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Mission critical

Monday, 22 July 2019  
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VetScript Editor's pick: July 2019

Waikato’s first round-the-clock, multidisciplinary veterinary hospital is providing another level of care for pet owners. At its head is veteran critical care specialist Trudi McAlees. Venetia Sherson reports.

Critical care veterinarians see the whole spectrum of horrific injuries to animals. Trudi McAlees’ cases routinely include major trauma and toxicities and, more rarely, wounds inflicted by guns, knives, boots and – in one case – an arrow. But she is thankful that, in New Zealand, she doesn’t have to deal with deadly snake and tick bites.

In Australia, where she trained and worked for 16 years, such cases were common and confronting. The Australian tick (Ixodes holocyclus), often described as the ‘paralysis tick’, and venomous snakes are hazards for animals with access to the bush. “Australia is a great place to practise critical care, but not necessarily for pets who walk in the bush,” she says.

Trudi is a criticalist at The Referral Centre in Hamilton, Waikato’s first 24-hour, multidisciplinary veterinary hospital providing small animal emergency and critical care. The centre opened in March and is part of a practice owned by Hamilton veterinarian Keith Houston. He says it came out of a need to provide a range of specialist and referral services beyond what pet owners received at their regular veterinary practices.

“We are an extension of veterinary practices. It’s the same as when people receive day-to-day care at their GPs but are then referred to specialists with particular knowledge and expertise.”

Animals hospitalised have veterinary supervision and on-site nursing care 24 hours a day and seven days a week. Unlike after-hours centres that operate between 6pm and 8am, animals do not necessarily have to be transferred to the referring veterinary practice in the morning.

For Trudi, who heads the centre, the job represents a culmination of 27 years’ training and specialised practice. She graduated from Massey in 1993 and began her career in Waikato in a mainly dairy practice before heading to the UK, where she worked as a locum and travelled. She moved to Australia intending to spend two years working in emergency medicine and critical care at the University of Melbourne teaching hospital, but ended up staying for 16 years in that country, before returning to New Zealand with her partner to raise their young son. In 2008, she became the first person to achieve a Fellowship of the Australian and New Zealand College of Veterinary Scientists in Emergency Medicine and Critical Care, the gateway to her becoming a registered specialist. She has a particular interest in postgraduate training and helping practitioners deal with critically ill and emergency cases.

One of her aims at The Referral Centre is to recruit and retain veterinarians who want to work in a practice with higher levels of care. “There are huge benefits to working alongside specialist referral clinicians in one of the best-equipped practices in New Zealand.”

Such centres are rare in this country. There are three sites in Auckland and one at Massey University in Palmerston North. Others are being considered in Wellington and Christchurch.

Trudi says some people see them as competition to services already offered by GPs. “In fact we are complementary. We work closely with an owner’s regular veterinarian. Referred patients are sent back to the referring veterinarian as soon as they are ready to continue their recuperation.”

She says there are challenges in running a referral centre. One is education for the public and other veterinary practices to understand its role. Another is maintaining staffing levels across 24 hours. She currently lives in Auckland, but spends four days a week in Hamilton.

The family will move to the Waikato region this year. “Waikato feels like home. My mother grew up here and still lives here.”

The move will also be a chance to increase her range of livestock. Trudi succumbs to that common hazard – or perk – of a veterinarian’s job (depending on your viewpoint): adopting animals that need a home. “I took a cat home, temporarily, who had been brought in with a broken jaw. Thirteen years later he had travelled the world with us.”

She ‘fostered’ a blind dog for the same length of time. In Waikato, she says, her family will have dogs, cats, chickens, sheep, a couple of cows and a horse so she can again enjoy equestrian events.

Working overseas, she experienced a range of attitudes to animal management. In England, working as a locum with dairy cows, she was asked to do pregnancy diagnoses on a herd of 30 cattle. “The farmer thought it might be too much to do them all in one day and suggested it be spread over two days. He didn’t know the size of herds we have in New Zealand.”

She has also seen the good, the bad and the ugly in pet care. “Pig dog owners are some of the best in the world. They truly love and care for their animals.” But pets can also bear the brunt of anger. “Pet abuse is often present where there is domestic violence.”

In the inner suburbs of Melbourne, many animals were kept inside and sometimes driven to appointments by chauffeurs. “They were unlikely to ever experience trauma injury from recreational activities or car accidents.” But they did experience stress and obesity.

She has strong views on anthropomorphism, particularly when it comes to “fad” food choices that aren’t suitable for animals. And she takes a firm view on life and death decisions. “Whereas human doctors may prolong life as long as possible, despite a fatal disease, my first responsibility is to the quality of life of a pet. If a dog or cat can’t eat and is not in a position to enjoy life, I want to alleviate their suffering. It is hard to say goodbye to a loved pet, but I will be honest with the owner at those times.”

In the US, she says, there is more and more discussion about palliative care for pets. “But it raises the question: who are we palliating for – the pets or the owners?”

She believes New Zealand and Australian pet owners are more pragmatic. “They will usually make a decision in the best interests of the animal. They may feel guilty if they don’t have $20,000 to spend on a procedure that might prolong life, but they also appreciate that in many cases no amount of money would save an animal.”

However, some animals recover from horrendous injuries. The cat that was shot by an arrow went home after spending nine days in hospital; so did a pig dog that had had an altercation with a wild pig before plunging four metres down a cliff. “The owner did everything right. He very quickly judged the dog wasn’t well and brought him in immediately.”

Helping staff to cope with discussions about the ongoing wellbeing of pets is important. “Staff are often bearing the brunt of an owner’s anger and disappointment when a pet is unwell. One of our staff was recently accused of not caring whether an animal lived or died, after she followed our procedure of not providing a repeat prescription without a further check-up.”

Compassion fatigue is common. “Veterinarians often give too much of themselves. Burnout is an issue. We watch that carefully by minimising the number of shifts done alone, keeping a watch on junior staff and lots of debriefing.” She says after a long career, she is able to be more emotionally detached, which makes it easier.

The shortage of veterinarians globally also makes it difficult to recruit staff. “We have a locum from the South Island who flies up once a month to do a six-night shift. If we have no after-hours veterinarians, I am on-call.”

The Referral Centre is equipped with diagnostic tools including ultrasound and digital radiology and CT; MRI scans are outsourced. There are eight veterinarians, hydrotherapy and rehabilitation practitioners, and between 12 and 14 veterinary nurses working across the GP practice, The Referral Centre and the Waikato After Hours Veterinary Clinic.

Trudi would like to see more centres established. “There is a demand. Like hospital care, it’s catering to needs at the most specialised level.”

Keith Houston says the centre is “ticking along well”. There are advantages to veterinarians who refer animals, he says. “They are refunded 10% of total fees because they’ve still got to do the aftercare when the animal returns to them, and because we appreciate the referral.”