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A Spoonful of Sugar ….

September 19th, 2012

In the course of daily veterinary practice, few things have the capacity to upset a client like a refusal to supply medications without a consultation. So why do we do it?

I thought a little bit of an exploration of this issue might help.

The supply of scheduled medicines is controlled by law. If you think this is poppycock the sad fate of Michael Jackson should persuade you otherwise, or witness the stories in the press about human patients visiting multiple doctors in an effort to obtain pain relievers or sedatives from each.

Vets are in the same position as GPs – we must be able to  justify all the scheduled medication we dispense, if required to do so by regulatory authorities or our professional board. Failure to do this could mean a loss of our right to prescribe scheduled medicines, and thus the loss of our livelihood.

Sounds pretty scary to me. Fortunately, as with most things, a little common sense comes in handy.

If you are a regular client whose dog or cat has a chronic illness you are likely to be visiting us frequently anyway. There is no hard and fast rule as to how often we need to examine a particular patient but, in general, we would like to examine that patient no less frequently than every four to six months. Remember that one of these examinations will occur at annual vaccination and the requirement is likely to be for one or two additional consultations only over the year. That doesn’t seem so onerous.

So why do things get fraught? A case in point might be the dog with an ear infection that occurred at the same time last year, but we haven’t seen the dog since. We can hand you some ear cleaner over the counter but any of the other ear medications will contain schedule four (S4) drugs and so I’m sorry but we’ll have to see the dog. And, in truth, the nature of the problem may have changed and so different treatment may be required.

Case 2 might be a dog with arthritis on long term non steroidal anti-inflammatory drugs (NSAIDs). These medications can make a huge difference to the patient’s quality of life but they can have side-effects and I need to watch for those and also assess the progress of the patient to adjust treatment as necessary.

As often happens, it’s the most infrequent visitor to the clinic who seems most easily offended. We are not trying to be difficult, I promise you.

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Surgical treatment of cruciate ligament rupture in dogs

February 17th, 2012

Injury to the anterior cruciate ligament of the stifle joint (equivalent to our knee) is one of the most common causes of hindlimb lameness in dogs.

As such, I felt it might be useful to attempt a limited overview of the options available to clients for treatment of this injury in their pets. This post has been two years in the writing because a challenging case in 2010 made me re-examine my surgical technique and the advice I offer to clients.

The anterior cruciate ligament (ACL) is the thickest strongest ligament in the dog’s stifle/ knee and is vital for the stability of that joint

In choosing a surgical technique the  weight and age of the patient are critical, as is the level of activity expected by the owner after surgery. Be aware too that there is a spectrum of cruciate disease from the classic non weight bearing lameness at exercise that follows acute total rupture of the ACL down to the gradual and perhaps only partial rupture of the ligament.

For the last two years my technique of choice for dogs 17kg and under has been to use an tie external to the joint anchored under the lateral fabella (a small bone behind the knee joint). The material I use is called LigaFibre, I source it from a surgical specialist in Queensland and in dogs of this size repair is very successful.

I have trialled Ligafibre for larger dogs but the results leave something to be desired. Currently I have reverted to an old but effective technique where a graft of connective tissue is harvested from the surface of the thigh muscles and passed through the joint which has been opened surgically.

Regardless of size, I consider it mandatory for any patient having cruciate surgery at Millpoint to see Dr Liz Frank for post operative therapy aimed at relieving muscle pain and improving muscle strength. This accelerates the recovery from surgery.

Sometimes a dog will present with a thickened stifle indicating chronic cruciate injury or disease. If the joint is no longer unstable I do not take that patient to surgery but concentrate on managing the inevitable osteoarthritis with medication.

Cost of the surgery I’ve outlined above is $1000, and Dr Frank’s fees will add just over $200 to that.

I do not purport to be a specialist surgeon, and the methods I’ve described are drawn from my own experience and limited by my surgical equipment and skill.

Other, more modern techniques such as Tibial Plateau Levelling Osteotomy (TPLO),Tibial Wedge Osteotomy(TWO), and Tibial Tuberosity Advancement (TTA) involve cutting the tibia (the shin bone) to alter the geometry of the joint and so restore stability. They are available in Perth from several excellent specialist  orthopaedic surgeons.

Do they give a better result? No question. Do they cost more? Yes,several times more. My estimate, and I’m happy to be corrected ,would be $3000-5000.

And so the onus falls on you,the owner, to weigh up the options. For a small or medium size dog which by age or inclination has a less active lifestyle, a Ligafibre fabellar tie should do just fine. For a larger breed dog with no pretensions to athleticism, we should be able to give you an acceptable result after surgery at Millpoint. But if you have a canine agility champion,a very bouncy young large or giant breed,or if you as an owner are unwilling to accept any reduction at all in your dog’s athletic ability; you should consider referral to a specialist surgeon.

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Vale Dr Alistair Murdoch

August 21st, 2011

I spoke to Alistair Murdoch first when I was looking to buy a veterinary practice. Not Millpoint, just any practice. He was recommended to me as someone I should chat with about goodwill valuations and the mechanics of purchasing a practice.

At the time he had just sold his large practice at Wattle Grove. We had a very pleasant and,from my point of view, informative conversation. I put the phone down, said to myself  “well, he seemed like a nice bloke” and then thought no more of it.

Alistair must have remembered that conversation because, late in 1998, he approached me to gauge whether I would be interested in purchasing Millpoint Veterinary Centre. We reached agreement and I took over the practice in February 1999. I was very grateful when he agreed to return as a locum for two weeks in July of that year as I wished to return to the UK to be with my parents on their golden wedding anniversary and to introduce them to the girl I hoped to marry. With Alistair back at Millpoint I knew I need have no fears for the practice – I could save all my nerves for the proposal.

For the last twelve years Alistair has been a very welcome visitor. Unfailingly pleasant and courteous, charming the nurses and mixing mischieviousness and good nature in exactly the right proportions. I have benefited from his kindness to me and to the practice, and I think and hope he felt the clinic was in safe hands.

It is then with a sense of disbelief that I learned of the tragic accident that had taken his life last week. It is hard to comprehend that someone with so much joy for life, and zest for living should leave us in this way. 

Greatly respected both within the veterinary profession in WA and in his subsequent business career. A devoted husband and father. Many men hope to be thought of  in these terms – Alistair Murdoch was the real deal. Rest in peace.

From my family and all of us at Millpoint Veterinary Centre both past and present, our deepest condolences to Julie, Cameron and Lindon.

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City of South Perth Dog Laws Latest

June 4th, 2011

Amended new dog laws for the City of South Perth are scheduled to be voted on at the council meeting on June 28th.

The amendments have gone some way towards allaying the concerns of  local dog owner groups. Dogs are required to be leashed within five metres of organised sports but there are sweeteners in terms of enhanced access to certain parks.I have spoken to Kaye Hill and Clive Deverall and their tone is conciliatory. Local dog owners seem prepared to give the new regulations a trial. I hope they are given a fair go in return.The amendments were passed (by a single vote I understand) at the council audit and governance committee meeting last month.

Throughout this process, questions keep nagging at me. From where in council did the push for new laws originate and why? The council is obliged only to review the laws after a certain period, and there seemed no great need for change. I had some dealings with council two years ago (as I sought to move the practice) and was very impressed by the councillors. They copped some flak at the public meeting but this is quite undeserved as I doubt the proposals originated from them. Equally, I work with the rangers on a regular basis and a better bunch of men and women would be hard to find. I doubt they pushed for the new laws either, after all they’re the ones who’ll have to enforce them.

So why the new laws? A co-ordinated push by the WA local government association (several other local authorities are attempting to introduce similar legislation) based on a model dog law which isn’t released to the public?  A public liability issue (reportedly not the case)?  Complaints by sporting groups using Ernest Johnson Oval (they all lined up at the public meeting to say they had no problem with the status quo)? I’d like to think that at some point we will get a straight answer.

And to those of you surprised at the whole shemozzle I have a one word reply. Flagpoles.

Credit to Lyndsey Wetton’s article in the Southern Gazette as a reference for this post.

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Welcome to our website

June 4th, 2011

Welcome to the Millpoint Veterinary Centre website. Whether you are an existing client or a prospective one, we hope you find the site interesting and informative.

Those that know me will appreciate that I am not tech-savvy! I didn’t learn how to programme a video recorder when there were video recorders and the workings of an iPod are a complete mystery to me.  So why does the site look so good? Well I didn’t build it but I’d like to thank the people that did – Ben Maynard and the team at Typeshape and John Colebrook from Pixelcase who created the virtual tours.

I can recommend both Typeshape and Pixelcase highly, very professional and very decent blokes – thanks guys!

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