Talking with Brooke @ VMX

Brook & me after the opening ceremony

It is pretty cool when you get to hang out with Brooke Shields and discuss issues that are relevant to veterinary medicine. Brooke is a fervent animal lover and has had many animals of her own. Currently, she owns a Portuguese Waterdog that is as rambunctious as you can get them. Brooke joined me during the opening ceremony of VMX, the largest veterinary exhibition and conference in the world.

VMX attracts 15-17k people every year and is located in Orlando, Florida. It hosts many lectures and veterinary CE but also covers the biggest veterinary exhibition in the world. People from all over flock to Orlando in early January to see what’s new and to kick off the New Year with a bang. Hill’s sponsors the opening ceremony for quite some time and we tend to invite comedians, but this year we changed pace and wanted to invite someone that was relevant to our profession.

Brooke spoke about her love for animals and especially a bulldog called Darla, who helped her through quite a lot of turbulent times. I had the pleasure to read 2 of her books to prepare myself for the ‘talk show-like’ openings ceremony. Down came the rain describes her postpartum depression and we talked about how this influenced her life and how she was stubborn not to accept help in the beginning. After she did she talked about how people, therapy and drugs helped her over this depression. We related to the stresses in veterinary medicine with lots of depressive opportunities and discussed the high suicide rates under veterinary healthcare workers. We also discussed how to be able to perform under great stress and still be a professional and Brooke was open, funny and helpful about how she dealt with issues like this. Last but not least, we discussed clients (fans) that may be a bit too much. Although Brooke has a number of people helping her with her fans, lots of similarities came up when we compared ‘action’ notes. The other book, there was a little girl, describes Brooke’s loving but complicated relationship with her alcoholic mother. One passage that I really enjoyed was the one where she describes the first encounter between her husband Chris and her mother and a stool sample he had to carry for her during a hot sweltering day in NYC.

Before Brooke, Doug Mader talked about how Hurricane Irma destroyed his island in the keys. A wonderful story about recovery and hope after devastation. Doug definitely is an example for us all in resilience and keeping a positive attitude. He also showed that building a clinic that can withstand a class 5 hurricane both helps animals and people in need. I am proud that Hill’s is and was one of the companies that delivered free food to his and many other clinics in dire circumstances.

Next up is WVC with Mayim Bialek, I can’t wait and keep on cutting!

Happy holidays

Time flies when you are having fun, can’t believe this year is almost over! My last official trip was to Fetch San Diego, one of three Fetch conferences and the last conference of the year for many. San Diego is awesome, always nice weather (although it was bit snippy when I arrived), great food, and a wonderful convention center.

So what did I learn at Fetch? 1. There is a lot of nutritional myths going around and there are some vets actively promoting them. My advice is to always look for the evidence behind claims and yes, we do live in a world were marketing is used, so get used to it. 2. Work-life balance is very important, not only for yourself but also for people that are around you and that you work with. Happy people = happy workplace = happy clients. 3. Dr. Jessica Vogelsang has a magical new podcast talking internet/media craziness and debunking some real shockers (see point 1). If you are interested, look at: http://www.whatthewoopodcast.com

IMG_6672

What I like the most about these conferences is meeting awesome people and Jessica is surely one of them. I had the pleasure to also have dinner with Dr. Jody Lulich, his partner Joe and Dr. Sheri Ross. We talked, urology, of course and how we are going to enhance the #stopstruvitenow movement, which is taking over this beautiful globe!

IMG_6694

After Fetch, a crosscountry flight took me to Orlando, land of gators and lots of children and attractions. I spent 2 days, doing things that I would never do voluntarily, so the question remains, why? Tom Bohn, CEO of NAVC and I were taping 2 days of daredevil stuff for a video that will be launched at the opening ceremony of VMX in January. Helicopter rides, zip-lining, hugging gators, skydiving and being strapped to a flying canon ball, all was encompassed.

IMG_6885

Sometimes you just have to do things that are out of your comfort zone, I guess. None of them were really that scary and both the (inline) skydive and the sling shot were kinda fun to do. I do love my job with all the extremes that I have to endure :-).

Untitled design (9) What rests is to wish you all happy holidays and a fantastic start of the New Year. It has been a great year and the year is almost at its end. Long live the New Year! Keep on cutting..

Cats Galore in Istanbul

Cats, cats, cats, lots of cats in the street of Istanbul. This week I had the pleasure to give a couple of lectures about cat surgery and oncology at the First ever Cat Congress of Turkey. Warmly hosted by Dr. Mustafa Aktas and his team, we were welcomed and treated like royalty (although I did refuse an official picture with a sultan outfit). Cats are everywhere on the streets and they are treated well, they seem happy, well fed and allowed to prowl the streets without interference. As a matter of fact, Istanbul seems a cat capital as dogs were few to be found.IMG_6224

I was asked to talk about a couple of typical cats problems and the ones I chose will not surprise you: cat skin and the differences with the D-word. Cat mammary tumors and Cat SCC. I also had the pleasure to do a combi lecture with the famous Dr. Craig Clifford. We teamed up to talk about cat liver tumors, cat thymoma and injection site sarcomas.

As we have discussed a few of these issues on our podcats, I will link these lectures to our podcast in this blog. Here is my 3-second take on each disease:

  1. Injection site sarcoma. Seem to be less common which is good, but is a bad tumor in general, so watch it where you vaccinate! No more vaccines in between the shoulder blades, on the chest and hip regions! We like to vaccinate in the periphery of the cat, ie distal limbs and tail
  2. Feline liver tumors. Ever heard of the lucky cat syndrome? That certainly normally does not apply for feline tumors. They tend to be nasty, except liver tumors. The most common tumor is relatively benign and can be cured with surgery. I love those pedunculated masses!
  3. Cat thymoma is also most likely not invasive, Craig said if you open up the cat and hold it upside down, they tend to fall out! Typical medonc statement, obviously, but there is some truth to it. They tend to be noninvasive but do expect some adhesions. With careful dissection, most will come out in one.

IMG_6490

  1. Cat squamous cell carcinoma is a tough disease, especially around the face. Big margins are often not possible and hence a tendency for recurrence and progression. We referred to a recent article in which PDT (photodynamic therapy) was used with success in smaller lesions. https://www.ncbi.nlm.nih.gov/pubmed/29359611
  2. Cat mammary tumors are almost always malignant (85% of the cases) and should be treated aggressively. We just did a podcast on them so if you are interested just download our podcast and start listening to number 7. In short, (staged) bilateral mastectomies is the way to go! https://purrpodcast.net/podcast-archive/
  3. Last but not least, we discussed some cat reconstruction techniques of the face. Cat skin is awesome to work with but there are some major principles you need to think of. One of these is the importance of the subcutaneous layer in your closure. Always close with a solid subcutaneous suture pattern to prevent wound complications. Listen to our podcast with Dr. Bryden Stanley for more tips.

IMG_6360

Istanbul is a great place to visit, for work or for holidays. It is safe, people are friendly and there is lots to see. We would definitely recommend it, especially if you like cats!

 

Are you still living in the Stone age?

You know what? I am going to talk about one of my main soapbox topics: the mismanagement of urinary stones by surgery. What? You are a surgeon, how can you say that? Isn’t surgery the fastest and quickest way to get rid of them? Don’t stones get stuck when you try to dissolve them? No, no, no, no, noooooooo!

50% of all stones submitted to the Minnesota Urolith Center are struvite stones. 50%!!! What-the-feline-and-canine-f….? Correct, although we have advocated using diets for struvite stones for years and years, this number has not changed. Just to put it in perspective this is 50.000+ struvite cases a year and that covers only the ones that are submitted. Are we totally out of our minds?

Struvite stones can be dissolved safely in dogs and cats within a couple of weeks using the appropriate diet according to every urinary specialist. Yes, it is a bit more complicated in dogs than in cats (as they are almost always infected; ie the dogs NOT the cats). But still, 50% of stones all over the world are cut out for NOTHING. And no, I am a surgeon and I do love surgery, but I also am convinced that DO NO HARM is more important than me cutting out things, just because.

So what are we doing about it? Dr. Jody Lulich (Urology professor at the MUC), Dr. Susan Little, famous catvet, and I have decided to start a movement to stop struvite submissions by 2020. We have a FB page (do the plegde), we do lectures all over the world and we will carry the cone of shame everywhere we go for people that still want to cut out struvite stones.

https://www.facebook.com/struvitepledge/

We also realise we need to make this message simple, we listened to you and came up with a very simple and logical plan of attack.

This is it:

cat new-01

Cats: Urinary signs – take a radiograph (all you need) – check the MN urolith app for most likely stones – put them on a diet for 2-3 weeks (be strict) – recheck with radiograph:

Option A Stone is smaller – keep on trucking and keep them on the diet!

Option B Stone is as big as before – Check for compliance (Awwww I felt so bad for my cat so I just sprinkled a bit of over the counter beef jerky over its food) and if ok take the stone out by any means you like (we like minimally invasive btw).

In dogs, the only addition is to check for urinary infection and use appropriate antibiotics with the diet. Sometimes it can take a bit longer for the stones to dissolve, but still.

What about surgery being faster? BS, you do not prevent the stones from coming back after surgery, induce more stones by implanting foreign bodies and you should know how many people leave in undetected stones. And, additionally,  you torture the animal for nothing.

What about stones getting stuck? Are you serious? It really does not happen with struvite dissolution. And if it happens, it is most likely not a struvite stone anyway.

What about compound stones? If they were not that rare (only 10% of all stones submitted), it would be a good excuse, but most stones are struvite or Ca-oxalate.

Check out the awesome MN Urolith app in your favorite app store. The CALCulator is an amazing tool that will check more than 500k animals to predict what stone it may be in a specific breed, sex, and age of an animal. So if you have a 4-year-old DSH F cat you have a 69% change of a struvite stone!

https://www.vetmed.umn.edu/centers-programs/minnesota-urolith-center/whats-new

And although my mantra is keep on cutting, we do need a mindset change for struvites. Keep on dieting!

For more info:

www.purrpodcast.net

https://www.facebook.com/GVETSX

https://www.facebook.com/PurrPodcast/