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| Associate Professor Tom Gottlieb with Jamaica. |
This week
we were fortunate enough to catch a cuppa with Associate Professor Tom
Gottlieb, a senior specialist in microbiology and infectious diseases at
Concord Hospital, past president of the Australasian Society for InfectiousDiseases, current president of the Australian Society for Antimicrobials and
owner or cohabiter with Jamaica, an affable Australian Shepherd who prefers
that no one expresses her anal glands thank you very much.
I’m always
excited when I meet our medical counterparts. What kind of cases do they see?
Do they catch diseases from their patients? Do they love their dogs as much as
we do? So many questions. If you’re as curious as I am you might want to head
on up to the ASID Zoonoses Conference in Brisbane next month.
How did you get involved working with
infectious diseases? Do you have any favourite infectious diseases?
Like most
things in medicine you stumble into it. It all makes sense looking backwards but
somehow going forwards its just random choices you make. As a trainee I worked
in New Guinea and in New Guinea it was all infectious disease and in my time it
was all TB.
My
favourite diagnosis is TB because it presents in so many different ways, each
patient is a surprise in some way even though the management is very guideline
driven.
In
infectious diseases the hardest cases are the silly little old ulcers in
elderly people because they are so hard to manage whereas exotic diseases like
TB and typhoid are not that difficult to manage but people
think they are. So there is glory in managing some of those exotic diseases but
far less glory, and often much harder to manage the mundane things.
Once you
start in infectious diseases you realise that it is centered around antibiotic
management, so in the last 10-20 years the big interest has been antibiotic use
and antibiotic resistance because they go hand in hand.
In your role in ASID you’ve been
integral in organising a symposium on zoonoses. Why should veterinarians and
doctors learn about zoonotic disease together?
When I was training we had a wonderful workshop at the zoo one day with
vets and doctors and it hit me that a lot of the common infections we talked
about we had seen in patients but vets had had themselves – contracted from
their patients.
And I realised there was a lot of commonality. We tackle infections
often slightly differently. Some things I suspect veterinarians have cottoned
onto earlier and got onto the right approach and in some areas doctors might
have stumbled onto faster than vets. For example, I think one area that doctors
do well (or better now than they used to) is infection control and antibiotic
management, partly because we have been forced down that line through
regulation. Regulation is the most effective form of control, sadly, because we
are not easily pulled into line unless forced to. I suspect vets are the same
and I think in these two areas we’ve been laggards in - or vets need to do
catch up on?
We organised a summit about antibiotic resistance in 2011 where we tried
to pull all common groups together and we realised there was a way to go with antibiotic
resistance in veterinary or zoonotic infections as well. At the same time the
concept of “one health” was taking off (which is the new black) and we thought
it was a great opportunity to bring us all together. We organised the zoonoses
meeting partly out of subliminal intent to set up a dialogue about antibiotic
use in animals.
When the meeting happened I was surprised at how much common interest
and how much fun we have learning about each other’s strands of medicine. It
was such a success that just like any good party, we wanted to do it again.
I've always wondered if infectious
disease physicians are more likely to catch infectious diseases due to a higher
risk of exposure to infectious diseases. Is there any truth in this?
No, I
don’t think so. I don’t know anyone who has had any more infections than anyone
else. And partly - and unlike vets – this may be because we have referred
patients from GPs or the emergency department and so there is an expectation by
the time the patient comes, to know which way the wind is blowing. You can
anticipate things in referred patients, but you cannot anticipate left field
things, new events and diseases like SARS. When that came long nobody was
prepared. The point about SARS is we stopped thinking and we admitted patients
with respiratory infections and we didn’t protect ourselves from respiratory droplets
when common sense tells you that you should be protected. SARS caught us
unawares because infection control wasn’t up to it. But in a day to day
experience we can anticipate the risks fairly easily and therefore I don’t
think it is a major issue.
The other
thing is that most infectious disease aren’t contagious - they are caused by
microorganism that are often unique to that person and you have to try very
hard, by whatever exposure such as sexual contact or insect bite, to get it. That’s
unlikely to happen in my office.
It’s when
we’re unprepared and we don’t set up systems to deal with risks we should have
anticipated, that’s where we get caught. Hence the point about the first
meeting with vets. The doctors at the meeting talked about patients with
psittacosis, while just about every vet in the room had had it. It comes back
to the issue of infection control and thinking through systems to make sure
these are well covered to prevent infection of the vet or transmission of drug
resistant organisms.
How did you meet your Jamaica?
Our other
dog had died and we felt utterly relieved to be dog free. We could travel
without guilt. Bring on Italy, Spain. A few months after the deat, we went to
Fox Studios for a dog owners’ day, which was mostly people bringing their own
pets for a walk around. But there were a couple there with two Aussie shepherds
and their litter. We got smitten in that very moment and we bought the runt of
the litter.
And our
only regret is we didn’t buy two runts. Great error of judgement, that was. The
runt of the litter turned out to be a wonderful dog with a fantastic
personality which keeps us honest. (The previous dog was thoroughly loved and
died of old age).
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| Jamaica takes the fam for a walk. |
How would you describe your
relationship with Jamaica?
Intimate.
Your animals become your children, particularly when your children leave home
or give you grief, suddenly the dog is seen as being much easier to manage and
deal with and so much cheaper to run.
How do you spend time together?
In idle
moments we sit on the lounge and we peer deep into each other’s eyes. At other
times we walk because I am the designated walker on weekends. She is slowing
down a bit as she is not as partial to hills anymore, and nor am I, so we’re slowing
down together or maybe she is moulding herself to me.
We talk.
Well, I am sure she is talking to me, and at times out of desperation I talk to
her. When does madness creep in? When you start answering or writing letters?
But talking is okay isn't it?
Jamaica is
easy company and has a circuit of friends who are happy to take her in for
walks and stays and she is always looked after. Your life revolves around
having your dog catered to because the guilt is too much! So any non-dog
holidays are anticipated by dog organisation moments.
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| How could you not love this dog??? |
Does your infectious disease
knowledge inform the way you relate to Jamaica?
Does
infectious disease knowledge inform the way I deal with my children? Its often
through benign neglect and often to the consternation of my dear wife who felt
I was never there for the major illnesses and never took them seriously when I
was there. And sadly I have a similar attitude to Jamaica which is a “she’ll be
right” approach. That said its held out fairly well.
You learn
to be a little bit - not blasé, but not to get panicked by illness - because
you have to deal with it every day. That probably informs how you deal with
family medical stresses, you don’t push the panic button so fast - til you
really do need to.
What do you think Jamaica thinks
about veterinarians?
The only
major setback Jamaica has was when both Frances and I were away and so imposed on
our friendly vet friend to do a home visit. At which point he did something to
Jamaica that she has never forgiven him for [expressed her anal glands] and now
she starts barking when he is within a 5km radius of our house. That’s an
exaggeration. Probably 1km. He comes to the door and she growls, she eventually
settles down but she doesn’t growl at anyone else. I have learnt. Dogs or
Jamaica, don’t forget indignities like that.
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| Is that a halo? |
How has living with Jamaica changed
you as a human being?
I wish
things would change me as a human being but I suspect I am immutable. A few
people have commented on that, and mentioned they wish there was a way.
I have
learned to appreciate certain things in life. Poor Jamaica gets two chicken
wings a day and has had that for last ten years on instigation of the same vet.
And every night when she gets two chicken wings has unbridled enthusiasm and
joy for the same bloody chicken wings.
It makes you
realise that you can get sheer exultation out of simple things - you don’t have
to look too far beyond what is under your nose, so to speak.
Dogs also
teach you unconditional love, and that’s why we seek those animals.
Me and my
brother grew up in a very fastidious house as my mother obsessed by cleanliness
and didn’t have animals even though she was brought up on a farm. Funnily
enough when we both left home we got animals immediately. Girlfriends and dogs,
can’t remember which came first nor which were bigger priorities. . Having an
animal in your house changes the dynamic…and its fantastic.
You get
too preoccupied if there are only humans. The animal needs and relationship
adds an extra dimension to your household life and I think we’re all better for
it. When our first dog died, we said we didn’t want another dog. Now we could
travel. And now Jamaica is getting older we think the same – when she goes we
will travel and not worry about the dog. But I cannot help but think there will
be another dog around the corner. They force you to walk and not focus on
yourself and talk about doggy issues.
As an
addendum I’ve been asked for photos and realised I should do more selfies with
the dog. A selfie with Jamaica in Centennial park to compete with selfies with
Wife in Italy or Spain. That could be a new resolution.
Thank you Tom! Clearly, behind every good infectious diseases physician there is a great dog. Meantime if you need even more encouragement to attend the ASID conference, its also a chance to meet Nobel Prize laureate (and veterinarian) Peter Doherty. You can read his message for vets here.
