Saturday, July 27, 2013

Animals, People & Plants: Living Ethically. An interview with co founders Amanda, Graeme and Jalal.

Jalal relaxes with canine companion.
As veterinarians its easy to become buried in surgery and consultations and not consider the bigger picture of animals and the environment - I'm guilty of it too. So I am always interested to talk to people who take a "bigger picture" approach. Earlier this year I met Jalal, Amanda and Graeme, University of Queensland Veterinary Students who are keen to make a difference - not from the moment they graduate, but from right now.

Tell us about yourself. Where are you at and how did you get here?

Jalal: I was born in a small town called Woombye in the Sunshine Coast and lived there for the most part of my upbringing and also spent time living in London and Canberra too. Travelling and exploring the world has always been a major part of my life. When I finished high school I spent 3 years working odd jobs to save up for various overseas adventures. As for now I have found myself studying veterinary science at the University of Queensland in Gatton.

Amanda: I was born and lived in India for the first ten years of my life. I then moved to Oman for a few years before migrating to Canada with my family. Along the way I did a lot of traveling both by myself and with my parents who always encouraged me to have an open mind of the world around me. I completed my BSc majoring in Wildlife biology at the University of Guelph in Canada and moved to Australia to further my education in vet studies.

Amanda.
Graeme: I'm 23 years old, born in Winnipeg, Manitoba the coldest city of Canada (and the world!!). Growing up I was always passionate about wildlife and in particular the reptiles and amphibians around me. Given the, at times, absence of reptiles in Canada I decided to look further abroad to fulfill my passion. So, after completing my Bachelor of Anthropology I decided to get back on track with my dreams to help heal animals and the environments they inhabit. I've now come all the way around the world and am thrilled to be studying Vet Med at the University of Queensland. 

Why did you choose to become a vet?

Jalal: To be honest becoming a veterinarian wasn't on the cards throughout my schooling years. Instead I was fixed on becoming an international airline pilot. Once I finished high school though, the spark for flying planes began to wear off as my values toward life and how we live on this planet changed. I’ve always been very passionate about animal welfare across all facets of how animals serve humans (food, entertainment, pets, scientific testing and clothing) as well as a keen interest in wildlife conservation. It occurred to me one day that becoming a veterinarian could help me in many ways to aid in species conservation and to create reform in the standards of animal welfare. It could also provide me with a credible platform to educate people of how these issues have severe ethical implications as well as large-scale health and environmental consequences.

Amanda: My passion for animals, animal’s welfare and animal justice is deep rooted, to the point where I chose to become a strict vegetarian (amidst a family of carnivores) at the age of a year and a half. All my life I knew that I wanted to devote my energy and time making the world a better place for all animals (especially the non-human ones). After working at several animal related organizations/ establishments and dealing with frustrating bureaucracy I believed that being a vet was the way I would be able to successfully fulfil my goals. After many twists and turns along the way here I am now at the University of Queensland in my first few years of Vet Studies.  

Graeme with a black headed python.
Graeme: Being passionate about wildlife I worked for different organizations through high school. While working at a bird rehabilitation centre I realized how useful a vet can make him or herself in the field of wildlife conservation. Many of the birds I worked with could have been rehabilitated with the aid of a vet but because there was no one on site / no funds to bring someone in, most of the birds were euthanized. These tragic experiences, coupled with the extremely rewarding experiences of watching rehabilitated raptors fly free, helped to show me why becoming a vet was an imperative for me.

How did you get involved in APPLE?

Jalal: I went into veterinary school with the ambition to band together with like-minded students so we could become involved in projects that would aid in animal welfare and conservation. Soon after beginning my first semester however, I noticed there was a lack of any groups or societies that targeted what I was really aspiring to achieve. In my second week however I met two cool and enthusiastic students, Graeme and Amanda who had travelled all the way to Australia from Canada to study veterinary science. The three of us soon realised that our goals and ambitions of what we were passionate about were all the same and soon after we gave rise to APPLE (Animals, People & Plants Living Ethically).

Amanda: I was excited to experience all that Australian vet school had to offer me when I first moved here, not just academically but to hear peoples stories, see the passion, get involved with different groups. Graeme and I were shocked at the lack of student involvement in terms of animal welfare groups or ethics groups and were happy to meet Jalal who shared our interest and enthusiasm. Animals, People and Plants Living Ethically is the goal of our organization. We want to be involved in discussions regarding animals being used for our education from the live crayfish to the greyhounds, and even the pigs at the piggery. I'm a vet student today but I believe I am also a concerned citizen of the world and I want to take responsibility for the way animals around me are being treated for my education. This isn't an irrational concept and I was happy to see others in our first year vet class get involved with a.p.p.l.e.    



Can you give an example of the sorts of things APPLE has done to benefit the welfare of animals? 

Jalal: Our first initiative as a group was to increase and diversify the enrichment that the greyhounds at our clinical studies centre were being exposed too. We felt that as unfortunately the majority of greyhounds there are euthanized and used for our education, we could in return offer them the most exciting last few weeks of their lives through providing cool and interesting food enrichment toys. A small group of our members gathered together on campus one afternoon after collecting mounds of recycling and built them toys whilst watching David Attenborough documentaries. The day was a great success!

Graeme: Our first project was to build enrichment for the greyhounds on campus. This was inspired by one of our practicals where we saw the beautiful greyhounds without much socialization or interaction with each other. Because many of these dogs would be used in various ways for our vet education we figured we owed them our thoughts and time. This manifested itself in a project where we got a bunch of people together (a.p.p.l.e members) to build DIY toys for the hounds. We'll definitely be repeating this event. We received really good feedback and I think everyone had a great time. 

Greyhounds: many people are exposed to this breed through images in the media or by seeing them being walked with wire muzzles on. What are they like close up?

Jalal: Grey hounds have got to be one of the nicest, most beautiful and friendliest breeds of dog I have ever come across. There are an overwhelming number of these dogs around Australia available for adoption that I think would make a wonderful pet at home. I feel saddened that they have developed a negative connotation through what I think is an unethical, profit driven racing industry.

You seem keen to change the world. Who or what inspires you?

Jalal: For me there are a lot of things that inspire me to change the world. We are living in unprecedented times whereby our natural environment is being altered at such an alarming rate that many of us are rather blind to the sort of ecological consequences that will result for future generations. Whether it be working toward conservation of endangered species or creating reform in industries such as live exports and slaughterhouses, I am totally inspired and willing to do everything in my power as a veterinarian to make a positive change in this dying planet we call home.  

Amanda: My driving force is the dream that one day animals of all shapes and sizes, spiny or soft, feathered or hoofed, will be treated with respect. I think it’s sad but accurate, that as humans we have been dubbed the most destructive creatures on the planet. I believe that each of us can be conscientious of the flawed systems we propagate and take a stand to make it change. This is the dream that I will continue to chase professionally as a veterinarian and also on a personal level. 

Graeme: Growing up I always found the stories of Gerald Durrell to be inspiring. They spoke of a world which I didn't know but wanted to be a part of. His passionate and sometimes tragic accounts of wildlife drew my attention to the precarious state every animal (other than humans and the animals humans find useful) could or has found itself in. Those stories really got me thinking about the power of ecological conservation as well as single species recovery. It also inspires me to find the magical world Durrell describes and to foster its survival against ever increasing odds. 


Friday, July 26, 2013

Vets, zoonoses and infection control

A calf with a fever. 
Imagine examining a pyrexic calf. Opening and examining the oral cavity without the benefit of gloves or a mask. It happens all of the time, but three days after Dr Navneet Dhand examined this particular calf, it was diagnosed with rabies. 

He wrote about the episode, and some lessons learned, in a recent article in The Conversation which you can read here.

That was in 1996. Dr Dhand is now an epidemiology guru, and his research team has presented some findings which should jolt the profession out of its complacency - notably that veterinarians, as a profession, are woefully inadequate when it comes to infection control.

I wrote about this recently in The Veterinarian Magazine, but this story needs to be told and retold.

A study published by Dowd et al. in Preventative Veterinary Medicine, found that 44.9 per cent of vets had contracted a zoonotic disease through their work, yet only 40-60 per cent perceived occupational exposure to zoonosis likely or highly likely.

Principal investigator Dr Dhand didn't mince his words: 

“Not using appropriate protection when necessary is just like having unprotected sex with a stranger and thinking that it will be alright.”

Well, it isn't. According to the study, Australian veterinarians didn't use appropriate PPE most of the time when we should have known better, for example, when investigating neurological and respiratory cases. This is an even bigger concern as two of the most dangerous zoonoses - Hendra and Lyssavirus - can present in this way.

Only 75 per cent of veterinarians use adequate PPE (such as masks, gowns and gloves) when performing post-mortems, dental procedures and surgery. Gross.

Other findings included:

34.8 per cent of veterinary hospitals did not have isolation units for animals with contagious or infectious diseases;
* 21.1 per cent of practices do not have staff eating areas separate from animals;
* 60 per cent of workplaces do not make adequate use of national industry standard infection control kits designed to protect staff against infection.

Probably the most concerning finding is that despite a high risk of contracting a zoonotic disease, half of us considered our risk as low. The thing is, if you think your risk is low, you tend not to take precautions. 

There are some excellent resources to help vets improve their infection control practices.


Aside from some misconceptions about our personal risk, why are veterinarians not great at infection control? Is it because that dog on the table can't say "hey mate, you ain't coming near my anal glands without gloves?" or do we think we're all invincible? 

[And if you really need a jolt, check out the Australian Story episode about occupational exposure to Hendra virus in a veterinary hospital here].

Reference

Dowd K, Taylor M, Toribio J, Hooker C and Dhand N (2013) Zoonotic disease risk perceptions and infection control practices of Australian Veterinarians: Call for change in work culture. Preventative Veterinary Medicine 

Thursday, July 25, 2013

How to study in veterinary school


I was chatting to some first year veterinary students from the University of Queensland about a book some of them had found helpful. How to Study in Medical School, by Armin Kamyab, now in its second edition, is a lovely thin guide which can be read in a single sitting.

It contains some useful tips, the linchpin of which is taking excellent notes during lectures and then reviewing these after each day before you go to bed. The idea is that every day you spend around an hour for every lecture hour revising notes.

In principle I love this system, especially two tips:
1) Don’t just write it – ask why. For example, if intestinal biopsies are required to differentiate between inflammatory bowel disease and low grade lymphoma, knowing WHY helps you understand, facilitating learning and better recall.

2) Look up things you don’t know – it helps you understand better (it’s a more active way of learning) and facilitates better recall.

Dr Kamyab was clearly unwavering in his desire to excel in medical school. He applies a blanket “no sleeping” rule, i.e. no going to bed until you have produced excellent study notes every weeknight. Weekends are for revising one’s notes and that is all.

Don’t get me wrong. I like this book. I like the fact that he suggests we act as if there is a test on every Monday. It lends an urgency to one’s study, a knife to cut through the procrastination.

Like Kamyab I am very much of the view that time spent in the library is likely more fruitful than time spent at home.

“I always recommend studying at the library. If you go home, you will cook, watch TV, clean, lie down to rest, browse online, call family etc. Time spent on all those little things adds up. Studying at the library will avoid all those distractions.”

No argument there. But this is where my agreement ends. He goes on:

“I understand of course that certain students have families to spend time with, and important chores to take care of. The issue is simply to prioritise, and to figure out where studying falls on your list of priorities. For me it was #1.”

Number 1 it might be, but medical school and veterinary school last four to five years. The program seems very appealing and very structured, but if you keep this up for five years three things at the suggested level of intensity it is quite possible that:

a) You neglect your family, friends and companion animals who are likely supporting you and doing all those chores and earning income to keep you alive;

           b) You will excel academically but miss out on gaining any experience to round out your skills (for example, animal handling, nursing, working with wildlife and exotics);

c)   You may set yourself up for a big shock (and disappointment) upon graduation. Living in the library revising from nice neat notes is very different to dealing with real live animals in the often chaotic context of practice.

I am NOT suggesting that study is not important. But overemphasis on study, the concept of spending every day til midnight writing notes then going snorkelling for two hours on the weekend, is not my recipe for an excellent veterinarian. Ultimately, one is aiming to become a practitioner...you need practical skills, experience and the ability to do things (sometimes lots of things at once). With respect, I don't believe Dr Kamyab's schedule permits time enough to become a well rounded practitioner.

So what do SAT readers think? How did you survive vet school? Postgrad study?

Wednesday, July 24, 2013

Veterinary treatment of canine cognitive dysfunction

Senior and proud. Well, not sure about the proud bit. But yes, although he looks like a puppy, Phil is an older dog.
Dementia is well documented in human patients, less well characterised and possibly less than ideally managed in veterinary patients.

Sydney University BSc(Vet) candidate Ellen Rasidi is conducting a survey of veterinary practices related to geriatric canine patients, specifically the diagnosis and treament of canine cognitive dysfunction (CCD) aka "doggy dementia".

Geratric patients are known for their multiple comorbidities and it can be difficult to differentiate signs of dementia from signs of other neurological diseases, including neoplasia, vitamin B deficiency, anxiety, even degenerative joint disease. There are a limited range of treatments available, including (in trial phase) stem cell therapy, medication and dietary supplements.

If you are a veterinarian who treats geriatric canine patients you can complete the survey by clicking this link. It only takes about five minutes.

Women Veterinarians

An exotic species?: Sylvestor reads about Women Veterinarians.

Twas on a recent library mission that I came across a quaint book entitled Veterinarians and Their Patients by Charles Paul May, published in 1964. Chapter 7 deals exclusively with the topic of the female veterinarian, and makes for somewhat entertaining reading.
"Of 4000 veterinary students in North America in 1963, only about 150 were women, and not all of them would complete their course of studies. Many of them would marry fellow students, and they would make excellent assistants for their husbands, even serving as anesthetists."
Mr May tries to dispel some popular myths, pointing out that - contrary to popular opinion - women veterinarians are capable of working with large animals and sustaining careers for 25-40 years on occasion.
"The most misleading remarks are those indicating that professors, the public, and male veterinarians are prejudiced about women in this profession. If that were true, how could girls enter veterinary schools, serve as interns or assistants to men, and build up successful practices?"
I realise that such writing does not occur in a vacuum and Mr May was reflecting the predominant attitudes of the time, but we've come a long way since then (and hurrah for that).

Tuesday, July 23, 2013

Interview with Dr Mark Westman - Pets in the Park

Dr Mark Westman, founder of Pets in the Park, with a patient. Stylin outfit. (Yours isn't bad either, Mark).
SAT Interviewed Mark Westman. PhD Candidate. RSPCA veterinarian. All round nice guy. Truly an example of someone who takes their vetting to a higher level.

Who are you and what is your day job?

I graduated with a BVSc (Hons) from Sydney Uni in 2003, and my primary passions are shelter medicine and non-invasive companion animal research. I have been able to combine these two passions together by working part-time as a veterinarian at the RSPCA and commencing a full-time PhD at the University of Sydney. My research encompasses feline GIT parasites and feline retroviruses, and in particular my project is investigating the protective rate of the FIV vaccine under field conditions. My fantastic supervisors are Prof Richard Malik and A/Prof Jacqui Norris.

Are there any significant non-humans in your life? If so, who are they, how did you meet and what is your relationship like?

Dookie is my 15 year old Fox Terrier who has been with me since I first started university. Like many pets, she has been a constant and faithful companion through the highs and lows that life brings. She was also the first dog that I ever diagnosed with Addison's disease! She is the sweetest dog I have ever known, and I dread the day when I will have to learn to cope with her absence. My other dog, Chewie, died last year under traumatic circumstances (my father accidently ran over her). Chewie was a Terrier cross with attitude, a beautiful dog, and I miss her greatly.

Not all veterinarians work in shelters. What attracted you to this area and how do you cope with the inevitable heartbreak?

I have worked in shelters ever since I graduated - five years at the RSPCA, four years at the Animal Welfare League, and now back again at the RSPCA. I love working in shelters because I get to be a small part of a very beautiful process - that is, the journey of an animal from being surrendered by one family to being given a second chance by another loving family. Whenever people ask me how I cope in such a sad working environment, I always answer by saying the good work that happens at shelters easily outweighs the sad stuff.

Pets in the Park, right in the heart of Sydney City.
How did Pets in the Park come about?

Pets in the Park really came about by chance. I have always had a strong desire to have a net positive affect on this world by donating my skills as a veterinarian to worthwhile causes. I have volunteered my time on de-sexing programs in India, Thailand, Bali, and worked at the RSPCA in Port Moresby. Pets in the Park is really an extension of my work overseas to try to make a difference to animals in Australia. About four years ago, a friend told me about a food ministry that he helped co-ordinate and the animals brought along by many of his clients. I asked him if I could donate my time and come along, and so the next Sunday I took a table and esky down to the park in Parramatta where this food ministry took place. It was last year, however, that Pets in the Park really took off when three friends (Vicki Cawsey, Linda Warlond and Leah Skelsey) joined me to set up Pets in the Park as a registered cherity and open another clinic in Darlinghurst. Most of the credit for the success of Pets in the Park lies with these three women. My partner, Laura Taylor, has also been a huge support to me and has helped Pets in the Park grow exponentially.

How does it work?

Pets in the Park's mission is to provide assistance to Sydney's homeless and less fortunate through caring for their pets. How we do this is through free pet clinics, where we provide free health checks, vaccinations, flea and worm treatment, and basic medications. Currently we have two monthly clinics set up, one in Darlinghurst and one in Parramatta. The model for Pets in the Park is to choose a location for our clinics that ties in with human service providers, so that clients have access to support they may need while their pet is cared for by our volunteers. In Parramatta this is thanks to Stepping Stone Community Ministry and Parramatta Baptist Church, and in Darlinghurst this is thanks to St. John's Anglican Church and Rough Edges Ministry. We also run a quarterly de-sexing clinic, where animals recruited from our two clinics are transported to a veterinary hospital for free de-sexing and microchipping. Pets in the Park was successful in winning a City of Sydney Council Grant in January, which will cover about one third of our costs this year. The other two thirds of our budget is made up of donations, either monetary (we now have tax deductible status!) or in-kind from one of our wonderful corporate partners . We have received amazing support from Virbac Animal Health, Bayer, Advanced Anaesthesia Specialists, Jurox, and Princes Highway Veterinary Clinic. All Pets in the Park health clinics and de-sexing clinics are completely staffed by volunteers. 
A client presents his cat for treatment at Pets in the Park.
Practitioners offering low-cost or completely subsidised animal care are often criticised for taking business from local veterinarians. How do you address this concern?

Pets in the Park cares for animals that would otherwise not receive veterinary care. We ensure this by running a strict client referral only service, where clients must bring a letter from a human service provider stating they are homeless or at high risk of homelessness in order to receive our assistance. This not only again ties human service providers in with people who are in need of assistance themselves, but also helps us maintain a good relationship with veterinarians who realise we only deal with genuine hardship cases and therefore are not taking any business away from their hospital.

Can you tell us a little about your clients?

Our clients are either homeless in the true sense of the word (i.e. living on the street), or experiencing transient homelessness (e.g. living in and out of shelters or hostels, or other emergency accommodation). Many of our clients suffer from mental illness, and/or have spent time in gaol (I have been asked to inspect a client's stab wound before), and so all of our volunteers need to have good interpersonal skills as well as a non-judgmental attitude. Twice in the past month I have stopped to talk to people with dogs begging on George Street in Sydney to find both were already clients of Pets in the Park! As well as feeling horribly sad for these poor people, I was encouraged to see that Pets in the Park is already making a difference to those clients and their animals who are most in need of assistance.
The exceptional Pets in the Park volunteers. (Ed: I-spy some familiar faces...g'day Dr Kelman!)
 How can veterinarians, vet students, vet nurses and others help?

Pets in the Park is purely run by volunteers, and we need all the help we can get! We prefer veterinarians and veterinary nurses who are willing to commit to attending at least 50% of our clinics, as we like our volunteers to build strong connections with our regular clients. We also need help behind the scenes, including anyone with experience in marketing, fundraising and general administration. If anyone is interested in volunteering they can check out our website www.petsinthepark.org.au and email us mail@petsinthepark.org.au.
Pets in the Park helps people in need who need their animals.
Aside from supporting Pets in the Park, do you have any other suggestions for anyone who wants to improve the welfare of companion animals?

It may sounds cliched, but every veterinarian and veterinary nurse has the opportunity to improve the welfare of companion animals in their care. It may be as simple as spending an extra five minutes with a client to educate them about breeding (or not breeding!), or positive-reinforcement based training methods, or general husbandry. It all starts with a desire to have a positive influence on animals in your life, and not losing this desire to help no matter how long you have been in practice for.
A patient on wheels.
How do you manage to run a charity AND a PhD? Any tips for budding research students?


Sometimes not very well! Running a charity does take up a lot of my time, and balancing the two (as well as still working part-time) is often very challenging. For example, I am writing these responses when I really should be reading some articles on feline leukemia virus......fortunately, I have a very understanding partner, family and friends. When you are passionate about a cause, and motivated to make a small difference in this world, somehow everything manages to fit in. 
Dr Chris Brown supports Pets in the Park.

Monday, July 22, 2013

Three things I learned: periodontal disease in companion animals or, does my pet really need a dental?

Phil. Former sufferer of severe periodontal disease.
This is an icky subject very close to my heart. No, I don't have a festering abscess in my armpit (that would be both icky and close to my heart). I DO however live with a dog who had serious, severe periodontal disease. Phil did not have the ideal start in life and had bad dental disease when I met him: he could bleach my hair with a yawn. Several dentals and multiple extractions later he is a new man.

WARNING: THIS POST CONTAINS SOME IMAGES WHICH MAY OFFEND SOME READERS. 

This post refers to the sensational ASAVA webinar given by veterinary dentist Gary Wilson, of Advanced Animal Dentistry. He talked about periodontal disease (ie disease of the structures supporting the teeth - gingiva, periodontal ligament and alveolar bone). We all know it is caused by plaque (a combination of bacteria + food + saliva). Its by far and away the most common disease we see in companion animal practice (although often not the reason animals are presented for examination as many owners don't look in their pet's mouth). 

It is well established that periodontal disease leads to bacteraemia, which can lead to the release of endotoxins and inflammatory mediators and antigen-antibody complex formation. Such complexes can lodge in the heart, liver and kidney and can lead to chronic renal insufficiency which we see so often in our feline patients.

So what did I learn? 

That factors which predispose dogs and cats to periodontal disease include: proximity to salivary glands (e.g. the parotid duct is adjacent to the carnassial and if saliva pools it can contribute to plaque in this region); soft-food diet; overcrowding of teeth; rotated teeth (as often seen in brachycephalic breeds); retained deciduous teeth; systemic disease; malocclusions; slab fractures or damage to the surface of teeth; trauma; open-mouth breathing and FUR. Hair caught in the gingival sulcus becomes entrapped in teeth. Grooming dogs with long fur around the face is therefore important for their dental health. Even schnauzers!
Molars from a small dog with severe dental disease. Note that despite having three roots, each tooth came out whole. That isn't normal! You should need to section these teeth before removing, but check the size of the granulomas on those root tips. These were not happy teeth. In fact, they practically jumped out of the dog.

Severe dental disease in a dog presented for vaccination (i.e. not for dental disease - this was an incidental finding). Note the marked gingival recession and entrapped fur.

I also learned that bone loss seen with dental disease is associated with osteoclast stimulation rather than direct destruction by bacteria, although antibiotics are still indicated to remove the inflammatory stimulus (as are extractions!).

Finally, I learned that bacteraemia associated with dental procedures lasts for approximately twenty minutes, which is a good argument for avoiding performing invasive surgery at the same time as dental procedures.

Upper and lower retained canine teeth in a poodle. Note again entrapped fur, food matter and other not-so-nice scented crud. 
Although I try to limit myself to three things, I could not help but also learn that while we tend to see chronic gingivitis, acute, severe gingivitis can occur but is easily differentiated from gingivostomatitis as it only involves the gingiva which is 1-2mm thick. 

We perform dental examinations and procedures often (you can see why), so it was nice to get a "fresh" perspective on a not-always-fresh topic. I was glad that Dr Wilson mentioned that xylitol, present at low concentrations in many dental rinses for dogs, must be avoided in dogs with liver disease - and at high concentrations (found in chewing gum, artificial sweetened foods etc) it can prove fatal.

Dental work is one of the most rewarding and important things we can do to keep pets healthy. Once he had had his festering teeth removed Phil certainly got a new lease on life.

[Phil would also like to thank Dr Christine Hawke, of Sydney Pet Dentistry, for extracting his more challenging teeth].