Global Veterinary Surgery

The second week of April 2019 was extra special as I got to see my mom and friends in Holland and had the privilege to talk for enthusiastic veterinarians from the Nordic countries and Holland in beautiful Bergen, Norway.

Our organizers, Andrea and Neeltje, arranged 2 days of lectures and laboratories. The first day, Georgie Hollis talked about wound management (keep them moist and clean and they will heal) and Ulrika Groenlund about proper antibiotic management of wounds (often they are not necessary). I had the honor to talk about 5 tips for reconstructive surgery.

My tips included: simple local flaps and the importance of the panniculus muscle, axial patterns flaps including the caudal superficial epigastric axial pattern flap, the proper suture material and surgical equipment for derm surgery, the toe filet flap and the skin-fold flap.

The next day we had a laboratory of 4 hours, where the candidates learned to do a reconstruction of the head with a simple U-flap, a wound reconstruction of a neck wound with a omocervical axial pattern flap, a caudal skin fold flap for a lesion between the hind legs and challenge. The winners received some awesome prices.

Cool new gadgets: the organizers used slido.com to get questions from the audience and check out the ubercool nose plugs for when you are in areas that do not smell as good, they are pretty amazing! https://nosaplugs.com/

I loved being in Bergen and for all participants and my amazing organizers, thank you so much! Please note that the lecture notes are available for the participants in a special folder, check with Neeltje for the passcode.

https://www.intelligentwoundcare.com/

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!

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

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!

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.

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 :-).

 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, 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.

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.

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.

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!