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Category: Opinion

  • Linear foreign bodies, part 1: tips for diagnosing with radiography

    Linear foreign bodies, part 1: tips for diagnosing with radiography

    Linear foreign bodies can be tricky to diagnose, compared to normal foreign bodies, for many reasons. Mostly because you often don’t see the classic obstructive pattern appearance on radiographs or ultrasound.

    In this short blog series, we are going to cover some hints and tips that can make diagnosing a patient with a linear foreign body easier. Then, we’ll discuss things that should be considered when deciding whether you are the right person to take the patient to surgery…

    So, let’s start with radiography.

    1. Not all patients with a linear foreign body will be completely obstructed. This means you won’t always visualise classic intestinal dilation. In fact, it has been reported that up to 50% of patients with a linear foreign body will not have an obstructive pattern present on radiographs.
    2. Look for the characteristic small “comma shaped” gas pattern. This is caused by plication and bunching of the small intestine around the tether.
    3. The small intestine can appear to be bunched up in one area, rather than spaced out around the abdomen. However, obese animals – especially cats – can have “pseudo-bunching” due to large amounts of abdominal fat bunching the intestine together.
    4. Loss of serosal detail is often seen due to inflammation surrounding the affected intestine.
    5. Always include a left lateral radiograph in your series. Gastric contents will fall to the fundus on the left of the abdomen and gas will raise to the pylorus, which will highlight the foreign body anchor in the pylorus.
    6. Perform thoracic radiographs to assess for aspiration pneumonia and a potential oesophageal component of the linear foreign body. If aspiration is present then you know you will need to continue antibiotic therapy postoperatively.

    In the next post, we cover some key points for diagnosing linear foreign bodies on ultrasound…

  • The other side of the consult table, part 2

    The other side of the consult table, part 2

    Never have I seen my cat so happy as the days post-operation when she was flying high on pain relief (I personally remember being quite grumpy the days after I had a tooth removed, but Bluebell seemed entirely unphased), but that doesn’t mean bringing an animal home from an operation is plain sailing.

    The initial internal struggle of a vet student handing their beloved pet over to fellow vets is shortly followed by the hurdles of “medication dose mathematics” and valiant attempts to get said pet to ingest said medication.

    I once thought myself quite adept in the arts of pill-giving when Bluebell was on a course of steroids, up until the day when she’d had enough and spat it back out directly into my jacket pocket.

    However, once these hurdles have been mastered, teaching my parents to do the same can be a whole other ball game…

    A little knowledge goes a long way

    I think having even a little veterinary background can be a useful thing when you bring a pet back home from something big like this. You are reassured by the knowledge of what to expect and what can be counted as “normal”.

    Whether it’s coming downstairs to a very full litter tray in the morning – as was my poor mother’s experience – or dealing with some temporary behavioural changes, a reduced appetite, sleepiness or cleaning up after the occasional accident.

    Forbearance

    It’s all part of the process. No human wakes up right as rain the day after a big procedure, and when you’re only small, even a minor operation can be a huge ordeal. As with most things, patience is the key.

    I do feel quite sorry for the animals who undergo to the trauma of an operation and are then forced to return to the scene of the crime a week later in the guise of a “check-up”.

    But, thankfully, when we bundled Bluebell bottom-first into her carrier for the second time, all was well.

    Fang facts

    In fact, we learned she is managing to lose not only weight – which, since she’s always been a bit of a chonker, came as a nice surprise – but teeth!

    Only one in the actual teeth clean however – apparently another five have been lost at some point in her life, with all of us being entirely none the wiser!

    Luckily, I think the fact that she is still a chonker is evidence enough that losing those teeth didn’t phase her in the slightest.

  • The other side of the consult table, part 1

    The other side of the consult table, part 1

    There comes a time when even doctors and nurses have to make a visit to their local GP (perhaps somewhat begrudgingly), and I wonder if that evokes a similar feeling to when veterinary professionals take their own pets into an appointment?

    My own cat is going in to get her teeth cleaned in a matter of days, and although it is by no means her first trip to the vets, the act of taking her in feels slightly more surreal to me now than it did before I began my training and gained a more similar perspective to that of the vet or vet nurse behind the consult table.

    Familiar faces

    I’ve volunteered at my local practice for years and know the more senior members of staff rather well, but a newer face will obviously ask me the standard check-up questions and explain things the way they would with any other owner.

    To be honest, I never know whether to pretend it’s all new to me or admit I’m a third year vet student; I worry it sounds a bit off to just come out with it without being prompted – a bit like meeting Gordon Ramsay and blurting out that you, too, own several cook books and make a mean Shepherd’s pie.

    The hardest part

    The last time my cat, Bluebell had to undergo an operation I unfortunately had classes, and although the vet in question knew me well and offered to let me watch, I wasn’t able to – and with a small twist of irony, now that I am free as a bird, the logistics of COVID mean that I must once again sit this one out.

    Along with being the unfortunate messenger of the truly unknowable cost of a procedure to your parents (whose eyes widen at even your lowest estimates, though you try to explain it’s best to get it out of the way when she’s young and healthy), knowing the risks is probably one of the hard parts of being any medical professional – from hearing someone cough, and unconsciously jumping to the worst-case scenarios, to taking your pet in for routine surgery with the anaesthesia mortality statistics circa 2018 committed to memory.

    Not in control

    As ever, the advice you’d give to someone else never has quite the same effect when you try telling it to yourself, and when you’ve experienced the position of the person “in the driver’s seat”, so to speak, it can be hard to surrender control.

    COVID allowing, I would like to be in that operating room myself – and not just because it would be the first lot of EMS I’ve managed to wangle in the past nine months, but because, even if you are distanced from the world of veterinary medicine for any length of time, it never distances itself from you.

  • Could COVID-19 close the door to the veterinary course?

    Could COVID-19 close the door to the veterinary course?

    It has long been a fear – among those inside the profession and outside – that university places to study veterinary medicine are not as accessible as they should be.

    There is a perception the course, if not the vocation, is slightly elitist – not helped by the impression of most clients that the medical bills they are unaccustomed to paying for themselves mean vets must be absolutely rolling in it.

    I certainly think of myself as extraordinarily lucky to have snagged one of the over-subscribed university places four years ago. I had parents who could afford the time and who were willing to drive me to various EMS placements, and I lived in close proximity to friendly veterinary practices with the patience to have me shadowing them every week.

    Resources

    I also went to a school with the resources to support me through my studies and had a stable and happy home life, which gave me the secure space I needed to revise and prepare for interviews. I even had a grandmother willing and able to drop everything to fly to the other end of the UK for my Edinburgh interview at pretty much last minute’s notice.

    Veterinary medicine is an incredibly competitive, and sometimes arduous, application process, and even students with all the money, time, and educational and familial support in the world struggle to make it in.

    I can only imagine how the added pressure of COVID-19 could have made this process so much harder and reduced its accessibility even further.

    Striking a toll…

    When you combine the mental health pandemic secondary to the coronavirus pandemic with the mental health crisis affecting medical students at every stage of their training – even as early as pre-interview – it becomes apparent how striking a toll this year may have had on some would-be vets.

    Money can also, unfortunately, be a crucial factor when applying to any university position. With the financial burden impressed on countless families since the start of 2020 – and with national unemployment sky-rocketing – the door to further education may be closing to many more.

    Parents worrying about job losses and money problems may be less able to support a child through the application process, and those students coming from complicated or disruptive households have not had the option to take their studies elsewhere – namely a café or school library.

    Tears in tiers

    Those students who have remained in Tier 3 for the majority of the year will have been hit harder by these factors than those in lower tiers.

    Concerns have also risen for international students and maintaining diversity in the course. Overseas vets and vet students are invaluable in many facets of veterinary medicine – for example, they make up a large proportion of vets working in food safety and public health.

    I think it’s important that universities consider an application from every angle and consider the less obvious setbacks brought about by COVID-19 that are perhaps being over-looked. I want the veterinary community to be diverse and self-supporting, and this starts at the very beginning.

  • Mistake grieving

    Mistake grieving

    Everyone makes mistakes – we know that. But that still does not mean it is easy to let go of it, forgive yourself and move forward.

    A talented vet at work said something that has proven to be a golden nugget of advice – it’s okay to give yourself time to grieve; however, set a time limit.

    Essentially, you allocate and schedule time to grieve the mistake or negative event.

    Allowing time

    The powerful thing about this is that you are allowing yourself some time to think about it, which is better than trying to pretend all is okay. You get to dissect it and determine what went wrong, and have some time to deal with the emotions; however, you set a strict time limit.

    The time limit is important because rumination on mistakes can be very detrimental – you then start to add extra meaning to the mistake, then you create beliefs about yourself based on the story you created that are not real.

    By setting a time limit on your grieving process you still face what happened, but reduce the time you think about it. This is important, as the longer you think about something the more weight and importance you add to it, and the bigger and more significant it becomes.

    Shifting focus

    The longer you focus on disempowering thoughts, the more likely it will lead to disempowering beliefs. Your thoughts are not you; they just happen – so this means you don’t have to own them. Therefore, you can control how much weight to add to them and what beliefs you generate from them.

    Setting a time limit means you shift faster towards moving forward and focusing on what really matters, and what you must do next.

    Next time you are tackling something difficult and need to process it, set a time limit. Let yourself identify the lesson, learn from it and deal with the emotion – but when the time is up you let it go, and forgive and forget.

  • In the pink

    In the pink

    I can probably count the number of blood samples I’ve taken to date on a single hand.

    That does sound pitiful, I know, but please hold off on any judgement as I was unfortunate enough this year to have a total of 10 weeks’ work experience cancelled due to the recent pandemic.

    Like everyone else, I suppose, I saw 2020 panning out a lot differently as I began it… but from dark clouds come silver linings, and I am now proud to say that one of my startlingly few blood samples was drawn earlier this month from a flamingo.

    Going to the zoo, zoo, zoo

    My cohort is probably luckier than most, as the large majority of our learning is conducted online, with the exception of the occasional in-person presentation, practical or day’s work at Bristol Zoo Gardens.

    flamingo
    Eleanor takes bloods from a flamingo, under the close supervision of a zoo vet / Bristol lecturer.

    However, I’ll be candid and say the involvement of the local zoo in the running of my masters was the thing that really drew me in the most, the money and time being a small consequence if I had the chance to work alongside those who were living my dream – a dream I’d harboured for more than a decade and a half.

    And while I’m sure the thrill of my day’s work with those lucky individuals will fade (though it hasn’t yet), I think that short window spent working with the most amazing creatures and talented professionals almost makes up for all the time lost this summer.

    A very different experience

    It’s safe to say that working with wildlife versus small domestic animals is an entirely different ball game. For example, I have a friend who had a week’s EMS in a practice specialising in wildlife and spent most of the first day chasing a deer around a local park.

    Even if you are lucky enough to have the wild animal behind closed doors and easily accessible, or even if it’s already restrained or half-tranquilised, it’s astonishing how difficult a simple routine check-up and x-ray can become.

    It can take time to safely capture and restrain an animal, especially one as long and ungainly as a flamingo (don’t let the croquet scene in Alice in Wonderland fool you). Add this to the time taken to anaesthetise it, draw bloods, run checks, top up its fluids, take several x-rays from an array of angles – all while maintaining COVID-19 regulations on top of pre-existing health and safety considerations. It was no wonder my friend and I had about five minutes to wolf down our lunch before running off to the afternoon’s activities.

    Meal for none

    As a person who loves their food, it is with great surprise that I say I have never been so happy to skip a meal in all my life. I think I would have quite happily gone on working through until midnight, had government COVID-19 policy not mandated we leave the zoo by 5pm. I honestly didn’t want to leave, but I walked away with a strong respect for all of the staff working there on a daily basis.

    Working as a vet requires a sack full of patience at the best of times, but working with wild animals brings the job to another level. Not only do you strike the balance every day between interfering too much or too little, no other medical professional has to work with patients every day who are so unwanting of your help and will stop at nothing to get away.

    I do think that if doctors and nurses had to use bait to draw their patients in, bar the practice doors, and then try to grab them one by one with a very large net, medicine courses might not be quite so over-subscribed.

  • Research the change you want to see in the world

    Research the change you want to see in the world

    As a good 60% of my masters is research based, there will come a time, all too soon, when I must decide definitively what avenue of research I want to explore.

    We don’t have much time to touch upon research or develop our skills in the area on the vet course due to the huge level of content we need to consume throughout the five years, but those skills are both highly transferable and infinitely invaluable in the field of exotics and conservation.

    Choices, choices…

    I’ve been looking forward to the research aspect of this course for the best part of the last six months but it’s shocking just how difficult it is to pick a single topic to dedicate yourself to.

    Topics include:

    • one health
    • immunology
    • genetics
    • behaviour
    • marine biology
    • climate change
    • wildlife
    • domestic animal studies

    …the list is quite something.

    Making your mark

    What it all boils down to though, is what really sparks an interest in you? What questions do you want the answers to? What species hold a special place in your heart, and what field do you want to expand your knowledge in?

    For me, the question I’ve begun to ask myself is: what is the change I want to help bring about?

    As a veterinary professional you can’t always let yourself be swayed by issues of the heart, yet there are many aspects of animal welfare, captivity and treatment that make this far easier said than done.

    The trouble is that we live in a world of law and legislation and attempting to enact change driven purely by an emotional standpoint will get you nowhere. You cannot simply request for laws to be changed or regulations to be put in place because it’s “the right thing to do”. You must scientifically enforce your argument, and that means peer reviewed, tried and tested research.

    Agent for change

    It wasn’t until 2012 that battery farmed eggs were outlawed in the UK, and only in 2016 did SeaWorld – a multi-million dollar entertainment enterprise – pledge to end their removal of Orcas from the wild and their captive breeding programme.

    Some might argue that these changes are on completely different levels and have different value, but neither would have been brought about without the tireless work of countless dedicated professionals who took the time to bring facts together into a case that changed laws that had been around for decades.

    It’s a long old process, the documentary Blackfish (which inarguably had a hand in the decline in SeaWorld’s popularity) took months to produce, and it took an additional three years after it’s release for it’s impacts to come to fruition. With this in mind, I wonder just how much change I’m really capable of with my three-month research project – which, due to COVID-19, is almost certainly set to be entirely desk-based.

    Little by little

    I believe even the small changes are important; even those made by collecting data and typing up hypotheses and conclusions from home – even if you don’t actually get to spend any time working with the animal whose quality of life you’re trying to improve.

    I have a particular interest in stereotypies – which, for those not in the know, are repetitive movements, sounds or behaviours displayed by captive animals due to frustration or a lack of mental or social stimulation. They are the direct consequence of human intervention in their natural behaviours, and ever since learning about them in the first year of the vet course the topic has stayed with me.

    If I’m lucky enough to explore this field at the start of next year I’ll be grateful for any minor contribution I can make to the far too-small pool of research that is thankfully starting to grow.

  • The power of affirmations and using them properly

    The power of affirmations and using them properly

    Affirmations are positive phrases and sentences you repeat to change either the language in your head or the beliefs you have about yourself. These affirmations can be incredibly powerful when it comes to personal development.

    Our brain is wired to notice the negative outcomes of our actions so we can prevent them from happening again. But it doesn’t stop there – instead of just stopping, being objective, looking for the main lesson and moving on, our brain adds meaning to what happened; and we attach that to how we think of ourselves and, over time, begin to believe it is true.

    A prime example is when you didn’t achieving something and you made that mean you are not smart enough or not good enough. Instead of being objective and looking at how the failure resulted from approaching the problem the wrong way, or preparing incorrectly, your brain jumps to the simple conclusion you are not good enough.

    Brain training

    Affirmations can help rewire our brain, and begin to challenge and eliminate those negative and limiting beliefs we have about ourselves.

    An affirmation that tackles this example could be: “I am smart and resourceful, and put in the work to achieve what I want.”

    You may not initially feel you believe the affirmation when you begin, and you may feel a bit silly; however, with time and repetition this affirmation will eventually become a belief. You can train your brain to think differently if you want to.

    Using affirmations

    Some pointers on how to use affirmations:

    • They are best in the morning, as this has the added benefit of setting up a positive mindset for the day. You begin the day with empowering beliefs that will give you momentum to push through the challenges you will face. You essentially set yourself up for success. You can then continue to remind yourself through out the day.
    • Repetition is the key. Don’t just say it once, say it over and over again. Put reminders in your phone or alarms that go off that have the affirmation on it. Put sticky notes on the mirror or fridge, or in your car…
    • Combine it with emotion and intensity. Say the affirmation with confidence – shift your body into a powerful stance, shoulders back, chin up, breathe in deep. This combination will help you feel that what you are saying is indeed true, as you feel it in your body.
    • Start to give an example of when the affirmation is right. “I am smart and resourceful, and put in the work to achieve what I want… because yesterday I solved problem x that was presented to me.”

    Affirmation is powerful when used correctly – and can be life-changing for eliminating negative self-doubt.

  • Good intentions

    Good intentions

    Less than a month into my master’s degree in wildlife health and rehabilitation, and it’s already become apparent that a vast array of misconceptions are held by the public concerning local wildlife.

    I’m already armed with far more wildlife facts than I ever thought my brain had room for. For example, did you know that a group of hedgehogs is called a prickle? Or that bees have five eyes?

    The vet course is a lengthy and arduous endurance, and even so a whole wealth of animal knowledge gets left out because, for the average vet, there’s little need to know that a kangaroo has three vaginas. Unless, of course, you’re a vet working in Australia – in which case, g’day!

    The unfortunate facts

    In my lectures, alongside these charming facts came the statistic that in the majority of wildlife rescue centres, more than 50% of “abandoned orphan” admissions are a mistake on the well-meaning public’s part and are, in fact, just young fledglings still getting used to their wings.

    That’s in excess of 50% of “avian orphan” admissions that have to be assessed, put through the system, housed and then released back into the wild – more than 50% of resources wasted.

    It’s also true that feeding hedgehogs milk and birds bread can make them ill, and that setting out food or bird feeders can provide a breeding ground for disease transmission and propagation.

    And it’s a truth that is kept somewhat from the public that, for a large proportion of wildlife casualties, there is little to be done but palliative care and euthanasia.

    Small acts of kindness

    This topic really gets me down, because with all of the ecological, environmental and diversity destruction ongoing around the world, small acts of kindness and sympathetic good deeds seem few and far between – and as someone passionate about wildlife and conservation, the last thing I want to do is discourage them.

    A lot of problems exist in this world, and humans cause 99% of them, so when someone goes out of his or her way to try to do the right thing and it ends up causing more harm than good – whether he or she knows it or not – it seems like such a waste of good intentions.

    swallow
    Image © raquel / Adobe Stock

    Can’t do right for doing right

    The real crux of the matter is the paradox of education. It’s understandable that the public make mistakes regarding wildlife when so much is still unknown to the professional community.

    That being said, if the wide range of new data at our fingertips could be available for the layman, such mistakes might be mitigated. However, there’s only so much unrequested education people can tolerate before they just give up.

    Similarly, if you let every member of the public who brings in an injured animal know the percentage of animals that have had to be euthanised that day, they might just take it on themselves not to bring it in at all, or (an even worse possibility) attempt to care for it themselves.

    Sad, but true

    Stories of people attempting to hand-rear everything from birds to large cats are, while superficially admirable, most often doomed to failure.

    Research is constantly being conducted into nutritional requirements, behavioural norms and habitat necessities on all the species we’re still not 100% on… and that’s pretty much all of them.

    If the leading minds in the field are still messing it up, there’s not much hope for the average Joe – even with all the good intentions in the world.

  • The new etiquette of dog walking, post COVID-19

    The new etiquette of dog walking, post COVID-19

    Having been lucky enough to spend the past few days in Cornwall – at a time of year where dog walkers are plentiful and you can hardly take two steps without tripping over something small and fluffy – it’s struck me that COVID-19 has not only shaped the way we interact with one another, but also with other animals.

    Although the British public as a whole has never been labelled as “overly friendly”, we never used to go out of the way to cross the street to avoid each other; now, however, that’s become a regular occurrence.

    The way we behave around other people has had to change over the past few months, but I think it’s worth arguing that a change in the way we behave around pets is equally necessary.

    Group walks

    Dog walking in groups has obviously been reduced to a maximum of six (furry friends notwithstanding of course), along with many other social activities across the country, but it is still important to maintain social distancing and not be tempted to go back to old habits.

    Taking care when holding another dog’s lead, or getting tangled in a web of leads as your dogs are overwhelmed with seeing each other again – it’s also important to obviously be mindful of other members of the public, as six dog walkers marching down the street, each with one or two dogs in tow, is now the closest thing to a booked out concert and can seem quite intimidating to some poor person just trying to get to the shops.

    Up close and personal

    Approaching dogs you aren’t familiar with is a situation that should always be treated with caution, but coronavirus adds an extra element to consider.

    I was enjoying a pub dinner recently when a couple came in with the most adorable 10-week-old border collie and made the whole room erupt into a cooing, aww-ing mess (myself included). It seemed that everyone’s instinctual reaction was to approach, but in the current climate almost everyone stayed seated – if a little mournfully.

    So much has been written in the papers about whether our animals can transmit the virus, whether they carry it on their fur from where their owners have touched them, if they’re asymptomatic carriers (etc) that I don’t think a lot of people know what they should or shouldn’t do around other people’s pets. There is also the question of whether the owner would feel comfortable with you getting close enough to pet them in the first place – and as a further minefield, the addition of face masks can make it very difficult to read a persons facial expression to gauge their reaction.

    mask
    Face masks can pose a problem for dogs. Image by ivabalk from Pixabay

    Facing the facts

    Face masks can also pose problems for dogs, being a species that relies heavily on physical over verbal communication. The absence of facial cues can be disconcerting for some dogs and make them more nervous or prone to aggression than they might ordinarily be.

    Furthermore, if the dog in question did not grow up in the world of face-masks and visors, or has had a negative experience with a person wearing a similar item, it can cause it to be excessively wary, stressed and defensive. If a dog is too young to remember pre-COVID life, he/she may also not be used to heavy traffic or large numbers of people.

    It’s perhaps more important than ever to consider an animal’s individual circumstances before engaging with it. If in doubt, ask the owner for his or her permission and a little bit about the dog. For reference, a yellow harness or lead is often used to indicate a particularly nervous dog.

    Assistance dogs

    A final consideration that I’d hope would come naturally to everyone is to give way to people with service dogs, whether they are guide dogs or for other purposes.

    Although training is already underway for some guide dogs to learn to social distance, a lot of dogs were never prepared for these circumstances and a full two-metre distance isn’t always entirely possible or safe (for example, two people passing each other on a thin kerb beside a busy road).

    Being mindful of service dogs and taking care to give way when possible goes a long way in ensuring everyone can stay safe and well.