Sunday, October 23, 2016

Five things to help every Itchy Pet.

There are vets who love to see itchy pets, and there are vets like me, who feel (and live) the pain of an itchy pet.

Piper, my itchy, beautiful dog, has multiple allergies, and is extremely itchy if we slack off in her management plan.
My dog Piper!

What many pet owners do not realise, but many vets do, is that the list of causes of itchy pets would fill multiple A4 pages in small font.  When a pet owner takes their pet to the vet because they are itchy, many expect a quick fix, and are surprised when the "fix" that is dispensed to them stops helping as soon as they stop or reduce the medication.

If you take me, as a pet owner, as an example, Piper has severe allergies to certain foods, parasites, grasses and pollens.  The one thing she isn't showing a reaction to is Wandering Dew (thank goodness) as this is the one of the few plants I seem to grow well in my backyard.

If you listen to pet owners of itchy pets on the beach, they will tell you stories of getting the "itch injection" from the vet, or the use of a "XYZ" shampoo from the pet shop, or adding "ABC" oil into their food, or even changing their food entirely to "Abracadabra magic mince".

When I went to the most recent Dog Show in Sydney, there were many stalls selling oils to rub on, or salves to apply which would solve all of these problems too.

The problem lies is - those who are saying that are probably right - for them -  those solutions probably did work for their pet. I would never, in a million years, discount something that actually helped an individual pet.

BUT... I would be, and am, extremely critical, of saying that any particular medication would help every single pet out there.


As a vet, I could never make that claim.

As the owner of a pet with allergies, I would never believe anyone who would say they could cure my pet of her allergies or offer a therapy that would make a 100% guarantee.

If you could do that, then get a cure for asthma or food allergies in all children - once you have done that, then I might listen to what you have to offer for my pet.

However, that doesn't stop me from sharing some strategies that will help every pet that is itchy - irrespective of the cause. It may not stop them from itching totally, but it will certainly make a difference for your pet.

I am sharing five things you can do to help every itchy pet before you bring them to a vet for their itchy skin.

 Your vet will love you if you even do the top three before you come in.

1. Flea, tick and parasite control.

You don't see a flea? That is good, but fleas can still be causing a reaction in your pet, either through the multiple bites of one flea or through the fleas being effectively groomed out by your pet's itchiness.

You don't see the lice?  Well, most times neither do we, but we would still treat for this very common cause.

You don't see the mites?  Well, unless you have microscopic vision, you probably wouldn't see these, as I need a microscope to see them  too.  There are some mites (such as sarcoptes mites) where (according to my textbook), I need to do 30 skin scrapes before I could say it is not a problem.   As for me, I prefer to treat on suspicion of it instead!

What can we do to help you narrow it down? 

We often do skin scrapes to look for mites (deep if we think we have demodex - especially if your pet is young, or superficial scrapes if the signs are suggestive of sarcoptes).

What can you do?  

Trust your vet to help narrow it down.

What would we recommend (in general)

For Fleas/Ticks/Demodex mites - we suggest Nexguard each 3 weeks or Bravecto three monthly until the skin looks normal and then back to the usual recommended frequency for dogs only.(note this may be  different to the labelled dose, please speak with your vet if you have any concerns about this recommendation).

For Lice - Advantage applied each two weeks for 3 doses for both dogs and cats.  We did this for our cat Dash, when her skin biopsies suggested she had a lice problem.

For Sarcoptes mites - Use Revolution (first choice) or Advocate (second choice) each two weeks for 3 doses for both cats and dogs. If this does not work, there are other medications that we can use (once we confirm the diagnosis).

2. Washing the bedding

Pet's bedding (or our own if that is where they sleep) harbours bacteria, yeasts and flea eggs/larvae.

Washing bedding in hot water with antifungal shampoo (we use Malaseb made by Dermcare in our situation, but you could also use PAW Mediderm shampoo instead).

Then hang it out in the sun  to dry.

All of this needs to be done twice a week.

Reducing these in your pet's bedding will add to the overall reduction of re-exposure to yeasts, bacteria and flea eggs. 

3. Food, glorious food.  Keep a food diary.

If you kept a food diary for yourself, you would get a shock on how much you actually ate.  Well, a food diary for yourself is really for weight loss.

A food diary for your pet is identifying the potential protein sources that could be the cause of their allergy.

For your pet, honesty is always going to be the best policy.

You might find the allergen yourself when you realise that your pet gets worse the day after they eat that special treat you buy them.

Many food trials fail because a pet still gets access to the morning piece of toast, or the afternoon cookie, whilst they are on the expensive food allergy diet.

What are the common food allergy culprits?  Chicken, fish, soy, rice, beef, lamb.

It isn't as simple as changing brands of foods - if your pet is allergic to chicken, and you change from one chicken based food to another, you have not changed anything.  It is also not an issue of quality either, although the better quality foods are, well, better for your pet anyway.

With Piper, we had to learn the lesson that simple or novel protein diets are helpful.  We feed her Royal Canin Anallergenic, supplemented with Prime 100 novel protein rolls (she loves the Crocodile and Tapioca) for variety.

Food trials take 6-8 weeks at a minimum - that is a long time to be strict with what your pet can eat, but if you have a food allergic dog like us, it is worth it.

4. Essential fatty acids -

Fish oil (EPA/DHA) in high doses can help in up to 30% of pets.  If you are lucky, your pet is one of these.

The dose rate is still under scrutiny - no one really knows the best dose rate, but the usual starting one is 50 mg/kg of EPA/DHA combined. 

For example, if your fish oil tablet is 1000 mg but only 60% of that is EPA/DHA, then you really have 600 mg of effective fish oil. if your pet weighs 10 kg, then 10 X 50  is 500 mg.  So, to round things up, you would give one of these capsules once a day.

5. Wipe them down and condition them well.

Never underestimate the benefit of a quick wash down with water from the hose after a trip to the beach, or wiping a pet down with a clean damp tea towel after a frolic in the grassy park.

These actions are able to physically remove pollens and other allergens from your pet's coat. 

Dry skin is a common cause of itchiness, especially in young puppies with overenthusiastic owners washing them weekly. Moisturisers vary in their effectiveness, but we use QV bath oil in Piper, but our options also include Alpha Keri Oil rinses and Colloidal Oatmeal based conditioners.

We spray Piper down daily (well, at least we are supposed to).  Granted, we also use a prescription spray too on her bad "flare up" days.

Five things your vet can do?

We can do lots to help pets, but it often takes more than one visit.  Often the first visit is to get an overview of the problem, to deal with the existing infections that we have, and to come up with an initial plan.   We do this through a series of easy but important tests, such as skin scrapings, skin cytology and fungal cultures.

The follow up visits with us are designed to come up with a longer term plan - on either how to diagnose the underlying problem, or how to manage the one we know we have a bit better. 

I am Dr Liz, the mad vet from Bellambi.  

Tuesday, October 11, 2016

Three Moments in Time that Could've and Should've Ended my Veterinary Life

Today, is World Mental Health Day2016.  As Prince William said, to paraphrase, "We all have Mental Health, and we need to look after that as well as we  do our Physical Health." 

As a member of an industry where the suicide rate is four times the national average, it is important for each veterinarian (and every person) to look at how they are going to support their own mental health, as well as they do their own physical or family health.

Many many many years ago, when I was a new graduate veterinarian (it was the early 1990's, so yes, last century), there was a day (or three)  when my boss at the time (I shall call him Dr Bob), wasn't in a good mood.

He was known as the charmer, or the happy one of the practice.  He was having a bad day (aka several), and as a result it was equally unpleasant for everyone else.  Many pet owners were extremely unhappy as a result, and they let the rest of us know about it.

As I was the bottom of the pecking order, alot of the angst fell onto me, the one person who had the least experience to deal with it.

That vet had a genuine reason for being in a bad "head space', and he needed people to be compassionate to him about it, not critical or angry that he couldn't be there for them.  He had been there so many times for them and their pets, and just once, he needed some of the compassion and kindness flowing his way.

It was a hard lesson for me, as a young veterinarian, that I  had to learn.  I had to learn it with no support from my colleagues or fellow workers. 

I had to develop a strategy to cope with the lack of kindness or compassion from some pet owners and even fellow colleagues during these moments if I was going to continue to be a veterinarian. I had to get over my own anger towards these same groups for their lack of kindness, and realise that I had to be self reliant, and practice kindness to myself.

One day, I knew that  was going to be facing or dealing with what Dr Bob was dealing with, or if not that specific thing, I knew I was going to be dealing with the emotions he was dealing with.

That was the reality, as I saw it,  as a young veterinarian. I knew my life was not all going to be  puppy licks, happy days and good things happening all of the time.  I was going to have bad bad days.

It was also not going to be filled with people asking "RUOK?"  In fact, it was going to be the opposite.  It had the potential to be filled with people who were willing to kick you in the guts even when you were down.

Being a veterinarian is part of my DNA... it is something that I can't get away from, as it is something that I have breathed and lived since I was in fourth class.  But despite that hard core passion and desire for my life's calling, there have been times where I had to question my life's choice, and perhaps look to another path.

But for those of you who are part of the animalclinic family... please do not worry that I am contemplating quitting any time soon.  There is a reason why I am described as focused and driven. I am stubborn, and have a strong core belief in the care for my animals.

So what are the the three main things that could've (and should've) ended my veterinary life?

1. When the Dog Bites....

Oh, how I cringe when I go to greet a pet with liver treats in my hand, or after I have examined their mouth, eyes and ears, to have the pet owner say with  a wry grin "he/she bit the last vet we saw".

Really?  I just had my hand and/or my face so close to this pet extending my hand of friendship and love. This pet owner knew what their  pet was potentially capable of, if they met someone new.

Yet they thought it funny.

They think its funny that their pet didn't bite me at the initial visit, or they think it hilarious that their pet  goes on to snap or lunge.

Charming... not!

I refuse to believe or accept that bites and scratches are an acceptable "occupational hazard" for the veterinary profession.

Yes,  I know we are dealing with living creatures and as a result we can be bitten or scratched. But, I will not accept it is OK to being bitten, or that it is funny that I could be.  

My first ever memorable dog bite was by my own dog, Burek, when I was trying to separate him from another dog during a dog fight. I was only 8 at the time. That bite was to my right hand.
My dog Burek - in the 1970's.

The second memorable incident was when I was working as a vet nurse:  a German Shepherd thought they wanted a taste of my right cheek. I am forever thankful to the vet at the time who did not tolerate that and took every step to protect me.

The third most memorable incident that almost ended my career was when I was an experienced vet, a practice owner, and a young mother of three children.   A 2 year old Rottie that I had known as a puppy,  turned around and bit me twice on my right arm (to the bone) whilst I was listening to his chest.

I still have the scars and the ongoing pain in my right forearm.

I still remember the fear of entering my consultation room in the months after that.  It took alot to  work through my fear, and to feel safe and happy again with dogs.

What did I find that helped me?

It was, strangely enough, the wonderful pet owners whom, when I explained my situation, allowed me to go slowly, and muzzle their pet if needed.  They allowed me to regain my confidence around the animals that I loved so much. 
Confidence regained! Thanks Lillie

There was some pet owners who were not so gracious - and I have to thank Dr Bob for giving me the gift of dealing with that too. 

2.When I have to do the hardest part of the job

This is a moment that replays itself on multiple occasions, sometimes on the same day.  Each one takes a small part of my soul every single time.

In case you aren't sure what I am talking about, it is about euthenasing a much loved family pet, or dealing with the grief of a pet owner whose pet has suddenly died (such as brought in dead due to some trauma or disease).

Yes, this a moment that replays itself regularly, and as a vet, I will never know which particular patient will be the "one" that may be the one that will end my career. 

As an empath (one who feels the pain of a sick or injured pet or person acutely), I feel physical pain when I see or I am with a pet in pain. Each one causes me physical pain.

Some  pet owners cannot handle that look of my face, misinterpreting it as a judgement on them.  It isn't.

When I hold the paw of a pet about to cross from life to death, I feel their pain slip away from them as they go into peace.

Every single time, a little part of my soul dies with each pet that dies at my hand.

Because this moment is so personal, it is important to me, as a human being and veterinarian that this is as peaceful for the pet as I can possibly make it. 

I have heard from fellow veterinarians of the one euthenasia which broke their soul -  and ended their career.

Will this happen to me?

Who is to say, but it will not stop me from providing this service with as much kindness as I can - after all, it is my last gift to the beautiful animals I feel lucky to serve.

Please be as kind to your vet during this difficult time, as they are to your pet.  We do not intend to make this time any more difficult that it needs to be, but we know that it is a very difficult time for everyone, from making the decision to being there for the last breath. 

The loss of a much loved family member hurts everyone. Please, be kind.

3. When we were broken into so many times it wasn't funny.

It is a sad reality of being in business that we are the easy target of  graffiti, burglary or vandalism.

The graffiti experts call this art - I call it abuse and vandalism. Buy a canvas at Bunnings and put it in a gallery if it is art. 

We have had to change our external garden area 6 times in 15 years, we have had plants ripped up, pots broken, windows smashed, and disgusting graffiti on the front window and side walls.

We have had stupid things stolen like a water tap handle, and a bucket of paint.  We have had valuables stolen, such as my late father's tools during the time we were renovating the vet hospital back in 1997.  Tools that he had spent 50 years collecting were stolen. 

But there was one year that in the space of a few months, were were broken into 5 times (not including graffitti or broken pots).

It even made it into the local newspaper as "news".

It was so intense that I had to consider the possibility that it was personal - that someone or some group of people did not want us to continue to be in business.

That is a horrible thought. 

Fortunately, the Police discounted that theory. It was just a series of being "unlucky".

For the thieves and those who think vandalism is fun - what you do does hurt people and cause pain. If that is your intention, well, it worked. I am sorry that you derive joy from the pain of others.

Insurance doesn't cover most of the damage caused, and what it did cover - well, it just increased my insurance premiums. The only group who won were the thieves and the insurance company.

For me, well, I have zero tolerance for thieves and liars.  

As for the future? 

As I head into the next twenty five years of my veterinary career, I am mindful of the whole set of new challenges that I  (and my colleagues) need to face.  Challenges such as technology, corporatisation, other disruptive process , and increased regulation of the veterinary profession itself but  with deregulation of the animal care industry in general.  

The veterinary profession is going to look very different in the future, and sadly, despite the  innovations that will improve the health of our pets, I am going to be saddened at the way this is going to be delivered to the animals and their families that I love so much. 

I try to live life with understanding, compassion and kindness to myself, my family and to the animals that are part of the animalclinic family.

The lesson I learnt with Dr Bob that it is vital to practice self compassion and kindness to one-self. This is a gift that everyone needs to give themselves. 

It is with compassion and kindness to my animal friends and myself that I approach each day.

I am Dr Liz, mad vet from Bellambi - as I say to family, it is my madness that keeps me sane.

It is with gratitude that protecting and recognising mental health in all people is getting the public understanding and support that it deserves. 

Monday, October 10, 2016

Musings of Dr Liz - My pet is sick so I went online...

"My pet is sick so I went online...."

What an interesting thing for a vet to hear when she is surfing the net, and listening in on a public available webinar on pet care.
Online advice given to a sick pet! You are coughing? Wear a mask. (wrong advice by the way)

It was spoken by a pet owner, whose only claim to knowledge about pets is that she found one on the beach, and kept it.


She is a caterer for humans, and as she has a pet, cooks for them too.

She did her research online on what was good, and what was not so good, and used her cooking skills to come up with her recipes. Since her pet improved from her cooking, she reached the conclusion that her cooking was good for her pet. 

She spoke with such authority that  anyone would believe everything she said.

I do not doubt that her pet (or any pet) would improve with any nutrition compared to what they probably were able to get when they were on the beach.  What is concerning is that she has used this as an example of her expertise in pet nutrition.

What I heard and saw epitomizes the problem with the internet

But, I do understand her dilemma - her new found pet was unwell.  What I do not understand is her solution to this dilemma -  she went online for help. 
Online advice would not identify this cause for "a watery eye" - this is a huge corneal ulcer which requires a special stain to identify the extent of.

How many of us are guilty of going online to find the answer to a problem that we may be having?

I know I am guilty of going to google to find out what is wrong with my car or computer.  Ask a computer person or a mechanic on how dangerous that can be.  (Hint - it is very dangerous,)

So how dangerous is it getting information online for your pet?

Well, it depends.

Dr Google or the internet is not evil or wrong.

It can give us the right answer if we are asking the right question, and if we are looking at the right places.

If you already have a definite diagnosis, then searching for information online can help you understand the condition better. There is nothing wrong with that. I would do the same. 
Online advice can give you the wrong answer if the wrong question is asked - Oops!

Ideally, you should be asking your vet for the information, but I do understand that sometimes it can be hard to understand difficult medical concepts when you are really worried about your pet.

What if you aren't sure what your pet has? Or if you think you know what the problem is, so you go searching for that?

  A classic example of where the internet can steer you wrong,  would be the dog that is straining to go to the toilet - it is not uncommon for us to get a phone call on how to help the constipated dog or cat, and it is one of my more popular blog posts in the past. 

That is where it can be dangerous, and harmful.

You see, if we give advice on how to help a constipated cat, and it has trouble peeing instead (the stance is similar), the cat could die.  Or if we give advice on a constipated dog, and it is due to a bladder stone, ditto - a dead or very sick animal.
The internet isn't a microscope, so won't see these struvite crystals in a cats urine (a common reason for straining to urinate, which often presents as "constipated cat".

The other problem is that anyone whose only claim to knowledge is that they breath and have had pets all of their lives can claim to be a pet expert. There is nothing stopping anyone declaring themselves an expert or a specialist online.

Many pet shops declare themselves to be pet specialists all the time. 

Except vets - vets cannot call themselves a "specialist in pet care".
Every vet is "Lab tested" for quality prior to graduation!  True!

Having a vet degree means that despite my years of study and experience, I cannot claim myself to be a specialist in pet care, but the owner of a pet shop or a dog trainer can. You see, the law treats us differently.

And sadly, many pet owners are choosing the advice of these people, over those who have gone on to further intensive study at university to actually study animals in depth.

So, next time your pet is sick, who are you going to consult?

For some of you, it won't be your vet because after all, they (the vet)  are going to (God forbid), charge you for access to their knowledge and expertise.
Dr Poodle Vs Dr Google - least Dr Poodle has her paw on the job!

For some of you, you will ask your vet because you have a great relationship with them already, and you value your pet so much that anything you do pay is worth it. You know your vet treats your pet like family, and you trust them to do that in any recommendations or treatments they do.

Sometimes my pet's do the "examination" Go Lillie!
I am Dr Liz, and as the mad vet of Bellambi.  I do go online for information myself, but usually through my membership of the online community of Veterinary Information Network  (or VIN. Through VIN, I am part of a community of thousands of veterinarians and specialists worldwide.

For existing animalclinic family members, we are happy to answer any of your questions via email any time of the day or night (we try to respond as soon as humanely possible, usually within 24 hours).


Saturday, October 1, 2016

Musings of Dr Liz - What the Veterinary Oath Means To Me

In my childhood years (from Year 4) to be exact, I had dreamed of becoming a veterinarian.

I know I am not alone in that. Every day, I hear someone say "I wanted to be vet", but they are now something else,  or "My daughter/son want to be a vet."  It is a common ambition for a child, as when you are young, you do not think about the reality of your choice. 

Like many of my fellow veterinarians, I studied hard at school, foregoing other activities to do achieve my dream. In 1984 I graduated from Wollongong High School with sufficient marks to get into my chosen degree.

In 1989 I graduated from the University of Sydney with my Veterinary Science degree.  The culmination of many many many years of hard work, dedication, sacrifice (of friends, family, money, prestige, life).  

With that degree in my hand, with my other on my heart, I inwardly made a solid vow of the type of veterinarian I would be.

The core of everything I am and do is what is in the best interests of the animal in front of me - their health and welfare is the centre of my  world.  It always was as a child growing up, and it is now, as a practicing veterinarian.

As a veterinarian, I see myself as a voice for those who cannot speak, against those who would do them harm.  I have always, and will always, do this by keeping up to date on all things pertaining to our animals, remaining open to new concepts and ideas, changing the way I do things in keeping with to ensure that I always remain current.

Always - and I can't stress this enough - the individual pet's welfare is always at the core of everything I do - with kindness and compassion.

I share  with you  the Global Veterinarians Oath. 

The Oath does not expect me to perform procedures on pets that are potentially harmful, even if this is what the pet owner wants, or that I should succumb to the pressures of individual groups who have their own agenda for the sake of making a bit of money.
It is very fortunate the Oath does not expect me to do that, as I will not perform procedures which are harmful to the pet (either in the short term or longer term), and I refuse to bullied or insulted into performing procedures if it goes against what is in the animal's best interest.

The Oath does not expect me to lie to pet owners, and tell them what a great job they are doing, when all I see are rotting teeth, skin sores, or pets who cannot even stand on their own.  The Oath does expect me to be of service to those pet owners, when they ask for my help, without judgement.

The Oath expects me to act with compassion and kindness to everyone, which I try to do.

This I try to do every day.

To all of my fellow veterinarians, veterinary assistants/nurses/techs - Thank you for being the superheroes.  The work you all do every day continues to be my inspiration.  When you think no one is watching or caring when you are having a bad day or when things do not go well, know that I am sending positive vibes your way, and that you are in my thoughts.

I am Dr Liz, the mad vet from Russell Vale Animal Clinic.  It is with compassion and kindness that we look after the animals under our care, not just because of the veterinary oath, but because we, like my fellow vets and their support team all over the world, had chosen to dedicate our lives to animals.