Tuesday, May 8, 2018

Goodbye, Michael

cats, cat, grief, losing a pet
Michael (left) with a younger Hero - the first moment they sat together.

Today’s post has been extremely difficult for me to write.

Less than a week ago I said goodbye to Michael, the cat I’ve cohabited with for most of my adult life. At 17 years and 7 months old, after several years of very stable, well-managed chronic kidney disease, Mike got worse. Her appetite reduced over the last few weeks, and despite medication, fluids and lots of TLC her quality of life took a nosedive very quickly.

It was paramount to me that she did not suffer. She died in her family’s arms, in a room full of people she loved and who loved her. She was a uniquely outgoing cat – she would approach visitors (one – a cat lover – said she could be “intimidating” in her enthusiasm!). She chased large dogs out of the house. She would solicit a chin scratch or belly rub from anyone. Inspect any suitcase/handbag/backpack or shopping bag. Conquer paper bags and cardboard boxes. Go through the groceries before they were put away.

cats, grief, Michael, Mike
Boxes were also fair game.
I adopted her when I was a veterinary student undertaking a volunteer, live-in position in a local veterinary hospital. At just four months old she had been picked up by a good Samaritan, having attempted to cross the treacherous Parramatta Road by herself. She was put up for adoption, but quickly moved into my bedroom.

I did a cursory examination and thought she was a boy. I named her after Detective Mike Hoolihan, the lead character in the Martin Amis novel I was reading at the time: TheNight Train. This was fortuitous. Detective Mike Hoolihan was female – as Mike turned out to be.

She put up with a lot of time away on my part doing prac work, sat in on study groups (sat on where possible), and was always there at home when I was working long hours to comfort me after a day at work.

When the vet clinic I was living in was broken into, she was the one who woke me, with her hackles up and her coat so puffed up she looked twice her size. She was growling at the door and ready to take on the intruder, who fortunately fled the scene.

She’s moved house with me, supported me through several intensive periods of study, and motivated me to try to improve the world for companion and non-companion animals alike.

I really believe that until her last day she enjoyed a life worth living. It was the right time to let her go, although being in a home without her feels empty. She would normally wake me. Realising his food source was sleeping in, Hero eventually woke me this morning and we both looked for Mike. Normally Michael would herd me down the hallway and into the kitchen. It was always about food, except when her kidney disease really kicked in. In the last few months she would usher me into the bathroom first, demand I fill the bath a little with cold water, and have a drink before breakfast. And then chase that with a glass of water on the coffee table, before heading back to bed.

Michael, feline chronic kidney disease, polydipsia
Like other cats with kidney disease, Mike was constantly drinking. She preferred drinking from glass - preferably someone else's.
There are a hundred daily routines she won’t be part of anymore and each one, right now, is an unexpectedly painful reminder of her absence.

Grief is a very personal thing and people experience it differently. Losing someone after almost 18 years, someone I connected with on a daily basis in a very real and tactile way, is hard. Being a vet possibly made the decision easier, and I was able to euthanase her myself, respecting her preferences. She deserved that – she put in at least as many hours in the study as I did over the years (if she wasn’t in the kitchen, we’d say “Mike is in the office, doing the hard yards…).

cat, Michael, cat on textbook, Clinical Medicine of the dog and cat
If you could learn by osmosis by sleeping on textbooks, Michael would have been an honorary professor by now.
But it hasn’t made grieving any easier, nor has knowing she was old and “had a good innings”. Despite what I know about grief, I think I really thought it would. 

In our work, veterinarians experience the loss of patients far more frequently than doctors do, but it doesn’t give us mastery over grief.

I’ve been flooded with memories. Michael, the times we lived through, the patients she met and comforted, and the losses she comforted me through. The friendly head-butts, the gentle paw in the face to get me up in the morning. All I could do the day she died was look at every Michael photo I had. She was in the midst of every family gathering. She put up with Hero through his annoying kittenhood phase. She helped teach veterinary students – she appeared (photographically) as a case study in classes, her tufts of discarded fur were donated to a research project on humane rodent deterrence. She spent much time being warmed by this very keyboard and it still contains tiny traces of her fur.

A colleague sent me a paper about the dual process model of grieving, which holds that we tend to oscillate between loss-orientated and restoration-orientated processes for a while, and I’ve found myself fluttering about in this space. Loss-oriented processes are things like grief work, intrusion of grief, denial/avoidance of restoration and breaking bonds or ties. Things like poring over old photos or formally recording Mike as deceased on the Companion Animal Register. Restoration-oriented processes include attending to life changes, distraction from grief, doing new things, and establishing new roles, identities or relationships(Williams and Green, 2016). This is the bit I am working on at the moment, but its still a bit raw. A veterinary colleague who lost his dog late last year said to me "its like feeling demyelinated". 

In Michael’s honour I am raising funds for the Cat Protection Society of New South Wales. They do an extraordinary amount of advocacy for cats, from rehoming cats to making important submissions on animal welfare policy. Thousands of cats and kittens have enjoyed better health care and welfare, and avoided suffering, due to their work. Donations over $2 are tax deductable. If you wish to donate you can do so here.


UPDATE: before I finished this post, Michael’s page raised over $1500 which was our modest goal. I am so grateful to the people who have donated. If you would like to make a donation to the Cat Protection Society via Michael’s page you can still do so.

Michelle de Kretser, in the Sydney Morning Herald this week wrote a beautiful article about losing her dog Minnie.

You can read the full article here.

I am very grateful for the kind words from clients, colleagues and others who have shared the impact of losing animals they bonded with over the years.


WILLIAMS, B. & GREEN, R. 2016. Understanding bereavement in animal owners. In Practice, 38, 140.

Wednesday, March 14, 2018

Veterinary palliative care

How do we best care for senior pets, companion animals with chronic or terminal illnesses? When I grew up, diagnosis of a chronic disease was a one-way ticket to the vet. Fast forward and we now have successful triple therapy and monitoring for patients with heart disease, prescription diets and medications for animals with kidney disease, veterinary oncology surgeons and chemotherapy protocols, and a suite of analgesics that work on different pathways.

Veterinary palliative care is not about extending quantity of life, but extending quality of life. Quality of Life, or QoL, refers to states of comfort or discomfort, and a combination of physical (for example disease-related) and non-physical factors, such as satisfaction, sense of control, social relationships, extent of emotional or physical discomfort, and management of stress(Lavan, 2013). In one study, 86 per cent of owners of companion animals with heart disease said they would trade the animal’s longevity for their quality of life(Oyama et al., 2008).

One of the tricky issues for vets (as it is for paediatricians and medical professionals working with patients who cannot report their own QoL) is that we rely on proxies – the owners – to report an animal’s QoL. While people are very in tune with animals they live with, there is the potential for a mismatch between an animal’s actual QoL and one’s assessment of it.
Different interventions can impact QoL positively or negatively, which is why it is important to talk about and assess QoL. As companion animals are living longer overall, and living longer with disease, there is scope for our profession to learn more about palliative care.

In 2017, the AustralianVeterinary Palliative Care Advisory Council was founded as forum for discussion of this important area. One of the founders and a huge driver behind it is Dr Jackie Campbell. As the owner of Sunset Veterinary Care, Jackie’s dayjob involves helping people navigate end-of-life decision making (you can see her TED talk here. She is the first Australian vet to achieve certification in Animal Hospice and Palliative Care (CHPV), and also holds a diploma in Canine Myotherapy. She has an interest in degenerative joint disease and pain management.

In May, the Australian Veterinary Palliative Care Advisory Council, of which I am a member, is holding its inaugural conference on palliative care. The day-long conference includes, a palliative approach to pain (Dr Jackie Campbell), palliative care in the terminal cancer patient (Dr Kathleen O’Connell), physiotherapy of the geriatric patient (Brooke Marsh) and supporting clients through grief and loss (Rosie Overfield). I will be reviewing QoL assessment and ethical decision making.

If you are a veterinarian, animal physiotherapist or allied animal health professional with an interest in improving the QoL of patients, you can find out more and register here. www.avpcac.com/conference


LAVAN, R. P. 2013. Development and validation of a survey for quality of life assessment by owners of healthy dogs. Veterinary Journal, 197, 578-582.

OYAMA, M. A., RUSH, J. E., O'SULLIVAN, M. L., WILLIAMS, R. M., ROZANSKI, E. A., PETRIE, J. P., SLEEPER, M. M. & BROWN, D. C. 2008. Perceptions and priorities of owners of dogs with heart disease regarding quality versus quantity of life for their pets. J Am Vet Med Assoc, 233, 104-8.

Thursday, February 8, 2018

The Declaration of Responsibilities to Cats

cat, rest, Alex Soojung-Kim Pang
Cats. They're complex.

The world seems divided between those who care about the welfare of cats and those who would rather see them gone. Welfare of cat populations – owned, semi-owned and feral – is a complex, emotive issue.

What is beyond doubt is that cats are sentient beings, capable of suffering. In the words of Professor John Webster, they have “feelings that matter”. And if we are going to address problems associated with cats – particularly semi-owned and feral – responsibility needs to be taken by Governments, NGO, cat owners, cat breeders and sellers, those who feed cats and veterinarians.
International Cat Care has released an “International Declaration of Responsibilities to Cats”.

I was interested in all of it, but as a veterinarian particularly interested in my responsibilities to cats. These include ensuring cats in my care have their welfare needs met, refusal of declawing (fortunately not an issue as declawing for non-medical reasons is not legal in Australia), stress-minimising veterinary facilities and handling, encouraging them to microchip and desex cats, providing pain relief when required, providing humane euthanasia, striving to keep up to date about cat welfare and working constructively with local authorities and NGOs on cat welfare issues. All of which I am happy to continue to do. 

You can read the full declaration here.

If you agree, you can sign the declaration here.

Here is a message from International Cat Care:

We’d be really grateful it you would read and sign the Declaration. You can also support this initiative by posing for a photo using one of our signs and sharing this photo on social media. If you do this, please use the hashtag #catdeclaration, as we’d love to see your photos!

At present, after a ‘soft launch’ of the document, we have just under 6,000 signatures from 80 different countries.

In addition, we need help in translating the Declaration into other languages, so it can be used worldwide. Can you help? Currently we volunteers for Hebrew and Portuguese translations, but would be very grateful if anyone could help with others – it would make a big difference.

Friday, January 19, 2018

Should pets be allowed on public transport?

Dogs like Chiana would get out and about more if they could travel (with their owners) on public transport.
If you could travel with your pet on public transport, would you consider giving up your car? According to a study by Jennifer Kent and Corinne Mulley, a number of Sydney-dwelling dog owners would consider relinquishing their private vehicle if they were able to travel with their pets on public transport.

The study, published in Transportation Research Part A, included a survey of 1257 Sydney-based dog owners. It confirmed that because dogs are prohibited on most forms of public transport in Sydney (they can be transported on a bus, if contained, and at the discretion of the driver), dog owners have no alternative but to drive on non-walkable, dog-related trips.

That includes trips to dog walking spaces, dog-friendly cafes and bars, and visiting family and friends, as well as trips to the vet.

The Annandale Hotel is one pub advertising its canine-friendly facilities.
I must admit that I don’t frequently peruse the pages of Transportation Research Part A, but this paper is hard to put down. There is an acknowledged need in Sydney, like other cities, to reduce traffic and its associated environmental costs. At the same time, urban planners seek to promote the well-being of citizens and engagement with recreational spaces. Reducing people’s dependence on cars – by providing excellent public transport – is one way to do this. But we also need to ensure that public transport is accessible and meets people’s needs. Its a human and animal welfare issue.

The authors found that each household made an average of 3.8 dog-related trips by car each week. Considering there are 4.9 people living in Sydney, and 1.6 million households, 39 per cent which comprise at least one canine, that is a possible 2.4 million dog related trips – by car – each week. 

This includes trips to the vet, 86 per cent of which are by car. Concerningly, 13.9 per cent of dog owners surveyed said that lack of transport had prevented them from taking their dog to the vet in the last 12 months.

This certainly resonates with my experience. We have a number of clients who, living in the city, don’t have space for a car. Some rely on car-share services to get to the vet, but car-share services only provide a certain number of pet-friendly cars – and these are often booked.

Allowing pets on public transport would benefit those animals because it would enable them to accompany owners on trips, and make vet visits they may otherwise not be able to make (or not be able to make without incurring additional expenses). It would benefit owners because it would allow them to enjoy more time outside of their home with their dogs (and for most dogs, that’s good for their mental health).

Indeed, the study found that if pets were allowed on public transport, more than 55 per cent of dog owners would attend additional activities with their dog – and 20 per cent would consider not having a car.

This would benefit the non-pet owning public (and the environment) by reducing the number of dog-related private car trips per week.

Of course, there would need to be some rules and guidelines to ensure the safety and well-being of humans and animals. The authors examined policies of countries and cities where pets are allowed on public transport. Strategies included confining pets to one area of a bus or train carriage, restrictions around travelling during peak periods, and rules about carrying dogs in lifts and on escalators. Most placed limits on dog behaviour by requesting that dogs be accompanied at all times and be on a lead, and/or in control of an owner.

You can read more about the study here, or if you have access download it via Science Direct here.

Where have I been?

Happy New Year! As I mentioned last year, I’m posting less frequently as I am working on a long-term animal welfare project which has necessitated some serious reclaiming of my time. 

One of the biggest things to happen last year was publication of #thevetcookbook, a project put together by Deepa Gopinath, Jenna Moss Davis, Asti May and myself, and produced by the Centre for Veterinary Education. I will post about this further, but there are some (limited) copies available through the Centre for Veterinary Education. You will need to create a profile and login to order a copy online, or you can phone them directly.

I will continue to post on matters related to the veterinary profession and animal welfare from time to time, and I appreciate all of the emails and suggestions.

Thursday, December 7, 2017

The Riptide Project: helping our profession, one cuppa at a time

cuppa, tea set, riptide project

Imagine being able to debrief over a cuppa with a veterinarian who gets it? Or gaining an insight into the career trajectories of others? The Riptide Project, established by New Zealand veterinary student Vicki
Lim provides just that. They’re looking for stories, and veterinarians – anywhere in the world – who are prepared to share their wisdom over a cuppa with other veterinarians.

Vicki explains how it works here.

How did you get the idea for The Riptide Project?

The Riptide Project currently exists in two forms. One is the sharing of stories from veterinary professionals from all over the world. The other is the “cuppa” register where veterinary professionals can get in touch to either give or receive a cuppa.

I was initially working on a different veterinary mental health initiative. I left when it began to take on a more profit-driven direction, as that didn’t sit well with my personal views on improving mental health in the veterinary profession. I was already slated to speak at WSAVA 2017 in Copenhagen so had to come up with something else on the fly, so I looked towards my previous experience in the industry. 

As a vet student, one of the things I really enjoyed was getting out and seeing practice and interacting with the vets and nurses. So many people in our profession have such diverse and valuable experiences. I wanted to share these insights with other veterinary professionals in the hope that it would strike a chord with them, or provide a perspective that they would not have otherwise experienced.

I’ve very thankful for the support of Hill’s Pet Nutrition NZ, Boehringer Ingelheim NZ, and Massey University, for their generous help in bringing The Riptide Project into being. I wouldn’t have been able to do this on my own!

How does it work?

I have an informal chat with the vets and nurses you see on the page. It usually takes an hour or so, and I try not to ask any pointed questions – I prefer to let the people ramble and share their stories. The conversations are recorded and transcribed, so it’s easier for me to be mindful while I speak with these veterinary professionals, rather than try and remember verbatim what they’re saying. I upload a selection of quotes with photos – a good number are shot in film, to keep it old school and even more intimate.

As for the cuppa register, veterinary professionals usually write to The Riptide Project directly, or the learn about it from the website at https://www.theriptideproject.com/cuppa.

To date, we have had way more people willing to give their time and a cuppa to a fellow veterinary professional than people who have written in to ask for one, but we’re hoping to change that and get some cuppa buddies going!

Have you had many people sign up and are you looking for more?

The interest in people who are keen to help out has been really heart-warming, but we are definitely still looking for more!! It’d be fantastic to get this off the ground and to a point where these veterinary professionals who want to help their colleagues are able to do so easily. So if anyone who is reading this needs a listening ear, or who wants to be one, we want you!

How do you think vets and nurses can help each other?

I think the dynamics of each vet/nurse relationship really differs, so it’s hard to generalise. But some of the best vet/nurse relationships I know of involve experienced mentors devoting time and attention to fresh graduates, highly skilled nurses who are able to pre-empt vets’ needs, and enable them to perform their duties efficiently (and vice versa), and vets/nurses who are just great mates. 

I once asked a vet and nurse together what helps them to cope with the stresses of the job, and they both pointed at each other and said “her”. Having a supportive workplace and colleagues is essential, and I think the sooner we come to the realisation that we are all one big team, the better.

For more information, visit www.theriptideproject.com, check out their facebook page https://www.facebook.com/theriptideproj/ or follow on Instagram: theriptideproject 

Sunday, November 26, 2017

Are smaller dogs better?

small dog, microdog, dog breeding, dog welfare
Phil is hoping whatever is in the oven is for him.

Small dogs are growing in popularity globally. Because I happen to cohabit with one, a colleague recently forwarded an article about some of the welfare issues around breeding for size (specifically, lack thereof). Not that I bred or even chose Phil, but that's another story.

Prospective adopters may be attracted to smaller dogs because of a perception that they are easier to care for than larger dogs (not always the case), they are cheaper to keep (definitely true when it comes to food and veterinary fees although there is significant individual variation), they’re easier to keep in high-density urban areas (often pet-friendly apartment complexes place a size or weight limit on dogs - this be a can of worms that I will leave unopened for this post), they’re easier to transport (that depends), they often live longer and they’re “cuuuuuuuuuuuuuuuute”.

This article raised a concern that because of the shrinking (in size) canine population around the world, some breeders tried to capitalise by breeding for miniature dogs, either by line-breeding, introducing smaller breeds or selecting for chondrodysplasia (abnormal development of cartilage and bone associated with shorter legs, made famous by Dachshunds, corgies and so forth).

None of the above strategies are foolproof and some may introduce inherited disease. The other issue raised is that unscrupulous breeders may try to breed “un-thrifty” dogs to create smaller animals, or even adopt out puppies at a very young age (I have seen the latter time and again through online selling of pets – the owners are mislead). Another technique mentioned which horrified me is the restriction of food to stunt the growth of puppies.

And small breeds aren’t perfect. Phil, the poster-child for dental disease (now living with zero teeth and the tiniest little jaw on the planet), is a good (or bad – depending on how you look at it) example. Smaller dogs are more prone to severe dental disease, retained deciduous teeth, bone loss and even jaw fracture. They’re also more prone to tracheal collapse, myxomatous mitral valve disease (MVDD), and different types of lameness (patella luxation, femoral head necrosis) than their larger counterparts (cruciate ligament rupture and hip dysplasia). Females are more likely to require a caesarean due to disproportionate foetal size.

Smaller dogs reportedly have increased risks of adverse drug reactions and anaesthetic complications, although the latter relate largely to drug dosing and anaesthetic monitoring/supply of an appropriate external heat source, which can be controlled.

They’re more likely to suffer from dehydration when they’re sick, e.g. with diarrhoea, because they’re tiny and lose a lot of fluid. They’re more likely to get sick from eating human food, simply because we tend to feed them proportionally more than we might feed a larger dog (these are generalisations) and they’re more likely to have behavioural problems. Again, the latter is likely – at least in part – to be due to our management of small dogs. Because there is a perception that they do little if any harm, humans tend to tolerate behaviours such as growling and snarling when moved off the couch, that would be unacceptable in larger breed dogs. They may miss out on opportunities to socialise if they’re being carried around. And their tiny bladders make them harder to toilet train, simply because they fill a lot more quickly. 

This is an issue because dogs may be surrendered to shelters or euthanased for problem behaviour.

The article is not an attempt to trash small dogs, or any dogs. Dogs are beautiful, majestic, amazing creatures. This is a people problem. The point it makes is that selection of a dog for size only is problematic, is it can be associated with (some unintended, some simply ignored) negative welfare impacts that are lifelong. The article is making a case for veterinarians to prepare for an increased case load of smaller dogs.

It’s a reminder that we need to really reflect on the way dogs are bred, and the traits that humans select for.


Freyer, JL (2017) The small dog trend: impact of size on pet health. Veterinary Focus 27(3):2-8

Monday, November 20, 2017

The Recent Graduate Survival Seminar and an update on the Vet Cook Book

puppy, hiding
First day at work feels?
It’s that time of year again – final-year students from most Australian veterinary schools are about to graduate into fully-fledged vets.

The first year out isn’t easy. Despite the hours (and there were many) of practical, clinic-based learning it’s still not the same as being confronted with animals we are ultimately responsible for. Competence and confidence take time to develop (and so they should) – but it’s easy to be impatient.

As a mentor of new graduates, and receiver of the occasional distraught phone call, I recommend seeking support, attending continuing professional development events (if not for the knowledge, for the networking), and having something non-veterinary in your life that can recharge you.

Every year the Centre for Veterinary Education (CVE) runs the Recent Graduate Survival Seminar, a one-and-a-half day review of the skills you will need when starting or returning to practice.

The theme is clinical reasoning, which is common across all areas of practice.
Among the speakers this year are colleagues James Carroll and Anthony Bennett, who were in my year at uni and are now successful mixed practitioners in Southern NSW and stars of the TV show Village Vets. There’s also Professor Geraldine Hunt, who taught us surgery, invented a novel approach for porto-systemic shunts, could close wounds that no one could believe would heal (they did), and is about as flappable as Ripley from Alien (although internally she did have anxieties like other vets, documented in the excellent book Pitfallsin Veterinary Surgery).

Also on the program are some amazing speakers including medical doctors, cattle vets, mixed practitioners, pathologists, regulators and specialists.

I will be giving a talk called “why is it so hard to be a good vet”, about some of the ethical challenges that practice throws our way.

If you want to check out the program or enroll, visit here. It has been designed to be as affordable as possible.

If you’re interested in reading more about clinical reasoning, there are three fantastic articles on clinical reasoning in fine medicine available via the Journal of Feline Medicine and Surgery.

The other big news is that the CVE threw their support behind the Vet Cook Book and it’s in the process of being printed. The Vet Cook Book, for those of you who recall, is an attempt to promote collegiality by collating recipes and stories from veterinarians, nurses, groomers, kennel-hands, doctors, receptionists, counsellers…anyone involved in our profession.

Behind the scenes there have been some very intense weeks between the editors, the team at the CVE and the printers. Things one takes for granted – turning 100+ word documents into a single volume, working out how to price a book you don’t know how many copies you will sell, working out the weight of pages in advance – has been challenging.

The book is now for sale via the CVE website, and there is a discounted price for students and nurses. You can order here - you do need to create a login, but it doesn't take long.

It contains recipes, stories and mental health tips.

Late last week we received the news that a number of organisations have come on board as sponsors. This means that if we sell all of our copies we should have some funds so that the CVE can develop and provide a mental health resource (the details to be worked out – we’re going to consult a number of groups including contributors once we have the figures).

As we state in the book, we’re under no illusion that a pavlova will end mental health issues or even the shocking suicide rate in our profession. But we do believe that making and sharing meals with colleagues is one way to start meaningful conversations.

DECLARATION: I work with the CVE on a volunteer basis from time to time.