Saturday, December 6, 2014

Helping dogs in rural and remote Indigenous communities

With Stephen Cutter, Sophie Cutter, Brooke Robertson and Linda Bradbury. We desexed and wormed these puppies.
Considered living remotely? There are lots of awesome things about living in remote Australian communities – no peak-hour traffic, stunning scenery, and wildlife just dropping by.

Ahhh bliss, The light hits Uluru just before sunset.
But access to veterinary care is restricted – some communities are 500 or 1000km to the nearest vet, and vet care can be out of the reach (both physically and financially) for many living in rural and remote communities.

As a result, many animals in these communities suffer from preventable conditions including reproductive disorders like pyometra and transmissible venereal tumours, parasitism (heartworm disease, tick-borne disease, high worm burdens) and problems that stem from lack of population control (dog fighting, for example). This leads to poor health and welfare, but also impacts on human health and wellbeing (for example, the rate of zoonoses and dog bites).

tick parasite puppy
Tick found between puppy's toes as he recovers from anaesthesia.
I’ve just spent two weeks volunteering in my favourite Territory (sorry Canberra, but the NT has stolen my heart) with AMRRIC – Animal Management in Rural and Remote IndigenousCommunities.

Our teams set up field hospitals, asked owners whether and which dogs they wanted desexed, performed surgery and returned the dogs to the owners afterwards. It’s very different to city practice in just about every way. Red dust seems to be ubiquitous. Sometimes we had the owners or local kids watching the surgery. (And for the vetty minded, total intravenous anaesthesia and flank speys are the norm). At the town of Mutitjulu, our view from the surgery was Uluru – just sitting outside the window like a big red dog. Two days in a row it actually rained on Uluru, the entire rock turning briefly silver.

The view from the window.
Temperatures in Central Australia can soar. A lot of dogs dig holes in the dirt because it is a bit cooler. More so if your hole happens to be right beside a tap.
The reason I’ve been involved with AMRRIC so long is that this is an organisation that recognises the important role that healthy dogs have to play in Indigenous communities. I can’t think of a better way to help people and animals simultaneously.

Lots of dogs. Desexing definitely improves their quality of life - and that of the community.
You can support AMRRIC by becoming a member, but another way is to send a family member or friend an AMRRIC donation card for xmas (see here). Its a really easy way to make a difference.  


Disclosure: this is not a sponsored post. The author is a member and volunteer for AMRRIC.

dogs desert water
Cooling off with a friend.
Travel tip: if you do visit Uluru, you can do the base walk (a 10.5km round trip) - OR you can hire a bike from Outback Cycles (we paid $30 for three hours) and ride around. The best time to do it is the second the bike hire opens - 6.30am, as the temperature climbs rapidly (and if you do it this way there is still plenty of time to watch the sunrise). From the Cultural Centre its a 14km round trip. As we rode past walkers who were sweating and fading and just looking like they were having a really uncomfortable time of it we realised this was a brilliant decision. Why stroll when you can roll?

Thursday, December 4, 2014

Resources for veteriarians and vet students on social media use

Phil small dog coffee

Do you use social media? If you do, chances are you have your own set of rules about what you post, or who can view what post. I’ve often heard people say, “I’d never post anything I wouldn’t want my grandmother to see” – which works if you have a conservative grandmother. But grandmothers are entitled to be just as liberal and colourful as they wish, and may not be the best yardstick of social media etiquette.

The British Veterinary Association has just released guidelines for veterinarians using social media and online networking forums. (Check them out here).

While the guidelines recognise that vets are human beings and an awful lot of human beings are on social media right now, the document also states that

The standards expected of veterinary surgeons in the real world are no different to the standards they should apply online, and veterinary surgeons must uphold the reputation of the veterinary profession at all times.
These guidelines follow the Australian Medical Association’s social media guidelines, which were released shortly after the epidemic of “planking” ravaged social media. Even paramedics, doctors and nursing staff were susceptible.
The full guidelines can be viewed here.


Have you ever felt conflicted about social media and professionalism?

Wednesday, December 3, 2014

Three things I learned about blogging

guinea pig blogcademy blogging
Does my blog look big in this? Randy checks out the Blogcademy mug.

What’s it like running a blog with three to four hundred THOUSAND unique visitors a month? I found out when I attended the Blogcademy in Sydney.

The two-day workshop is the brain child of Kat Williams (RocknRollBride), Shauna Haider (aka Nubby Twiglet) and Galadarling (aka Galadarling), who teamed up to teach people the ins and outs of blogging.

Their sites aren’t vet or animal sites, but these are giants in the blogging world, and their experience is valuable to anyone navigating the world of blogging – whether it’s a bona fide blog or microblogging via social media (Facebook, twitter, Instagram etc).

I don’t intend to blog to that scale, although it was fascinating as a consumer of blogs as well as a blogger, learning about how much advertising money that sort of readership attracts, and what it allows bloggers to do (quit their day-job, develop a travel budget, collaborate internationally, dictate to advertising and PR companies the angle a post will take and not be dictated to).

Meeting Kat Williams, Shauna Haider and Galadarling - some of the biggest bloggesses on the planet.
Blogging is on the rise. One delegate, a journalist, summed it up in a nutshell.
“I work for a major newspaper and you guy [bloggers] are taking over our job.”

They may be from different continents and different professions, although they share a mutual love of sequins (alas I'm yet to find a veterinary job that incorporates sequins).
Here are a few points I took home from the workshop.

  1. Blogging = work, work, work. Good bloggers are accountable, post at the same time each day, week or month (ahem), and help their readers. Galadarling, who blogged for free for ten years before she made money from it, works on her blog and its associated bits and pieces (social media, email etc) for around ten hours a day. She has a blogging agent. Shauna, who does it on the side to promote her design studio, does 3-4 hours a day. These ladies command massive audiences – but they are professional bloggers. Their work ethic is impressive. Even at the conference they burned through content with a single break in the middle for lunch – when they workshopped people’s blogs. There’s no fast-track to international blogging success – stuffing your posts with key-words or monetising before you have an audience are things that will turn readers off.
  2. A good blog has a clear purpose. Bloggers should constantly audit themselves – why did I start this blog? What problems does it solve? Where is it going? Who is its ideal reader? (Kat Williams suggested that your ideal reader might be yourself, five years ago). The most popular blogs teach people something, and the most popular posts tend to be DIY guides, how-tos, advice, behind-the-scenes glimpses or problem solving posts. As Galadarling said, “People using their computer [to read blogs] really want to get off their computer and use their hands.” Or play with their cats.
  3. .   Design counts. I’m not a fancy-schmancy person, but Shauna convinced me that looks count a LOT. Once they land on your blog you have around 2.5 seconds to get someone’s attention. More, not less, white space is recommended. She recommends using a maximum of 6 colours (including black and white) and using colour palettes. Using your own images, and creating those images in your own style, is an important part of your blog’s tone.
  4. .   Be ethical. I am being a bit naughty here as I said I learned three things, but one thing these bloggers have in common is that they make an effort to do the right thing by others. If they have a sponsored post, a) they disclose it and b) they make sure that post is helpful to their readers. Rather than just advertise new hair pieces, Kat gave her readers a how-to hairstyling guide for bridesmaids using those pieces. They also don’t advertise anything that goes against what they stand for. For example, Galadarling writes about self-esteem, so won’t advertise products that play on people’s anxiety. Kat is inked, and won’t advertise tattoo removal services. They don’t erode their own privacy by exposing their inner turmoil, but they give readers a glimpse into their own lives. They don’t rip images or posts of the sites of others. Even watching these girls work together was positive – they respect and support one another, and they know each other’s work inside out. In fact their role modelling of ethical collaboration, though it wasn’t on the program, was the highlight for me.

cats blogcademy
Michael is going to process all this new info and aid in the implementation.


The above represents the tip of a Titanic-sinking-sized iceberg of notes I took down. To find out more about what I learned, keep checking in over the next three months and watch SAT morph.

Tuesday, December 2, 2014

Help! There's a lump on my pet! (Part II)

cat carrier
Tira isn't too impressed.
So there's a lump on your pet. In yesterday's post we discussed how veterinarians work out what that lump is. Today we're going to talk about staging and surgery. When it comes to cancer, the two important things you need to know boil down to this: what is it? and where is it? They are deceptively simple questions. Sometimes it takes a number of tests to determine the answers.

Why is surgery required? Surgery is performed for a number of reasons. Sometimes the aim is to achieve a diagnosis, by obtaining a biopsy and exploring the extent of local disease. Often the aim is to cure the patient – by removing all abnormal tissue. In human patients, 60% are cured of cancer by surgery alone1. In cases of advanced or aggressive disease, surgery may be means of relieving pain and improving quality of life (palliation). Surgery may be combined with chemotherapy or radiotherapy to ensure that microscopic disease is not left behind.

What planning is required and why? Surgery is similar to medication in that we can think of surgery like a “dose”. If we under-dose the patient by failing to remove enough tissue, we potentially leave cancer cells behind. If we over-dose the patient, that is, remove too much tissue, we may have complications including delayed wound healing, poor functional outcomes (for example, if too much muscle is removed) or poor cosmetic outcomes. To determine the correct dose, we need to know what kind of tumour we are treating and the likely behaviour of that tumour.

What do we need to know to plan surgery? Firstly it is important to know what the tumour is. A biopsy is sent to a pathologist for evaluation of cells (cytology) or tissue (histopathology). In most cases this provides information on the type of tumour and the grade, which can in turn help us predict how that tumour will behave (for example, is it more likely to spread to distant sites in the body (metastasize)).

Secondly, we need to know where the tumour is – is it isolated to a single anatomical site, such as a lump, or is it present elsewhere in the body, for example metastases in the lymph nodes or lungs. Knowing the location and the extent of the tumour is important in determining the most effective treatment. The process of finding this out is called staging and may involve blood tests, chest x-rays, ultrasound, sampling lymph nodes and even advanced imaging with CT and MRI. This helps us to determine whether and how we can remove the entire tumour, and what additional treatment may be required.

A chest x-ray. This dog has concurrent congestive heart failure and some suspicious looking areas in the lungs.
Can’t you just remove as much of the tumour as possible? Unfortunately this approach doesn’t work well. It can be helpful to think of cancer like a crab sitting on or in the body1. If we remove the biggest part, the body of the crab, but leave the legs behind we’re in trouble. The body of the tumour is often the slowest growing part, while the edges of the tumour (the legs) are the most invasive. If we leave these behind, we may actually be selecting for the most aggressive parts of the tumour – and leaving ourselves without healthy normal tissue to close the wound.

What factors influence the outcome? Aside from the general health of your pet, the best outcomes are associated with slow-growing tumours that have discrete boarders and can be isolated from underlying tissue, small tumour size and a low histologic grade. If we are aiming to cure, our best chance for a cure is the first operation. Surgery may be less successful if the tumour is recurrent, is poorly defined, or has a history of rapid growth1.

It is often said that a chance to cut is a chance to cure for a reason. (In this case its also a chance to sample an awesome guinea pig cake).
Why do we submit the lump for pathology after removal? Following removal, there are two key reasons for having a pathologist assess the lump. First, the diagnosis can be confirmed. Secondly, the pathologist can assess the margins – that is the amount of normal tissue removal along with the lump. Clean margins consist of healthy tissue without neoplastic cells. “Dirty” margins have evidence of cancer cells or microscopic disease.

Are additional treatments required? This depends on the tumour type and stage. In many cases, the tumour is removed and that is the end of the story. If margins are “clean”, there may be no further treatment required. If margins are “dirty”, further surgery may be required. This should be performed as soon as possible to remove the entire previous surgery site. In some cases, chemotherapy or radiotherapy prior to or following surgery may improve the outcome for your pet.

References


Monday, December 1, 2014

Help! There's a lump on my pet (part 1)

rat lump tumour
Lump on a rat. Or is it a rat on a lump? Some lumps can grow so big that even if they aren't malignant, they get in the way. This one was removed, freeing up Lilith the rat here to use her forearm again.
Have you ever found a lump on your pet? This week I’m running a two part series on lumps in companion animals. What are they? What should you do about them? Can you just ignore them and hope they will go away?

It’s very common for an animal to present, either directly for the purposes of examining a lump OR incidentally (e.g. a vaccination, and by the way – is this lump anything to worry about?). 

Part 1 – What is this lump?

I’ve found a lump on my pet. What should I do? Don’t panic. Veterinary patients commonly present with lumps, of which there are many causes. A lump is a collection of cells in the skin (a cutaneous lump), or in tissue beneath the skin. Broadly speaking, lumps can be non-cancerous (for example, an abscess (pus), hematoma (blood) or inflammatory reaction (for example, hives or urticaria), or cancerous (neoplastic). Very occasionally a lump actually contains a foreign body. For example, when I removed a lump from the armpit of a dog, I found it contained part of a kebab stick which had migrated from the gut through the abdominal wall. I have to confess that was a very satisfying lump to remove.

Better out than in: the tip of a kebab stick was found in a lump in the armpit of a dog.

Cancerous lumps may be benign or malignant. There is no way to determine if a lump is cancerous just by looking. Cancer is a tissue diagnosis. That means that a biopsy is required to determine whether cancer is present.

The good news is that many cancers can be cured with early treatment. Contact your vet and arrange an appointment.

Can some lumps go away by themselves? Occasionally, but this is the EXCEPTION rather than the rule. For example, puppies may develop histiocytomas which can disappear. Similarly, warts (or papillomas) may occur (especially in puppies) then disappear over the course of a few months.

warts papillomas
Warts in the mouth of a puppy (this puppy is anaesthetised for desexing). They can be tricky to see when the mouth is pigmented like this, but if you look closely you will see rather a lot. Oral warts are not uncommon in puppies and usually occur in multiples.
wart papilloma papilloma virus
A close up of a large wart in a dog (the diagnosis was confirmed by histopathology). 
It’s only a small lump. Should I just keep an eye on it? While it can be tempting to “wait and see” if a lump changes or grows bigger, if the lump is cancerous then there is a real risk that the cancer will progress and may spread to other sites in the body during this waiting period. The earlier a diagnosis is made, the better the outcome. The size of a lump alone cannot be used to determine whether or not it is cancerous.

It’s been there for ages. Sure, but that doesn’t mean it isn’t nasty. Cells in a lump can transform into cancerous cells over time. In some cases cancers are slow growing. Being around for months or years doesn’t mean a lump is harmless.

This benign fatty tumour (a lipoma) grew so large that it affected the dog’s movement. Surgery to move very large lumps like this is much more complicated.
Can't you tell me if its cancer just by looking at it? In short, no. Cancer is a tissue diagnosis. You need to examine cells or tissue to make a diagnosis of cancer. Sure, if its full of pus its more likely to be an abscess. Even more so if the patient is a cat who has just been bitten by another cat. But lumps can be misleading. Tumours often develop "necrotic centres" and may appear to be abscesses. 

Mast cell tumour margins
A malignant mast cell tumour on a dog that has been shaved for surgery. The circle around the lump indicates the extent of margins required to ensure the tumour is removed locally.
What does a biopsy involve? There are different biopsy techniques, ranging from a needle biopsy (where cells are removed from the mass for examination on a slide), to incisional biopsy (a piece of the tumour is removed), to excisional biopsy (the entire tumour and a barrier of normal tissue are removed). The type of technique used depends on the location and size of the lump. Where possible, we take a biopsy prior to performing any other surgery. There are exceptions to this rule: for example, where a lump is found in the testes we usually remove both testes by castration (this is an excisional biopsy).

Sometimes the result will suggest that surgery is not required. For example, in the case of small fatty deposits or cysts, surgery may not be required. Alternatively, in the case of some cancers like lymphoma, medical rather than surgical treatment is used most commonly (with rare exceptions).

Why do you recommend sending biopsies for histopathology? Because cancer is a tissue diagnosis. The most accurate information about whether something is a tumour or not, or what type of tumour it is, is gleaned from histopathology in most cases. The pathologist can look at the cells within the tissue architecture they are invading, and in most cases can identify what is going on – what sort of disease is present, what cells are involved, how aggressive is it (tumours can be graded). From this information decisions can be made about how big surgical margins should be to give the best chance of eliminating the disease. There is a tendency for some clients to see histopathology as an optional extra. In fact it provides valuable information. Removing a lump without doing histopathology is, in some ways, like taking an x-ray and not looking at it. If I perform a biopsy on any of my animals (and yes, I have done so) it goes for histopathology. I want to know what I am treating.

Tune in tomorrow when we talk about treatment of lumps.

Sunday, November 30, 2014

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.