Friday, October 21, 2016

Why we should care about veterinary dentistry?

WSAVA dental guidelines, veterinary dentistry, lion, wildlife, teeth
Dr Brook Niemiec performs an oral examination on a lion. 

What’s the most common disease seen in companion animal medicine? To some extent it varies geographically, but time and again oral and dental disease hit number one on the list. Why is that?

According to Dr Brook Niemiec (pictured above), Board Certified veterinary dental specialist of the American and European Veterinary Colleges and Fellow of the Academy of Veterinary Dentistry,  
“These conditions create significant pain and infection within the oral cavity, as well as the entire body – but because pets rarely show outward signs of disease, treatment is often delayed or not performed at all.”
One of the challenges of veterinary dentistry is that it is a relatively recent field. Yes, animals have always had teeth, but “in addition to the problem of a lack of perceived pain, dental education in the veterinary curriculum is limited and it is a subject clouded by myths and misinformation,” said to Dr Niemiec.

The number of specialist veterinary dental services available has exploded, as has the use of veterinary dental radiographs (it still stuns me to think that when I graduated it was not routine to use these, and we're talking mid 2000s, not the 1800s).

Dr Niemiec is chairing the World Small Animal Veterinary Association’s (WSAVA) Dental Guidelines Committee. WSAVAs working groups have already compiled Guidelines on vaccines, nutrition and pain management which can be accessed here.

The Global Dental Guidelines are set to be released at the WSAVA World Congress in 2017.

According to Dr Niemiec, the guidelines “will set the ‘gold standard’ to which all veterinarians should aspire - but we will also suggest minimum standards of equipment and care for veterinarians in parts of the world where companion animal practice is still developing. As part of the project, we plan to develop a simple, objective way to score oral disease in a repeatable fashion and to create educational resources, tools and continuing education (CE) for WSAVA members.”

As the owner of a now toothless Maltese who had terrible periodontal disease when I adopted him, this is a much needed initiative and I await the results eagerly. (You can read about Phil’s veterinary adventures here) (And while I did some of the work, Dr Christine Hawke, of Sydney Pet Dentistry, helped improve Phil’s quality of life significantly with her skills and advice).

One of the things I've observed through my career is an increase in the sensitivity of both owners and veterinarians to dental disease. We now have people presenting animals because they have bad breath, or because they have noticed gum recession, or because they're chewing on one side of the mouth. Veterinarians are more proactive in recommending treatment. I think we're saving a lot of teeth that would have been doomed were it not for early intervention. In part we have some very proactive veterinary dentists to thank for raising awareness - but there are still plenty of animals that put up with oral pain and discomfort for too long.

Members of the committee have more letters than alphabet soup, and are: Brook A. Niemiec DVM, DAVDC, DEVDC, FAVD, Jerzy Gawor, DVM, DAVDC, DEVDC, FAVD, Marco Gioso, DVM, DAVDC, Australia’s own David Clarke, DVM, DAVDC, Cedric Tutt, DVM, DEVDC, Ana Nemec, DVM, DAVDC, DEVDC, Gottfried Morgenegg, DVM, Marge Chandler, DVM, MS, MANZCVSc, DACVN, DACVIM, DECVIM-CA, MRCVS, Paulo Steagall, MV, MS, PhD, DACVAA and Rod Jouppi DVM. 

Thursday, October 20, 2016

Where do your views on animal welfare and ethics sit?

Tiles; hunting; animal welfare and ethics
Is it acceptable to hunt? Is it acceptable to hunt using other animals? A scene painted on tiles at the Cascais Town Hall.

Do you have a position on animal welfare and ethics? One tool designed to help you find out is the Animal Ethics Dilemma online learning tool, which is open to everyone.

You just need to set up an account by visiting here. Once this is done, you will be asked to answer twelve multiple choice questions. These are designed to determine to what extent your views on ethics reflect a utilitarian, animal rights, respect for nature, contractarian or relational perspective. It’s quite an interesting exercise – you may find yourself taking a strong utilitarian approach in one scenario while a strong rights approach in another. This is because most of us use a combination of approaches to dealing with ethical issues.You are then presented with results (your profile) indicating what proportion of your position falls where.

Sand-modelling, greyhound, dog
Santa's Little Helper, the pet greyhound from the Simpsons, sand modelled at Cascais.

Of course this is just a rough guide. With MCQs there is always the risk that your view is not represented in the five options, so you have to chose something that is close enough. 

SAT has moved its HQ to Cascais in Portugal to attend the European College of Animal Welfare and Behaviour Medicine’s annual conference. Our group has undertaken the exercise together and discussed how it might be used in teaching, including whether it would be helpful for Faculty to wear a badge indicating their profile so students can understand where differences of opinion might come from. Would such a tool be useful for communicating with clients? Many disagreements occur because we are coming from very different ethical perspectives, but in the main we’re not great at articulating these. So we don’t always understand why we disagree or the nature of that disagreement. This is a topic that will be revisited through the week. So what do YOU think? Does it help to know where someone is coming from? How do you communicate about ethics and welfare - do you refer explicitly to theory?

Cascais, travel, tiles,animals, lion, animal art
Animals feature in many of the scenes.
(For those interested in travel, Cascais is a mere train ride from Lisbon, and was the scene of some of the filming for the James Bond movie On Her Majesty’s Secret Service (1969) starring Australian George Lazenby as James Bond. It is famous for stunning hand-painted tiles and thus far (n = not many and only the ones I’ve seen in the street) the companion animals of choice her seem to be golden retrievers and chihuahuas).

Dog signs, dogs on lead,
It's Portugese for "entry only for dogs on a lead."

Monday, October 17, 2016

The puppy and the robotic vacuum cleaner

giardia, infectious disease
A stunning hand-made giardia plate given as a gift to an infectious disease colleague.

Robotic vacuum cleaners are all the rage, but they’re not perfect. Perhaps we’ve been living under a rock, but it was only on Saturday night when we learned of the Roomba-induced pooptastrophe that has been making waves on the internet. It serves as a warning to those toilet-training their dogs who wish to use a robotic vacuum cleaner.

The drama unfolded when a family went to bed for the night. During their slumber, their puppy defecated on the rug. Hadn’t ever done it before, but there it was. And the drama would have ended there, but for their automatic vacuum cleaner which kicked off at 1.30am, rolled over the poo, and then systematically distributed it over the entire house.

Fortunately the dog wasn’t infected with giardia or other zoonotic gastrointestinal pathogens (a tenuous link to the image posted above).

The interaction between pets and machines is something we need to increasingly consider, least of all for incidents like this which according to engineers aren’t isolated. It does make you wonder though, when people dream up these things, do they consider the impact on all species living within a household? In many cases, probably not. 

There is also this case of a cat commandeering a robot vacuum cleaner to strike a dog (not something owners should be encouraging) and at least one case of a dog allowing a robot vacuum cleaner to “escape” (none of these are documented in the peer-reviewed literature).

One of the reasons people use robotic vacuum cleaners is that they can be set automatically to do their work when the humans in the house are sleeping. It is less considered that animals are likely to be woken by the activity of a machine like this, and may find it disturbing.

It’s important to observe animals interacting with machinery like this, and ensure that the animals can get out of the way of the vacuum cleaner should they wish to. 

Friday, October 14, 2016

Vet Cook Book food-tography tips from Deepa Gopinath, and a free One Health course

The Vet Cook Book initiative has generated some interesting discussions and some even more interesting food related activities among members of our profession. There’s still plenty of time to contribute a recipe, a story, or both. We’re loving the photos that are being submitted!

For those who aren’t sure how to photograph their food, veterinarian, Cook Book co-editor and food blogger Deepa Gopinath has provided her top tips. Take it away Deepa!

Thinking of contributing to the Vet Cookbook? Wanna brush up a little on your food photography in the process? If we eat with our eyes, it follows that when we photograph food, we should make it look like something we want to gobble down immediately.  Food styling and photography is an art, but it doesn’t have to be a complicated one. It is possible to improve your food pictures with just a few simple changes. 

Here are my top tips for better food photos:

Lighting is everything!

Natural light is the best and cheapest source of light in my opinion. This of course means that if you cook in the evening, you should guard the food with your life overnight so that you can photograph it during the day. Find a lovely large window and place your food in front of it and side-on, so that the light hits the food from the side. Not enough light? Try a large piece of white cardboard or white sheet directly opposite the window, which will help reflect some light onto the food. Sunlight too harsh? Try a piece of baking paper taped to the window, which should diffuse the light a bit.

Background Knowledge

Try and find a suitable background for your food. Old wooden tables work best and I particularly like dark wood.  I find that reddish and yellowish wood doesn’t work quite so well in photos.  Other options are a piece of hession/burlap (cheaply available in Bunnings!), a linen tablecloth or an upturned wooden carton.  If you are lucky enough to have a gorgeous granite or wooden kitchen bench by a window, then you are blessed and you should use it!


Smaller, neutral-coloured delicate dishes photograph well and allow the food to pop. Vintage plates, bowls and cutlery make great props and when it comes to cutlery and utensils, the duller the better.  If you really want to get into it, try browsing through op shops to find cheap crockery and cutlery to use as props. 

Styling for Success

Try playing with heights and textures make a food photo more interesting. Think about layers of plates or bowls on plates, stacks of bowls, etc.  Add texture by using different types of crockery, tea towels and linens. If you are feeling adventurous, try a light scattering of dry ingredients such as spices, seeds or nuts.

Tell a Story

Is this a snack you might have while you are studying? Or a cake for afternoon tea? Is the dish something that can be gifted, so a delicate curl of ribbon might look good alongside it?  Does your cat supervise you while you cook? Keep it subtle though, and don’t let the props overpower the food. Often a suggestion of a story says everything you need it to.

Also consider process shots, especially if there are special techniques such as rolling pastry or making caramel, where it may be important to show a certain technique or stage of cooking.

Whether you use your phone or a DSLR camera, making a few simple changes can really help make your kitchen creations shine.  Any questions are very welcome- please comment or email vetcookbook [AT]

You can visit Deepa’s delectable blog One Small Pot here.

Free One Health course

One Health is about looking at the health of humans, animals and the environment together. Western healthcare has traditionally taken a very compartmentalised view of health, which is now being challenged. If you want to learn more about One Health, consider undertaking this free online course with Future Learn which promises a good introduction to the key concepts. More info here.

Wednesday, October 12, 2016

The greyhound ban and animal welfare: what next?

The past few months have been a rollercoaster for anyone who works with greyhounds in any capacity. So what next?

Many proponents of animal welfare are reeling this week following the NSW Premier’s decision to reverse the ban on greyhound racing.

In July this year, the Premier stunned just about everyone – animal welfare groups included – by announcing a ban on greyhoundracing in New South Wales, based on the findings of a Special Inquiry lead by the Honourable Michael McHugh.  The report raised multiple concerns about wastage of dogs in the industry, poor Governance, conflicts of interest, live baiting of dogs (securing small animals such as rabbits and possums – live – to a lure for the dogs to chase and kill – a practice that continues), systemic misreporting of injuries, discouragement of at least one veterinarian in appropriate record keeping, reliance on non-veterinarians called “Muscle Men” to treat dogs using outdated, unproven and cruel methods of treatment, poor socialisation of dogs and so on. The Inquiry evaluated a range of evidence and the report is over 900 pages long – and worth reading.

At the end of the summary, McHugh suggested two options: one was for the industry to follow 79 stringent recommendations (recommendations 2-80, page 22-29 of the report), although he stressed that it was unlikely the industry could reform to an acceptable degree.

“…the commercial greyhound industry has failed community expectations that it is an ethical and humane industry. Permitting GRNSW a further period of time in which to attempt to demonstrate it can successfully address issues of overbreeding and wastage appears to the Commission to be likely to prove fruitless and, at the same time, continue to result in the deaths of many more thousands of healthy greyhounds.”  (page 21).

Nonetheless, many were stunned that the Government took the decision to ban the industry. It is very rare for a Government to take decisive action on an animal welfare issue, and was a sign that a line was being drawn: it is not acceptable to use animals in this way.

According to a poll conducted by the RSPCA NSW, 64 per cent or two thirds of people living in the ACT and Canberra supported the ban. That is a majority.

Last week, the Premier stated that the date for the shut-down of the industry was “locked in” and it was the “right thing”. It was an “absolute decision”.

Nonetheless Baird has had detractors. Interestingly some news outlets covered the ban in an almost consistently negative light (one of these has a huge potential conflict of interest, having just acquired an online betting site). The same agency appeared very confident the ban would be overturned in the days before it was. People in high places – including influential radio personality Alan Jones – opposed the ban. Interestingly, Baird was photographed dining with Alan Jones the eve before the ban was reversed.

It was surreal watching the Premier state, after months of committing to a ban and recommitting last week, that he was wrong. 

Supporters and opposition alike speculated that the Premier was subject to intense political pressure. Greens MP Mehreen Faruqi argued that the dogs, and their welfare, were overlooked in the debate

There are two key approaches to animal welfare interventions. One is the “gold standard” approach. This is essentially what the Baird Government did – the gold standard approach recognises a standard, and if a practice doesn’t meet it, it may be banned or eliminated. In practice, this is rare, and tends to result in industry backlash. It recognises that some forms of animal use are simply unacceptable. Another approach is the “incremental improvement” approach involves gradually improving or phasing out some practices. While proponents of incremental improvement may recognise there are some forms of unacceptable use (those involving aggravated cruelty, for example live baiting of dogs), critics of this approach argue that its easy for people to pay lip service to welfare improvement.

Both approaches have disadvantages as well as advantages. The trouble is, oscillating between them can generate significant confusion. For example, if a ban can be reversed, to what degree will incremental improvements be enforced? What message is sent about animal welfare when legislation supported by the majority of the population on animal welfare grounds can be reversed? How much faith do organisations have in the Government now that a ban, seemingly “locked in”, has been overturned? Is any decisive action on animal welfare doomed to failure?

Was the ban a waste of everyone’s time? According to Premier Baird's facebook post, it wasn’t.
After recently being tasked with overseeing the transition away from greyhound racing, [Dr Keniry] has spent the past few months on the ground talking with industry participants.Dr Keniry strongly believes that the announcement of the greyhound ban was a watershed moment for greyhound racing. He found in his meetings with trainers and breeders that the industry is now willing to make the drastic changes that it has resisted in the past.
(It is probably worth noting here reports that Dr Keniry attempted to resign from the taskforce before this because he did not support the ban). The publicity surrounding the ban has brought to light some serious animal welfare concerns about which many people may otherwise have been unaware.

So where to from here?

According to the Australian Veterinary Association, the NSW Government must be held accountable for improvements in greyhound welfare.

AVA spokesperson David Neck said: 
“The Premier made a commitment to greyhound welfare in July, and that commitment should be honoured. The NSW Government must ensure the greyhound industry adheres to the highest possible standards, and commit adequate financial and human resources to the task. The first step is for the Government to implement and fully fund the recommendations of the McHugh report, starting with the recommendations for truly independent regulation, separate from the commercial and operational aspects of the industry. We need a truly independent system that allows veterinarians to proactively speak out and improve greyhound welfare.”

In other words, there is a lot of work to do.

A good start, perhaps, is to re-read those 79 recommendations in the McHugh Report and consider how these can be implemented.

Another lesson learned is the need for veterinarians to ensure they operate independently. No matter who he or she is employed by, a veterinarian should be able to make accurate records of animal injuries and deaths and alert appropriate authorities. We should be vigorously defending not just our rights, but our professional obligations, to do so, and support each other in this regard. 

Sunday, October 9, 2016

Will laboratories in the future employ Labradors?

Labrador, lab test, dog sniffing diagnosis, canine olfaction, UTI
Lachie the Lab may be employed to do Lab tests. Literally.

Laboratories are typically fairly sterile places to work, but are they about to get a lot more exciting? According to one study published earlier this year, laboratory staff may be looking forward to sharing their space with four-legged colleagues. Indulge me for a second while I contextualise.

There’s a well-worn veterinary joke that goes something like this. A man brings a very limp parrot into a veterinary hospital. The veterinarian auscultates the bird with a stethoscope and pronounces it dead. The owner says, “Come on? You haven’t even done any tests. You can’t tell me this parrot is dead. How do we know it’s not African sleeping sickness or something?”

The vet rolls her eyes and says, “Okay”. She leaves the room and returns with a cat and a Labrador. The cat jumps on the table, sniffs the bird, and jumps off. 

The dog sniffs the bird and immediately sits.

The vet types away at her keyboard and prints an invoice for $600. “Your bird is definitely dead,” she says.

“Six hundred bucks??,” the owner cries. “What’s that about?”

To which the vet replies “I wasn’t going to charge anything, but what do you expect for a cat scan and a Lab test?”

Labrador, old dog, senior dog, UTI, canine olfaction
Lachie is not amused either.

Such a dad joke. And yet it contains a kernel of truth: the lab test thing is getting real. Not to the extent that it is used on parrots, but it seems to work on people. In a Hawaiian study, Labradors and golden retrievers were trained to sit if they detected bacteria in human urine samples.

Why dogs? Well, they have olfactory acuity 100,000 times stronger than us, and can detect parts per trillion. Dogs are already used to detect explosives, cadavers and even detecting cancer. It takes around 48 hours to detect bacteria in urine via culture. A dog can do it in seconds.

Plus, unlike most humans, they seem to love sniffing urine (alas, it is one of Phil’s favourite activities in the world).  

The dogs used in this study (n=5) underwent an 8-week training period, learning to ignore the myriad of odours found in human urine and only focus on locating samples that had tested positive for bacteria.

Why the focus on urinary tract infections (UTIs)? They’re super common, especially in patients with neurological conditions such as spinal cord injury, and the elderly. They can be challenging to diagnose early in the course of disease, leading to delayed diagnosis and potentially secondary complications like pyelonephritis. UTIs are the leading reason for hospitalisation in people with spinal cord injuries, and they are the most common nosocomial (hospital acquired) infection. If you have a urinary catheter in hospital, like up to 20 per cent of hospitalised patients, this increases your risk of a UTI by 5 per cent per day.

The dogs were very good at the task, being able to be taught to accurately discriminate culture-positive from culture-negative urine samples. They were able to detect the key offenders – E. Coli, Enterococcus, Klebsiella and Staphylococcus aureus – in concentrated OR diluted samples.

Why is this a big deal? Well, according to the researchers who wrote the paper, detecting negative samples quickly will help prevent use of antimicrobials when they’re not needed. But for patients, detecting UTIs at an early stage, when less aggressive therapy is needed, may lead to faster resolution and better outcomes.

There were some limitations of the study. Obviously it was a small-scale study and the results need to be validated. Still, an overall sensitivity of 100 per cent and specificity above 90 per cent is impressive. The researchers took many steps to eliminate confounding factors, for example all testing was single or double blinded and dogs were trained using samples from different patients so it could be insured that they had not merely learned the scent of samples from specific patients. However, while case samples were only used once in the testing phase, control samples were used throughout each day of testing so it is possible that dogs might have learned to identify what was new in the line-up.

Its positive to see us acknowledging and using the skills of other species in a way that benefits the health of another. But the paper raises some important questions:
  • How do we ensure that dogs (and other species whose unique sensory apparatus we benefit from) are not exploited? What sort of working conditions would be needed? Presumably dogs can’t sniff wee all day, sessions would need to be limited and regular breaks provided for toilet walks and other activities.
  • Could dogs be taught to detect UTIs in other dogs, thereby benefitting their own species? What about other veterinary patients? Other disease conditions, e.g. cancer? It would be nice to see the species in question benefit from their own special skills. (It would also be nice to work in a multi-species staffed clinic).
  • We still rely heavily on culture and sensitivity to diagnose UTIs – is this now a bit old school? Are there other biomarkers that could yield a rapid result?

Maurer M, McCulloch M, Willey AM, Hirsch W & Dewey D (2016) Detection of bacteriuria by canine olfaction. Open Forum Infectious Diseases doi: 10.1093/ofid/ofw051

Thursday, October 6, 2016

What do plane crashes have to do with veterinary medicine?

Canada from the air, air crash investigations, mayday
This sort of view, though serene, isn't my favourite...
What do plane crashes have to do with veterinary medicine? On the surface, not a lot. But dig deeper and there’s much we can learn from air plane incidents and the crews that rise to the occasion.

I’ve held a fascination for air crash investigations (and Air Crash Investigations), motivated in part by a “concern” about flying. When I visited Canada last month for the One Welfare Conference and mentioned to delegates that one of the things I knew about Air Canada was the famous GimliGlider incident, a number of them spoke to me about the incident with awe and pride. I was even taken on a tour of the site of the landing – in which all 61 souls on board survived – by a very generous colleague. (You can watch the episode about Air Canada flight 143 from Edmonton to Winnipeg here, and understand why Bob Pearson is one of the top ten guests I'd invite to a dinner party if I could).

The thing about air crash investigations is that they really have perfected the morbidity and mortality conference. Veterinary teaching hospitals have caught on and now investigate incidents and “near misses” like their medical counterparts, but nothing surpasses the rigor of the air crash investigation.

For those who are nervous about flying, investigations like these are a comfort for several reasons. Firstly, they usually prove that a series of errors, oversights or misses are required to cause a catastrophe. Secondly, they result in changes – the aircraft system is changed, parts may be recalled, so a similar incident never happens again. And third, it’s good to know that a whole industry is focused on learning maximally from errors.

So it was that I found myself engrossed in Highest Duty by US Airways pilot Captain Chesley Sullenberger (aka Sully) and the late Jeffrey Zaslow, on the flight back to Australia. For those who don’t know, Sullenberger led a team who landed Flight 1459 into the Hudson River after a terrible (for the birds and the engines) bird strike which destroyed both engines of the plane. They had 208 seconds between bird strike and impact on the water to make decisions which saved the lives of all 155 people on board – but they had no chance to prepare. (You can see a documentary about it here) (I acknowledge that it is no small matter that bird strike is termed for its impact on the plane, not the Canada Geese who were killed in this incident. It is likely that they were killed instantaneously).

Canada Geese fly over the racetrack at Gimli, where an Air Canada flight made an emergency landing back in July 1983. In these case birdstrike was not a factor, but when I visited the track the birds happened to be there.
The book contains a fascinating account of Captain Sullenberger’s incredible training, but also a couple of memorable insights that I’ve picked out here.
  • “A delay is better than a disaster” – this was a quote that Captain Sullenberger had found in a fortune cookie and kept. In any profession where lives depend on operators, be they pilots or surgeons, preoccupation with meeting targets and being fast can cost lives. As Sullenberger wrote, “Integrity is the core of my profession. An airline pilot has to do the right thing every time, even if that means delaying or cancelling a flight to address a maintenance or other issue, even if it means inconveniencing 183 people who want to get home, including the pilot. By delaying a flight, I am ensuring they will get home. I am trained to be intolerant of anything less than the highest standards of my profession. I believe air travel is safe as it is because tens of thousands of my fellow airline and aviation workers feel a shared sense of duty to make safety a reality every day. I call it a daily devotion to duty. Its serving a cause greater than ourselves.” (p320). Systems change and they can be flawed. Throughout the book, while not placing any blame on any airline, Captain Sullenberger discusses the way airlines and protocols have changed, sometimes emphasising profit over safety. He provides a lovely overview of the system he works within, a perspective that can be lost when you’re in the thick of things. This is important in campaigning for change.
  • Sullenberger points out, throughout his book, that the things that make him great at his job – like putting feelings aside in times of crisis, being out of contact and away a lot, being very analytical, and being lovely to passengers, crew and later all of the people who recognised him from the news – make him less great at relationships. Hurrah for the honesty. “I try,” he writes. “But sometimes, by the end of the day, you can feel like you’ve said everything you’ve wanted to say.” (p75). And this: “I’m cordial and gracious to everyone, and genuinely interested in their stories. Sometimes, when I get home, I can be frazzled and used-up and short-tempered. I can be impatient with the girls. ‘You have your priorities wrong,’ Lorrie has told me firmly. ‘As nice as you are to strangers, that’s the same nice you need to be to me and the girls’” (p314). Anyone been there?
  • The best job in the world is “the job you would do if you didn’t have to”, because that is what will motivate you to “toil in obscurity” and work hard. “People who love their jobs work more diligently at them. They become more adept at the intricacies of their duties. They serve the world well…I flew thousands of flights in the last forty-two years, but my entire career is now being judged by how I performed on one of them. This has been a reminder to me: we need to try to do the right thing every time, to perform at our best, because we never know which moment in our lives we will be judged on.” (p327).

What’s most inspiring is the nature and extent of training he did, but also the fact that he’s humble. His entire team – like the veterinary team – had to think under pressure, work out which rules would help and which ones to discard to save lives. Captain Sullenberger’s book is definitely worth a read, and probably a bit more educational – and I’d say inspirational – than the film. You can find it here Next on my reading list is QF32 by Richard de Crespigny, about this flight.