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Category: Opinion

  • A vet’s role in an environmental crisis

    A vet’s role in an environmental crisis

    Climate change and mass extinction have been hot topics over recent weeks. But, if we’re being perfectly candid, these subjects should have reached the headlines a long time ago – which is perhaps why so many people have taken to the streets of London in protest.

    Though I share the plight of the people who have, and continue to demonstrate, as well as the frustration in the rate of progress being made (as it can appear, at times, to be achingly slow), there is nothing to be gained for mourning the time that’s been lost, as it’s time we will never get back.

    The only change we should concern ourselves with is that to come and, in the current climate (no pun intended), the next generation of vets will be vital in filling environmental, public relations and food health roles as they never have before.

    Food industry

    In recent lectures we have been encouraged to research and understand elements of the food industry outside of our curriculum. One expert informed us that if we carried on consuming and demanding food at the rate we are now, we would require five-and-a-half planet earths’ worth of space to feed the population within the next 100 years.

    earths
    Within the next 100 years we will require five-and-a-half planet earths’ worth of space to feed the population, it has been claimed.

    This statement introduced what went on to be a two-hour seminar, and although none of the content was to be examinable, we all paid attention.

    I think it’s because we all understood that what we were being taught went beyond text books and exam papers – it represented a facet of the veterinary career that probably very few of us had even considered before applying for the course, and yet now seems one of the most important.

    Turning the tide

    A veterinarian’s role in conservation is no new thing, but with multi-species extinction on the rise, and with no signs of slowing down, it’s never been more important to encourage graduates to forego the comfort zones of first opinion practice and expand their experience in this field.

    It’s only by pooling together the research, time and expertise of as many trained medical, zoological and biological professionals as possible that we can begin to turn the tides, and protect the most vulnerable, but beautiful, creatures on our planet for good.

    Sustainable diet

    As for the world food crisis, reaching a solution is two-fold: finding a sustainable diet, and then finding the most efficient and cost-effective means of producing this diet on a global scale.

    Veterinary involvement is paramount for this to be achieved. Not only are vets crucial for both ethical and reliable research, they are also the bridge between the scientific and farming communities.

    By working alongside the farming industry and educating the next wave of agricultural workers in efficiency and sustainability, we can begin to form the infrastructure from which real, tangible change can be seen in all of our futures.

  • Create rules when you can’t remember everything

    Create rules when you can’t remember everything

    We all know it is impossible to know everything. Even when you are studying for an exam it is still hard to remember the specifics of whatever you are learning.

    What I found helps me is to create rules around things that can have serious implications if I don’t remember them. The rules are there to trigger me to stop, think twice, or look up something as I know I am missing something.

    DSC04162_non-feat
    Gerardo Poli with colleague Alex Hynes.

    I find rules simpler and easier to remember, especially if I link them with imagery or a case.

    For example…

    An example of a rule is: “Don’t give cats dog doses of furosemide.” I used this rule for years while in general practice, as I rarely treated a cat in congestive heart failure. This prompted me to go to look up the dose, rather than give a dog dose of furosemide.

    Another rule I had was “sodium abnormalities are best corrected slowly”. This was because it is safer to treat it that way rather than to determine the time frame over which the abnormality occurred, which is often hard to determine.

    About rules

    What is the difference between a “rule” and remembering the specifics…

    • Rules are simple: “Don’t give cats dog doses of furosemide“ is easier to remember than the actual doses themselves.
    • Rules are easier to remember: the rule does not contain specific or detailed information, therefore it takes the pressure off you trying to remember everything.
    • Rules improve safety – especially if the rule is there to prevent a detrimental outcome from occurring.
    • Rules are good for teams: your entire team can remember them and it does not rely on a detailed understanding of why (although it does help if everyone understands why, they will over time as it is triggered). The rule is applicable to all team members – from inexperienced vets to nurses or technicians, and even experienced vets. They can all look at a patient with a hyponatraemia and remember that slow correction is safer than rapid correction. That will prompt them to stop, think, and ask if the sodium is being corrected slowly.
    • Rules trigger learning through repetition: the more often you are triggered to look something up or explain the rule, the faster you start to remember the specifics.

    So, go create some rules around something that is important for everyone to know, but they all struggle to remember.

  • Staying motivated

    Staying motivated

    When your course is a minimum of five years long, and your days are filled with lab work, lectures and study, it can be easy to lose sight of the big picture – the real core driver behind why you wanted to be a vet in the first place.

    Forgive me if I’m wrong, but I’m sure no 18-year-old, fresh from 14 years of full-time education, has ever signed up for their degree purely for a love of spending the fleeting British summertime in an exam hall and 9am-5pm every day staring at a white board.

    For most of us, investing the money and dedicated years of our lives that university demands are all part and parcel of building the foundations for our futures.

    What’s it all for?

    For vets especially, many options are available: whether you’re driven towards specialised surgery, welfare, research or first-opinion practice, it all starts with the same degree, the same path, the same investment.

    However, while the journey may be unavoidable, the repetitive humdrum of student life (and life in general for that matter) can make it difficult to keep your eyes on the end goal.

    How bad do you want it?

    It’s not a matter of commitment. Trust me; if you even manage to get an interview for a veterinary course, you’re as committed as they come. There’s no way you’ll find a teenager voluntarily scooping poop – from a staggering variety of sources – on their weekends without a real solid mindset as to where they want to be.

    poo
    “There’s no way you’ll find a teenager voluntarily scooping poop – from a staggering variety of sources – on their weekends without a real solid mindset as to where they want to be.” Image © chelle129 / Adobe Stock

    When I was applying to vet schools, the standard requirements for work experience ranged from four to 12 weeks. I just about managed the latter, but I had friends around me doubling that – don’t ask me how.

    Getting sidetracked

    University life can be repetitive, not to mention full on… in a particularly heavy week, I managed to have a dream about revising ectoparasites, so let me tell you, sometimes there really is no escaping it.

    Through all this it’s understandable you might lose track of the driver that got you here in the first place, let alone what you want to do when you leave. When you‘re struggling to keep your head above water to deal with the task in front of you, how on earth are you supposed to look so far ahead?

    Personally, I didn’t realise I’d reached this point until very recently.

    The epiphany

    My university had organised “practice consult sessions” with some of its vet surgery’s genuine clients. Each client came to us with his or her dogs and had been told by our teaching staff to be as difficult as possible in an attempt to get us out of our shells.

    In groups, we had to practise gathering a patient history – not easy, as it turns out, when the client’s been instructed not to play ball – and describe a simple neutering, addressing both pros and cons.

    Not only did this supply a very realistic “hands-on” scenario, it forced us to use the collective knowledge provided to us in countless lectures and seminars and regurgitate it in a manner that was both professional and understandable. For example, a lot of the clinical terms we’re encouraged to memorise aren’t commonly used by the general public, so you must find easier ways of explaining things without oversimplifying anything important like surgical risks.

    Remind yourself

    I can’t describe how motivated I felt when I came home after that practical – I was buzzing.

    I had stood behind real vets in real consultations for so long, watching how they interacted with clients and patients and itching, from such a young age, to do what they did. I wish I could carry that feeling with me every day, but, of course, after a while you find yourself treading water again.

    I think the important thing is to give yourself moments every now and then to stop and reflect on how far you’ve already come, as well as where you want to go. The course, the workload, life in general – none of it’s easy. But if you want it enough, it’s so, so worth it.

  • Thank you for everything (so far)

    Thank you for everything (so far)

    I’ve talked before about how being a vet student is tough, and how getting into a place on a vet course is maybe tougher still – and I won’t lie to you, the studying, the extra hours put in after school, the weekends (if not weeks) spent knee deep in mud or muck (or a pungent mixture of both) all helped me gain my much-coveted place at university.

    But, if I’m being honest, that’s only half of the story…

    For every vet student (in fact, any student) who managed to get into university with half the support I had: for you I have the utmost respect.

    I think I was around six years old when I first decided to become a vet – and, from that moment on, my family’s unwavering support is probably the main reason I made it.

    The unglamorous bits

    Looking back, I realise my parents probably put up with a lot more than the average parent would. There’s a necessity to start getting work experience as soon as possible when you’re looking to become a vet – not just to meet course requirements, but to make certain the job is actually for you. University makes it very expensive to change your mind.

    Author Eleanor Goad with her “kind and dedicated” mum, Sandra.
    Student blogger Eleanor Goad with her “kind and dedicated” mum, Sandra.

    I wasn’t lucky enough to live down the road from many farms, so, back before I could drive, my dad drove me to countless placements across the country, with only the occasional grumble about the state I’d leave his car in. It turns out you pick up straw from a farm like sand from a beach and it really does get everywhere.

    My mum works as a junior sister on an endoscopy ward, so she’s no stranger to the less glamorous parts of a job, but even she would recoil from the brown patches on my jeans after a day at the dairy – not to mention the stench as I walked through the door.

    The emotional bits

    Of course, there’s more to support than petrol and laundry. I’ve always been somewhat of a perfectionist and I think this – combined with the pressure of such a long-term dream – made exams, and the course application process in general, a very stressful time.

    Through tears and sleepless nights, I always had someone to lean on – and even when I doubted myself, they never did.

    They both took valuable time off from full-time jobs to come with me to open days and interviews – and when, last minute, I decided Surrey wasn’t the right fit for me (despite that it was right on our doorstep), my nan gave up her weekend to fly with me to Edinburgh.

    On results day, my parents and I crammed together on the sofa, and I think we all screamed (and probably cried) when we learned I’d got in to Bristol.

    Unwavering support

    With no real animal background to speak of, my parents are undoubtedly a large drive behind why I decided to become a vet. When I was young, all I knew about my mum’s occupation was that she helped people, and that seemed like a pretty good job to have!

    They’re both kind and dedicated people, and I think that’s what helps inspire me to work so hard on this course, even when it seems overwhelming. I might be in my second year of vet school, but the support didn’t stop when I walked onto campus; from food and toilet paper supplies to a warm voice on the end of the phone, I know they’ve got my back.

    I should probably call home more often than I do, but that doesn’t mean I’m not eternally grateful – both for everything they’ve done and continue to do.

  • Brachycephalic syndrome

    Brachycephalic syndrome

    The pug, shih-tzu and chihuahua are all breeds vets would describe as brachycephalic. This means their noses are proportionally shorter than the rest of their head – a far cry from their ancestors that would have these in about a 1:1 ratio.

    A lot of people find the large, puppy-dog eyes and wrinkly face charming and adorable. But, in truth, the aspects we love the most about these breeds might not be so desirable from the dogs’ own perspectives. The pug might be one of the nation’s favourite breeds – popularity for them has been on the rise in recent years – but, for vets, this is mirrored with a growing concern.

    Unintended consequences

    After cats, canines were the second animal to be domesticated by humans – and we have been selectively breeding them for thousands of years. Sometimes this is advantageous and the animal benefits from improved speed or stamina, but other breeds are less lucky – Labrador retrievers are prone to hip dysplasia, boxers to heart disease and pugs to a condition known as brachycephalic obstructive airway syndrome.

    The characteristic grunting and wheezing associated with pugs is not an endearing quirk, it indicates a far more sinister underlying issue.

    Pugs have changed dramatically just the past century, being purposefully bred for big eyes and a progressively flatter nose. Although, from the outside, this may not appear too big of an issue, it can lead to a severe impediment of the dogs’ ability to breathe, and the bulging eyes can also cause issues such as cherry eye, dryness and irritation.

    The big picture

    In June of 2018, Disney released Patrick, a film starring a pug as the main character, prompting the BVA to request its brachycephalic working group assist the studio in reducing any negative impacts the film might produce – particularly the anticipated interest in pugs after the movie’s release.

    Vets want to raise awareness of side effects of pedigree breeding, but it’s a fine line between showing concern for animal welfare and challenging a person’s livelihood, particularly as a lot of breeders idolise their favourite breeds and see no problem with the way they are made.

    Subsequently, a lot of the public are unaware of the link between some breeds and certain congenital diseases, and the increase in demand for pugs and similar dogs means the issues are only going to get worse over the next generations of breeding if nothing is done to raise awareness.

     

  • First time for everything

    First time for everything

    I’ve been lucky enough to not, until very recently, have a patient die on the operating table.

    Nothing quite prepares you for what you experience in that moment you realise the animal is crashing. We had CPR training at uni, we run through the practice crash box to refresh everyone of what’s in it, and I hadn’t had to use it yet.

    “There’s a potential caesarean coming down,” one of the receptions had come through to the kennel area to inform me. “I’d better shuffle those appointments I’d just opened up for you.”

    Inauspicious beginnings

    On arrival, the bitch in question was four days overdue, with no indication of labour, an open cervix, and generally looked fairly flat – but not as though death was imminent.

    A C-section was agreed as the best course of action, and she was moved through to prep where the nurses already had everything ready to go – thanks to the prior warning. More nurses than usual were hovering, as it’s all hands on deck for a caesarean.

    It took me longer than usual to get the catheter in – perhaps the flat veins should have been a warning sign that she was actually in worse condition than she seemed. I was usually pretty good at catheters, but everyone has off days, right?

    Auto pilot

    Fluids running, antiemetic given (she was drooling a bit and it has been shown to reduce anaesthetic requirements), abdomen clipped, ready to induce… a trainee nurse asked an RVN to confirm the heart rate as she was struggling.

    I picked up the propofol and instantly the bitch did the “death gasp”. At the same moment, both the RVN and I realised she was crashing. I had no time to think; I grabbed an endotracheal tube and intubated, while the nurse started chest compressions. Another nurse connected the oxygen and started ventilating.

    Somebody thrust some adrenaline into my hand and I’d barely asked “where’s the dose chart” before it had been pointed at. I hastily drew it up and administered, while asking the trainee nurse to bring the surgical kit in from theatre.

    One after another

    Image © sunnysky69 / Adobe Stock
    “I never really had time to think about how awful the whole situation was – and yet everyone just got on with their jobs.” Image © sunnysky69 / Adobe Stock

    By that point I think we’d all accepted we would likely lose the bitch, but needed to keep her going while we tried to get the puppies out.

    As soon as I incised into the abdomen, green-tinged fluid poured out (she was on an angle as the nurses were still doing compressions). I exteriorised an enormous uterus and start fishing out placentas, opening them, clamping umbilical cords, cutting and handing on to a nurse, receptionist, practice manager, anyone who was present – they all knew what to do.

    Puppy after puppy came out – I was astonished at how quickly I was working and there were still more. Meanwhile, the prep room floor was becoming a lethal sea of peritonitic fluid.

    “How are they? Any alive?” I asked, still working, hoping something would come out of this horrid mess. I already knew the answer: most of the puppies were completely rigid, seemingly long dead.

    All over

    Once every puppy was out (no survivors), I ran for the phone and rang the owner to explain we were keeping the heart going. I then gained permission to euthanise. However, as I returned to prep, I realised she was already gone.

    Everyone was quiet…I donned a pair of gloves again and solemnly started stitching up.

    Calm under pressure

    While it was happening, I never really had time to think about how awful the whole situation was – and yet everyone just got on with their jobs; each of us doing our bit to try and save some lives at least.

    On later reflection, even though we didn’t succeed, there was nothing more we could have done. We worked extremely fast from the moment she started to crash, and even though it was a miserable situation with a devastating outcome, I was extremely grateful for the calm manner in which everyone handled it.

  • Stress: your nemesis or superpower?

    Stress: your nemesis or superpower?

    As a veterinary student, I’m certainly no stranger to stress.

    There’s a running joke within my friend group that “diamonds are made under pressure”, which helps us all to feel a little better when the pressure on ourselves begins to rise.

    But, whether it’s a coursework deadline or juggling my work-load with my social life, there’s always something going on in the back of my mind like an internal, manic hamster wheel.

    Duck feet

    I’ve grown up wanting to be a vet. This obviously came hand-in-hand with an admiration for those in the veterinary profession – and the medical field as a whole.

    Saying that, I don’t think my younger self was ever fully able to appreciate all the time, energy and exertion that went on behind the scenes. When you’re greeted by a medical professional – whether at your local GP or veterinary practice – the (hopefully) calm and collected individual you meet across the desk is only one half of the story.

    You know the popular analogy of a duck, peaceful and composed on the water’s surface, but frantically kicking underneath? Well, you can be sure, 9 times out of 10, there’s some heavy paddling going on behind every good doctor or nurse that you meet.

    We’re in this together

    I really don’t think it matters what kind of medicine you practice or study – human or animal – it all comes with its fair share of stress. There’s a reason my course and my future career are commonly associated with poor mental health, and it’s sad how careers that do so much good have the potential to cause such harm in the process.

    I think this really highlights the importance of “clubbing together” in the work place, whether that’s the university common room or the staff room of a first opinion practice. Medical degrees, along with the jobs they lead to, are demanding – there’s no getting away from it. But there’s no reason we have to do it alone.

    #bekind

    A little bit of kindness goes a long way, so if you see a colleague or fellow student struggling – even though you may have a lot going on in your own life – maybe try to ease their load a little, and one day they will return the favour.

    If you make sure to be kind to yourself and have a good work-life balance then stress can be your superpower, rather than your downfall. It can be a great motivator if you don’t let it get on top of you and keep you focused on your goals through all the distractions life can throw at you.

    To be honest, no matter your profession, course or lifestyle, stress is inevitable. It’s how you cope with it and what you choose to do with it that counts, and, ultimately, helps you grow.

  • Don’t tar all dogs with the same brush

    Don’t tar all dogs with the same brush

    Pit bulls, mastiffs and German shepherds are some of the breeds regarded by many as being aggressive and dangerous.

    In the same way some dogs are best known for shedding on beloved white furniture or having deep, dreamy puppy dog eyes, these breeds have an established reputation as dogs to be feared and not raised as pets.

    Mirror image

    A lot of the time, the prophecy is self-fulfilling. Dogs are incredibly intelligent and receptive animals, and unbeknown to a lot of owners, are highly tuned to our actions, expressions and moods – and will often act accordingly.

    As pack animals they are programmed to respond to the emotions and vibes given off by others – meaning that if you’re feeling angry or agitated, just your tone of voice or the expression on your face could cause your dog to begin to feel the exact same way. It’s a mirror affect.

    Last resort

    Most dogs are not inherently violent; aggression is often a last resort in the face of fear, stress or anxiety.

    The head vet at the local practice where I’ve volunteered for several years told me the first thing to do when presented with a frustrated owner, and an angry or aggressive dog, is to ask about its home life, not its genetic background.

    According to the RSPCA, no evidence suggests one breed is more aggressive than another. However, it’s a much-debated topic and four dog breeds are prohibited in the UK:

    • dogo Argentino
    • fila Brasileiro
    • pit bull terrier
    • Japanese tosa

    Selected traits

    In university, at least, I’ve been taught no dog is born aggressive.

    Mankind has been domesticating the canine for somewhere between 20,000 to 40,000 years, which has involved selectively breeding for certain traits, ranging from hair colour to docility. As a result, some breeds are easier to train than others or will react differently to scenarios that are stressful or confusing.

    Of course, some breeds are better suited to households with children or to assisting the disabled, but no dog should be entirely defined or judged by its breed.

    Socialisation

    The argument of nature vs nurture is perhaps very prevalent for this debate.

    The first 4 to 14 weeks of a dog’s life will define everything it considers normal – this is known as the “socialisation window”. For example, if, within this time, a puppy has never seen a certain breed of dog, or a large truck, they will find these stimuli stressful and may even behave aggressively around them.

    The calmest and most well-behaved dogs are often down to a responsible breeder who took the time to familiarise themselves with many different people, sounds, smells and places, before passing them on to the owner. We’ve been told that, as clinicians, it will be our responsibility to encourage clients to do the same with their puppies before this invaluable time window runs out.

    So many factors contribute to the character of a dog besides its breeding. It’s the job of vets to inform all dog owners of these in the hopes these negative stereotypes are, one day, put to rest.

  • Pedigree prejudice?

    Pedigree prejudice?

    The decision of whether or not to get a new pet is an important one, but the decision of where to get it from might be more important.

    Volunteering for two weeks this Christmas at a cattery has really made me believe we, as a society, need to undergo a significant evolution in terms of how we approach buying our furry friends.

    Every year, thousands of dogs and cats kept in rescue shelters are euthanised because they never manage to find a new home. At the same time, according to Government estimates, 560,000 puppies are born in the UK each year, at a minimum.

    Changing attitudes

    As a second year vet student with little experience as either a breeder or a dog owner, I recognise I have little position in which to tell people where to purchase their pets. But if our attitude to pet buying remains unchanged, this self-perpetuating issue will only continue – in fact, with dog and cat ownership on the rise, it might get worse.

    We appear to prefer the new to the old when it comes to pets, in the same way that, given the choice, most people would opt for a brand new car over a second-hand model.

    We also seem to be very blinded by the ideology of our favourite breeds. Pure-bred animals make up a very tiny percentage of shelter occupants and are also often the first to be adopted.

    Domino effect

    Most sheltered animals are there because their owners couldn’t cope, changed jobs, moved abroad or even passed away. The animals that never make it out of shelters aren’t necessarily aggressive, undisciplined or even unfriendly, it’s simply because they don’t match up to our idea of the perfect dog – which, to me, is truly heart breaking.

    So many advantages exist to adopting from a rescue shelter, for starters you kick off a really positive domino effect by not only creating room in a shelter for another animal to be taken in, but by educating your family and friends to an option they may never have fully considered, potentially leading to more adoptions.

    The process will also be less expensive than buying a pedigree puppy or kitten and you have the added bonus of knowing you are both changing and saving an animal’s life.

    Happy and healthy

    Even if you do decide to go with a breeder, you can still look out for animal welfare by buying from one you trust and is properly licensed.

    You can help to validate the health of the puppy/kitten by asking to see the mother – if she seems happy and healthy this is a good indication of the same for her offspring – and ensuring the animal you are taking home is fully vaccinated and treated for worms.

    By buying from recognised and responsible breeders, rather than puppy/kitten farms, you are still helping reduce the number of animals that needlessly end up in welfare and to move towards a future where shelters never have to put a healthy animal down.

  • Tree of life

    Tree of life

    Seeing a “tree of life” can be an intimidating sight. When you see this number of pumps for one patient, you instantly know things are pretty serious. This sight is almost a daily occurrence in our ICU.

    Now, your first reaction may be to turn around and walk quickly in the other direction. However, rather than feel overwhelmed at the whole sight, think of the saying: “How do you eat an elephant? Piece by piece.”

    Take things one step at a time.

    Step 1: stop and reset

    Gerardo
    The “tree of life” in full effect.

    Take a deep breath and reset. This is important, as these patients are complicated. If you’re not mentally ready for handover then you will miss important details critical for understanding the patient as a whole.

    Step 2: understand the patient

    It is important to know what is going on with the patient as this will provide context to the “tree of life”.

    If you are handing over, make sure it is comprehensive. If you are on the receiving end of a handover make sure you are paying attention, and ask questions or seek clarification.

    Step 3: group the meds

    Grouping the meds helps chunk them. Group them into categories such as pain relief, antibiotics, antiarrhythmics, pressor agents and supplements (such as glucose and potassium). It also puts their use into perspective.

    Step 4: know what the fluid therapy plan is

    This step is often forgotten. Always ask what the fluid status of the patient is. Also, at what phase of the fluid plan they are in – correction of perfusion, rehydration or maintenance. Also, consider if there are any on going losses being accounted for.

    The next time you walk into an ICU and are about to take handover of a patient who has a “tree of life”, it won’t be such a daunting task if you follow this process. I truly acknowledge anyone out there who has learned to see this sight as an exciting challenge, and the chance to learn and make a difference.