The musings of Dr Liz - 2013 Reflections

The past few weeks have been "quiet" on the blog posting side, not because I was slacking off, but because it is sometimes wiser to keep your mouth shut (or in this case, stop my hands from pressing the "publish" button.)



RIP to our dear Fitz

I have been reflecting on the events of this year - the highs, the lows - on a personal, professional and business level.   You see, for me, these three things are so intertwined,  that the sadness of what I do professionally can bleed into the other two.  And with that, the other two need to be really joyous to be able to cope with the constant onslaught of sadness.

And when you get a year where the personal and business sides aren't so great, then.... reflections help put it all into perspective. 

My parents always taught me to smile - every day - no matter how you may be feeling inside, or what the outside world may throw at you.  So I do smile - every day.  Don't our pets do that to?  Whenever you see them, aren't they always smiling at you? Happy to see you?  Doesn't that make you feel better? 

My parents also taught me to take deep breaths, and face challenges that life may give you.  After all, the challenges I face can no way compare to the challenges that they had faced in their youth, or the tragedies that others have or are facing.   Our pets also have to face challenges now that they never had to - all of the things of our modern lives - the things that take us away from them, like the computer games and the hard working families that barely have enough time for each other, let alone the family pets. 

As a veterinarian, I, like many of my colleagues have had an emotional ride - sometimes it is "Woo Hoo - how exciting - we have helped your pet make a full recovery".... to the lows of saying goodbye to old  friends.  As Russell Vale Animal Clinic is in its fifteenth year of business, sadly, this year  leans towards saying goodbye for many of my beloved pets.  And so, reflections allow perspective.

I keep an album of all of the beautiful cards of thanks I have received over the years... they include

Dr Liz (me) with Tegan, and an abandoned kitten - now known
as Patches and in a loving home - One of our "wins" this year!

notes of thanking us for our care in the recovery of loved pets, as well as thanking us for our gentle hands at the end. This year, this book has been opened a lot more than in previous years - to reflect upon  as well as to add to it.

"Not to hurt our humble brethren is our first duty to them, but to stop there is not enough.

 We have a higher mission--to be of service to them wherever they require it."

Saint Francis of Assisi (1182 - 1226)

The core of what we are at Russell Vale Animal Clinic is to be "of service" to our animal friends whenever they require it, with kindness and compassion.

It is this thought I hold close to my heart during my reflections.  Have we been true to ourselves this year? Have I and my family been of service to our  animal and human friends?  And if we  have, then it is a good year.  And upon reflection, that is all anyone can ever ask of themselves - to be true to oneself.

It is easy to look at the superficial things of business success  (the awards and prizes) and business failure (the old beat up car, house needing repairs, and lack of money in the bank account) - and find that the balance sways from side to side, with the equally sway up and down of the emotions (success/failure).  It is easy to feel despondent about life not being fair, or go the way you had planned it to go,  or to be angry at those who attack you.

But it is with  love, truth, compassion and kindness which makes a family and a life, and in developing this, our lives are enriched.

As you reflect upon this year, remember to be kind to yourself and to others.   If you have been true to yourself, then it has been good year, irrespective of what has happened around you and to you.

I am Dr Liz, and on behalf of all of us at Russell  Vale Animal Clinic, we wish you and yours a safe and Meowy Christmas, and hope you all have a Barking Great New Year!

A funny/bizarre/is it a full moon? thing happened on the way to, at the, and on the way home from the office, dear!

One of the things that is exciting about the veterinary profession, is that you never know what is going to turn up, or who you are going to meet.  

This post is all about the lighter (or weirder) side!

Just another Sunday at the vets....
Many years ago, before I was the boss of Russell Vale Animal Clinic, I used to work the Sunday shift at another vets. It was usually boring, and mostly consisted of re-checks of the cases seen during the week by the "regular" vets.  And most Sundays, I had no vet nurse for back up or reception.

This particular Sunday started like any other - I cleaned the cages, fed and walked the animals, answered the phone, and served at the counter.  I was in the back kennel room, and I didn't see the elderly gentleman walk in with his dog, but there was an almighty screech of the door bell.

When I walked out to the reception area, there he was, sitting down, with his dog sitting very quietly next to him.  The man looked at me as I walked in, but the dog was very obedient, and didn't move - he was looking lovingly at his owner. 

"How can I help you", I asked, leaning over the big front yellow counter that separated me from the

A bit stuffed!

rest of the room. The counter was quite tall and wide, which meant that I couldn't see the bottom half of the owner nor of his pet.

"My dog is stuffed", the owner said. As a vet, I am used to  a lot of different comments on what the owner thinks the problem is, but I had never had anyone say that before.  They usually say or "they are not well", or "I think it is time", or " you tell me, your the doc".

I walked around the counter to face the gentlemen, and said " I am sorry to hear that, let me have a look at him, what is his name". All the while, the dog's loving gaze doesn't shift.

And as I start to move closer to the gentleman and his dog, I realise that something is amiss.  The gentleman grabs his dog, on both sides of him, lifts him up and swings him around, so he is now facing me, with two glass eyes, and a loving expression.

The dog, literally, was stuffed!  This dog had cancer, which was treated by one of the other vets in the practice, who the gentleman thought was working that Sunday. Alas, it was me.... facing a stuffed dog.

The look on my face was priceless, and fortunately, the vet hospital did not have CCTV, otherwise, I have no doubt, it would've made it onto youtube!


The sex change -
The consultation room can be a magic room sometimes.  It sometimes doubles as the "sex change room". 

At every vet check, we go through which sex the pet actually is -  there are usually only two kinds - male or female ( though we have see the hermaphrodites - the ones who look like girls externally but are boys internally or a mix of the two)

It is always a funny moment when you lift the tail of the kitten, and instead of it being a girl, it is a boy.  It is even funnier, when the client says "how do you know".  A hard one to answer - the two testicles sitting in the scrotal sac gives it away a little bit, I guess.

Your dog ate what?
TV shows are made of the strange things that dog's eat.  We have had dogs eat tampons, used condoms (gross, I know -  can you imagine what it was like when we made them vomit it up? eeewww).

The strange ones come when you xray the dog because it has a back problem, and find a strange object in the stomach.  Or the dog that is "not doing right", pass a blue coloured poop (on further investigation, it was the arm of a little blue teddy bear).

The Clayton's stitch

Many years ago, a gorgeous dog, named Barry came in with a cut on his leg.  It was a big cut, and you could see the muscle underneath.  It needed stitches.  We anaesthetised Barry soon after he came in, as we know that the sooner you stitch it up, the less likely that it will get infected.

Barry went home the next morning, happy as Larry.  The wound looked great, and he was happy.

But the owner was not happy at all when he saw the wound.  "I am going to sue you". the owner says, angrily, and in a very threatening manner.

I was absolutely dumbfounded.  My associate vet had  worked hard to clean the wound, flush it well, and then close the skin using "plastic surgery quality" dissolving skin sutures, so you can hardly see a wound. They had stayed back to do it, without asking for any extra pay, even though they were paid it.  I stayed back to help him with the anaesthetic, as it was the type of surgery that this vet loved to do.  At the end of the surgery, the wound  looked amazing - all you could see was a shaved area, with a little line where the laceration had been. 

"There are no stitches!" Barry's owner exclaims. " I am going to report you to the Mercury, for
ripping people off.... there are no stitches there at all. How can you rip people off like that."

To this day, I have no doubt the owner still believes he was ripped off because we managed to "stitch up" a really deep laceration with the care and skill to make it look like nothing had been done. 

This is the "Clayton's stitch"... for those who remember the slogan... it is the stitch up you have when you haven't had a stitch up.

The high rise balls! (graphic terminology ahead!)

Desexing a male dog is never a routine procedure. Usually, the boys have two testicles sitting in the scrotum (sac), and the surgery is a routine one (with the little anatomical variations that vets have to deal with, but owners are usually non the wiser).

It is becoming increasingly common that we see the dogs with only one obvious testicle, and then we have to go searching for the retained (or cryptorchid) testicle.

But I was accused once, when I was a newly graduated vet (so over 24 years ago), of pushing the testicles up higher instead of removing them.

"Ya shoved them up higher!" this agro male shouted at me, a few days after the surgery. " I took my
dog home, and he had these two things swelling up every time he saw me"

As a new graduate, I hadn't yet developed the skill of keeping a straight face when the pet owner says something completely stupid.  Admittedly, I still haven't developed that skill, which is one of my faults, but I know I will never win an Academy Award for acting! 

What this owner was concerned about was the swelling of the accessory sex glands which sit on either side of the penis, and become swollen when the dog is excited.  As that area is shaved, coupled with the fact that this was probably the first time this guy actually looked at his dogs abdomen (as he needed to check the surgery wound), the bulbous swelling was a real shock.

Fortunately, my grey haired and bearded boss was walking past and overheard this discussion, and gave his appraisal of this situation " Why would we shove the balls up higher for you to see? Do you realise how  difficult that procedure is, because, technically, that is impossible to do!  If that is what we did, then we didn't charge you enough!"


Welcome to the mad side of my veterinary world - there are a lot more stories, but when I shared them with my  family, I was told that they were "funny weird" not "funny - ha ha", and I guess you guys want "funny ha ha" (but I did share some "funny weird" because I couldn't help myself).

This is mad Dr Liz, signing off... end of November 2013..... thanks for all of you being part of the animal mad animalclinic family.

And the silly season is yet to begin....

Astonishing Secrets - Your New Puppy or Kitten

"You're a cutie"

Welcome to another Astonishing Secret, and this is the practical information you need to help you and your newest family member settle into a new routine.

Puppy licks and kitten purrs are what warms every vet's heart, as we are all driven by the love of our animals.  And everyone loves babies.... of any species.

But what is the most exciting part?  It isn't the puppy breath, the waggy tails, the play stance..... for me it is the knowledge that the future holds so many moments of  joy, companionship and fun times.

We know that many pet owners are choosing their new family pet from ads on gumtree, or pet rescue sites or other avenues on the internet.   And with that, comes a decision on whether they trust the seller's "vet check" of the puppy or not.  My take home message is -  by all means trust, in principle, the seller's vet check, but ALWAYS, for peace of mind, get your own thorough vet check too.

And this vet check should be within 24 hours of picking up your puppy.

What are the common problems we see in new puppies and kittens that are hidden by breeders or missed at the initial vet check?

• dental issues - we commonly see "base narrow canines" or mismatched jaws which cause problems.  This problem is on the increase, and many pets act in as if they are uncomfortable, making a thorough assessment difficult.

Protecting your pets against parasites also
protects your famiy too.

• ear mites - these are little creatures with hairs on their legs, which often causes intense itchiness around the head and neck area.  Many breeders treat with an anti-mite product, so the pet appears to be "mite free", and in some cases, we are seeing mite infected pets from a reputable breeder, because of drug resistance.

• coccidiosis and intestinal worms -  even in the best environments, the immature immune systems of the young ones make them more likely to be infected. 

• microchip mix - ups. What we mean here is that the microchip in the new baby, does not match the microchip number on the paperwork that has been handed to the new owner. It is easier to sort out before the papers have been sent to the government, rather than trying to fix up weeks later. One of the things we do at Russell Vale Animal Clinic is to "scan and check" every pet at every visit to check that everything is up to date.

• heart problems - it is well known that the most common age to diagnose a congenital heart problem is at 12 weeks of age, but many puppies or kittens will show problems at a younger age too.

• umbilical hernias - the little "cysts" on the tummy which can come and go. They may seem normal to breeders as they are common, but they are not normal.

Of course, there are many things that our puppies and kittens can get that I haven't listed... that is why a vet check within a day of getting your new baby is sooo important.   After all, after spending many hundreds, or even thousands of dollars on your little baby, what difference does spending $50 or $60 make (depending on where you go)

At Russell Vale Animal Clinic, from Dec 2013 to Dec 2014, we will be introducing something new.

 It is a trial, and it is up to you on whether it is something that is worthwhile keeping.

For puppies or kittens less than 16 weeks old...

• all pets acquired from a breeder where the puppies parents have been sighted, a complete vaccination certificate, AND a veterinary health certificate has been issued..... the vet check is FREE.

• all pets acquired from the RSPCA or another registered pet rescue organisation, with a complete vaccination certificate ..... the vet check is FREE.

Our normal puppy/kitten check price is $60, which is a comprehensive physical examination, as well as a complete assessment of your pet's preventative healthcare - such as vaccinations, heartworm prevention, intestinal worming, microchipping information, dental care, what to eat, how to care for them the first few nights, and much much more! It takes about 40 minutes not including your registration time, so it is a very comprehensive and thorough check.  Tests such as skin scrapes or ear swabs are included also (normally $40 each).  But if your pet is acquired through the above places, then your first vet check with your new puppy or kitten is free.

We do not support puppy mills or backyard breeders who do not care for their pets at all.  Often these are sold through pet shops or online.   But these are the ones that definitely need the vet check ups.  These vet checks are at the usual price of $60.

 

Your new pet checklist

• The paperwork you should get includes

• Vaccination Certificate
• Any genetic tests/checks done on the parents
• Any hip/elbow/eye scoring tests done on the parents
• A recent (no more than 5 days old) Veterinary Health Examination Certificate
• Microchip Certificate of Identification in your name (within 7 days of your pet joining your family) and a Copy of the Change of Owner form (for your peace of mind)

• Make a list of when your pet is due for their next

• intestinal worming
• Heartworm prevention
• flea control
• vaccination

• The usual bedding, collar, tag, kennel, toys

• As there is a waiting period on pet insurance, get it early - some vets, like us, offer 4 weeks free pet insurance, but we do need to examine your pet first before we can activate your complimentary months pet health cover with PetPlan.

Congratulations on the newest member of your family - we look forward to being part of it all with you and your pet.

Questions?  Why not ask us at Russell Vale Animal Clinic.  Email us or call us on 42 845 988

Obsession with Pet's Body Image

As I was trawling through the net, trying to get inspiration for my next Animail Tails, my monthly e-news, I decided I would do a focus on pet obesity.

Going through google images of all that is out there about this very serious topic, it made me realise that what I was looking at recommending, in terms of the perfect body shape for your pet, could be paralleled into the body obsession of our  human world - the desire for the perfect body.

I began to feel really awful, as we shouldn't be obsessed about how we look, and we shouldn't be aiming for perfection, because each of us are already perfect, in our own unique way.  We should look at our pets in the exact same way - they are already perfect.

We should be sensible about our body weight, knowing the risks that come from carrying more kilos than you should, whether you have four legs or two.

Lily loves to jump on our scales
as she smiles for the camera.

At Russell Vale Animal Clinic, we weigh pets at every visit, and we print off weight charts also. We use this information, as well as examining your pet, to check their Body Condition Score (BCS).  We start this from the first visit.

Fortunately, most of my pets I have known since puppyhood/kittenhood, so if their weight starts to creep up, as it does when they are 2-3 years of age, then we can make helpful suggestions (or Dirk can do the guilt trip speech) to get them down a bit.

It is harder when I see an adult overweight pet for the first time.  My own GP once asked me do I talk to my own pet owners about their obese pet.  "Of course I do I said.  I am not oblivious to the risks of obesity."


Obsession with a pet's body image is wrong, but being diligent in maintaining a healthy weight range is absolutely the right thing to do.  We always go back to what is the healthy weight range for each individual pet, and aim to keep them there from year to year.

Overweight pets are prone to a wide range of health problems, such as

• Skin problems - overweight pets often have fat folds in front of their necks or at the base of their tail, these areas can sweat and become infected causing skin fold pyodermas
• Heart disease - the heart needs to work harder to pump blood around. It is only when the heart starts to fail that you may see signs, such as coughing, difficulty in exercising, gagging whilst drinking, and poor appetite.
• Arthritis and other joint disorders - as expected, the joints will suffer increased "wear and tear" as a result of the overuse
  
  
  
  
  
  
  Please monitor your pet's weight each year, and don't spoil them to the point of obesity. 
  I am Dr Liz, and I am for happy, healthy pets.... always.
  
  

Musings of Dr Liz - Pet Owner? Carer? Pet Parent?

Welcome to another one of my musings, but this is one in which I really do need your help to come up with the most sensible answer.

"And whose family do you
belong to? Are you a
child or a pet or both?"

Recently, I read a blog by a much older, more experienced, and overall, very funny veterinarian where he talked about pet parents, pet guardians, pet owners. And it got me thinking (which is awfully hard to do on a Sunday morning, trust me).

I write alot about loving pet owners.... and for me, the important part is the "loving" part, not the "owner" part.  I will admit that I never thought about whether I should use "pet parent" instead, and what you, as loving owners/parents/carers/guardians of those happy smiling animals around you, actually think of it all. Would it make a difference to the overall gist of what I write, and about the relationship you have with your pet if I used a different phrase?

Should we even be using the word "pet" and choosing something else?

At Russell Vale Animal Clinic,  we usually refer ourselves as Auntie Liz (Dr Liz to you humans),

Uncle Dirk, goofing around with Benji (2008)

and Uncle Dirk (Dirk), as it gives us leeway to spoil our visiting pets as much as we can.  But then, I know some people who are attached to the leads of these animals, look at us as if we are mad (and they are right, we are).  My madness hurts no one, my pets gets lots of treats, and actually start to enjoy a vet visit - as who doesn't enjoy a visit with their Auntie or Uncle, and getting spoilt?

The problem lies in that some people think of these terms in the literal sense - so calling yourself a pet Auntie or Uncle is, well (hopefully) not literally true.  But is there a problem in using this phrase?   I don't think so. Or I should say, I hope not, as I often refer to pet parents as Mum and Dad too during the check ups, and talk about sisters etc.

"Family means everything"

The absolutely single most important thing is the relationship, the friendship, the love and respect between kindred animal spirits - human, animal - it is unique for every single one of us. 

Some, like you and me, feel in our bones our connection with animals. It is such a part of us, that the phrases don't matter, as the relationship is at a significantly deeper level... A spiritual connection of kindred or like minded spirits.

As a loving pet owner, the connection is one of kindred spirits. When one half  is absent, the heart feels incomplete. Your thoughts are where they are, and what they are doing. When one half dies, it is a painful, deeply felt loss.  In my head, when I think of people who feel like this about their furry family members,  I write of them as my "loving pet owners".   And in the consultation room,  I think of them as pet parents (the mums, dads, sisters, cousins, grandparents etc, depending on who is the room at the time).  But the relationship is the same.

How do you think about your relationship with your furry family member?  What phrases do you read about that make you feel squirmy, and what phrases do you read that makes you say "yep, that describes me exactly" when it comes to describing your relationship with your pet?

As I am more in tune with animals than I am with people, I really need your help here, so at least I can get it half right with you.

I am Dr Liz, and I am the vet at Russell Vale Animal Clinic. We absolutely love animals, and we are thankful that they (mostly) love us too.

Understanding the veterinary diagnostic process

I used to be an avid reader of mystery novels, such as Agatha Christie, and I used to love reading all about Holmes, and his elementary sidekick Watson. Trying to solve the mystery, to piece all of the clues together, like pieces of a jigsaw,  to come up with the solution to the whodunnit was lots of fun.

This gave me great training in what I do every day as a vet, except the whodunnit is often a "what disease process caused this" type of  mystery.  And like the crime solvers of modern times, vets, like me, do a series of tests to get more information, so we can reach the right conclusion, not just "any conclusion".  We all  know of stories when the wrong person is convicted of the crimes just so a conclusion can be reached, and we all know this is wrong, even though modern forensics acquits them eventually.

In veterinary medicine, shortcutting the diagnostic process to reach any answer, can lead to a misdiagnosis (the wrong conclusion) , which makes no one happy in the long run.

Recently, a loving pet owner, whom I met for the first time, said to me "I do not want to do any tests that are  unnnecessary".  This was said to me after examining her very sick elderly dog Terri, and explaining the tests that I would like to do to identify more what could be going on.  She was, however, very concerned about her beloved friend, and wanted to know what was wrong with her. 

Of course, as a new time visitor to Russell Vale Animal Clinic, she didn't know that I never ever

Our Lab!

recommend any tests that are not needed.  I do, however, be as thorough as possible and let owners know of all the tests or procedures that may be suitable to help me reach a diagnosis, but I would let them know which test was the best to start of with.

Once I explained the steps we take in diagnosing a pet, she understood, and we were able to work together to identify Terri's problem.  Unfortunately, the tests confirmed my initial suspicion, which was that Terri had cancer, but it also gave it a specific name too, and with that, we had good options of treatment.  

Let us be clear on what a "diagnosis" actually is - A diagnosis is the final conclusion of what the pet is afflicted with... no ifs, buts or maybes. It is 100% accurate, to the point that if the pet went to another veterinarian with similar signs and tests results, they would come up with the same diagnosis.

A "presumptive diagnosis" or "differential diagnosis" allows for the ifs, buts or maybes - it could be this, it could be that, but it is more likely than not it is "abc" disease.  A "diagnosis" and a "presumptive diagnosis" may be the same thing, or they may not be.  And this is where the danger lies - calling the presumptive diagnosis or "initial assessment" a diagnosis.... this can lead to a mis-diagnosis.  And we all know what happens when a pet (or a human) is misdiagnosed.  

So how do vets get to a diagnosis? 

There are several ways to get to the answer, with the specific steps changing depending on the situation, but it mostly falls into two main ways, which also inter-relate too.

- pattern recognition of disease

- diagnostic problem solving 

What both techniques have in common is that they always start with information about the pet, such as age and breed.  Questions are asked of the owner about what they have noticed different.  Knowing the pet's previous medical history is so important. 

With that information, we can then go and do a  full and complete hands on examination to try to find little clues as to the changes in the pet's body. We review things  such as temperature, heart rate, breathing rate and pattern, swellings in the abdomen or changes in the eyes.... we are looking for any abnormal finding to go onto our list of clinical signs.

Vets are experts in this, as they know what is normal, and thus, what is abnormal. 

Once we have our list of clinical signs and abnormalities, then we go into the next phase, and this is where it splits into the two ways of figuring out what the problem is - the "diagnosis"  the path may be  either "pattern recognition" or "diagnostic problem solving", or a even a combination of the two.

Getting back to Terri, her problem list would be

1. Not eating well for 4 days

2. Lost 1 kg in 2 weeks (about 8% of her body weight)

3. Not drinking much

4. High temperature

5. Lethargic

6. Dental disease 

7. Caudal abdominal pain with possible mass.

Pattern recognition medicine means
matching the pattern signs of disease
to a single disease.

"Pattern recognition" is used daily by all vets to diagnose common diseases which have consistent presenting signs.  All owners are guilty of using this also, when they search google for the "diagnosis" of their pet's ailments, or for when they seek or follow advice of friends or relatives on how to treat their pet's condition. For example, in our area - vets would use this way to diagnose "paralysis tick poisoning", or some acute skin conditions, such as hot spots.    

The limitations in pattern recognition is that it quickly excludes a whole raft of other possibilities for that pet's clinical signs, and thus, can easily lead to a mis-diagnosis, and thus inappropriate therapy.  In Terri's case, she came in for nausea and dramatic weight loss.   The nature of the weight loss, and where she had lost weight from,  made cancer likely, but how would you feel if, as a vet, I said to you "your pet has cancer" just based on how they look?  I know exactly what you would say, as I have said that line to clients.  "How do you know?" you would ask, quite legitimately.  Terri also could've been diabetic, or had a bowel obstruction or any other million of conditions causing the same signs.

In the situations where I have come out with the cancer assessment  upfront (although it is rare for me to do that), is based on physical examination findings that support it. But in Terri's case, whilst I might have suspected it, I didn't know for sure, and certainly, not sure enough to come out and give her the horrid "C" word diagnosis.  And I certainly would not have come up with which specific cancer she did have without further tests.  Without the specific cancer, I wouldn't know what treatment options that would've been available for her.

So that brings me to the next way - which is "diagnostic problem solving".  This can be easy or complex, depending on the particular situation.  Using this pathway, all things are considered, a logical pathway is taken until, at the end of it, a diagnosis is made (or as close to it as possible). 

We look at the problem list, and we go through each item individually, making mental notes on which organ system is involved.  We then make a determination on the most independantly signficant sign we want to "work up".  We then make a list of the potential body systems that are involved, then the possible conditions/ diseases that could affect those organs, and then systematically go through to see if they fit in with the other signs the pet may be showing. After all, everything has to fit, somehow.
 

Now, in some cases, this is enough to come to a diagnosis, but in most we need to gather more information, whether it be through tests or more questions of the owner or physical examination.  

In Terri's case, the most specific sign was abdominal pain with a possible mass in the caudal (near her hind legs) abdomen.  Radiographs and/or ultrasound would help define what is going on. 

The next most specific was her overall signs of general "unwellness".  Blood tests give us a insight to the internal going-ons and the Comprehensive Health Profile is a good place to start.  At 12 years of age, Terri had never had any blood tests at all (this would be like an 80 year old human, never having blood tests - unheard off in our society).  

From the loving Terri's owner's perspective, she did not want to do any tests that were not needed, but she desperately wanted to know why Terri was unwell, and what can be done to help her. 

 Unfortunately, she wanted (and hoped for)  a "pattern recognition" path of diagnosing, when Terri needed the "diagnostic problem solving" technique.  Obviously, there is a cost difference in the two aswell, and I don't doubt this factored into the owner's mind. 

As a vet, every test I do or order is never unnecessary, as it gives me information about the pet that I didn't know before, AND, that I need to know to better help understand what may be going on internally.   Even if the tests do not show up anything specific,  and haven't given us a concrete diagnosis, they still have given us information on what the pet does not have.  And like any mystery novel, that is half the battle - you go through the alibis of the suspects, and cross them out as you go along, added to the information you have, to eventually be left with the guilty one.

When owners ask me "what is the right test to diagnose my pet's condition", I usually say "it is the last test we do"... by that I mean, we may need to do a series of tests to determine what is going on, and it is usually the last test that confirms the diagnosis, ends up as the right test to do. 

As a pet and human parent myself, I do understand the frustration and worry of an unwell child or pet, and the uncertainty that comes with it.  I do understand the desire and  urgency for an immediate answer and solution.  As a vet, when many of the diagnostic steps I take are second nature to me, I may sometimes forget what it can be like from the pet parents perspective.  When I babble on about this test and that test, and the other whatsamajoobie thing that goes into something else to grab a sample, I can get so caught up in trying to get the answer to solve the mystery, I forget that you don't know how hard my brain is working to come up with a short list of possible conditions, and if needed, tests to confirm or refute these possibilities.

If at any time you, as a loving pet owner feel that I am forgetting you in this process when I am looking after your pet, you have my permission to remind me.  After all, your pet needs all of us to work together to help make them better.
 

Diagnosing illnesses in pets (and in people) is not always easy, no matter how it looks so on TV.  Dr Google does an awfully poor job of it too.  What I didn't talk about is my belief that helping pets is not all science and knowledge but also experience, care and empathy.

I am Dr Liz from Russell Vale Animal Clinic. Has this helped you understand a little  bit more about what we do?  I hope so.  Let me know what you think.

Rethinking the High Risk/Low Risk to Disease in our Pets

Have you ever held a belief, one which you always thought to be logical, and therefore, true... and then be confronted by a different view, which, in reality, resonates with your experience?

In the past, examples would be finding out the world was not flat, or that we are not the centre of the universe.  The belief which has been shaken recently in me, is (almost) as dramatic.

This belief is not religious or political - I won't go there in my blogs - but it is about how we think about our pet's risk to disease, especially those  such as Parvovirus and Canine cough.   These are two very highly infectious, highly contagious diseases which affect dogs in all areas, including our own beautiful Wollongong dogs.

Parvovirus can be fatal if severe and untreated, and Infectious Cough (Canine Cough), whilst not fatal, the cough can be severe enough to be debilitating - who likes to hear their pet sound like a goose, honking multiple times a day.

My previously held belief on the high risk / low risk pets to becoming infected or exposed to disease, was based on the premise of increased chance of exposure to these same diseases.

That is, if you were a social butterfly, ready to meet and greet the world, go to the Dog Park or beach or other area where dogs frequently visit, then you were a "high risk" pet. 

And those pets who were indoors more often than not, were rarely likely to see another dog, let alone pick up anything from them, were "low risk".  

I mean, if you never saw another dog (or rarely saw one), surely you were at a lower risk of picking up these infectious diseases - you wouldn't get within cooee of these bugs, thus, you wouldn't get sick? Right?

 Wrong!

This is where I was challenged by an alternate view, by a Canadian (no less). Whilst he talked about views which I didn't agree with, such as he felt the three year vaccine (Triennial) was experimental, and therefore, we shouldn't be experimenting on our dogs, he did come up with some impressive quotable lines, such as "we are more likely to believe a simple lie than a complex truth".

What I am trying to talk about today is the concept of what is a high risk  or a low risk pet with regards to risk of disease.

The challenge was - a pet at high risk of infection or disease from preventable disease, or for that matter, any infectious disease, is actually the one that hardly ever sees another dog or cat.   The reasoning being that the pet is not exposing itself to enough environmental stimulation or "boostering" of their immune system.

 Therefore, their immune system is unprepared when it is attacked by a sufficient stimulus, and if they are unvaccinated as a result of the belief of "low risk", they were at an even higher risk of disease.

 Based on my original belief (which is held by many), this would be the "low risk" patient - that is, exposure to disease is unlikely or rare, and thus vaccinations are unnecessary and over-kill.

A true blue human example of when a "low risk" is really a "high risk" would be the toddler that goes to preschool for the first time -  don't they always end up snotty nosed a few days later, when they come down with whatever they have picked up at their daycare centre?  If they went rarely, their immune system would only get a sporadic boost to get the army ready to fight the virus/bug it needs to.  So, you the poor parent spends the remaining 6 days, getting a snotty nosed kid better, just to throw them back in, and start the process all over again.

Now what about the pet that is the social butterfly?. This would be child that goes two to three times a week to preschool.  Whilst they may be snotty in the first week or so, after that they seem to be "immune", in general to the bugs, and you, as the lucky parent, are dealing with a less snotty child in the long run (woo hoo!).   Under the new premise, this would actually be a "low risk" patient for becoming infected with disease, as the ongoing exposure to low levels, during their social activities, actually means that they are "auto-vaccinating" themselves.  That is, being exposed to lower levels of the virus, during the social outings, makes them less likely to get full - blown - pet-killing- disease, and, in theory, less likely to need vaccinations also. Under the old belief system, we had them in the "high risk" category, as they were more exposed to infection, and obviously, needed to protect them more.

I envy the old days, when ignorance was bliss - as vets, we vaccinated everything that moved, because we had seen the horrendous effects in those pets who suffered profound, protracted bloody diarrhoea and absolutely excruciating nausea and vomiting (Parvovirus),  or those pet's whose long mucoid snot and yucky eyes, if they did not die, often led to ongoing seizures and brain damage (as a result of Distemper).  And loving pet owners knew they needed to vaccinate or immunise, as this was the best thing to do.  Those were the simple times.

Now, we are in the "modern" times, and less pets are being vaccinated than ever before, because people read alot of stuff on the internet, based a simple lie, rather than opening their ears to the complex truth.

Why does this pose a risk for our pets? 

Because this Canadian vet made a very valid point -  if every pet owner vaccinated every pet as they should (assuming it was safe to do so) as puppies, and if every pet vaccinated their pet each three years as they should (assuming it was safe to do so),  then the "modern" vaccination recommendations of Triennial vaccinations could possibly work.

But as there are many unvaccinated or irregularly vaccinated pets in our community, and then we dilute the communal immunity even lower with a longer vaccine interval, then the risk of disease in our pets may change (i.e increase) , and this is something that the veterinary "powers that be" probably didn't consider in their projections.

Now I have to give a disclaimer -  Russell Vale Animal Clinic was the first veterinary hospital in the Illawarra to introduce Triennial Vaccinations in our dogs, and the first to introduce in-clinic vaccine titre testing (in accordance with WSAVA guidelines).   I say this to show that we practice in accordance with WSAVA guidelines.  But, I also have been a vet for over 20 years, and I remember clearly the animal wards full of puking puppies, and the seizuring dogs, and the blue eye (from hepatitis).  It is my biggest fear that we may fall back into those dark days because of  complacency, fear, and lack of compliance from owners.

As a vet, and pet lover, I will be monitoring this very closely, and amend my protocols accordingly.  So rest assured, that when I examine your pet, in my consultation room, and they have come in for their regular check ups (as all pets should twice a year), and when we assess their need for vaccinations (which I do all the time),  I will take all factors into account to do the right thing, for that pet, using the knowledge I have at that time.

This is what I love about my veterinary profession - we care, and we always try to do the right thing by our pets - because that is what we are all about.

I am Dr Liz, the vet from Russell Vale Animal Clinic.  We would dearly love to see you and your pet for their regular health checks, so why not come in and check us out.

Behaviour Bites - The Power of Fear

"The only thing I am scared off is
that the batteries are flat in the remote
and the food bowl is empty." says Pusski

A word of warning before you proceed - this post will pose a challenge for most of you, and it does get deeply personal, a bit depressing, and opinionated.

 In other words, not one of my more happier posts.  It goes into a dark place - fear.

  Fear is a place that those loving pet owners with pets with anxiety and phobias need to dip their toe in to understand what their pet goes through when they suffer seperation anxiety, or when they are scared of fireworks or storms.  It needs to be said to explain why giving a few doses of Rescue Remedy, or a dose or two of valium just won't cut it, as this seems to be the favourite of many owners.

It is also not your standard noise phobia or anxiety article or chat. This is written to help you understand what your pet is actually feeling when they are hiding under the doona in your bed when the thunderstorm is on.

"If I can't see it, then the boogey man can't get me"

In any fight or war, you need to know who or what your enemy is.  And, as any strategist of war knows, you also look at what you want  your outcome to be, what collateral damage is within acceptable limits, and at what point do you need to rethink your strategy for your campaign.

Sometimes, the best strategy is to give up the fight, and at other times, it is to stop using a water pistol  when the army should be using something a lot stronger.

In an anxious pet, the enemy is fear - the fear of what they think is going to happen (otherwise known as anxiety), the fear of what they remember happening in the past that was really really scary, the fear of being alone, the fear of being in the company of others that they don't know, heck... even the fear of the vets (though fortunately I don't have too many of those).

• What strategies are available?   - There are lots, but which one is going to work in your pet?
• What is your acceptable outcome? - is it a calm normal pet? or one that doesn't hurt itself or others?
• What collateral damage is acceptable?  In other words, how much effort, financially and emotionally are you prepared to put into helping your pet?.
• And at what point do you reassess and rethink your program? Is it after a single treatment? Are you going to give it more time?

"I may look docile now, but in a thunderstorm
I am all over the place. I need help"

In fairness to most medications and re-training programs (behaviour modification) - it takes at  least six months of ongoing work, tweaking medications, re-adjusting training etc before we can call it a failure (or a success)...  and this often doesn't fit in with many owners of wanting a quicker, effortless solution. To want a quick solution is normal and understandable if the power of fear is not understood or appreciated.

 And we have a life, family and other big commitments too.  But once you understand what fear is and does, then you will appreciate that the solution to your pet's fear and anxiety is not always easy, and that there are never any quick fixes (other than a permanent one).

Fear has a real power - when you have experienced real fear as a result of the actions of another or from an scary event, it changes you forever.  You will never ever be the same person you were before. Never, no matter how outwardly the "same" you look or act. And if the cause of that fear is still out there in the community, that makes it harder still.

If that fear provoking person (or event) crops up every so often, and not necessarily in a threatening way, but just by their presence, then the sick gut, the dry mouth, the heart racing, the head spins and you don't know which way to go. Your mind races a million miles an hour, remembering all of the real  things that that "thing" did to you.  And you want to escape. You want to hide. But that thing is not hurting you now - but the anxiety (the anticipation of pain) is.

That is fear. It happens.  It's how we deal with it, that counts.

"Under my blankee works for me"

But, in some of us, fear takes on a life of itself, and refuses to be controlled or manipulated. The veterinary behaviourists call it maladaptive, in that this reaction to this fear serves, well, the reaction serves no purpose, and it is actually harmful, when the pet hurts itself, hurts others or damages property.

From a personal perspective, you never forget true fear or the event that caused it. All you can do is develop strategies that help you cope with that fear in a non harmful way to yourself or others. And the surprising fact is, that an unrelated situation is able to trigger a severe fear reaction (this is generalisation). I say this to show that I personally understand the fear that our noise phobic dogs and cats feel - it never goes away, they need help (like we do) to develop strategies to help them deal with it.

Our pets often try to develop their own strategies to cope.  Some are not so great (such as shredding doors, eating tin sheds - lacerating themselves to bits).  Some are better - finding a nice dark place to hide, and hope that if they can't see the evil, the evil can't see them. They will shake, tremble, pant, pace if they have to, or they will just sit still and freeze in pure fear.

What are you doing to help your pet with strategies to cope? 

Did you realise that vets should be your first port of call when your pet has a behavioural problem, not your last?  Don't wait until the problem gets severe, but when you first notice signs.  Most vets are knowledgeable about the basics of anxiety, but only the veterinary behaviorists are the experts in it. In other words, there are experts out there who can help you.  But don't leave it until it is too late.

I am Dr Liz, and I am here to help your pet whenever I can, and can help your pet seek the therapy they need.

Microchipping, your pet, and responsible pet ownership

"We are special - we deserve to be microchipped.
We can't tell you where we live, but we can tell
you when we are lost"

As a vet, I dearly love that that most of the pets I see are absolutely adored and loved. As part of our complete check up, we not only do a complete physical examination, we also check every single pet's microchip and their details.

Now.... here is where I see a huge.... almost massive... disconnect between my own clients who I know love and adore their pets..... and many lost or stray dogs (rarely cats) we see almost daily.

At my last tally, 70% were either not microchipped, or had microchip details which were not accurate or up to date.  And this meant a stressful time for everyone.... for us, the pet (they are not home), and the family from which they came.

From a veterinary hospital perspective, scanning and checking for a microchip is time consuming.  I won't deny that at all, but it is time well spent in my opinion, if it means that if we ever need to rely on that information, we know it is accurate.  Wouldn't you agree?

Checking the database registries, and going through the information with the loving pet owner is also time consuming.  But wouldn't you want to know that the changes that were supposed to have been made on the database were never done (for some reason)?   I know I would!

Every single pet that comes in for a vet check or full consultation have a horrible thing waved above their shoulder blades waiting for a bleep, which indicates that the scanner has read a number.

A number is a number, which means nothing if that number isn't on a database that it is supposed to be on. 

And so, the next thing we do is check the databases to see what information is there, and is it accurate or not.  The main one we check is the Companion Animal Register, which is the database that all NSW based pets need to be on.... by law!

And then we have the stray dogs (and cats), who come in with no sign of any identification on them at all.

What is so hard about microchipping your pet?  

It is not expensive.... and if you love your pet, it shouldn't matter how much it costs... because suffering the loss of a loved pet, and not knowing where they are is so painful, that to ensure that you have taken all steps you can to make sure they come home, is.... what does that mean to you? is it worth whatever?



As for me....Scanning a pet and finding out that
- it is not on the Register at all
- the microchip is in the previous owner's name

-the microchip is in the breeders name and the current owners have owned the pet for many  years
- the microchip is in the address of the current owner from four addresses ago with disconnected phone numbers

- the pet's name and details on the registry is different to the name the current owner or Good Sam claims it is...

Finding out all of the above does not make me feel warm, fuzzy or excited! In fact, it makes me feel sick. It means that people didn't care or didn't care to know what responsible pet ownership actually means in NSW.

I didn't write the laws, and God knows, I opposed the majority of the rules that the NSW Government brought in with respect to the Companion Animals Act, but the law is the law. I may not like it, but I must abide by it.

Recently,  I saw a new pet that had been owned by the current owner for the past 11 years, and it was still in the breeder's name.  Fortunately, this pet never left home, so no harm was done at the end of the day, but what about those pets who have left home.... with lonely owners expecting the chip to bring their pet home.

The other day,  I saw a Maltese Terrier who was brought in as a stray.... it was not microchipped.   And this is a scenario that is almost weekly, rather than a rare occasional occurrence. This is devastating for me and my team, as we are faced with an absolutely gorgeous friendly dog, who through no fault of their own, had no identifying tags or chips to let us know where home was.  By law, this dog had to go to the local pound, where we hope he was able to be re-united with his family.  But I didn't feel good about him going there at all, as it could also mean a death sentence.  Seven days in an unmicrochipped pet.  Criminal, in my view.

I won't go on with stories, as it would end up as long as War and Peace, or the Lord of the Rings!

What does microchipping your pet involve?

If you are new to our practice, then your hand will get weak from the forms you need to fill out, because you will need to fill out
Form 1 - new client form
Form 2- NSW Companion Animal Register Identification form (which is for NSW only)

And.... in accordance with our AVA Microchip Accreditation status (and because we believe in pet recovery first and foremost),

Form 3 - we also place all microchipped pet information onto the National Pet Register.

We are only one of two veterinary hospitals in the Illawarra who are AVA Microchip Accredited, which was a surprise to me when I looked it up.  We have been AVA accredited since the scheme began (after the introduction of the Companion Animals Act in NSW (1998). And we maintain this accreditation through our determination to offer a veterinary grade accredited microchip service at a competitive price.

The actual implanting of the microchip is quick, easy, short - and your pet is usually filled with liver jerky to make the "big needle" that everyone talks about, easier to take.  It really is not a big deal at all where your pet is concerned.

I am Dr Liz, and we love helping animals get back home.  We have a facebook page dedicated to reuniting pets, and we spend many hours weekly dealing with stray pets and getting them home.  Please do the right thing, and have your pet microchipped, and then have that chip checked every year at your pets next  vet visit.

If you need more information, if you have lost or found a pet, do not hesitate to contact us on 02 42845988.

If you have a smart phone, you can download the Pocketvet app - it also has a lost and found pet feature - which means if you have lost a pet, it will send an alert out to all fellow Pocketvet app in our area. Click here for the links to Pocketvet

How to deal with fleas which won't die

My father was an absolutely interesting man, and whilst not perfect, there was one thing which was truly special about him - and that was his love of animals, and even more special, on how they seem to gravitate towards him.

After he died, we eventually rented out our family home, to a family with pets.

 

Asleep - on the bed - and I wonder what else they are sharing..
fleas, maybe?

And recently, they moved out, but their pet's fleas did not.  

So, I have now had to deal with an all too common scenario faced by many loving pet owners - how to deal with fleas which won't die... or as the true situation is - how to eliminate the flea plague living in your house.

It has been over  month since the tenants have moved out, and during that time, the house has had three seperate environmental flea treatments.

The first one was a professional pest control treatment (and I was warned a second one would be necessary).  

We still were getting emergent fleas (the little ones).  The professional flea treatment did work, as we

Ugly Fleas !

had no adult fleas, but  like any other human being, I got impatient, and bought the flea bombs from the supermarket about a week later.  It promises to sterilise the flea eggs, and stops them from hatching for up to 9 months.

I visited the house almost daily, and found no fleas - and thought! wow!  that has worked.  And then, I couldn't visit for a week and a half.

I was there one afternoon, and after 2 hours, had to leave. Those little blighters were at it again!

So I set off another set of flea bombs,  as a knee jerk reaction.  But I had to ponder why did I, or why should I, need to repeat the treatment?

The answer is because of the flea life cycle - they hatch in "waves", and they must go through the egg to larvae to pupa stage - and whilst the flea treatments work on the adults, and the flea bombs on the eggs, they do not do much for the larval or pupae stages!

Patience is a virtue, but being attacked by these fleas is really challenging mine.  On many levels. As  one who loves animals, as a veterinarian, and, now, as a landlord.

As an aside,   I often get the comment from clients about "grass fleas" - I now have a new "brand" of fleas - I have  have "carpet fleas", "tile fleas", "timber floor fleas" and "laminate fleas", as what is jumping me on me when I am in my old house are definitely fleas, but seem to come out of nowhere. The fact is that these are all the same type of flea, which is the "cat flea".

The real flea problem in any environment are the eggs that a pregnant adult  flea lays, which she does on the pet, which fall into the environment...wherever the pet may be.

So, this is all about how to deal with fleas which won't die.  This is what I did to clear up my flea problem (which is still ongoing, but at least I can work for several hours in the house without being molested)

• Patience - essential - the flea eggs can live in the environment for up to a year. To expect to be flea free after a single treatment is not a realistic expectation.
• 95% of the flea problem is in the environment, with 35 % in the pupae (not able to be killed readily) stage.
• Vaccumming regularly is essential - this stimulates eggs to hatch and continue on the life cycle - the adult fleas are then killed by any flea bombs or treatments, or sucked up into the vacuum cleaner bag - to die a slow death via flea collar). How regularly?  I would recommend each 2-3 days, and emptying the vaccum cleaner bag each time.
• Quality flea control on your pets - we would suggest using Frontera flea spray (Ilium) - even though as a spray it is an initial nuisance, it will provide the best flea protection your pet can get.  (Of course, if your flea problem is not as bad as mine, then you can use the spot -on type treatments). In my situation, there are no pets in the house, so the fleas are choosing me (as the closest living creature) by  default. 

The musings of Dr Liz....A satisfied Pet Owner

Welcome to another of my musings... and this one is inspired by a statement made by a speaker at

the Australian Veterinary Association Practice Management conference in Sydney in July 2013.

The speaker was a dietician, who spoke about Work/Life Balance.  And in amongst all of what Work/Life balance was all about (which isn't about working less, and life-ing (living)  more), she talked about her own business, and how she assessed and measured and therefore, ensured client satisfaction.

The comment that pricked my ears, was the one where she made that the customer satisfaction was increased if they liked the dietician, and it was unrelated to the information or knowledge of the dietician.

And I thought "Wow".  Sounds very much like one of my earliest blogs that I wrote a year ago... Life is a popularity contest, was/is the title

There was another blog written by someone else that I read a few months ago -  this blog  equated

A photo of Paige entertaining one of
my patients at home - a "hospitalised"
patient at Russell Vale Animal Clinic.

trust to likeability in the workplace.  The problem I had with that blog is that it implied that it was your fault that you were not trusted, as you must've done something dishonest to have deserve that.  And I do have a problem with that comment.

Con men or scam artists cannot be trusted, but aren't they likeable?  Isn't this how they get away with what they do? Aren't we more likely to trust the likeable, even if they don't deserve our trust (or our like?).

This is me at home, with Leo,
an injured stray in 2011... I look awful,
but how about the care he is getting?
If care was based on my looks, it would
be a bad score.

What about how someone looks?  There was  another webinar on customer service, and it make a point that  attractive sells.  We are more likely to buy if the person is attractive, well dressed, well groomed.

Does the care I take of your pet change or differ if I wear daggy trackpants and a comfy Tshirt, or if I am not wearing any makeup or if my hair is due for a trim?  It doesn't, but your perception of my care does.  And thus,  your satisfaction of what I do.   And I get that, which is why I don't even own a pair of daggy track pants (and I don't wear a Tshirt to work). I can't make myself look like Elle McPherson, nor can Dirk look like Brad Pitt. And it is no help that make up causes a bad reaction - my eyes go all puffy, they go red and I feel ill.  So my basic makeup is, well, minimal.

Sad, as I do like to be comfortable when I am on the floor playing with the puppies and dogs, or doing the cat whispering with the cats on the Feliway sprayed bench... and having legs up to heaven would  be nice, considering I am short.

There are so many nuances to happy, satisfied pet owners, and I don't believe it is all about how we look where loving pet owners are concerned.  I think it is a complex mix of things, and I, and all of us at Russell Vale Animal Clinic work towards making your pet as happy and healthy as they can be, and as a result, make you as satisfied as  you can be with what we have done, and how we have done it. After all, isn't this what you want from your vet?

I am Dr Liz, and all of us at Russell Vale Animal Clinic get absolutely excited every day that we turn up at the vets. Call us on 42 845988 or book online (via our website or email us directly).