecrazy houses you see on the internet all the time where someone has built elevated shelves, bridges, stairs and pathways just for their cat.
  • Use pheromones and, where appropriate, medications to help desensitise cats and try to counter-condition them (ie provide positive reinforcement when positive interactions occur).
  • When it’s a matter of outside cats coming and poking through windows and freaking out indoor cats, Dr Carter recommends using mothballs. These are toxic so they need to be crushed, put in a container with a few holes in it so vapours can escape, and left in the path of unwelcome feline intruders (but not so close as to repel one’s own moggies). Apparently 75% of cats will be repelled.

She also tackled the tricky topic of urine spraying, which I didn’t realise occurs in up to 25% of single cat households. Nonetheless, the biggest cause of urine spraying is stress and the biggest cause of stress (to cats) is other cats.
House soiling is different to urine spraying. Urine spraying is almost entirely behavioural, and involves spraying typically small volumes of urine on a vertical surface, in multiple sites, and cats tend to adopt a typical posture for this.
House soiling usually involves bigger volumes, in fewer areas, with occasional faeces involved, and often indicates urinary tract disease. Medical conditions should be ruled out.

But humans aren’t blameless here. Good litter tray hygiene (daily scooping, weekly 100% litter change, cleaning waste with an enzymatic cleaner such as Urine-Off or Biozet) reduced inappropriate urination by 76% in female cats and 56% of males.

Dr Carter gave her talk as part of a sponsored session for Hill's Pet Nutrition.

Monday, May 25, 2015

AVA Animal Welfare Forum kicks off 2015 Pan Pac Veterinary Conference

The Dermcare team, at their display which incorporates some fake allergenic plants (lest delegates go into full anaphylaxis on contact with wandering jew) are pointing to entrants of their "Clinic Cat of the Year" competition. Phil managed to enter, so if you feel moved to vote (so far he is losing to the 130 other cats) click here.
SAT is currently amongst the bright lights and big city (all those sky scrapers bring that song to mind) of Brisbane, where almost 1000 veterinarians have gathered for the 2015 PanPacific Veterinary Conference.

The conference officially kicks off today, but yesterday the Australian Veterinary Association hosted its inaugural animal welfare forum.

Within the profession, animal welfare matters are a source of sometimes heated debate. Just like in the general population, the veterinary profession consists of people with a spectrum of views on animal welfare – from those who believe animals are a resource to be used, to those who subscribe to an animal rights position, and the majority on a spectrum somewhere in between.

That presents something of a challenge for an organisation representing the majority of veterinarians in the country. Veterinarians work across a range of fields from companion animal practice to production animals, Government policy, public health, consultancy and meat inspection. It’s not unexpected that a veterinarian who treats cattle prior to live export might have a different view than a vet who treats pets in the city.

The difficulty is that the AVA is a single organisation, and there is a need to find the commonality in the views of members so that when it comes to making statements about animal welfare the position of the AVA is strong.

The forum was facilitated by Mark Strom, an organisational strategist and business consultant who has a PhD in the history of ideas. He uses techniques like grounded questions to open the way for collective understanding. As I could understand, a grounded question is one which helps draw out a story. An abstract question might be something like, “what do you want our profession to look like?” while a grounded question might be “who are you proud of?” or “what are the best examples of the AVA helping vets tackling something controversial?” [I spent last night in my hotel room trying to think of grounded questions about animal welfare, sadly without any animals to bounce ideas off].

It’s very clear that some veterinarians see themselves as belonging to an industry, and some see themselves as belonging to a profession. When it comes to animal welfare, some do not believe we need a strategy because animal welfare underpins everything we do. Others believe it must be explicitly put on the table so it cannot be overlooked.

The discussion – which audience members could participate in anonymously via text message – was very interesting. Is there any point, someone asked, in the AVA having a position on a particular animal welfare issue if members of the organisation have such different views? Is there a way of an organisation publicly having no consensus?

Since the Australian Animal Welfare Strategy (AAWS) was dismantled by the current Government, there has been something of a vacuum. The AVA has stepped in and is developing an animal welfare strategy. Other policies for future discussion include a policy on pain relief in livestock undergoing husbandry procedures – something SAT is a big supporter of.

It is telling and I think excellent that the 2015 Pan Pacific Veterinary Conference began with an animal welfare forum. Hopefully this will be an annual event. My view is that welfare and wellbeing need to be in the forefront of the minds of veterinary professionals, regardless of the industries we work with and within.

We're looking forward to the scientific program and plenary sessions.

Meanwhile, while we are fortunate enough to be at the conference, other vets like John Skuja are dealing with some really challenging circumstances as they help out in Nepal. You can read about him here.

Saturday, May 23, 2015

Should academics be recognised for non-peer reviewed writing, and other weekend thoughts

For the love of mud. SAT reader Chester ensures he will be getting a bath as he takes advantage of low tide.

What are you up to this weekend, folks? SAT is preparing to shift its HQ to (hopefully) sunny Brisbane for the 2015 AVA/NZVA Pan PacificVeterinary Conference. The Pan Pacs (a name which always invokes in me memories of Strictly Ballroom), where the the Australian and New Zealand vet associations join forces, only happen once every five years.

Close to 1000 vets are expected to flock to Brisbane to find out what’s happening in the profession.

So this weekend we’re madly packing our bags and planning what promises to be a busy week ahead.

In news from the web…

It’s true that universities promote community engagement. At the same time, they fail to reward academics who make a genuine effort to reach out, cementing the divide between the “ivory tower” of academia and the rest of the world. Blogging, for example, is one way to connect with a wider audience, but unis don’t formally recognise blogging, or writing newsletter articles, or talking to local community groups, at all.

This thought provoking piece by Professor Bill Laurance explains the problem.

If you’re in the mood for something light, check out thisincredible selection of animals with majestic hair, via SAT reader Rach. Just when I thought it couldn’t get any better than the feather duster budgie, the hairy pig and the Mary River Turtle gave me some serious hair envy.

Friday, May 22, 2015

Cats as therapy: When Fraser Met Billy

Hero helped me read When Fraser Met Billy. Complete with his plush Corgi (this is quite appropriate as Fraser and Billy grew up on the Queen's Balmoral estate).
Companion animals are important to people in so many, many ways. Take Billy Booth, a kitten who was rescued from a deceased estate just in the nick of time (the house was to be boarded up but someone went in to check). Thanks to Cats Protection in the UK, the grey-and-white moggy was rehomed to the family of a three-year-old boy diagnosed with autism. Fraser, born with a range of conditions, barely communicated with a soul, but he took to Billy the moment he saw his photograph. And when the pair met in the flesh, the connection was undeniable.

In When Fraser MetBilly, Fraser’s mum Louise Booth documented the incredible bond formed between Billy and Fraser. And this is not a cutesy-lovey-dovey fairy-tale book about how warm and friendly animals are. You can hear Louise talk about Fraser and Billy here.

In part, it’s a frank, honest and very brave discussion about the impact of Fraser’s condition. Louise describes Fraser’s birth, her experience of post-natal depression and learning to meet Fraser’s very different needs by “trial and horror”.
“Now I was on my own with a baby that bellowed and vomited for twenty four-hours a day, seven days a week. Slowly but surely, my sense of isolation began to deepen.”
Fraser’s autism meant that he was hypersensitive to noises, and prone to meltdowns at triggers that other children might not have noticed. His hypotonia meant that he struggled with mobility and needed splints to walk.

When we think of pets as therapy, we tend to think of dogs. After all, cats tend to be more independent creatures, less sensitive to those around them, limited in their ability to provide any physical form of aid and keen to do their own thing. Certainly as a vet most of my experience of animals in therapeutic roles relates to dogs – though I wonder having read When Fraser Met Billy whether some people are self-conscious about sharing their own experiences with feline friends.

Louise’s account of Billy brings into question all of the above assumptions. At first she was a bit awkward raving about the impact of Billy on Fraser’s world, but Cats Protection had no doubt this was not a one-off. They alerted the Daily Mail, resulting in this article (worth clicking this link for the photos alone).

While n undoubtedly equals one in this case, it’s impossible to doubt the positive impact Billy has had on Fraser – despite one falling out between the pair when it appeared Billy was favouring the kids next door. He sat through some of Fraser’s major meltdowns. He was a calming presence during major life transitions. He allowed himself (literally) to be leaned on by a toddler. Billy even encouraged Fraser to walk up the stairs when no one else could convince him to.

The not-so-explicit storyline is the importance of Billy to Fraser’s family – his parents Louise and Chris, and sister Pippa. One gets a sense that the mere presence of Billy was a much-needed balm.

The photo on the cover of the book, by Daily Mail photographer Bruce Adams, makes for one of my favourite book covers ever, and the story behind it is beautiful. (Louise tells the story of the article, and the process of organising the photographer, in the book. As with everything involving Fraser, it wasn’t simply a matter of inviting a stranger over to take some happy snaps. The idea had to be introduced slowly, repeated, and executed sensitively so as not to trigger any sort of anxiety or meltdown).

This is a beautiful book for anyone with an interest in animals, pets-as-therapy, kids, any parent that has ever had a toddler that has had a meltdown, and anyone working with animals who seeks to better understand the relationships we form with them.

You can see more photos of Billy and Fraser on their facebook page