Weekend links

Phil and Coco beat the winter chill in their beds.

Hurrah...its the weekend again! Although here at SAT we know all too well that lots of you will be working, studying or cramming. (What evil mastermind made May the month of intense exam preparation anyway?) Even so, exam prepartion inevitably leads to some procrastination. So we can thank our readers for these links! 

Have you ever considered training a reptile? Australian scientists have taken on that challenge, reporting early success at training goannas to avoid cane toads which if eaten will kill them. Read more about this incredible project here.

If you have not yet seen the video of a brave cat who took on a dog that was attacking a kid, you need to see it (click here). Tara, a former stray who followed the family home, took on a lab x chow. The boy, Jeremy, sustained some nasty bites but is now doing well. 

These photos of a girl and her bulldog are stunning, albeit concerning in part (am thinking about baby's face too close to dog's face...I know some readers will say "come on, don't be so risk-averse" - but you have to remember just one bite changes everything. And animals - like us - aren't always predictable). Still, I can appreciate some beautifully composed photos, and Rebecca Leimbach has captured something special about Lola and Harper in this series.

Worried about what would happen if rabies were to arrive on our shores? Professor Michael Ward, Chair of Veterinary Public Health and Food Safety at the Faculty of Veterinary Science will talk about the impact of Rabies on our Northern communities at the uni on Thursday May 22 at 1pm in the Veterinary Science Conference Centre. All are welcome.

Finally, most news publications can't resist stories about animals with prostheses. The Huffington Post has put together this collection of the most well-known cases in recent times.

Is it time for greyhound racing to retire?

A retired racing greyhound goes to the beach.

The Animal Welfare League of Australia has just released a policy on greyhound racing, which clearly calls for the end of the sport (see here). It is interesting that in the US, 43 out of 50 states have reportedly implemented a ban on greyhound racing.

Will Australia follows suit? The biggest concerns about the greyhound industry from an animal welfare point of view are a) the overall husbandry of the dogs involved and b) the huge "waste" - not really an appropriate term but all of those dogs deemed not fit for racing, or those that are retired that no one wants.

As a companion animal vet who treats a number of rescued greyhounds that are then kept as pets (really the tip of the iceberg of the numbers affected), I see conditions commonly in these dogs that reflect poor husbandry. For example, more often than not they require extensive dental work or teeth extractions, secondary to a poor diet or biting of cages, at a reasonably early age. Some suffer chronic gastrointestinal upsets. Numberous greyhounds that I currently treat require fluoxetine (aka Prozac) to reduce anxiety. Many have separation anxiety, some are hypervigilant, some have noise phobias.

Of course there will always be trainers who do really look after their animals, but there can be no doubt that there is a systematic failure to protect the welfare of racing greyhounds in Australia and overseas. Just look at the current parliamentary inquiry into greyhound racing in NSW: animal welfare is included within the terms of reference - well and truly AFTER financial matters are discussed (i.e. it is listed from item "j"). Little wonder that some animal welfare groups see no alternative but to call for a ban of the entire industry.

The Animal Welfare League's statement reads:

AWLA does not support the exploitation of dogs for sport, gambling or entertainment purposes. Racing greyhounds face negative welfare outcomes during training, transportation and racing. An unacceptably high number of healthy greyhounds are injured, discarded and euthanased annually across Australia. Also, the industry has proven incapable of safeguarding the welfare of the vast majority of dogs considered unviable for racing.

Because of these issues, we advocate for an end to greyhound racing in Australia. While greyhound racing remains active, we support:

• revision of the current regulatory regime to ensure effective and transparent control of all aspects of the industry
• the introduction of mandatory and enforceable welfare standards for the breeding, sale and post-racing treatment of greyhound
• registration and identification requirements applying to other breeds of dogs also applying to greyhounds
• consistent and rigorous enforcement of the Rules of Racing

Things I learned about minimally invasive desexing

If dogs could be vets...

WARNING: Surgical images in today's post. Some readers might be grossed out so please scroll carefully.

Last night the University of Sydney’s veterinary surgical team put on a wonderful series of talks themed around urogenital surgery. Sure, it’s not everyone’s idea of the perfect Wednesday night, but if like many vets you spend much time examining and operating on these areas, they are fascinating. And listening to surgical specialists talk is a beautiful thing. Anyone who can throw phrases like prostatic avulsion and intramural ectopic ureters into sentences that make perfect sense to non-specialists is very talented indeed.

The audience sat transfixed last night as Dr Laurencie Brunel described laparoscopic ovariectomy and ovariohysterectomy (OHE) (keyhole desexing of female animals). Again, maybe not a big deal to some but in companion animal medicine, reproductive surgery is common, it can be life-saving, and if there's a better way to do it we all want to know about it.

Have you ever wondered why vets don’t perform keyhole surgery? Is this something we should move towards? Well, if you look at the size of incision made for a routine spey (especially in cats), one could argue that this is practically keyhole surgery. [NB the pic below is NOT a cat so this is not illustrating my point!]

Reproductive tract of a German shepherd dog. Note the "Y" shaped uterus - the ovaries are at the top of the Y near the haemostats or clamps, the arms join at the bifurcation, the uterine body, and the cervix is below.

But good vets always look at viable alternatives. The advantages of laparoscopic desexing are that one has beautiful surgical field magnification – one can see the ovary in situ, as we did in Dr Brunel’s magnificent videos last night (seriously, I could have watched these over and over), and the associated vessels. Other advantages include (debatably) a smaller incision, reduced tissue trauma (i.e. less overall tissue handling, more precision), diminished pain and faster patient recovery.

Laparoscopic desexing is contraindicated in some animals: those with a congenital or traumatic diaphragmatic hernia where insufflation of the abdomen with CO₂ would leak into the thorax and inhibit ventilation; animals in oestrus; and where pyometra (pus in the uterus) is present as the uterus is very friable and the incision is tiny. One would have to be a magician to get a pyo out of a keyhole incision.

This is also a uterus - but the dog (in this case a chihuahua) has pyometra. The arms of the uterus are distended with pus. The uterine body is just below the crease in the uterus at the top of the photo. The ovaries are still intra-abdominal in this pic, at the ends of the arms which are at the bottom of the pic. Not a uterus I would want to be pulling through a keyhole incision.

Obviously another down side is the need for specialist equipment which requires some outlay of cashola. Medical equipment ain't cheap. Not to mention training. Initially one would be much slower at desexing – increasing the anaesthetic duration – and be a bit awkward. Is that a reason not to explore this technology?

Anaesthetic-wise, as with all patients we should be making sure that the patient is ventilating and oxygenating well – and remember that abdominal insufflation can increase pressure and reduce cardiac output (insufflation pressure should be <15mmghg be="" may="" o:p="" positive="" pressure="" required.="" ventilation="">

Also…all patients are clipped as if for an exploratory laparotomy (that’s the opposite of keyhole – where we open the patient from the bottom of the rib cage down to the pelvis, enabling full exposure). Why? In case of complications we don't want to have to prep the patient again. We also want the patient to have an empty bladder, as laparoscopy involves inserting trochars into the abdomen and a full bladder could be easily perforated.

So laparoscopic desexing, depending on which instruments one has available, involves palpating the abdomen carefully to avoid the spleen, insufflating the abdomen, inserting the instruments (through a single or multiple ports), visualise the ovaries, grasping them, severing the vessels using electrocautery and removing them through the hole. 

Potential complication include trauma to the spleen, reduced visualisation of the ovary due to haemorrhage (tilting the table so the patient’s head is elevated can be helpful), dropping of the ovary back into the abdomen once removed (this necessitates converting the laparoscopy to an exploratory laparotomy), burning of the peritoneum with bipolar electrocautery/vessel sealing device, haematoma at site of placement of a spey hook if used (this is avoided by using a taper-cut needle to suspend the ovary), and leakage CO² from the operating cannula incision, causing the abdomen to deflate like a tired old balloon and making visualisation really hard.

Discovery of pyometra or a diaphragmatic hernia are both very good reasons for converting to a laparotomy.

So there you have it. In general practice within Australia, the standard technique is OHE via a small laparotomy incision. Partly because most vets are trained in this technique, they can do it quickly, if there are complications the incision can be extended and that’s how it has always been done. 

But skilled practitioners can use laparoscopy to perform the procedure in the same time. It can also be used to perform prophylactic gastropexy, removal of bladder stones, biopsies and insertion of some feeding tubes. It will be interesting to see the uptake of this technology, used already for decades in the human field, in veterinary practice. (But if anyone offers you the opportunity to watch a video of a laparoscopic spey, I recommend it).

Anaesthesia and pets

Dixie with her collection of toys.

Last week I put together an article about the late Dr Martin Pearson, a veterinary anaesthetist who was tragically killed in a hit-and-run incident on Anzac Day. The driver remains at large. Its a really sad, abrupt end to the life of someone who clearly put his heart and soul into the profession. Hopefully the person involved in the accident will come forward and Dr Pearson's family can get some closure.

In talking to former colleagues and reading about Dr Pearson's career I learned that he had much to do with the registration of alfaxan CD, an anaesthetic agent used commonly in dogs and cats. Compared to many other agents it has a very high safety margin and is widely used in Australia. That and his many other achievements are a very special legacy.

On the topic of anaesthesia, one question pet owners often ask is what is the risk of anaesthetic death? Fortunately these are very rare.

It depends mostly on the underlying health of the patient at the time. We talk about ASA scoring, which is essentially providing a health score to patients - ASA I refers to healthy animals that are admitted for elective surgery (e.g. desexing), right up to ASA V which is a severely unwell, moribund animal. Why would anyone anaesthetise such a patient? The point is to avoid it where possible, but often its the only chance we have of saving them.

Dr Thierry Beths presented an excellent webinar last night for the ASAVA on anaesthesia of compromised patients. He reminded us that:

• Animals undergoing emergency procedures were 1.6x more likely to die (Brodbelt 2007) - mostly because emergency procedures are carried out in compromised patients because they cannot be delayed.
• An increased ASA score is associated with increased mortality. So in one study, dogs with an ASA score of I or II had a 0.05% risk of anaesthetic death, while those with a score of III-V had a 1.33% of death (Brodbelt 2008) - more than double. The numbers are very low, but the impact on the animal (and owner) is devastating of course.
• Most anaesthetic deaths occur in the recovery period - usually within three hours of recovery. Dr Beths said this may be due to removal of monitoring equipment. Other factors such as hypothermia can play a role.

Many anaesthetic complications can be avoided simply by chosing drugs carefully, monitoring the patient and taking standard precautions (fasting patients prior to surgery, providing intravenous fluids where required, maintaining the airway, minimising anaesthetic time etc.) and anaesthesia in companion animal practice is generally very safe.

Interview with Dr Justine Lee, CEO of VetGirl on the Run

Dr Justine Lee, author, blogger and founder of VetGirl on the Run.

Here at SAT most of our interviews are presented in the written word, but in a first for us, the tech-savvy Dr Justine Lee, founder of VetGirl, has answered our questions via podcast. 

The double-boarded Dr Lee discusses her fascinating veterinary career (including a period as a C-student: there is hope for everyone) and how she came up with the concept of VetGirl, a veterinary continuing education provider that is currently taking the world by storm. Last time I skyped Dr Lee she was preparing to summit Mt Kilimanjaro (as you do). Well, she made it up there and back down again. 

Fortunately, you won't have to battle altitude sickness to hear from her. Instead, in the comfort of your own office/bedroom/cave, you can simply click here.