What do ticks look like?

Tick in situ on a dog. This is an engorged tick, note the enormous sac. The mouthparts are attached to the skin.

One of the common questions asked by clients is what does a tick look like when it’s on a dog? It’s an important question as ticks are nasty and paralysis ticks can kill dogs and cats. But there are also some cases of mistaken identity – I’ve known some people mistake scabs, warts and nipples for ticks, with some disastrous consequences.

A tick in the hand.

So here are some ticks in situ. The engorged ticks tend to be easier to spot, as they are bigger.

Ticks are often found in hard to groom places – around the face, ears, head and neck, as well as between the toes. But really they can be anywhere. Dogs and cats in tick areas should be searched regularly for ticks, even when on tick prevention. And tick prevention saves lives.

Ticks between toes. These can be tricky for dogs to remove themselves.

Make sure you use a product that is REGISTERED for use in the species you apply it to. Remember that dog tick products can contain chemicals (especially permethrin) that are incredibly toxic to cats. There have been quite a few cases lately where cats have been exposed to these products by keeping close company with dogs treated with these products (e.g. mutual grooming). Unfortunately our evidence suggests that point of sale information from pet shops is not always accurate in regard to safety of tick products in cats. If in doubt, or if using a new product, ask your vet first.

Postcards from the bush, a relationship that began with a meatball, and volunteering in your PJs

Why did this emu cross the road? I don't know, but he or she did it in FOUR incredible steps. Check out those prehistoric looking legs.

SAT has gone bush, and confronted our “nomophobia” (ie fear of no mobile reception) head on. Turns out the bush has plenty more to offer than phone signal. Like an array of incredible wildlife.

This little gecko was in the sink at our accommodation.

Its great when you can actually watch sheets of rain moving across the landscape.

...and ticks in spades. These little suckers were from one dog. Its about 10 per cent of the total population removed from this dog. They are being submitted to Professor Peter Irwin at Murdoch University for important research. 

Meantime the world kept spinning. Chris sent this beautiful link about a stray dog who joined a team on a 700km adventure race, thanks to a meatball. The team members did the right thing and took responsibility for the dog (and we hope also appropriate quarantine measures).

Volunteer in your pyjamas? I love this idea. The Do Something Near You folks are promoting the concept of armchair/not-leaving-the-house volunteering to prove that a difference can be made with very little effort.

heir DoSomethingNearYou.com.au website is now listing virtual volunteering opportunties such as:

·  Five minutes to spare with a phone? Help the Red Cross by becoming a Telecross volunteer. Make daily phone calls to older Australians to check on their wellbeing. This helps them to live independently and remain connected to the community.

·  Are you an animal lover? Help scientists who study penguins in the coldest parts of the world by annotating their images of wildlife in Antarctica and the Southern Ocean. All from the comfort of your own home.

·  Are you a natural history buff? You can assist the Australian Museum by transcribing specimen labels, field notes and diaries. This helps to unlock the hidden knowledge in their vast collections. And it can all be done via computer.

·  Want to help people in developing countries? You can assist theUnited Nations with their work in developing countries. If you have skills in writing, editing, design, research or translation, then the UN wants you as a virtual volunteer.

·  Are you a bibliophile? You can help the State Library of WA by volunteering to transcribe 70,000 hand-written WA Biographical Index (WABI) cards. No matter where you live in Australia you can give them a hand online.

Check out http://www.dosomethingnearyou.com.au for more ideas…or do some volunteering in person. Just enter your postcode to find out what is going on near you.

Ingrown toenails in pets, and why nail clipping is a good idea

Nails can become a source of pain if not managed. (I met this little dog in the US, and yep someone had painted her nails).

If you’ve not suffered the displeasure of an ingrown toenail before, those who’ve had one can tell you of the seemingly disproportionate pain. Weight bearing, touching or even the vibrations through the ground of someone standing near the affected toe can be excruciating.

We see ingrown toenails in senior pets, most commonly cats but I do see them in dogs and increasingly in guinea pigs. The aetiology is somewhat different to human ingrown toenails but the impact is the same – it causes discomfort, pain, inflammation and often infection. A toenail is, after all, a foreign body which, once it starts growing INTO tissue, the body wants to reject.

One reason I think we see this most commonly in cats is because they are furry. Hairy toes mean it can be hard to see the nail. The second of course is that many cats are “foot shy” – they don’t like their feet being touched, and they’re variably direct about telling you so.

Ingrown toenails are seen most commonly in older cats, I suspect because arthritis means it can be hard to bend and flex to reach and groom the toes – and it may be harder to use enough strength when employing a scratching post or similar to remove the offending nail.

The sum total of this is a nail which keeps growing.

So I thought I’d show what such a nail can look like and demonstrate how big they can be.

This cat had two other ingrown toenails. Note this one extends from the nail bed (top) curling right around and inserting into the tissue of the toe.

What to do to avoid these? Regular nail trims. Though I’ve done thousands of them, in most cases I need someone (ie a vet nurse) to hold the patient while I trim the nails (especially guinea pigs). Just about every vet clinic provides a nail-trimming service.

Better out than in. A huge ingrown toenail is removed. Note how sharp and pointy that thing is at the end. Not nice at all.

It’s well worth getting young pets used to you handling their feet, and trimming nails regularly. They grow back pretty fast. For pets with arthritis, sometimes pain relief solves the problem of overgrown nails if it allows them to weight bear to an extent that the nails can be worn down naturally, or if it enables them to groom properly.

Guinea pig in position for a nail clip. This nail clip was being performed by the owner of a guinea pig at a guinea pig show.

This is another pic from the US (hedgehogs are exotic to Australia). This little hedge is having a nail clip.

From a veterinary perspective, these are one of those problems that feel really good to solve. There’s the nail, then it’s gone – and the animal can walk properly again (though multiple ingrown toenails in the same animal at the same time are more common than not so it’s usually a repeat process til they are all gone). I never get bored of removing them (I never get bored of hedgehogs either).

Hi from Central Australia

Corazon walks past amazing rock formations. 

I’m currently in Central Australia, volunteering with AMRRIC (Animal Management in Rural & Remote Indigenous Communities) with a fantastic team and enjoying restricted wifi. There’s something amazing about being invited into a community, setting up a field hospital and doing surgery on some truly beautiful dogs.

Here’s a little peak at where we are…

This little dude (a sand goanna or Gould's monitor) was sunning himself on the road.

Brumbies. Looking like art. Note the little foal at the rear.

Here he is.

Atul Gawande on Being Mortal

Medical writer and surgeon Atul Gawande, author of Complications, Better and The Checklist Manifesto (yep, a book about checklists – which is an unexpectedly BRILLIANT read) just released Being Mortal.

This is not a book about veterinary science or veterinary practice but it is of interest to such an audience in the main because it deals with systematic problems with medicine – problems that will affect us all (if they don't/haven't already).

In this book he reflects on end-of-life care of human patients, including his own dad. 

BeingMortal takes aim at our fetish for medical intervention, right up to someone’s dying moments. It’s something as a vet I’ve come to appreciate. It is common, when I euthanase an animal, for the owner to tell me that they wish that a family member who recently died in hospital could have died at home, without all of the treatment that has become the norm for preserving human life – ventilators, antibiotics in the face of insurmountable infection, feeding tubes and so forth. Of course these technologies have a place, and have saved lives – but sometimes they simply prolong a life, which may not be a life the patient considers one worth living.

He is, as usual, very critical of his profession – in a constructive way. It takes guts to be critical of one’s profession, and I don’t imagine one publishes a book like this without copping inevitable flak. Gawande is also a physician with the maturity to admit and reflect on his mistakes. He recognises his own role in perpetuating the problem. Which makes for compelling reading.

Gawande astutely observes our fetish for intervention, and suggests that medical students may be set up for this early in their careers.

“You become a doctor for what you imagine to be the satisfaction of the work, and that turns out to be the satisfaction of competence. It is a deep satisfaction very much like the one that the carpenter experiences in restoring a fragile antique chest or that a science teacher experiences in bringing a fifth grader to that sudden, mind-shifting recognition of what atoms are. It comes partly from being helpful to others. But it also comes from being technically skilled and able to solve difficult, intricate problems. Your competence gives you a secure sense of identity. For a clinician, therefore, nothing is more threatening to who you think you are than a patient with a problem you cannot solve”.

Agreed. The problem of course is when attempts to do something – because we fear doing nothing- impact on the quality of life of patients.

Much of the discussion is around the care of the elderly, which – though improving in some areas – can be barbaric. Part of the issue is the obsession with safety which is prioritised over and above patient autonomy.

“Nursing homes have come a long way from the firetrap warehouses of neglect they used to be. But it seems we’ve succumbed to a belief that, once you lose your physical independence, a life of worth and freedom is simply not possible.”

He well and truly argues against that conclusion, discussing palliative care and hospice in a way that I’ve not been exposed to prior. And it’s a conversation that all health care professionals – and those who will use their services - should be involved in.

“The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet- and this is the painful paradox – we have decided that they should be the ones who largely define how we live in our waning days. For more than half a century now, we have treated the trials of sickness, aging and mortality as medical concerns”.

The problem is that our population is aging. Now, more than ever, all of us need to consider the important question: when should we try to fix and when should we not? (One of the big revelations for me was the evidence in Gawande’s book that in opting to “not fix” there is still much we can do to improve quality of life).

Gawande argues that there is more to being old than simply being safe and living a bit longer, that the meaning in people’s lives is their ability to shape their own story, that we can ALL work to reshape our aged-care institutions – and even our culture – to improve the quality of everyone’s lives. I was in tears when I finished the book, but they were tears of hope. Gawande’s is a really positive message. This sort of reflection is what should lie at the heart of medicine.

“The battle of being mortal is the battle to maintain the integrity of one’s life – to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be. Sickness and old age make the struggle hard enough. The professionals and institutions we turn to should not make it worse. But we have at last entered an era in which an increasing number of them believe that their job is not to confine people’s choices, in the name of safety, but to expand them, in the name of living a worthwhile life.”

Animals aren’t a big feature of the book – although the ability to keep an animal in a home, hospice or aged care facility definitely improved the quality of life of many – but the content is relevant to anyone, vets, vet students or otherwise. In fact, it’s a book I’d recommend to any mortal. And it’s one I hope my doctor reads!

Reference

Gawande, A (2014) Being Mortal: Medicine and What Matters in the End. Metropolitan Books.

Poodle hair, emotional assistance dogs and other gems from the web

Forget the hair do. Its about the tennis balls.

Today we took a break from working to hit the park where we met a gent walking four magnificent Standardbred poodles…one of whom was sporting a pretty stunning head (and body) of hair.

Profile pic. Just don't try taking those balls...

...this dude might get them.

Phil had a trim too but went for his summer crew cut (good for spotting ticks, and any other creepy-crawly that might come his way, as well as getting rid of all of that excess fur that surface allergens love to stick to).

New look for summer. Phil with his personal groomer, Amanda. 

Highlights from the web this week include this dog who caught a ride on an ambulance. Once the ambos realised that Buddy was on the truck, they had no option but to let him in (read the story and see the pics here).

Which leads us to the topic of assistance pets and emotional support pets in particular. I’m definitely a believer in the concept of pets as therapy, and I think access for animals should be increased, but are there people abusing the assistance-animal tag?

According to this fantastic article from the New Yorker, yes they are. Journalist Patricia Marx decided to test exactly where her emotional support animals would be allowed. In an assignment that made me extremely envious, she took her assistance turtle, snake, pig, and even alpaca to places where, it seems, no animal has gone before.

Read the full article here. Its a long one (one cup of tea will get you through it) but brilliantly written.

On the topic of public health, a recent case involving a rabid cat in the household of an animal hoarder has resulted in the euthanasia of fifty cats. More details here. 

Whatever you're up to this weekend folks, have a safe one and include the non-humans in your life.

Poor Phil was exhausted after watching those poodles.

Cheeky dogs: the story of artist Dion Beasley

Dion Beasley's Cheeky Dogs are featured on t-shirts. This one lists different Indigenous words for dog.

Dion Beasley is an Indigenous artist best known for his drawings of Cheeky Dogs. So popular are his designs that they have spawned a company, www.cheekydogs.com.au. Dion is profoundly deaf and has reduced mobility due to muscular dystrophy. However, through his art, and with the support and collaboration of disability support educator Joie Boulter, Dion has found an outlet. Their story one inspirational story documented in Outback Spirit by Sue Williams.

Joie spoke to SAT about Dion’s work.

What is a Cheeky Dog?

A Cheeky dog in an aboriginal community is one which has a tendency to bite or attack, while in other situations just means a fun-loving dog.

How did you meet Dion?

When Dion came to live in Tennant Creek, he attended the Tennant Creek Primary school (with his cousins) where I was teaching at the time. Soon after I went on long service Leave and so was able to spend more time with Dion, and this continued when I retired the following year.

Can you tell us how Cheekydogs came about?

“Cheekydogs” (the Company) was formed in 2006,several years after Dion came to live in Tennant Creek with extended family. Dion was (at that stage) a very insecure little boy with extremely limited communication skills, but expressed daily experiences through his drawings. He particularly drew dogs which had a special quality about them. I believe that this special talent of Dion’s could be used to enable him to provide a vocation for himself, with the potential to provide a form of financial independence into the future(hopefully).

This led to Dion’s drawings initially being transferred onto shirts and later onto a variety of products. At this stage my husband and I decided to form the Cheekydog Company as the avenue through which Dion’s art work could be used for his benefit.

Dion greets some cheeky dogs.

What makes Cheeky Dogs great subjects?

Little did I realise at the time, how important dogs (and drawing) were to Dion’s wellbeing. Dion is absolutely fascinated by all the dogs he has encountered in all the communities he has lived in throughout his life. The dogs Dion draws are taken from real life and with his amazing memory he can recall all the dogs (and in which house they lived) he has met. His love for all dogs is evident by his excitement when travelling around communities. As well as drawing the dogs he also loves to photograph the dogs and so has many hundreds of photos of dogs of all sizes, shapes, colours and temperaments.

Last week he attended the clinic (desexing) in Tennant. He was in seventh heaven, travelling with the workers, bringing back the dogs and watching the whole procedure! One of the workers showed Dion the procedure of collating the data on his I-Pad and Dion very quickly was picking up the idea.

There are plenty of Cheeky dogs around...

How does Dion come up with ideas for his drawings?

Dion constantly talks about dogs and is self-motivated to draw subjects of his choosing. Often late at night Dion becomes absorbed in his drawings (he’s definitely a night owl) and is happy drawing into the small hours of the morning. Dion is also extremely knowledgeable about drawing aerial views of communities in which he has lived, so drawing communities with their many dogs is an exciting experience for Dion (and one which he regularly partakes in).

How important is Dion’s work to him?

I think that Dion’s drawing and love of community and associated dogs is essential to his emotional wellbeing. He becomes totally absorbed in his work and will not be distracted by any interruption. Dion is a very contented, creative soul when engaged in drawing, constructing or photographing. What more can I say about this wonderfully creative artist? He has a great sense of humour and delights in simple pleasures.

Do you live with any dogs?

We do not have a Cheeky dog here (a little selfish on my part, and no secure fence). Dion travels down to his grandad’s house every day, taking a container of dog food which he happily feeds to the dogs at Mulga Camp .He really loves the Camp dogs but is not so keen on the well-bred varieties!!

Dion leads the pack.

Do you have any advice for veterinarians or vets visiting communities for desexing programs?

Sorry, no advice for those visiting communities but if Dion was able to join in the activities in the communities his day would be made!

Thank you Joie and thank you Dion for your inspirational drawings. If you want to own an original Dion Beasley, whether its a t-shirt or artwork, visit here.

Should pet insurers be able to track pets?

Sleeping ferret.

There are a few medical insurance companies in Australia that offer a free pedometer or activity logger and a cheaper premium on the condition that the insured performs a certain amount of physical activity daily.

It seems that pet insurers are going in the same direction. I received a media release about a UK company that offers a GPS activity tracker (below).

The news that a British pet insurance provider will begin using GPS dog collars to track a pet’s activity may be the first sign that the industry is really beginning to move with the times, according to insurance technologist Aquarium Software. The device, adopted by More Than insurance, which is similar to those used by car insurance companies to track dangerous driving patterns, is aimed at ensuring a healthier – and hopefully vet free – lifestyle for your animal.
 
Manchester and US-based Aquarium believe that the new tracking device will bring the industry more in line with other insurance markets and make it more profitable for insurers. The average vets’ bill currently costs around £300¹ and with that figure rising with the advent of more advanced veterinary treatment, the micro chipped dog collar will encourage owners to take better care of their pets.
 
“This is the first sign that insurers are really seeing the benefits technology can bring and by rolling out a GPS device like this, they’re creating a bigger data arsenal from which to better assess each individual insurance quote,” explained Mark Colonnese, Sales and Marketing Director for Aquarium Software. “The bottom line is that for the first time in the pet market, each insurance case can be individually evaluated, based on an individual pet’s analytics, something that was not previously possible.”
 
The technology, which is deployed in the form of microchip syncs up with a pet owner’s smartphone or tablet, before being passed down the line to the insurer where they measure a pet’s activity against recommended healthy guidelines. The healthy activity rate is calculated based on age and breed of dog, but Aquarium believe that now the technology is in place, there is no limit to its future use.
 
Pets that are exercised within the healthy recommended amount will qualify for cheaper insurance premiums discounted up to 20% as well as other benefits including healthy dog treats, free vaccinations and tablets and food, which also ensure a healthier lifestyle for your animal. The device also defends itself against wrongful use by dis-counting any activity over a natural speed for a dog, for example car travel.                        

“This technology is creating data all the time and as it progresses patterns will appear in other aspects of a dog’s existence that may be able to further accurately process each individual case down the line,” said Colonnese. “We may notice certain hotspots of healthy pets or be able to notice harmful trends based on location or time of activity when correlating the information back with claims databases and vets records.  What is really exciting is what else can be done with this type of technology and data, we know from experience this development is just scratching the surface and our R&D team are currently working on some very exciting proof of concepts”
 
Aquarium has provided bespoke technology for the insurance industry for years, but recently the integration innovators have shifted their focus to the pet market in an attempt to make it both more profitable to insurers and valuable to pet owners. “Naturally this advancement is something that we consider exciting for a market that was previously struggling to keep tabs on rising vets fees, claims leakage and insurance fraud,” added Colonnese.
 
“This device puts the ball back in the customer’s park, with them now having more control over what they pay an idea that’s not been available for pet insurance previously. Safer drivers pay less car insurance, securer homes receive better contents insurance quotes; so why don’t healthier pets receive better premiums? Well now they can. Bring it on!”

It’s an interesting development. The company states that the technology will allow them to reward owners whose dogs perform the prescribed minimum activity levels, help locate lost or stolen animals. But is that all they will do with the data?

Yes, veterinary bills can be expensive. But how many of these bills are related to an animal’s general level of daily activity? I’d argue very few. For example, the top reasons for insurance claims in Australia, at least in 2011, were dermatitis, otitis externa (ear infection), arthritis (may be related to lack of activity, but can be related to over-activity, eg athletic dogs), gastroenteritis, cancer, pneumonia, snake bite, diabetes (may be exacerbated by lack of activity), cataracts (often associated with diabetes but not always) and multiple fractures (source here).

So how does it benefit insurance companies? Well, it may reduce insurance fraud and reading between the lines, this has to be where insurance companies save money. Additionally, information might be sold to third parties who have an interest in knowing where the dog owners in your area are hanging out (for example where to locate a new vet clinic or pet shop). Maybe that isn’t a bad thing. Targeted marketing is surely less offensive than being bombarded with a bunch of irrelevant information and resources.

What about the activity levels…these can vary significantly between animals. Is it reasonable to assume, for example, that every German shepherd at every life stage should be walked for two hours per day (as in this example).

And a GPS tracker is a whole different kettle of fish to a pedometer. Is this a slippery slope? How much personal information do we want to provide to insurance companies?

On the human health insurance front the concept of genetic testing of policy holders has been raised…what about tracking and micro chipping people to ensure they’re as healthy as they say they are?

And what are insurance companies planning for cats? A GPS activity tracker might not be the most sensible means of detecting fitness in this species.

What do you think about pet insurers tracking pets?

Counting cats: esimates of feral animal numbers

Feral cat in a tree in the Northern Territory.

Fact-checking is important, but easily overlooked. Some “facts” are born as estimates, published then cited and regurgitated without being question. This can be very problematic when the topic is emotive, for example the number of feral cats in Australia.

Some parties have a vested interest in talking the number up, others have a vested interest in talking the number down.

But it seems that there are plenty of sources willing to publish unverifiable figures without considering how indeed such figures were determined or indeed stating that this could be a gross under or over-estimate. We're probably all guilty of this at some stage or another, but its worth teasing out some of the implications.

For example, I’ve heard that there are more feral cats in Australia than there are people. That seems like an awful lot.

According to our Federal Environment Minister, Greg Hunt,

There are up to 20 million feral cats taking up to four native Australian animals a night. That is over 20 billion Australian native species being destroyed a year. 

You can read the interview here: http://www.abc.net.au/landline/content/2014/s4119674.htm

Those are staggering figures.

Such figures are cited to justify significant funding for eradication programs:

GREG HUNT: We're looking at an increase from a little above $40 million over four years to $90 million and what I have done is already spoken to the national head of Landcare. He has said that his groups want to be part of this. But what if the numbers are flawed? When we use big figures to justify spending big figures, shouldn’t we be taking steps to ensure that those figures are as accurate as possible?

The ABC’s Fact Check has provided a very insightful discussion here (great reading for anyone who has ever made a grand sweeping statement in an assignment and why your marker has circled it in red and written "source???") suggesting that the evidence base of Mr Hunt's claims in that instance was probelmatic.

Of course, it’s unlikely that anyone will be able to determine the absolute number of feral cats in Australia – they can’t really be counted one by one. The discussion highlights some of the challenges of estimate numbers of wild animals in general.

Is being a vet all fun and games?

Fire up the vet-mobile, kiddo! (FYI the Lego Friends Heartlake Vet clinic is sold out all over Australia. Are we selling an impossible dream about the profession?)

Is being a vet all fun and games? The American Veterinary Medical Association is certainly pushing this angle. They’ve recently released a comic book for aspiring vets (see post here), and now comes a computer game.

It’s strangely addictive, although again very simplistic – a single diagnostic test yields the definitive result, there are two or three treatments to choose from, and the patient gets better every time. It’s definitely fun, but not sure it helps aspiring veterinarians or clients manage expectations in a realistic way (play the game here).

A screenshot from the game. A client presents their pet for an appointment. What happens next?

Granted, I’m not sure that designing a game which reflects reality better (gathering of history and physical findings, sorting helpful clues from red herrings, determining the most likely tests to yield a diagnosis based on pre-test probability, interpreting those tests appropriately, discerning which treatment options are appropriate for the patient, negotiating the best diagnostic and treatment plan with the owner, assessing response to treatment and re-evaluating the patient etc) would be particularly easy to design.

In my experience of designing hypothetical teaching cases for veterinary students, I can tell you it can take months to build a case and factor in many possible paths and outcomes.

But hang on, this is just a computer game. Am I taking it all a bit seriously? Yes and no. One of the big problems in our profession is attrition and burnout, and one of the key reasons is the discrepancy between being a vet and the reality of being a vet. Are we doing aspiring vets favours by pushing the angle that a good vet gets the “right” diagnosis and performs the “perfect” treatment every time? I’d argue not.

This computer game is based on the premise that veterinary patients have “tame problems”. I learned about Tame vs Wicked problems in Tom Chatfield’s book “How to Thrive in the DigitalAge” (The School of Life. London: MacMillan 2012).

He was discussing the Angry Birds app, but the analogy applies here:

“In sociological terms, Angry Birds presents what is known as a ‘tame’ problem. First addressed in a 1973 treatise by the social theorists Horst Rittel and Melvin Webber, tame problems include games like chess and the majority of mathematical propositions. They are problems in which the person trying to solve them has all the necessary data at their disposal, and knows from the beginning that there is a final solution or winning proposition.

In contrast there are ‘wicked’ problems: problems where there is no way of formulating the issue at stake definitively, nor any such thing as a single definitive solution. Each wicked problem is a unique set of circumstances, themselves entwined with other sets of problems. A typical wicked problem might be the economic health of a country or company, or somebody trying to decide the best course of action in their personal life. In each case, the only kind of solution that can be hoped for is a strategy that ‘tames’ aspects of the problem, breaking it into different elements and suggesting better and worse ways of tackling these. In these terms, life itself is a wicked problem.” (p112)

Misrepresenting our profession, no matter how good willed that is, can mislead vets and clients, leading to disappointment when expectations aren’t met. So I’m not sure this is a helpful resource. But have a play and decide for yourself.