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Category: Opinion

Language: lost (or gained) in translation?

We spend five years at vet school learning a myriad of vet jargon; a whole new language, with a fair bit of Latin thrown in too.

When you think about it, even the “simple” descriptive and directional words – e.g. caudal/cranial – were alien to us before vet school. The funny thing is, just as you become fluent in vet-speak, you have to be able to translate this back to English for clients.

I used to listen to vets converse with clients while on EMS placements, and could easily pick out those who communicated better. When witnessing those who weren’t so good at translating, I swore to myself I would never befuddle a client with medical words – surely it’s not that difficult to explain things in simple terms?

Slipping

Are you in danger of confusing your clients with “vet” words? IMAGE: pathdoc/Fotolia.

While having a non-vet family and boyfriend has helped keep me “bilingual”, I fear I am starting to fall into the jargon trap already.

The first sign appeared when in conversation with the aforementioned better half who, while not in the profession, has grasped a fair idea of the vet world after some years by my side.

After listening to one of my many ramblings about vet life, he asked “what is a mucosa?” and I suddenly realised I was possibly losing my ability to communicate like a normal human being.

Meanwhile, I have found myself on more than one occasion having a complete mental block when trying to think of the “normal” word for something, with the technical term holding strongest in my mind. But I guess that comes with experience, and explaining things to different clients in time.

Beneath the surface

The way vets communicate with each other is important too – while the language we use can seem subtle, it can have deeper meanings.

One particular word I fear is becoming normalised within our profession is not a medical word at all – “survive” (and the derivatives thereof). New grads may joke about having “survived” X number of months in practice, and when asked “how are you getting on?”, “surviving” is all too common an answer. Throwing this word around makes it seem as though it loses meaning, but I think it actually has the opposite effect.

The Oxford Dictionary meaning of “survive” is to “continue to live or exist, especially in spite of danger or hardship.” And we relate this to the veterinary world all the time.

Justification?

The all too frequent use of the word either suggests we are in a constant state of hardship – be that emotional, physical, mental or financial – or that we are exaggerating.

If you truly feel you are “surviving” at work, seek advice, says Jordan. IMAGE: alphaspirit/Fotolia.

Justified or not, I think we use the word too often; we shouldn’t be merely “surviving” – we all worked hard to enter this profession, and nobody said being a new grad would be easy – but it doesn’t need to be horrific.

If you feel like you’re coasting along, just about surviving, talk to your friends, colleagues, an independent ear – get some advice to find out either how to get more on top of things, or whether you’re truly in the right kind of practice environment for you.

And if you’re more than surviving, stop brandishing the word about carelessly for the sake of those who feel they’re just about keeping their heads above water. The language you use is more important than you may realise.

September 1, 2017
Accountability and responsibility: which causes more fear?

It’s very daunting standing in your first consult as a real, qualified vet – even if it is “just a vaccine”, which invariably turns into “actually, this has happened“, or “now you mention it“, and so on.

But why is it we have that constant feeling of being on edge – more so than a few months previously, when we were still students?

A noticeable shift certainly occurs to being an actual vet, rather than someone who always has a supervisor to have the final say, or take the brunt of the backlash of a mistake.

However, is it the accountability or the responsibility worrying us the most?

Pressing concern

Mistakes are inevitable, but rarely catastrophic. IMAGE: pathdoc/Fotolia.

As soon as we swear the oath enabling us to register as veterinary surgeons in the UK on graduation day, we become accountable to the RCVS.

In the past year, I have witnessed more than one speech telling us a) not to be scared of the college, and b) not nearly as many complaints, disciplinaries or registration removals occur as we think.

Exact figures aside, the take-home message has been: if you don’t knowingly do anything wrong or illegal, the likelihood of serious consequences is very low. You can’t get struck off for making a simple mistake.

The veterinary press, however, seems to over-represent those who are struck off or reprimanded; after all, you never hear about how many vets were not struck off this month or doing their jobs as they should.

Perhaps this is where the unease stems from? And why the RCVS seems so keen to tell us these individuals convicted of misconduct are a very small minority of the profession?

Are new grads really scared of the RCVS?

Talking to my colleagues, the general feeling is we understand we won’t get struck off for making a mistake. However, if the fear has anything to do with our regulatory body, it’s more the confidence knock we would have as a consequence of having a complaint against us made to it.

Of course, an element of worry surrounds being banned from practising as a vet, but I don’t think I would rank it top of the “things to be afraid of as a new graduate” list.

Instead, in that list, I think responsibility carries a greater weight. As students, we were always supervised and, ultimately, the fate of an animal’s life never truly rested in our hands. Any decisions we made were either backed up or steered in the right direction by clinicians.

Now, it’s down to us. Yes – other, more experienced colleagues should be in each practice with whom to discuss cases or reaffirm decisions, but when it comes to the consult room, you’re on your own.

Experience is king

Jordan, pictured during her final-year rotations.

What if I miss a heart murmur? What if miss signs of glaucoma, a pyometra or a lump? The list goes on. What if I could have done more investigations earlier? What if I misdiagnose something and prolong pain because I didn’t prescribe the right treatment first time?

These questions going on in our heads, coupled with a niggling feeling we have forgotten something or misread a dose, are the root of the fear. I believe this is what scares us, more so than the RCVS.

The animals – and us inherently wanting to do our best for them – makes us worry. We worry our lack of experience could be at the expense of an animal’s health – or even their life.

The only way to get past this is to gain that experience to have confidence in our decisions and learn from the mistakes we will, undoubtedly, make.

My mum said to me this week: “This is the only time you’re ever going to feel like this,” and she’s right. (But don’t tell her I said that). Even if we start a new job in the future, we will have a lot more experience under our belts, so shouldn’t, in theory, feel as lost or scared as we do now.

Being a new graduate vet is a unique position for a myriad of reasons and we need to embrace it. The fear that comes with this newly found responsibility will ease with time, and we can take our careers in whichever direction we choose.

August 16, 2017
New vet schools are not the solution

We’ve barely had a day of news in the past year that didn’t include Brexit. Yet, do any of us really know what the real consequences will be?

Within the veterinary profession, specific factors are undoubtedly going to be influenced by Brexit, even if we don’t know the extent of these yet. They do, however, include a great deal of legislation on welfare and meat hygiene, but also the future of the UK veterinary workforce.

It has been suggested the proposed coalition of Keele University and Harper Adams for yet another UK vet school may help boost numbers of veterinary professionals in the UK post-Brexit, especially when it is suspected we may be facing a shortfall.

I disagree.

Not a new problem

Is training new vets going to be of detriment to the health and well-being of those in the profession already? IMAGE: GianlucaCiroTancredi/Fotolia.

Yes, the veterinary profession has a shortage of experienced veterinary surgeons right now, but this was the case before the EU referendum was even in the pipeline – SPVS, for example, called for veterinary surgeons to be added to the UK’s shortage occupation list in 2015.

Sure, post-Brexit, it is likely to get worse – for example, the uncertainty surrounding the whole situation is (anecdotally) already seeing some of our EU vets searching for jobs overseas and leaving. This isn’t just “vet news” either – the BBC (despite the ambiguous statistics quoted) also recognised the effects of Brexit on the veterinary profession in an article this week.

But opening new vet schools isn’t the answer. For example, there is increasing awareness in the veterinary profession of the importance of mental health and a resultant expanding of the resources available for those who are struggling.

We also frequently hear buzzwords such as “compassion fatigue” and “burnout”, which we need to do more about.

My point is: we need to look after our current vets. This would prevent them getting tired and fed up, and ultimately leaving the profession – or, at least, leaving a clinical practice role.

Sold the wrong idea?

The Voices from the Future of the Profession report produced by the BVA/RCVS Vet Futures initiative in 2015 stated 50% of recent graduates thought their working lives did not meet their expectations. This disillusionment, set among a feeling of being undervalued, overworked and lacking a good work-life balance (something I’ve written about at length) leads to vets turning to other careers before they have a great deal of experience – this is what should be addressed.

We need to focus on the well-being of the vets we have instead of luring even more school leavers into a profession they have false preconceptions of.

More new graduates will not solve the problem – and this is coming from one. They will simply dilute the profession and struggle because there are less “experienced vets” to mentor them and help them hone their skills and knowledge. Ultimately, a large proportion of these will become stressed and leave within a couple of years – the vicious cycle is thus complete.

Teaching tussles

On a vet school level, irrespective of Brexit, this announcement is too not welcomed. At Glasgow, I have met clinicians that have chopped and changed between vet schools because there aren’t enough experts willing to teach, resulting in a bidding war between the universities.

We now have nine vet schools across the UK and Ireland. The Aberwysth-RVC programme (for which updates on their plans were announced earlier this week) and the Keele-Harper Adams course are only going to add fuel to that fire. Where are we going to suddenly magic up so many more diplomats and EU specialists to teach? Or, for that matter, clinical skills and first opinion teachers?

Couple-of-years-qualified graduates aren’t going to have the same breadth of experience to prepare students for a variety of surgical or clinical scenarios – they are not an adequate substitute.

Reasoning questioned

Is it simply a case of money, as Jordan claims?

The plans for new vet schools is not about saving the profession, nor is it about Brexit. It is down to academic institutions seeking high-achieving school leavers to attract more undergraduates and gain more funding.

It is ludicrous a university can just decide to open a vet school off its own back and threaten the resources of current vet schools, which include teaching staff and the availability of EMS placements, especially since many of the new course models (Nottingham, Surrey and the two proposed courses above) do not have their own teaching hospitals and, instead, use external practices.

It is true the new courses will be monitored and analysed once they have an intake of students to assess whether the graduates will be allowed to practice as veterinary surgeons, but by then, it’s too late.

There needs to be regulation to prevent it getting to that point, for the sake of the profession and the disillusioned school leavers applying en masse to these new courses.

July 30, 2017
The gender pay gap – don’t put up with it
I used to consider myself a bit of an anti-feminist – but before the majority of the profession tear strips off me, let me explain…

There are a number of very strongly opinionated feminists around – on your Facebook feed, in the news and also friends or colleagues – you know the type; those who rant on and on about how a builder whistled at them when out running or how it’s disgusting women can’t walk home alone at night without fearing some sort of assault.

Don’t get me wrong, these are issues that shouldn’t be ignored – but by the time I’ve read the 17th Facebook essay about an objectifying song lyric, it starts to get a bit boring.

Keyboard warriors

In my opinion, these sort of things need to be considered sensibly.

Yes, it’s horrible we live in a world where a female is less safe than a male at night in a city, but what are you going to do about it?

Moaning on Facebook isn’t going to save your life. Swallowing your pride and spending a couple of quid on a taxi, instead of walking, might.

I hated being associated with these hardcore, self-proclaimed feminists, because I think those who aren’t campaigning for equality – but are just man haters – give the rest of the female population a bad name.

The ‘real’ working world

I also used to be naive to things like the gender pay gap, because it didn’t affect me at the time. However, now I’m about to enter the “real” working world, in a predominantly female profession, a recent headline caught my eye.

An article in The Guardian regarding the gender pay gap of university graduates stated: “Women who studied veterinary science experienced the widest gap, earning about half as much as their male counterparts”.

I’m not really sure about the accuracy of the study they refer to, and I’m certainly not aware of such a drastic gap among any of my colleagues, but it did get me thinking.

For new grads, I struggled to see how there could be such a gap, where so many internships and graduate programmes having standardised remuneration packages. However, concerning those who are a few years into their careers, there is the theory women are less likely to ask for pay rises than men.

In this day and age

Hardcore, self-proclaimed, man-hating feminists who aren’t campaigning for equality give the rest of the female population a bad name, says Jordan. IMAGE: dundanim / Fotolia.

The pay gap is undoubtedly noted across the profession as a whole, with the SPVS Salary Survey in 2014 noting a gap of 10%.

This begs the question, why? How on earth, in the 21st century, despite being a predominately female profession, can there be this difference?

This does, of course, depend on what is being taken into account.
- Do men progress quicker to partnership roles?
- Are there more men than women in these senior positions?
- Is that accounting for the increased number of women in part-time veterinary work compared to men?
We have a private profession where salaries vary so much depending on the employer, the value of an employee to a practice, location, and other benefits or job perks. Therefore, it is hard to speculate without being able to compare colleagues with similar abilities and experience in like-for-like roles.

Unacceptable

All that aside, there certainly is a pay gap in some form within the veterinary profession, and this is unacceptable. It should be unacceptable in any profession.

Maternity leave may well be inconvenient and expensive for employers, but that should not result in discrimination, purely for being born female.

To all the veterinary feminists out there, instead of getting angry at the world, do something for yourself and for the rest of us in the profession – ask for the pay rise you deserve and do not allow yourself to be undervalued purely because nature made you this way.

Don’t put up with financial discrimination. There are enough women in the profession to drive a change, and that we should do.
June 30, 2017
SNAP cortisol test
While hyperadrenocorticism is not an uncommon incidental finding in patients presenting to our emergency clinic, hypoadrenocorticism is a lot less common. Or, possibly, more frequently underdiagnosed.

Textbook clinical presentations combined with haematology and biochemicial changes can make diagnosis straightforward, but not all patients will present with all the classic signs.

The SNAP cortisol test is a quantitative ELISA test that measures the level of serum cortisol in dogs.

To complicate things further, hypoadrenocorticism is the great mimicker of diseases; it is often impossible to arrive at a definitive diagnosis without knowing the cortisol levels.

The SNAP cortisol test allows clinicians to determine cortisol levels in-house – a blessing to those of us who work out-of-hours – but is not without its limitations.

Suspicious signs

Patients with hypoadrenocorticism often present with vague and non-specific clinical signs, but certain clinicopathological changes help raise the suspicion:
- a decrease in sodium-to-potassium ratio (below 1:27)
- azotaemia
- an inappropriately low urinary specific gravity, despite evidence of dehydration or hypovolaemia
- a leukogram unfitting to the degree of illness of the patient (a “reverse stress leukogram”- neutropenia, lymphocytosis, eosinophilia)
- anaemia
- hypoglycaemia
- hypercalcaemia
Although most Addisonian patients will not present with all these signs – especially those in the early stages of disease or those with atypical Addisonian disease (glucocorticoid insufficiency only) – any patients showing any of these haematology and biochemicial changes should have hypoadrenocorticism ruled out as part of the diagnostic plan.

Imperfect ELISA

The SNAP cortisol test has been advertised as an in-house assay to aid the diagnosis, treatment and management of both hyperadrenocorticism and hypoadrenocorticism, although the quality of the result is not perfect. This quantitative ELISA test measures the level of serum cortisol in dogs.

In one study¹, the SNAP cortisol test appears to have a good correlation with an external laboratory chemiluminescent assay test; however, in 12.8% of cases (5 of 39 patients), the SNAP test result could have led to a different clinical decision regarding the management of the patient.

Since long-term Cushing’s management relies on reliable, repeatable cortisol level detection, this high level of discrepancy is unacceptable, especially when more accurate alternatives are available at external laboratories.

Still useful

Despite this, it is still very useful helping to assess for the presence or absence of hypoadrenocorticism, especially in an emergency setting.

I use the SNAP cortisol to measure the resting cortisol level. If it is below 2ug/dL or in inconclusive range (between 2ug/L and 6ug/L), but the clinical picture suggests hypoadrenocorticism, I would perform an adrenocorticotropic hormone (ACTH) stimulation test and send samples to an external laboratory. If it is well above the inconclusive range, I would not perform an ACTH stimulation test.

In summary, I think the SNAP cortisol test can be useful in helping assess for hypoadrenocorticism, but would still recommend performing an ACTH stimulation test and running the samples externally.

However, use it with caution for hyperadrenocorticism diagnosis and its long-term management – especially when more accurate and economical alternatives are available.
June 27, 2017
SNAP FeLV antigen/FIV antibody test

The past decade has seen a significant shift in the prevalence of both FeLV and FIV in most European countries. This, coupled with a better understanding of the viral dynamics of FeLV, will influence the interpretation of the results of in-house diagnostics tests of these viral infections.

FeLV is an RNA virus that undergoes classic retroviral replication that incorporates its own genes into the host genome, known as provirus. Of those infected, approximately 30% to 40% will not be able to mount an effective immune response and will become persistently viraemic (“progressors”).

The SNAP FeLV antigen/FIV antibody test.

These cats will have a high proviral load, remain persistently antigen-positive and eventually succumb to the disease. These cats have a poor prognosis, with 70% to 90% succumbing to the disease within 18 to 36 months.

The remaining infected cats will become “regressors”. These cats will be able to mount an effective immune response and, eventually, become antigen-negative; however, will still be provirus-positive as these cannot be completely eliminated.

In extremely unusual circumstances, these cats may recrudesce and become viraemic again later in life – previously known as “latent” infection – but these cases are extremely rare. Cancer and corticosteroid-induced immunosuppression is thought to be responsible in these cases.

FeLV prevalence

The prevalence of FeLV is now much lower compared to 10 to 15 years ago, with successful culling and selective breeding programmes meaning the risk of false positive results is increased.

A positive result could be because it is a true positive (FeLV-associated disease), transient positive or false positive. A much higher chance exists of a true positive within at-risk groups – young cats with lymphoma, anaemia or leukopenia, and cats with unusual infection or unexplained wasting diseases.

A positive result in healthy cats should be considered suspicious. These cats could be regressors and should be retested 12 weeks later, where the result should become negative. Alternatively, it could be a false positive and an external lab should be used to confirm infection, preferably using an alternative method – such as DNA PCR – to test for the presence of provirus.

FIV prevalence

The interpretation of FIV test results, both in light of new disease prevalence data as well as epidemiological evidence, needs to be revised.

The prevalence of FIV in Australia is a lot higher than previously thought. In a study based on cats from the inner Sydney area, the prevalence of FIV is 16% in domestic cats with outdoor access, 21% to 25% in two feral cat colonies and up to 32% among some populations of “sick” cats (Norris et al, 2007). An owner survey revealed almost 80% of Australian cats spend some time outdoors, posing most cats at a high risk of FIV exposure.

Although no current statistics exist on the percentage of cats vaccinated for FIV, an increased vaccination rate will have a significant impact on the reliability on the results from in-house tests.

Combination test

As the name suggests, the SNAP combination FeLV antigen/FIV antibody test detects the presence of FIV antibodies. This test cannot distinguish antibodies from those naturally infected, vaccinated or derived from maternal antibody. To add to the confusion, antibodies can take anywhere between two to four weeks – and sometimes up to six months – to develop after initial infection.

To overcome this problem, PCR is needed to determine the presence of viral RNA (ELISA-positive, PCR-negative).

It should be noted the presence of FIV antibodies in naturally infected individuals is only indicative of a persistent infection. It is not correlated with the presence of immunodeficiency or diseases directly related to FIV. In fact, new epidemiological evidence shows FIV infection does not cause illness in most cats and does not seem to cause reduced lifespans.

Summary

Any cat having a FeLV-positive SNAP test result is considered to be actively shedding virus, regardless of its health status. A cat that has a FeLV-negative SNAP test means it is not viraemic, thus not shedding virus, but does not necessarily mean it is free from infection.

On the other hand, the true FIV status of a cat remains difficult to determine in-house. A positive result could mean persistently infected, maternal antibody, vaccine-induced antibody or a false positive, whereas a negative result could mean true negative, early infection or false negative.

Regardless of the result, the true relevance of the FIV status in the acute management of an otherwise healthy cat is questionable, considering the new epidemiological findings.

June 19, 2017
Preconceptions

Many preconceptions about the veterinary profession exist, with many of us having heard the old “is that seven years of training?” or “vets are all loaded” comments (cue eye roll). But what about on a personal level?

Now I’ve finished vet school and passed (yippee!), I’ve been faced with a couple of misconceptions when I’ve told people I’m a qualified vet (pending graduation).

Most frequently – and from almost every person who didn’t already know I’ll be starting a mixed job – I’ve been faced with the assumption I’ll be a small animal vet. After the fourth time this happened, I started to wonder…

Do I have the “smallies vet” look? Is there even a “look”?

I always thought I had the look of an equine vet, if anything. Is it because I’m slight and average height? Perhaps it is assumed someone of my build couldn’t possibly wrestle a sheep or calve a cow.

Old-fashioned ‘values’

Perhaps the prejudice stems from deeper than that. Is it because I’m female?

Despite the proportion of graduates entering the profession now being 80% female, I think the public still expects a farm or mixed vet to be male. Why? A simple misconception or an age-old prejudice whereby it is assumed men are more intelligent than women?

So far, I have been lucky to have never found myself in a demeaning situation in veterinary practice in the UK because of my gender (other than having to clarify it to avoid assumptions based on my name alone). I do, however, have colleagues who have been faced with sexism in a veterinary context.

Maybe it just hasn’t happened to me yet, or maybe I’m too bloody-minded to notice. I think that’s why the assumptions about my career choice took me by surprise.

Midlife crisis

Another odd question I was asked recently was: “Are vets like GPs – arrogant middle-aged men?”

I didn’t really know how to answer that…

Yes, there are older vets (not always men) who have something of a superiority complex and view internships as a rite of passage, whereby it is to be expected to be overworked and underappreciated and, because they went through it once – and have progressed in their career – they now have the right to treat the interns like dirt.

So yes, I guess so. There’s no question many of these exist, but many more wonderful, experienced vets exist who remember how hard it was in the beginning and try to help, teach and guide you where they can.

The veterinary profession is changing and, although it might take a while for the preconceptions to catch up, the public view of it will change too. Maybe I’m wrong and I’ll still be fighting the assumptions 40 years down the line.

Like they say, to assume makes an ass out of u and me!

June 18, 2017
Giardia SNAP test
Following last week’s discussion about pancreas-specific lipase tests, this week we look at Giardia SNAP tests.

Giardia is an important differential diagnosis in domestic species presenting with gastrointestinal disease, with a reported prevalence varying between 10% in household dogs and up to 100% in canine shelters and breeding colonies.

The Giardia SNAP test.

Younger animals – particularly younger than six months – and the presence of both acute and chronic diarrhoea have been found to have a higher likelihood to be tested positive for Giardia. However, the accurate identification of giardiasis continues to be problematic, particularly in chronic cases.

Several reasons exist for this:
- The shedding of cysts is often intermittent.
- Excretion of coproantigen may continue for several weeks, despite resolution of clinical infection. This is because it is a protein expressed by the organism during cyst formation, not the whole organism.
- Reinfection can occur after a period of clinical resolution.
- Chronically infected animals can often be asymptomatic.
In-house test

The Giardia SNAP test is an in-house test that detects faecal Giardia antigens. Although this test boasts to have both a high sensitivity and high specificity – 95% and 99.3%, respectively – be cautious in interpreting the results as they are based on a population with high disease prevalence (100%), which is not characteristic in most general populations.

In a prospective study with naturally acquired canine chronic subclinical giardiasis by Rishniw et al (2010), it was found this test has little value as a screening test because of its low positive predictive value (probability a positive result being a true positive), especially when the prevalence of disease is low (10% or less).

This means a positive result is substantially more likely to be a false positive, supporting the complicating factor of persistent coproantigen beyond clinical resolution of disease.

High negative predictive value

Despite this, the test has a high negative predictive value – a negative result being truly negative – meaning it is useful in helping rule out the disease.

In a nutshell, consider your patients’ likely risk of infection. If the risk of giardiasis is low, a negative result helps you rule out the disease, but a positive result is non-conclusive due to the high risk of false positive. However, if the risk of disease is high – for example, puppies from shelters or breeding colonies – a positive test will help confirm the diagnosis.

With regards to tracking patients treated for Giardia, if clinical signs have resolved, due to the high chance of false positives, repeating the test does not provide valuable information.

Giardia intestinalis. Optical microscopy technique: Bright field. Magnification: 6000x (for picture width 26 cm ~ A4 format). Image by Josef Reischig / CC BY-SA 3.0
June 14, 2017
Using canine pancreas-specific lipase test
Accurately diagnosing pancreatitis in dogs is so tedious and difficult, we used to wish for a single test that could save all that hassle – hence the arrival of the pancreas-specific lipase (PL) test, designed to help vets worldwide with this difficult situation.

So, how do I use this test? I don’t use it to diagnose pancreatitis, but to help rule out acute pancreatitis.

Stay with me…

Standard diagnosis

The pancreas-specific lipase test.

First, let me go back to the basics. Historically, pancreatitis is diagnosed based on a combination of supportive evidence from medical history:
- physical examination findings
- complete blood count
- biochemical analysis
- abdominal ultrasound
- occasional histology
The reason to do all these is because no parameter is sensitive or specific enough.

Ruling it out

PL is exclusively of pancreatic origin, which inherently gives PL tests a high sensitivity (reported to be between 85% to 95% in acute pancreatitis) and thus has a high negative predictive value (the probability subjects with a negative screening test truly don’t have the disease). This makes this test useful in ruling out acute pancreatitis.

Notice how I specifically mentioned acute pancreatitis? Chronic pancreatitis is often associated with fibrosis and atrophy, so is not usually associated with leakage of pancreatic acinar cell enzymes, and thus makes this test insensitive to diagnosing chronic cases.

Looking at specificity, PL tends to have a variable specificity – between 59% and 98% depending on the test methods used – meaning it has a modest positive predictive value (the probability subjects with a positive screening test have the disease).

False positives

In a prospective study assessing the diagnostic accuracy of SNAP PL and Spec PL tests, Haworth et al (2014) found 40% of the 38 dogs presenting with acute abdominal disease gave a “false positive” result when used to diagnose pancreatitis. This supports the fact disease in organs closely associated with the pancreas or the pancreatic ducts – liver or duodenum, for example – can cause concurrent mild inflammation of the pancreas without causing clinical pancreatitis itself.

Personally, I have removed foreign bodies several times from patients who were referred for suspected pancreatitis.

My take on the SNAP PL is a negative is highly unlikely to be pancreatitis, which, in itself, is useful information as it helps rule out a common disease, but a positive can still be caused by many other abdominal inflammatory diseases and an ultrasound performed by a skilled operator is still needed.
June 6, 2017
Don’t fear tuition fees
With the upcoming general election, the question of changing tuition fees has cropped up again.

People obsess over the fact rising tuition fees are putting poorer families off from sending their children to university. But I think they’ve got it wrong – tuition fees aren’t the problem.

Struggling with debt? Poor or middle-of-the-road people struggle because they don’t have enough “maintenance”, not because they have to pay tuition. IMAGE: pathdoc / Fotolia.

Tuition fees are only paid back once you earn enough to manage it. Therefore, they don’t affect the student in the present, while he or she is studying. Out of interest, I recently logged into my student loan repayment account and was presented with a pretty scary number.

Irrelevant

Having calculated what I’ll pay back on my starting salary, I found, to begin with, the debt will actually continue to increase because I would be paying off less than the interest that accumulates every year. That just seems ludicrous – how will I ever pay it off? The answer is I won’t. The loan is written off after 30 years; so, assuming I won’t come into a massive sum of money or win the lottery, the total owed is irrelevant.

I’m not really sure of the economics of how on earth the loan companies or government can find this sustainable, but I’m just discussing how it affects the students here.

The point is, we should ignore that big scary number of total debt and just think of it as a graduate tax. You go to university to get a good education, which should give you the knowledge and skills to get a better career or progress more quickly within that career. For that, you accept a (very small) proportion of your pay packet every month disappears into the ether of student loan repayment – and, since you don’t pay it back until you reach the threshold for repayment, it is not unaffordable.

Surviving during semesters

What is unaffordable is trying to survive at university with nothing in your bank account. Poor or middle-of-the-road people struggle because they don’t have enough “maintenance”, not because they have to pay tuition. The issue is having enough money to live off now.

It’s all very well suggesting students get part-time jobs to help them pay their way through university, but that can be detrimental to the end result as it takes away time from studying and, in some degrees – such as veterinary – it becomes near impossible due to contact time and, later, rotations and clinics.

Some people do manage it, and fair play to them, but it’s certainly tough.

Stuck in the middle

IMAGE: rutchapong / Fotolia.

It’s not just the poor who struggle. In fact, the poor are better off because of means testing. It’s often the people in the middle who are stuck – those whose fates have been decided by some higher power that has ruled they’ll receive less government funding because their parents’ income means they should be able to support their children.

Wrong!

That’s okay for the rich, but for those in the middle, the family often cannot afford to stump up the difference.

What about mature students? It’s ridiculous they are still means-tested even though they could well have been living independently for years without the financial support of their parents and may not even have anything to do with them anymore.

Measured maintenance

Maintenance should not be one size fits all either. Vocational degrees, such as veterinary, require many more materials than arts degrees, for example. Over the five years of my veterinary degree, I bought:
- protective clothing (boiler suits, lab coats, wellies, waterproofs, scrubs, gloves and hospital shoes)
- equipment (a thermometer, stethoscope and dissection kit)
- books amounting to an estimated £700 (not including my laptop)
On top of that, there’s the petrol and accommodation costs of EMS placements and rotations, not to mention the fact having to do EMS in holiday time takes away the opportunity to get a summer job.

Veterinary is an expensive degree, with many applicants not quite realising how much so until they’re in too deep. So, surely maintenance grants and loans should reflect that?

The political parties are isolating young people and students for various reasons, and part of me believes it’s because they don’t understand what we want or need. We need to stop obsessing over tuition fees and ask the students themselves why they are struggling.
June 2, 2017