Helplessness against broken nature…

Vet student in surgery

The definition of inoperable changed for me today, I’ve always understood sometimes there will be challenging surgery, and sometimes most will not do anything as there was nothing developed yet. However I never believed that there would be anything that is impossible to operate on.

With every single patient I am prepared to give everything that I have got to try and do everything possible. So today was no different, I spent 45 minutes removing 3 litres of fluid from the abdomen by syringe. And then it was time to go to surgery which I had spent several hours preparing for in study to make sure I was on my game to assist with the surgery today.

It all went wrong trying to open the abdomen, first we thought the scissors were bad, but then we realised it was the tissue that surrounds the linea alba on the abdomen that was 10cm thick and hard. We found a way in though going around this – and this was where it all fell apart.

The only way I can think to describe it is like when frozen food melts on the way home and then when it is refrozen everything becomes one totally mixed up. Even the bladder was not visible and “melted” into the body wall… The doctor I was with had never seen anything like it, and I really hope that I never ever get to see anything like it again…

The most horrible feeling in the world is that of helplessness… And that is where I am right now.

The secret to getting your dog to do what you want…

How to behave so your dog behaves review

So often I see owners getting frustrated that their dog is not doing what they want… Yet I also see a dog that is confused. It’s all a case of miscommunication and in the next few minutes I am going to give you the secret to getting your message across.

If we go back to the beginning we need to consider the most basic thing – that is getting your dogs attention. However we need to do this in a positive way – make it a great experience for your dog to give you their attention. I believe in positive reinforcement so when you dog does what you want, you should give them a treat for it. So let’s take a quick look at how to get your dogs attention – basically when you say their name you want them to give you attention (look at your face) and wait for your next command.

Start this simply, position yourself in front of them now you want to say their name, and the minute they look at your face give them a treat directly to their mouth. Repeat this everyday for short periods – to get the association with their name and this you need to get a result on the first time. So if they do not look at you, then don’t keep repeating yourself but wait and then give them the treat when they do – it will get a lot quicker as you go on and the association becomes stronger.

It is important to do this in a small controlled area with few distractions when you first start, once you have the basic action of your dog giving you attention working 90% of the time in this area you can increase the area or add more distractions and build up.

Now once you have mastered getting their attention you can use something called a variable ratio for the positive reinforcement where you reward them randomly so that they never know when to expect the treat – but know that it will occur sometimes so carry out the behaviour in the chance that they will be rewarded.

You can then use the same techniques of positive reinforcement to train other things once you have your dog giving you their attention on demand you can give a command for a behaviour – and then reward them for doing the behaviour.

I think behaviour and learning is something every pet owner should understand, however it is often confused or twisted in the way it is explained. The best book I have found for learning about behaviour is by Dr Sophia Yin, and is called How to Behave so your Dog Behaves. I know it says “dog” in the title, however the principles here can be used with anything from chickens to elephants so in my opinion it would be a highly recommended read.

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The VET Festival for One Medicine – Day 2 Roundup….

Festival busker at vet festival

In his last lecture yesterday Noel said that he had txt God asking for the Sun to be turned on, and this morning it really was. For the first time all week my sunglasses came out of their bag and onto my head. However that is not what I want to write about so back to the VET Festival…

Today is day 2 (and the last day) of VET Festival 2015….

vet festival with Noels ordered sun

One of the first vets I met when I arrived at the Fitzpatrick Referrals center on Tuesday was Clare Rusbridge, one of the senior neurosurgeons at the center. On Tuesday I learnt a ton (I will write about this later!) and Wednesday even more, however today blew me away with an update on Canine Epilepsy. Pushing the limits of technology Clare used interactive txt polling to engage the audience. It was such a big topic that I will write a post just about this later, however the take home messages were that diazepam is not effective (I tested Clare’s reaction here to confirm it!) and that diagnostic tests do not exist for idiopathic epilepsy. Something else I was shocked by is that pharmaceutical companies consider a seizure drug “effective” if it reduces seizures by just 50% – personally this seems a low threshold for me…

Canine epilepsy with Clare Rusbridge

I then headed outside of the main lecture streams (they’re being recorded so I will watch every single one later!!!) however I wanted to learn some more about The Humanimal Trust. This new charity is all about vets and human doctors working together towards One Medicine – sharing expertise for the benefit of all. Even though we are both in the medicine field until today there has been little collaboration between vets and doctors. Actually when you look at the drug development cycle it takes around 13 years to get a new drug to market, and 10% of drugs do not make it on a mouse model… Yet if vets were engaged and dogs were used in the development the time and cost to develop new medicines would decrease greatly! The Humanimal Trust is all about animal and human healthcare moving forward together sharing advances.

The Humanimal Trust for one medicine

It then all became about the spine, such a small amount of time for such a big topic, and my first lecture with Noel. This was different to most with the opening words being about remembering that picking up a scalpel needs to be a carefully considered and thought out decision. It has become tradition for Noel to pick on a member of the audience to help with demonstrating different techniques, and today it was Ian Holsworth…

Noel Fitzpatrick demonstrating on Ians Holsworth

I then had the pleasure of hearing Laurent Findji talk about hepatobiliary surgery – this is surgery of the liver and gallbladder with the associated connecting duct to the intestines. Generally liver surgery is one of the more interesting parts of soft tissue surgery with some highly technical procedures. The liver is split into different lobes all connected to a central area – in terms of surgery the left liver lobe is a lot easier to remove than the right liver lobe. Also it is somewhere you need to be able to get good exposure as the liver sits right against the diaphragm at the end of the ribs.

Laurent Findji talks about hepatobiliary surgery

Something I was really interested in learning about were limb sparing surgery options where instead of amputation a bone (or part of one) may be removed and replaced with an artificial one or a part from elsewhere in the body. This was given by Will Eward from the Duke Cancer Center who is a vet and a human orthopaedic surgeon. During this I learnt loads that will be useful into my future – however the most important points were that when dealing with cancer it really is important that surgery should be planned properly, as correcting future mistakes can be devastating. Once a joint capsule is contaminated then it must be removed preventing artificial joints from being placed. The most dramatic surgery discussed here was a rotationalplasty which is where a knee joint is replaced with the ankle joint – success of this hinges on which way you rotate the foot.

Dr Jane Goodall speaking at VET Festival 2015

The last lecture of the weekend was delivered by someone that is a driver of change in the world for the better, Dr Jane Goodall. The room was packed, and this was the first speaker of the weekend to get a standing ovation from some of the smartest vets, vet nurses and vet students in the world. Dr. Goodall told her fascinating story of how she went from a little girl reading Dr. Doolittle to one of the foremost experts on chimpanzees. It is not my story to tell so I will leave it there; however it is a reminder of how one can achieve whatever they dream if they take the risk.

Dr Jane Goodall standing ovation

The VET Festival is now over; however the journey to One Medicine for One Health has only just begun and I hope that I, as well as you all will be part of it!

The VET Festival for One Medicine – Day 1

Noel Fitzpatrick - Pets Hugs and Rock and Roll

In a field in the grounds of the new Surrey vet school I arrived to a festival today thankful for boots and in typical British fashion with big grey clouds threatening overhead. This was not a festival like any other, in fact it was the first festival I had ever been that had a CT scanner in a tent in a field…

This is day one of the VET Festival – not your normal festival but a place where people pushing the limits of both Veterinary and Human medicine have come to share the latest and future planned advances to benefit both animals AND humans.

Festival CT Scanner - The VET Festival

The day may have started grey, but after the welcome by Noel Fitzpatrick the atmosphere was electric, and heading in my first lecture with Professor Nick Bacon it became apparent why.

Cancer in cats - Professor Nick Bacon

Cancer in cats is sadly very common, and though the cells are often the same as in humans the treatments are not. However there is now the first veterinary oncology hospital which Noel Fitzpatrick opened last Wednesday and today’s first lecture was by one of the senior vets running this hospital Prof. Nick Bacon. This was such a hugely informative lecture that I have decided that it deserves it own entire blog post later in the week to prevent this one becoming a story. The key point was summed up by Nick however when he said “Please please please stick needles into things as it gets easier”. Cytology (looking at cells under a microscope) is an important skill learnt by experience.

Spinal Nerves with Colin Driver

Something that I’ve struggled with until today was the spinal nerves (the other part the cranial nerves are much simpler!). Colin Driver gave a thorough explanation starting with the basics of how the Upper Motor Neurons control the Lower Motor Neurons by inhibition (aka stopping a signal). Therefore UMN problems cause an increase in muscle tone and reflexes, whilst LMN problems cause a decrease in muscle tone and reflexes.    This helps us to determine where the problem is and a appropriate treatment plan. The severity of spinal cord injury has a logical progression of: loss of postural reactions, ataxia, paresis, paralysis, loss of superficial pain and finally loss of deep pain.

External Skeletal Fixation with Jerry

During my first break I managed to find the interesting toys, and spent an hour getting a introduction into external skeletal fixation from European Diplomat Jerry O’Riordan which was very cool as I got to have a play on some fake bones. This is something we don’t currently use in Slovakia so I was very happy to have a opportunity to learn more about this.

Peri-operative pain management orthopaedics with Duncan Lascelles

Then I jumped straight into peri-operative pain management in orthopaedic patients with Duncan Lascelles who was brilliant. What, when and where you use the different types of pain medications can make all the difference to an animals pain level. It is important to remember that pain is a plastic system that can be hyper sensitised and so in some painful orthopaedic conditions it may be worth delaying surgery to control the pain first. This will allow much better (and easier) control of pain post operatively. Also the importance of complementary non-drug therapies need to be remembered and used here as well!

Gait analysis with Julia Tomlinson

It was then onto gait for me, a relatively new field that is expanding very fast – at present a lot of the research and books here are equine focused however canine gait analysis is becoming a much more important part of veterinary medicine. Understanding how the muscles work, and that different parts of the same muscle may have different functions in movement is very important and not something really taught during anatomy at the moment. One of the most important tools here is video to allow the analysis of a animals gait at different speeds especially with smartphone apps for slowing down videos!

Lectures today finished for me back with Duncan to learn about chronic pain – something that can actually shrink your pain as it causes a decrease in the size of the cognitive areas. Even more shocking is that in America in 2012 treatment for chronic pain cost $600bn which is more than cancer, heart disease and diabetes combined! A multimodal approach is important to consider with the example of osteoarthritis being used with NSAIDS to control the pain whilst exercise (which releases natural endorphins) was introduced, along with nutritional changes before reducing the NSAID use.

One Medicine with Noel Fitzpatrick

The keynote at the end of the day had Noel Fitzpatrick introduce One Medicine and the difference that it can make to the world. Animals are often used to develop cures for human patients, yet this does not feed back into veterinary medicine, and vice-versa. In over 100 years the parts of veterinary surgical textbooks about prosthetics have barely changed. Though 92% of dog owners consider their dog a family member, the survival rate for osteosarcoma is only 10%. In HUMANS the 5 year survival rate is 70%. Yet in veterinary medicine we have a new technology called bone wielding which allows us to do amazing repairs of disastrous injuries – yet this technology IS NOT used in HUMANS. Take home message – One Live, One Medicine.

Paws, Hugs, and Rock and Roll was the them of the evenings concert with people coming from all over the UK to be here to support One Medicine and One Live!

Noel Fitzpatrick - Pets Hugs and Rock and Roll

The future of veterinary oncology treatment, not just for animals…

Fitzpatrick Referrals - Oncology and Soft Tissue Hospital

The future of veterinary oncology treatment, not just for animals…

Sometimes I get very lucky, and this week is one of them times (much needed after the past 2 months) as I was invited to the grand opening of the new Fitzpatrick Referrals Oncology and Soft Tissue Hospital in Surrey.

One of the things that I hate most about medicine is when the words “There is nothing we can do” come into play. Personally I don’t think these should ever exist, and yet when it comes to pets and animals they commonly are used. This was the start of change for the veterinary profession when after changing the face of orthopaedics Noel Fitzpatrick decided that something needed to be done about cancer.

Fitzpatrick opening - cutting the ribbon

As it was very well put today by Noel I’ll stick with it…

“Cancer doesn’t care if it is in your child or your Labrador; it is still a cancer cell!”

Yet though this is true, and many of the tumours seen between humans and animals are the same, animals do not get the same care that humans do. Whilst a animal shouldn’t be stuck in bed hooked up to tubes, it should still get the best treatment and chance of a cure as possible. And being different is where Noel has brought in one of the leading medical oncologists Dr Kevin Kow alongside two of the worlds best veterinary oncologists.

Fitzpatrick referrals reception
Fitzpatrick referrals cat ward

The building itself is amazing, and I really am jealous of the Surrey Vet School students that will get to learn and practice there. Everything is the most modern design using the latest in research to make it as relaxed experience for animals and owners as possible. From the cat wards where you can see every cat for monitoring but the cats cannot see each other through to a central prep area where everything is accessible from one easy space.

Fitzpatrick Oncology Prep Area

The last stop on the tour today was where the future is going to happen which is planned for 2016 when the UK’s most powerful animal linear generator will be installed. This will allow for high power radiation to be delivered accurate to very small areas within the body to help treat cancers of the brain, liver, spleen and kidneys.

The passion behind medicine