Saturday, October 26, 2013

Date with Phil and Sofi: a road trip to meet dog designer Pat Starnovsky

Champion tracker Miles may be long gone, but his memory lives on.
Ever since Nell Thompson posted about her dog-specific holidays, I’ve been inspired to plan more dog-specific roadies. Phil loves car trips. When he sees me set up his car seat he practically trips himself over with excitement. So a few weeks ago we accompanied friends Emma, Alice and Sofi to visit canine enthusiast Pat Starnovsky in Winmalee.

How better to end a road trip than at a beautiful house with a tiered, bushy backyard with plenty of spots to sniff and pee. Unfortunately Pat’s backyard copped a fiery hiding last week, and while Pat and her home were spared most of the neighbourhood was razed. Many Winmalee residents lost their homes and, worse, their pets, in the disaster. It will take months to recover.

But back to our little road trip. It was a joy meeting Pat and hearing about her life with dogs. Pat competed with her beloved Weimaraners in tracking and rescue back in the 1970s, and she had beautiful photos of some of her prize-winning dogs.

Pat is also a champion knitter. And I don’t mean the odd pair of bed socks. Her skills are frequently called upon to create hand-made masterpieces for humans and their canine companions.

By the time we arrived on her doorstep, Pat had knitted and hand-beaded three beautiful winter jumpers for Phil.

Phil scored a hand-beaded stylish knit, Alice scored a tiara.
Sofi and Phil spent the morning walking around the pool
Sofi and Phil do laps around the outside of the pool.
...chasing bugs...

Sofi chases bugs near the window. Note the bushland outside the window.
...and reading books about dogs in knits.
Emma and Sofi peruse "Dogs in Knits".
After relaxing by the pool we attempted to capture an awkward family photo in Pat’s fantastic drawing room.

Pat, Anne and Sofi, Alice and Phil. 
Pat, Emma and Sofi, Alice and Phil who was having a little sneeze at the time.
Pat doesn’t have her own dogs currently, but it is clear she absolutely adores them. She showed me photos of a Christmas tree she had made just for dogs. Each branch was spiked with a doglicious piece of cabanossi, kibble or a meaty treat. The dogs at the party were each given five minutes to take their pic…but many were just so overwhelmed by the selection they couldn’t choose.

As we were leaving, Pat offered to hand-knit me a sweater, and produced a photo of a cable-knit number that was so complex I thought she was joking.
She was dead serious.

I asked if I should send my measurements. She half closed her eyes as if they were lasers calibrating, looked me up and down and pronounced that my arms were 17 inches.

“I’ll check,” I replied, having no idea at all about the length of my limbs.
Pat then produced a tape measure and proved that she indeed has laser vision. Spot on.

She asked me to choose a colour from her wool chart. I picked aqua blue.
“It would look better in this colour,” she said, pointing to a shade of beige.
Phil, Sofi and Alice were tuckered out, and slept all the way home.

Two weeks later I received in the mail not only the most exquisite cable knit sweater in the history of time – with stunning buttons -, but a matching, equally cable-knit number for Phil. And she was right about the colour.

The contents of the amazing package I recieved in the mail.
Phil and I in our matching cableknit Starnovsky sweaters, doing our best impression of Country Road models (NB that isn't mist in the background - its smoke from the fires).

Friday, October 25, 2013

Improving the way animals are cared for in natural disasters

A hungry possum affected by the fires. Image courtesy South Penrith Veterinary Clinic.
As bushfires continue to burn throughout New South Wales it is impossible not to consider the animal victims - companion animals, wildlife and livestock. Its important not to get overwhelmed by the enormity of it all - there are still plenty of positive things that we can do. If you aren't close to the fireground consider donating to groups that have been helping animals, including the RSPCA and WIRES.

If you are close to the fireground and an injured critter wanders into your backyard, take it to your nearest veterinarian (in the case of companion animals may can be re-traced to their owners via microchip). 

Veterinary clinics close to the firegrounds have been inundated with animals. Dr Robert Johnson from South Penrith Veterinary Clinic posted a video (click here) of a hungry little possum in the Springwood fires.

Image courtesy South Penrith Veterinary Clinic.
Image courtesy South Penrith Veterinary Clinic.
Image courtesy South Penrith Veterinary Clinic.

Image courtesy South Penrith Veterinary Clinic.This beautiful little green tree snake, from Heather Glen Road in Winmalee, can't be returned to its home as the area is completely burnt out. 
[Spare a thought for the staff at South Penrith Veterinary Clinic and other clinics in areas surrounded by the fires. Dr Johnson, Dr Jane Roffey and their team - Robyn, Kathryn, Jess, Natasha and Parice - have been working a full hospital, with only one paying customer - the rest are rescued animals and boarders whose owners have been evacuated due to fires. Dr Johnson wanted to extend his thanks to people who had offered help - from Provet to clients and members of the community].

The NSW Department of Primary Industries is seeking to enhance the way we care for animals during natural disasters and are hosting a series of regional workshops on this topic.
Everyone who is responsible for animals must have information, guidelines and tools to help them prepare for a natural disaster before their animals need to be rescued or, worse, are injured or killed as a result of a disaster.

The cost to the community and to individuals due to lost production, replacement of livestock, veterinary services, disruption to our food supply and emotional loss due to natural disasters is enormous. And the suffering endured by productive, recreational, companion and native animals is heartbreaking.
One vital way of caring for our animals and preparing for their welfare before a natural disaster is to improve the way we engage with people who own or manage animals – in commercial, companion and recreational contexts. Because native animals are an irreplaceable resource unique to Australia, their welfare is of course equally important.
A swamp wallaby is brought into care.
They are holding a series of half-day workshops in regional centres to determine what is already being done to care for animals before and during natural disasters, identify stakeholders and their needs, examine the role of emergency services and other agencies in animal welfare and work out what is the best approach.

If you have any experience please consider attending these workshops - being a voice for animals now will greatly enhance their chances of survival in the future. For dates and times of the workshop, please click here for the full PDF.

Thursday, October 24, 2013

Comparative oncology: How understanding and treating cancer in human and animal patients can benefit both

Beata Uvjari holds a Tasmanian Devil. Techniques developed to identify structural variation in cancer genomes may help solve the mystery of the Tasmanian Devil facial tumour disease.
Clinical trials are common in the field of oncology – whether the patient is human or animal. When conventional treatments fail, it is not uncommon for specialists to reach for a novel or experimental drug, with informed consent of the patient or pet owner of course. A number of my patients, under supervision of a veterinary oncologist, have benefitted from access to such treatments. I know friends and family members of the human variety who have also benefitted because of such treatments. [I would hasten to add that not all patients benefit, and that decisions to use novel or experimental treatments need to be made carefully, on the best available evidence, weighing up the best interests of the patient. I also think it is important to manage expectations as some patients expect novel drugs to be a "wonderdrug". This is rarely the case].

Comparative oncology is about sharing information between researchers working in the field of human oncology, and those working with animals including veterinarians. Drugs that attack cancer cells effectively in animals don’t always translate well to humans – and vice versa – but they can.

SAT interviewed Beata Uvjari, from the University of Sydney’s Comparative Oncology Special Interest Group (CO-SIG) of the Cancer Research Network, a group dedicated to maximising our knowledge by looking at cancer across all species.

What is comparative oncology?

Comparative oncology is a multidisciplinary approach to exploit animal tumours as models in order to increase our understanding of basic cancer mechanisms as well as their treatment. Naturally occurring cancers of animals share biological, clinical and therapeutic similarities to human cancers.

What is CO-SIG and who is involved?

The Comparative Oncology Special Interest Group (CO-SIG) of the Cancer Research Network (University of Sydney), hosted by the Faculty of Veterinary Science, was established in 2012 as a multidisciplinary biomedical and diagnostic pipeline linking clinicians, oncologists, epidemiologists and molecular researchers, pursuing broad-based clinical and interdisciplinary approaches for an increased understanding and treatment of cancer in all species.

The researchers and clinicians at the Faculty of Veterinary Sciences investigate a range of spontaneously occurring animal cancers, which provide excellent opportunities for clinical trials and biological studies and allow early and humane testing of novel therapies.

This is an oral melanoma in a canine patient, anaesthetised for biopsy. This patient was treated surgically and with a novel vaccine under the guidance of a veterinary oncologist, and lived much longer (and much more comfortably) than he would otherwise.
What does the CO-SIG group actually do?

The members of the CO-SIG propose to meet four times a year, and to invite speakers from both animal and human cancer disciplines to showcase cancer research and developments, and to increase awareness for collaboration across disciplines.  Students and members of the academic community are encouraged to attend the meetings to foster networking and mentoring with experienced researchers. 

What are some of the current topical issues in comparative oncology?

Some of the most exciting topics of comparative oncology have been presented by our recent speakers Prof. Tony Papenfuss (WEHI, Australia) and Prof. Chand Khanna (NCI, USA).  Prof. Papenfuss has talked about the use of next generational sequencing technology in analysing structural variation in cancer genomes and how computational comparative genomics can help to solve the mystery of a contagious cancer, the Tasmanian Devil Facial Tumour Disease.  

Another important link between human and animal cancers was presented by Prof. Khanna who has been using canine tumour cross-species genomics to uncover targets linked to osteosarcoma progression.  The survival for newly diagnosed osteosarcoma, the most common type of bone cancer, has not significantly changed over the last two decades; therefore understanding the mechanisms of metastasis of this aggressive paediatric cancer is urgently needed.  Given the accelerated biology of canine osteosarcomas, clinically affected pet dogs provide opportunities to study the development and progression of pulmonary metastasis.

A parallel oligonucleotidearray analysis of human and canine osteosarcomas could not only distinguish between the canine and human diseases, but identified two potential target genes IL-8, SLC013, which have been previously overlooked as diagnostic and therapeutic markers in human osteosarcomas.  Dr. Khanna’s results demonstrate the importance of a comparative oncology approach to improve our understanding of cancer biology and therapies.

Comparative oncology also has an important and essential role in cancer drug development. Traditionally, new drugs are evaluated in conventional preclinical models prior to human clinical trials. Canine patients could provide an integrated approach to translational drug development by being an intermediary between conventional preclinical models and the human clinical trial – and pet dogs treated with trial drugs can benefit from new treatments.

Use of novel treatments in animal patients provides additional information, such as dose, toxicity, pharmacokinetics and pharmacodynamics. [Ed - The decision to trial a drug on a canine patient is always undertaken with owner consent. No veterinarian or veterinary oncologist would advocate use of a drug on a trial basis that did not have a significant chance of benefitting the patient].

The importance of an integrated approach to cancer drug development is also highlighted by the work of our current speaker Dr. Chris Weir who has developed a cancer vaccine which has the potential to improve life expectancy and survival rates of patients suffering from brain tumours.  

Dr. Weir used cells from individual tumours, creating a unique and personalised vaccine for each canine patient. The vaccine successfully slowed the growth of tumours, helped prevent new ones from developing and prolonged the lives of the canine patients, some diagnosed with advanced cancers. The success of the canine trials opens up opportunities for human clinical studies, and gives hope to both canine and human cancer sufferers

These eminent studies provide strong evidence how a comparative approach to cancer could lead to the identification of cancer-associated genes, help the identification of environmental cancer risk factors, and most importantly, aid the evaluation and development of novel cancer therapeutics for human and animal patients.

Who can become involved?

Anybody who is interested in animal or human cancers, or just would like to learn about cancer research, is welcome to join us, our meetings are open to public.

To become formally involved with the Special Interest Group, one has to join the University of Sydney’s Cancer Research Network:

Formal membership is open to employees of the University of Sydney, people employed by teaching hospitals and Institutes of the University of Sydney, or people holding an academic title award from the University of Sydney, who are active in the area of cancer research.  Membership is also open to postdoctoral fellows and postgraduate research students enrolled at the University of Sydney who are doing research in the area of cancer. Further details can be found at:

Non-University of Sydney employees are also welcome to join us at our meetings, please email the chair of CO-SIG, Dr. Beata Ujvari (beata.ujvari@sydney.edu.au) for further information.

Our website:

Wednesday, October 23, 2013

Practice survival guide: VetPrac's essential tips

VetPrac and B. Braun's Aesculap Academy teamed up to produce this poster. Download the PDF here or visit www.vetprac.com.au (I love the way the pug on the left is looking a bit unsure about the whole group photo thing).
No matter how much you know, how good your intentions are and how much effort you put in, veterinary practice has a way of throwing curve balls. When we learn at university we tend to practice our skills in a controlled, protected environment. This can give a sense of great confidence - hey, I can work up an acute abdomen and manage it really well.

Enter the reality of practice. Multiple cases. Comorbidities. Phone calls. Distraught clients. HR dramas and interpersonal competition and conflict. Unexpected complications. The inherent unpredictability of biological systems. Multiple complex demands on our time. And there are some complications that are just so unexpected that you don't even think they can happen until they actually do (a cat that jumped from a colleagues arms INTO the ceiling springs to mind).

Learning is one thing - but applying that knowledge in the world of practice is wholly another.

Dr Ilana Mendels, founder of continuing education provider VetPrac, knows this too well. Ilana takes a "bigger picture" approach to practice and is always distilling life's lessons from clinical encounters...so I love the fact that she pulled together a lot of these pearls, including tips for mantaining good client and colleague relationships, tips for successful surgical outcomes and five-minute crisis management, and made them into a poster that you can stick on your clinic wall. I can just hear Ilana's calm voice saying "stay calm, gentle tissue handling, extend the incision..."

You can read an interview with Dr Mendels here and download the PDF of the poster by clicking here.

Tuesday, October 22, 2013

Preparing pets for evacuation in emergency & RIP Radike Samo, guinea pig

Radike (right) meets his new cage-mate Randy: you know guinea pigs are hitting it off when they share bok choy leaves.
I cannot begin this post without acknowledging that so many people have lost beloved pets in the terrible fires over the last week. There are many animals affected - even those that survive the initial blaze are subjected smoke inhlation, terrible burns walking on the fireground, dehydration and other injuries. 

Many areas remain under threat. The Australian Veterinary Association has provided advice for pet owners close to affected areas which you can view here. The RSPCA NSW blog has info on preparing pets for evacuation here.

If you have not already, consider volunteering your time or making a donation to wildlife care groups, such as WIRES (click here), which will be inundated. 

On a personal and wholly unrelated note, this week I farewelled Radike Samo, a guinea pig named after my favourite Wallabies player (I had to qualify the title of the post lest Wallabies fans read it and think that the great man himself had died). Radike (the guinea pig) passed away in his sleep peacefully due to unknown causes. He had suffered from recurrent dermatitis, cause undetermined, but at the time of his death was in excellent condition. His co-habitant Randy is missing him terribly.

Randy and Radike tuck into two faves: Dutch carrots and celery tops.
Radike came into my live as part of the cavy-chain. Anyone who owns cavies will know what I am talking about: you start with one, for which you need a friend, so you find that second guinea pig. Years later, one dies. But because guinea pigs are herd animals, they need company. The remaining guinea pig needs a companion.

So you get another one...and the eternal cavy chain is established. In my case the cavy chain has involved not just owning guinea pigs, but learning and writing about their husbandry, attending guinea pig shows dressed as a giant fairy (sometimes I wonder how these things come to be) and attending guinea pig medical and surgical emergencies anywhere from Sydney to Darwin (one of my most painful work-related experiences was a guinea pig bite sustained when trying to break up a fight between two pet boars living in a backyard pen 300km Northwest of Alice Springs. They were fighting over a sow. I underestimated their passion. Excruciating). 

When I adopted Radike I had just seen the most exhilarating sporting footage of Wallabies player Radike Samo scoring a try against the All Blacks. I'm not a sports fanatic but this moment left me breathless (especially the bit where he "throws a dummy" and sprints across that field with two huge, determined, pretty scary looking blokes in hot pursuit).


This by way of explanation that Radike the guinea pig was named such because of his ability to sprint. Sans All Blacks in hot pursuit, but you get the picture.

Randy and Radike enjoy fennel tops together.
When Radike's co-habitant Popcorn died I found Randy.

Randy and Radike hit it off - so much so that unfortunately I don't feel it would be appropriate to post the video of their first thirty seconds together (let's just say there was a mutual attraction and leave it at that). 

I will remember Radike, but Randy will fret for him until he finds someone else to eat and hang out with. What I do know is that cavy-chain wasn't meant to be broken. So I'm making preparations for a new addition.

[If you want to read more about guinea pigs, check out the guinea pig salad here or read about guinea pig treats here].

Monday, October 21, 2013

Three things I learned: surgery in small animal patients with cancer

CT is important for staging and surgical planning when removing tumours from animals. Image courtesy Dr David Simpson, Animal Referral Hospital.

Last week the AnimalReferral Hospital hosted a fantastic couple of talks for veterinarians. Medicine specialist Narelle Brown gave a comprehensive talk on hypoadrenocorticism, but today’s post will focus on the talk by Hospital Director and specialist surgeon David Simpson. He talked about surgical oncology and it’s an area of interest of mine for several reasons: a) small animal veterinarians perform a lot of oncologic surgery (the humble lumpectomy can be life-saving); b) I’ve enrolled in the Centre for Veterinary Education’s distance education program in medical oncology for 2014 as I want to try to expand my skill set for helping patients with cancer; and c) some of the oncologic surgeries undertaken by surgeons like Dr Simpson are just incredible.

The best thing about the talk was the logic and experience that Dr Simpson brought to the topic. The surgical principles are straightforward (even if the mass confronting one is not), but the way you express them can make all the difference.

Dr Simpson began the talk introducing two questions he asks in every single cancer case:
  1. What is it?
  2. Where is it?

They sound simple, but how many times do we remove a lump without the benefit of cytology or histopathology? The truth is often pathology and staging are declined by owners – which is their perogative – but in the case of malignancy it is really important.

The humble fine needle aspirate can be helpful in guiding decision making but is by no means definitive.

So what is the possible yield?

  • -      Neoplastic cells
  • -      Oil (from lipomas)
  • -      Inflammatory cells (can be associated with abscesses but also necrotic centres of tumours or mast cell tumours)
  • -      Mucus
  • -      Blood
  • -      No yield (this can happen with normal tissue but also tends to happen in the case of very fibrous tumours e.g. sarcomas, spindle cell tumours)

Dr Simpson is often requested to extend the margins of a biopsy site once histopath has returned a malignant result. He recommends making the biopsy site as small as possible and considering the ramifications for a wider resection when choosing the site. He is also very much against the use of drains in the case of narrow excisions as they increase the margins – and on a limb that can really limit options. (Of course there are some tissues where excisional biopsy of a mass is preferred: anal sacs, splenic masses, brain, thyroid and adrenal glands).

Surgical view of a massive hepatocellular carcinoma removed by Dr David Simpson. Image courtesy Dr David Simpson.

Staging helps answer “where is the mass” – and should be guided by the tumour diagnosis. For example, MCTs tend to metastasize to lymph nodes rather than the chest. Each location presents surgical challenges.

Decision making around an animal with a neoplastic mass or lump

Options
  • Do nothing
  • Palliate
  • Surgery
  • Chemotherapy
  • Radiation
  • Immunotherapy
  • Euthanasia

Factors that affect decision making
There isn’t just one way to treat a dog or cat with cancer and the truth is that many factors, physical, functional and philosophical, come into the decision making process.
  • Tumour type, stage, grade (“what is it?”)
  • Tumour location (“where is it?”)
  • The owner’s bond with the animal
  • The owner’s philosophy, biases and previous experiences with cancer in human or animal patients
  • Concurrent disease
  • Economic reality
  • Risks – morbidity and mortality associated with treatment

Dr Simpson argued that veterinarians should be clear about what they are trying to achieve with surgery and where surgery fits into the treatment plan:
  1. Diagnosis that will provide the option for more comprehensive treatment later
  2. Cure
  3. Palliative debulking (this is not ideal, wound healing may be compromised)
  4. Adjunctive to other forms of therapy.

A pulmonary adenocarcinoma removed by Dr David Simpson.
He offered several pearls of wisdom:
  • The first chance to cut is a chance to cure;
  • Avoid spreading and seedling the tumour by rough handling of tissue; avoid drains where possible; ligate the artery then the vein.
  • Try to think separately about excision and reconstruction – in major human hospitals the team that performs excision is often different to the reconstructive team. The advantage is that there is no compromise on aggressive tumour removal;
  • If it is worth removing it is worth performing histopathology [This is a mantra I personally live by…I run histopath on any lump taken off my animal because it rules out malignancy, because I know FNA isn’t perfect, and because I always learn].

Other interesting bits and bobs that I learned included that Dr Simpson now takes 2cm margins around MCTs; uses haemoclips to perform rapid splenectomise; and uses special tissue dye on large masses so when they are submitted for histopath the pathologists know the orientation of the mass. I’d never encountered the latter before and it’s a brilliant idea.