Adventure In Australia: Chapter 8: Playing Doctor

Wattle Grove, WA Australia

January 18^th 2016

DISCLAIMER: I will not be sharing details about clients and their pets, only vague references to what I saw and did. And I will not post pictures of client cats and dogs, and will only post pictures of birds if they are especially interesting, but will post no details regarding the clients.

Monday was my first day at Wattle Grove Veterinary Hospital. I was nervous in the way you always are when starting at a new place, but everyone was really nice to me and showed me around. I got there a little too early, but it gave me time to look around the clinic. The first veterinarian I met was Dr. Rita Perry, who told me that I could get involved with anything in the clinic, I just had to ask.

I spent Monday morning shadowing Dr. Lisa Winters in appointments. Lisa is a specialist in small animal medicine, and I really learned a lot watching her work and interact with clients. Things are mostly the same in an Australian veterinary clinic as they are in a Canadian one, other than a few product differences. And the fact there is no need to vaccinate for rabies here! Tick control is also year round. There was an interesting case of a large active dog that seemed to have rhabdomyolysis (or “tying up”) which you typically only think about in horses. We came to this conclusion after noting that the dog had very dark urine, but urine specific gravity was OK (making kidney failure less likely), and the dog improved rapidly on fluid therapy.

Around lunch time is when the Kanyana animals arrived. Kanyana usually sends down 5 animals that are in need of veterinary attention. Usually these are sick animals in the hospital or new admissions, but sometimes they are resident animals needing a check up. Wattle Grove also gets wild animals brought in by the public, which it treats and then sends to Kanyana. Our first patient was a little quenda with a spinal injury, the same one I saw and treated Thursday night. Unfortunately he was not improving, and needed to be euthanized. Euthanasia is a tough reality in wildlife veterinary medicine, where it is estimated that 60% of animals seen are euthanized or die, with the other 40% being split about 50-50 between animals that need intensive vet care, and animals that are suitable for rehabilitation. Not all those who go into rehab will survive. It may seem to you that it’s crazy for me to want to do this, when there is so little return on my “investment”. In fact many vets and animal lovers who love wildlife focus their efforts on large scale population medicine, with the hope to make a larger impact saving a species as a whole, rather than one solitary individual. That’s an admirable goal, and something I fully support, but for me I find it rewarding to work with a single injured wild animal, where I can do my best to help it heal, or can give it a peaceful death. I know I’m not making a dent in all the death that happens to wild animals, but I at least feel like I made an animal that has no one else feel better, and that I assuaged some of my guilt over the fact that human activity is a major contributor to wildlife injury and death.

Anyways, our next patient was a galah that was hit by a car, and was now not flying, had inappropriate defecation, and had not improved with anti-inflammatories. These signs pointed towards neurological damage (vs. just bodily injury/fractures), and the bird was euthanized. Dr. Tim Oldfield, owner of Wattle Grove and an avian expert, was the one working on the wildlife cases with me, and I learned so much working with him since he explained everything. He taught me how to properly euthanize a bird; you generally inject an anesthetic into their right jugular vein, which he showed me how to hold properly.

Next up was a little baby possum that had fallen out of a tree. Tim had me examine this guy, and I noted that the possum was not aware of his physical surroundings, was “star gazing” (looking up towards the sky), had abnormal nystagmus (where the eyes flick back and forth like they do when you turn your head, but they do this when the animal is not moving), had no pupillary light reflex, a weak menace response, and abnormal lunging behaviour. All these signs pointed towards brain damage, so I thought we were going to euthanize the little guy, but since he had just been admitted that same day we decided to give him another 24hrs and gave him an injection of metacam (an anti-inflammatory) and mannitol (an anti-inflammatory that targets the brain).

We also saw a baby tawny frogmouth that Kanyana was worried may be blind since you could poke him in the eye. We did an assessment and found that he indeed had no response to movement in front of and towards him, but he did have intact response to light. I learned that in birds this is not the same as a pupillary light reflex (PLR), as the signal is interpreted by the bird’s brain, making it a response and not a reflex. The fact that the tawny’s pupils constricted with light indicates that signal was getting to his brain, meaning he could in fact see and was not blind. We concluded that he was probably just a bit “dumb” and would hopefully learn how to be a proper bird with time.

In between all of this I learned how to surgically sex birds, which is a service Tim offers to his avian clients. You make a tiny hole in the bird’s left side and put a scope in. If you see a testicle (little bean like structure that may or may not be dark in colour) the bird is almost certainly a male, and if you see an ovary the bird is a female. The reason you go on the left side is that the reproductive tract in female birds is only developed on the left side (the right side atrophies). The bird is then tattooed under the wing (right side for males, left side for females), and a microchip can be placed in the left pectoral muscle (unless you’re a prized hunting bird in the Middle East where the location of chips are kept secret so they can’t be removed). There was also a sad case of a dog with a broken leg that had been left for days, but I’ll have more on that since she stayed for surgery.

The last Kanyana animal we saw was Wilgee, one of the oldest resident bilbies (she’s 7 and a half, nearing the end of her captive lifespan). Unfortunately Wilgee was declining in health and her quality of life had decreased, so the decision was made with Kanyana to euthanize her. Heartbreaking, but I take comfort in knowing we gave her a peaceful end to a long life.

In the afternoon I shadowed Rita on appointments, until it was time for me to go home with the Kanyana animals (a volunteer comes to pick them up in the afternoon).

January 19^th 2016

Tuesday morning I met the fourth vet at Wattle Grove, Dr. Todd Dalton, who grew up in Hawaii but was born in Australia so went to vet school here. I worked with Todd on some of the cases in hospital (animals that are dropped off to have a detailed exam with vets and often to have procedures done). It was pretty interesting work, and a good refresher on my veterinary knowledge (it still feels like I don’t know anything!)

This time I saw the Kanyana animals with Todd. We looked at a bronzewing dove that had been attacked by a cat. The bird was able to fly well when it escaped from its box, and the only injuries we saw was minor trauma on the carpi of the wings, likely from flying into the clinic walls! We also liked at a galah hit by a car that had no obvious fractures on radiographs so likely was just suffering from a concussion, and a wood duck with a pin in place to fix a broken wing who was doing OK. This was the same duck I had looked at on Friday. Radiographs showed the pin was in good position, so we decided to leave it in for another few days. I think there were maybe a couple other Kanyana animals that were euthanized, but I didn’t work with them and don’t have any notes about them.

I also worked with Tim on a couple of client owned animals. There was a budgie we removed a mass from, and a pair of chickens, one needing an abscess cleaned up and the other needing its crop emptied (man is that ever a disgusting smell). And a cute little quail!

One of the coolest things I got to do Tuesday was watch the surgery to repair the broken limb of the dog we had seen on Monday. Her femur was broken, and due to financial constraints of the owner we did what we could here and repaired it with an intramedullary pin (a large pin that goes into the bone to hold the two pieces together). Deciding how to repair a fracture depends on a lot of factors, including the type of fracture, what bone is broken, age of the animal, financial concern, and surgeon comfort with various techniques. Different forces work on fractures, and not all repair methods counteract the same forces (e.g. rotational vs. compression). Not all clinics have every repair option available to them, but sometimes you need to just do your best to help a client in need. Exposing the bone and putting the pin in place is exhausting work for the surgeon. You always take a radiograph to make sure the pin is in the proper place before you fully close the incision. Sterility is always important in surgery, but it is especially important with fracture repair as an infection of the repair tool in or around the bone can be devastating. Often surgeons wear thicker gloves since it is easier to rip a hole on sharp bone edges.

January 20^th 2016

Wednesday started off with watching Todd perform a cryptorchid castration. Cryptorchidism is where one testicle has not fully descended into the scrotal sac. The retained testicle may be just in the inguinal canal, or it may be further up in the abdomen. It makes the relatively routine procedure of castration more complicated, as the surgeon has to make an incision into a larger body cavity rather than just making one incision just above the scrotum. Things went successful with this castration though, with no complications.

The first of the Kanyana animals was a black-faced cuckoo shrike that we examined to assess some old wounds on his abdomen and hocks. The wounds were thankfully healing well! Next was a little red wattlebird who had been sitting back on his hocks, which is not normal. I remembered this little bird from my previous two weeks at Kanyana. Our concerns were that he maybe had a fracture, or perhaps a nutritional deficiency. I examined this little bird on my own, and noticed a large crusty scab on his right hock, which I then removed. It looked to be the capsule off an old abscess, and hopefully that solved our little friend’s improper sitting, as no obvious fractures appeared on radiographs (which I positioned for and took myself!).

Our third wildlife patient was a little corella (I don’t mean it was little, that is the bird’s name!) who we suspected to have psittacine beak and feather disease (PBFD). PBFD is a devastating viral disease that attacks a birds immune system as well as feather and beak growth as the name suggests. In the acute form birds die before the typical feather signs show up (except for damage to parrot feather down, since these feathers grow constantly), but there is also a chronic form. It’s very contagious and a very real problem for both domestic and wild parrots in Australia, with euthanasia being the primary method of control for infected wild birds like this little corella.

Next up was a little quenda (think of a large adorable rat) who had been attacked by a cat. He was going into foster care, so we checked him over (his wounds looked to be healing well) and dispensed medication. Like in North America, free-roaming cats have a devastating impact on local wildlife. Keep your cats indoors!! The last Kanyana patient was a magpie with potential spinal damage who in fact was now able to stand properly and so has a much better prognosis (vs almost certainly euthanasia for a paralyzed bird). I didn’t actually get to examine this bird.

We also got to see a pet bearded dragon who was suffering from metabolic bone disease. I could go on and on about the pathway of this disease, but essentially it’s a nutritional deficiency related to a lack of dietary calcium and/or low levels of vitamin D (e.g. from no exposure to UVB light), which is a vitamin that the body needs to properly absorb calcium. When the body does not have enough calcium it basically takes it out of bones, leading to a weak skeletal system prone to pathologic fractures. The body also compensates for low calcium by depositing fibrous tissue around long bones, so affected lizards often have large muscular looking legs and big lower jaws. They are often very reluctant to move. The frustrating part about this “disease” is that it is entirely preventable in captive reptiles if owners take the time to feed a species appropriate and nutritionally balanced diet, and research proper care and husbandry of reptiles – they all need a UVB light source! I hate watching animals suffer because people are too ignorant or lazy to learn how to care for them properly. Hopefully we as veterinarians can talk to clients before they purchase a new pet and educate them on proper care.

Back at Kanyana I helped Steve again with Molly the wallabies eye drops, which is always a great excuse to cuddle with the wallabies, quendas, and Munch the kangaroo (who I learned was blind!) This was my third time “helping” (Wednesday and Friday the previous week), lol.

January 21^st 2016

Thursday was a very exciting day for me. I got up early since Steve was going to visit Raffi and Henry, and I was super glad I got to visit these beautiful birds one last time. They are both so cool, and this time both Raffi (my BFF) and Henry cuddled with me! Henry was actually quite friendly, and made a number of content noises. Raffi also wouldn’t get off my leg when I was standing up to leave! I’m really going to miss them both.

I spent the morning shadowing Tim on appointments, where I got to work with both dogs and birds. I learned about mast cell tumours, wing trimming (to prevent flight in pet birds), hemorrhagic diarrhea, and got to help with a new puppy appointment with the cutest Jack Russell puppy ever! We also had a walk in of a dog suspected to be hit by a car. No fractures showed up on radiographs of the limbs and head, but there was a lot of what appeared to be blood in the nasal sinuses.

Todd was performing a splenectomy on a dog we had seen the previous day who had abnormal nodules on ultrasound, and he asked me to help him so I scrubbed up and helped hold things and ligate the splenic vessels before we removed it. One of the possibilities was a mast cell tumour, which carries a high risk of degranulation if disturbed, causing systemic effects like with allergies (mast cells are part of the allergy process).

In the afternoon Tim and I worked with a green wing macaw who was losing a significant amount of weight with no obvious cause. His feces was large and undigested, suggesting poor absorption from the gut so we performed gastrointestinal radiographs (unfortunately these also gave no clear cause to the bird’s problem). Attempts to take some biopsies were unfortunately also unsuccessful.

Since it was a busy day we only had time for one Kanyana patient, and echidna who had been hit by a car (one clue was a number of quills were blunted from being broken off when the echidna rolled after the impact). With echidnas you worry that they have fractured their long beaks, which we can’t repair and are necessary for the echidna to eat. Fortunately this little girl had no fractures on radiographs, just a small piece of skin sloughed off her beak, so she should make a full recovery. Echidnas are obviously a little difficult to work with because they curl up into a spiky ball, but we made it through!

When I got back to Kanyana they were pretty swamped, so I helped out by doing some treatments in hospital and assessing two new admissions on my own. One was a duck that looked in pretty rough shape and I suspected might have a broken neck, and the other was a little bronzewing that was essentially just pretty under nourished and weak. It was pretty cool assessing and treating these animals all by myself!

January 22^nd 2016

Friday Todd was nice enough to let me do a canine castration (under supervision of course!). It was nerve wracking, but also good to practice skills I will use often and remind myself that I CAN do this and I DO know some stuff! We had a couple other minor procedures, and then I shadowed Todd on appointments all afternoon. Kanyana had no animals to send down, so I decided to stay until the clinic closed at 7pm. Todd and I saw a lot of patients and I felt good practicing my client interactions. Sadly the afternoon started off with an emotional euthanasia, but I also got to meet THE CUTEST 12 week old Cavalier King Charles Spaniel, so it wasn’t all bad. We also saw a rat (with a fantastic 90s themed name!) and some rainbow lorikeets amongst the cats and dogs. We even had a dog and her puppies that were just born two days before! Sooooooooo adorable. We had a bit of trouble when the power went out for a while, but we did things the old fashioned way with pen and paper until it came back on. Todd was gracious enough to take me out to dinner after work, and we had a really nice night before he dropped me back off at Kanyana.