Saturday, September 6, 2014

Weekend read: tree kangaroos, veterinary imaging and that dog that ate 43.5 socks

One-year-old Tree Kangaroo joey Nupela with mum this week.
Tree kangaroos are incredibly beautiful, unfortunately rare creatures. The first encounter I had with one was visiting a colleague in Port Moresby, Papua New Guinea. A wealthy businessman was keeping a number of unhappy-looking tree kangaroos in barren enclosures (why do some wealthy people feel the need to possess rare and endangered wildlife when their husbandry is so appalling?).

This photo was taken in Port Moresby, Papua New Guinea. This Tree Kangaroo was kept by a wealthy businessman, and was going stir crazy in its barren enclosure.
Different species of tree kangaroos are found in lowland and mountainous forests in Papua New Guinea, Indonesia and in patches of Far North Queensland.

Taronga Zoo’s tree kangaroo joey Nupela was weighed this week, a year after she was born. Since leaving her mum’s pouch three months ago she has doubled in weight to 3.8kg – still smaller than your average Aussie cat (around 4.5-5kg).

Nupela hops on the scales while mum checks out the camera.
In fact it wasn’t her first weigh in. Keepers have been doing weekly weigh ins since June, training Nupela to follow a target and step onto the scales.

“She’s been growing rapidly and eating incredibly well, putting on about 10 per cent of her body weight each week,” said keeper Sam Bennett.

Among her fave foods are corn, grapes, beetroot and more recently eggs. She likes banana skins more than the banana – which would be handy if you were ever sharing a meal with her.

Nupela was born on September 4 2013 but no one spotted her til March when she poked her head out of the pouch. Her mum, Kwikila, and dad Parum, were paired up as part of a global breeding program.

Nupela in her mother's pouch.
The problem if course is that if we destroy the habitat of these beautiful creatures, we can breed as many as we want but they won’t be able to be reintroduced into the wild where they really belong.

Another earlier snap of Nupela from Taronga Zoo. This is the face of a threatened species.
Veterinary Imaging conference

The Australasian Association of Veterinary Diagnostic Imaging is hosting its conference on November 1 and 2 – at the Australian Museum. Not only do you get to learn all about veterinary radiography, ultrasound and advanced imaging modalities, you also get free entry to the museum all weekend.

For info on speakers and the program, click here
To register online, click here.

Great Dane eats 43.5 socks

Finally one veterinarystory doing the rounds of the internet at the moment is the staggering finding, on exploratory laparotomy, of 43.5 socks in the stomach of a Great Dane.

The dog, who has not been named, had been unwell for some time but it wasn’t until radiographs were taken that a knot of gastric foreign bodies were detected. Socks sound soft and gentle but inside the gut of a dog (or anyone really) they can cause havoc – from affecting gastric motility, obstructing gastric outflow (movement of the stuff in the stomach into the intestines and then beyond), mucosal trauma and basically pain, pain and more pain. The amazing thing about this case is a) the dog had to eat 43.5 before anyone twigged and b) that anyone has 22 (21 and a bit?) pairs of socks. Note, if you DO think your dog has eaten socks, or undies, or hosiery, or really any non-food item, call your vet immediately. I can't tell you how many Friday nights I've spent inducing vomiting to retrieve footy socks...but its a lot less costly, and a lot less risky, than waiting until those things cause an obstruction then having to surgically retrieve them. [Note, inducing vomiting works best within 2-4 hours of ingestion].

Another tip: lockable laundry baskets.

Check out our previous post about foreign bodies here.

Friday, September 5, 2014

Awesome read for doctors AND vets: The Bad Doctor by Ian Williams

The Bad Doctor just might change the way you read books. You can order it here.

Ian Williams is a medical doctor, but also a cartoonist. I learned about his graphic novel, The Bad Doctor, from a tweet (another excellent reason to get on twitter – it turns up some absolute gems). The book is about the troubled Dr Iwan James, a general practitioner who deals with everyone from incontinent old ladies to potentially psychopathic loners. We follow Dr James, the blurb said, “as he tries to do his best in a world of limited time and budgetary constraints, and in which there are no easy answers”.

Well if that doesn’t sound like your average veterinary career, I don’t know what does!!!

I read further. “Iwan’s cycling trips with his friend Arthur provide some welcome relief, but even the landscape is imbued with his patients’ distress. As we explore the phantoms from Iwan’s past, we too begin to feel compassion for The Bad Doctor, and ask what is the dividing line between patient and provider?”

Naturally I ordered it immediately, staked out the postie daily (truth be told, my postie is used to this) and pounced on the book when it arrived. The great thing is this is not just a book, it is a graphic novel, or comic. But instead of being about some dude in a purple suit branding baddies with a skeleton ring, it’s about one of us.

Dr Williams made time for a skype interview with SAT so we could probe him further.

Cartoonist and doctor Ian Williams.
Can you tell us a bit about yourself?

I am a cartoonist and a doctor. I studied medicine and qualified in 1989, and worked as a GP in North Wales, right out in the countryside, surrounded by agriculture and farm animals, for about twenty years. I was always into art and painting, and after medical school I did a post-grad certificate in fine art at Chester University and developed a side career as a painter and printmaker. I had solo exhibitions in galleries and sold over two hundred and fifty paintings and prints, but I wasn’t entirely comfortable. The language of fine art is very theoretical and different from the language of medicine which is very pragmatic. I did an MA in medical humanities to try to link the two sides of my career.

I was always into graphic novels and comics and I set up the website graphicmedicine.org which looked at the intersection between the medium of comics and the discourse of medicine. After writing about comics, at some stage I thought “ooh, I could do that” which is a very doctor thing to think. I gave up general practice for about three years [to focus on art] then worked in sexual health to pay the bills. Then I moved to Brighton, and fell into a general practice job just across the road from my flat. I am now working as a GP for two days a week. In the brief time I gave up medicine I spent all the time in my studio and kind of got cabin fever, so I think that seeing patients is actually quite therapeutic for me.

What drew you into medicine in the first place?

I was really idealistic when I was young and wanted to do some good and always had slightly left-wing, anti-capitalist leanings, hating the thought of being ‘in business’ and making money for the sake of it. I know that medicine is a business, but it seemed a more noble calling. I was also influenced by TV programs. We had all these medical dramas and sit-coms on TV, one was called Doctor on the Go. It was about medical students having wild adventures, and I thought ‘I’d like a bit of that’.

How did you become involved in graphic medicine?

Me and a few colleagues really started the thing off and it has been gradually gaining momentum. I coined the term when I set up the website. As soon as I launched the site, people from all over the world started contacting me. It changed my life, quite literally. I organised the first international conference. We got together in London in 2010 and people came from The States, Canada, Japan, and The Caribbean. Since then we’ve had conferences in Chicago, Toronto, Brighton and we just had a conference at John’s Hopkins University at Baltimore, which is quite a coup. Medical academics are taking us seriously and people who wouldn’t have previously looked at graphic novels or literature are understanding what they are about. We’ve had a couple of delegates from Australia, and MK Czerwiec (with whom I run the website) have been invited to Melbourne as visiting scholars. We are hoping that that will happen in 2015 or 2016.

A scene from The Bad Doctor. We couldn't help but notice animals feature prominently...
Many people struggle to be left brain and right brain, but you manage to juggle a career as a doctor, cartoonist, print maker and writer. Is it tough?

No. Well, I think I struggled a bit at first but not now. When I was doing painting and print-making, which was very abstract, I found it hard to talk to doctors about the paintings and where they came from. If you resort to artspeak you can sound like a complete dork. But comics have a kind of universal appeal and cross loads of barriers. Everybody can understand them because they read them as a kid. They are so self reflective, and ironic, and anarchic and irreverent, and you can say anything you want in comics and people can understand it,maybe because it’s a hybrid between words and images. This is where I found my voice.

Critics have praised your portrayal of Dr Iwan James, the main character in The Bad Doctor, as an imperfect human being rather than a God-like doctor. Do you think doctors suffer from trying to be someone they really can’t be, e.g. God?

Maybe. Part of the motivation was to relieve doctors of those self-imposed expectations. I’ve never met a God-like doctor. I know lots of doctors who feel like they can’t make a mistake, they should know everything – which may be fine if you are a specialist but as a general practitioner it is impossible. Doctors can also be quite judgemental, and I don’t really understand that. They get a bit high and mighty about people who smoke or take drugs or drink, or people who don’t make it to appointments, and part of that judgement comes from the hassle those people cause us, but a lot of it is adopted from the media, or from medical tradition which tends to be very judgemental about certain groups of patients. These patients become stigmatised and discriminated against, which is, I think, often unfair. It is usually the underprivileged and the poor who get stigmatised.

How long did it take to write and draw?

The whole process was about two years, but the real hard work was a concentrated year – which got more and more concentrated. The last six months was solid drawing and revising. The first year was trying to find the story, trying out what worked. It was a hell of a lot of work.

The late Megan Williams.
Do you have any non-human companions?

I used to have a sheep dog, Megan, and  I was besotted with her, although she was extremely difficult in character. She died a couple of years ago. I would really like another dog.

Dave the vet is a friend of The Bad Doctor's Dr James. 
While it isn’t a central theme of your book, many of your characters have pets and you’ve even got a vet in there (hurrah!). Obviously the bond between humans and animals is important – to patients as well as doctors. Why do you think this is?

That wasn’t at all conscious and I was quite delighted when you pointed it out. I was working in a rural environment where I used to work and it was a cottage surrounded by fields. The neighbours were farmers so out the front were prize-winning cattle and sheep. I also used to like it when I would visit a patient and they had dogs. It was like a little bonus when you visited someone and they had a nice pet. 

"It was like a little bonus when you visited someone and they had a nice pet".
My own dog was a reject farm dog who was probably quite inbred, possibly brain damaged and verging on unmanageable. We had people who tried to train her but they gave up. It was like living with someone you really love and adore who causes a lot of hassle and trouble. I’ve always loved animals.

Animals are so important in comics. There is a real anthropomorphic tradition. Bryan Talbot, a well-known comic artist and graphic novelist, talks a lot about this tradition and why people do it. Art Spiegelman has talked widely about why he used animals in Maus. Using animals allowed him to subvert expectations and the iconography of the holocaust,  but also tell the story without worrying too much about visual accuracy, and also permits a bit of distancing and layering of reality.

Thanks Ian. For readers who are interested in exploring the genre of graphic medicine, The Bad Doctor is the perfect place to start. But via Ian’s graphic medicine website I also came across:

The Epileptic by David B. (What a fascinating insight into one family’s struggle with a devastating illness, and some really terrifying traditional and alternative medicine).

Cancer Vixen (a comic about “kicking cancer’s butt” by a New York socialite – but also a brilliant perspective on being diagnosed with and enduring treatment of the disease we all fear).

The Complete Maus (This was the hardest but in some ways most rewarding of the books to read but isn’t a lightweight. In fact I had several very sleepless nights thanks to this book, which retells the story of the holocaust from the point of view of cartoonist Art Spiegelman’s father).

Thursday, September 4, 2014

RIP Sutcliffe, the baby bearded dragon

He was tinier than my favourite highlighters...

It’s been a tough week here at SAT HQ…despite rallying in his last days our little foster-bearded dragon, Sutcliffe, passed away on Monday. He was medicated twice a day, provided with UV lights, consciously not over-handled, provided with heat and – where possible – bathed in natural sunshine, but in the last 48 hours signs of metabolic bone disease returned with a vengeance. He became soft and doughy, lost his ability to grip, and despite injections of calcium and subcutaneous fluids, failed to make it. His absence hurts all the more because his feeding and medication regime topped and tailed my day.

Sutcliffe enjoys a spot of sunshine in the garden. This picture was taken approximately 24 hours before he passed away. I'm really the sun made an effort to come out on Sunday! I just hope all the other reptiles in Sydney are getting the warmth they need.
In reflecting on this exacerbation of disease, I wonder if the total lack of natural sunshine (due to some pretty bad Sydney weather) for about five days preceeding his death tipped him over the edge? He still had artificial UV light, but it isn’t the same. And he really did come alive when he could spend time outdoors. Or was he always on the back foot after a shaky start in life? Did I feed him right? Did he get the exact doses of calcium he needed?

It is hard to know. He never missed a dose of medication, nor a meal. His enclosure was pristine and never over-heated. What is certain is that he was a magnificent creature of extraordinary beauty, and for only five grams he managed to teach me a lot about MBD. And gee didn’t he love the sunshine. 

Sutcliffe on my thumb.
Every time the sun pokes out from around the clouds I think of little Sutcliffe, sitting on his twigs, holding his chest up and soaking in the rays.


He has been buried at home in the garden, and I’ve ordered a little headstone which I will lay over the site when it arrives (it measures 8cm) (you can view the stones here - I've ordered a tumbled riverstone). I hope that one day I pop outside and find a little lizard or skink basking on that stone.

Tuesday, September 2, 2014

Weepy eyes in white dogs and animals in community service

Phil with a mild touch of "panda eyes"(NB. he is wearing a hand-me-down from a puppy who grew out if it).

Owners of little-white-fluffies around the world will be shocked to hear of the crackdown on Angel’s Eyes. For those who don’t own an LWF, here’s the rub: they often suffer from discolouration of the fur around their eyes, giving the “panda eyes” or as one person put it “raccoon eyes” appearance.

Angel’s Eyes is one of a bevvy of products recommended to keep those eyes whiter than white. In the absence of an eye condition such as dry-eye (keratoconjunctivitis sicca), conjunctivitis or corneal ulcers (i.e. problems which require treatment), most of the time this is a cosmetic problem only. I personally avoid applying ANYTHING in the vicinity of Phil's eyes.

I get around it by giving my LWF a good eye-goober fur comb out with his own dedicated mascara brush (ain’t no way he’s sharing mine) and a face wash (he hates it but, thinking back to my childhood when mum washed my face, so did I – yet it didn’t kill me). I also have his little face trimmed once a fortnight. Overkill? Not if you see how rapidly eye-goobers can accumulate. That stuff gets stuck in hair, which hardens and forms what I can only describe as periocular eye-goober stalagmites and stalactites which can cause corneal trauma.

Phil after a face wash (in fact on this occasion it was an everything wash). Panda-eye effect is reduced. His appearance still may not be perfect enough to please some meticulous dog-show types, but I am not worried about that and I'm pretty sure he doesn't give two hoots.
Antimicrobial guru Scott Weese, over at the Worms and Germs blog, discussed the recent FDA crackdown on Angel’s Eyes here. He's right...in this age of awareness about antimicrobial use it seems insane to be incorporating antibiotics into such a product.

Human-animal relations and community services
For readers based in Adelaide, or those who visit, the Animals in Society Working Group is holding a workshop entitled “For the love of animals: animals, human wellbeing and community services” through the Australian Centre for Communities Service Research at Flinders University.

The workshop will bring together those researching human-animal relations in the community and community service practitioners who have an interest in how animals contribute to community health and well-being.  Anyone interested in understanding more about how human-animal bonds can be recognised, valued and supported in a range of community services is welcome to attend.

The one-day workshop, at $30 for employed or just $10 for students, will be held on September 30 from 9am-5pm. You can read more about speakers or register here.

Sunday, August 31, 2014

The joy of suturing

sutures in hand
Beautiful, simple sutures.
Last week we posted on what it takes to become an expert and just how much time experts put into developing skills (read the full post here). Coincidentally, Dr Ilana Mendels – so much a fan of veterinary continuing education that she became an official provider of it through VetPrac – emailed about an upcoming suture workshop.

Suturing? Isn’t that a basic skill and shouldn’t all vets be highly skilled at it? Well, yes and no. We learned those skills back at uni under guidance of specialists, then went out into the world and did our best. We practiced and practice, but as I learned last week pure practice doesn’t equal perfection.



Practice needs to be purposeful.

And then, when we DO become skilled, the action follows as second nature. We develop expert induced amnesia. When that happens, it can be hard to recognise problems and break bad habits.

As the ever-enthusiastic Dr Mendels says,

When we use our skills every day, we rarely remember action for action, how we came to develop the skill. We usually remember a frustration in learning, the awe towards our mentors and peers and then, through fumbling and practice over time - it one day clicks. 

So spending a day focusing on suturing, now that one has the benefit of experience under one’s belt, could be quite enlightening.
The suture is the central locus for a surgeon. It is the known thing, around which all the other things we know about surgery become significant and depend of each other.  The suturing workshop will be fun. We'll be doing some basic ties, and some fancy ones. We'll show you some specialist tips and share stories of "man vs tissue".

We will also go over some important points to remember about types of suture and needles, which is a funny thing that most of us ignore... If you're anything like ANY of the vets I've worked with you'll be familiar with "absorbable 3-0" as the regular request. But if you consider your skill as a craft, then the type of needles and materials become increasingly more important. And we will discuss this, because good surgeons, like good artists, know their materials as well as their canvas. 



There is a tendency for people to think they have learned one thing, ticked it off and can now move on. On the contrary. When its a skill you use every day, there's always something new, always something you can improve. (Of course, its always a little challenging when you do the best sutures in the universe and your patient goes home for "bed rest", gets a touch of ye olde cabin fever and jumps over the fence to hang out with next door's poodle...or lets their housemate nibble the sutures out prematurely). 

But seriously, I love the teaching philosophy behind this workshop, the palpable enthusiasm and the concept that we can always work harder at mastering (or tweaking) the so-called simple things we take for granted. It makes me wonder what other skills veterinarians and nurses use that are second nature, and whether we could benefit from revisiting some of those.