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.