Have you ever noticed that, sometimes after starving, the haematocrit (Hct) and haemoglobin (Hgb) levels appear a little high on pre-anaesthetic bloods prior to a surgical procedure that morning?
If so, make sure you look at the figures.
If, like us, your laboratory machine produces a band with a red marker in the middle indicating some elevation, make sure you also look at the absolute figures.
I recently saw a nine-year-old boxer that, after a surgical procedure, developed redder and redder skin and mucous membranes. She had high Hct and Hgb on pre-anaesthetic bloods and subsequently turned out to have polycythaemia vera with, eventually, a Hct of 84.9.
Four episodes of venipuncture (taking 200ml to 300ml of initially very viscous blood on each occasion), plus treatment with hydroxycarbamide, and she was feeling much better.
“If you’re going to bake, you should do it properly.”
There is an unwritten rule that, at the end of each clinical placement (or, in some cases, every Friday), veterinary students are expected to produce some sort of edible creation for staff at the practice that so kindly opened its doors to them.
The cop out (and to be quite honest, more expensive) option is a box of chocolates, which, while quick and easy, can be quite pricey depending on the size of practice you’re catering for.
Another quick(ish) fix is packet baking, which usually requires the addition of a couple of ingredients, sticking in the oven and “bang”, tray bake for the whole practice. While some people swear by these – and if you buy the right one, they can taste pretty good – I feel it’s cheating somewhat. If you’re going to bake, you should do it properly.
Plus, sneaky packet baking can leave you open to awkward questions about the recipe or how you made it, and vet students are already subject to awkward daily grillings on placement, so any that can be avoided if possible would be a bonus.
So that leaves actually baking…
Now, I’m no Mary Berry, but I can whip up a good brownie or some decent cupcakes at 11pm on a Thursday night if need be.
My personal go-to recipe is for coffee cupcakes – it’s simple, involves normal cupboard stocks, is fairly quick to whip up, yet has an impressive edge. After all, most vets live on coffee, so why not add a little more to their Friday?
12 Coffee Cupcakes
INGREDIENTS:
100g butter
100g caster sugar
2 eggs
100g self raising flour
1.5 tsp instant coffee granules mixed with 1 tsp warm water
METHOD:
Heat oven to 180 degrees celcius
Mix the butter and sugar
Beat the eggs in a bowl and add the coffee/water mix to the beaten eggs
Add eggs and flour to the mixture bit by bit and mix
Spoon into cake cases and bake for 15mins
Lift the cakes onto a wire rack to cool
Coffee Buttercream
INGREDIENTS:
100g butter
220g icing sugar
1 tsp instant coffee granules mixed with 1 tsp warm water
METHOD:
Mix the above until they form a paste consistency
Once the cupcakes have cooled, spread buttercream onto the cupcakes or pipe a swirl for a more professional finish.
So, when you sit down to watch the The Great British Bake Off this week, spare a moment to think of the veterinary students up and down the UK burning the midnight oil trying to concoct something even passable in an effort to persuade their vets they know how to do something right.
Cats, particularly long-haired varieties, can be carriers of ringworm but show no clinical signs at all.
Diagnosis in the absence of skin lesions is made by either Wood’s lamp over the entire body (only 50-60% of positives will fluoresce), or by taking coat brushings and incubating the hairs, follicles and debris in a dermatophyte test medium (DTM).
Once a cat is diagnosed as a carrier, treatment is the same as for those with lesions: oral itraconazole.
Even after consecutive negative results, the cat should always be considered a carrier, as it’s so difficult to eradicate ringworm from the environment. Treatment is still considered worthwhile, however, and effective cleaning will reduce/prevent further outbreaks.
The “suck it and see” approach can be perfectly reasonable depending on the situation. Photo: Freeimages.com/T.Rolf
“Prognose, prognose, prognose” is a phrase uttered regularly by a vet I’ve spent a lot of EMS and pre-uni work experience with.
Anyone would think he’s trying to drive the point home.
But it makes a lot of sense: although we have myriad diagnostic tests available to us, they won’t always give us a definitive answer, and the owner of an animal, for whatever reason, will often choose the option of “we’ll try this and see” before resorting to getting a clear answer, if necessary.
Suck it and see
Although many vets (and future vets) are perfectionists by nature who would, ideally, want to establish exactly what’s going on before throwing anti-inflammatories (for example) at an animal, it’s not always possible or cost effective to do that – and that is something we have to accept.
The “suck it and see” approach, however, can be perfectly reasonable, depending on the situation.
In my vet’s words: “half the time I haven’t got a bloody clue what’s going on” – and that’s okay. You can’t always get to the bottom of why and what is occurring in your patients, but symptomatic treatment is often both a reasonable and successful approach.
His advice is that you don’t necessarily need a diagnosis, but you MUST give a prognosis. You must forecast what you expect to happen with the treatment given (and give time frames) and inform the client that if there isn’t a marked improvement, if things go backwards or the disease process/condition behaves in an unexpected way, they must bring the animal back for reassessment ASAP. That way, the client has the responsibility to judge for themselves whether something more needs to be done.
Red light green light
This vet also promoted the use of a simple “traffic light” system, through which you decide – on a case-by-case basis – whether you’d rate them a “green, amber or red”.
Green – you know exactly what is wrong with the animal, you have treated accordingly and expect if to make a recovery (or, in the case of things like diabetes or atopy, can manage the condition successfully long term).
Amber – you don’t really know what’s going on, but it isn’t immediately life-threatening and diagnostic tests aren’t urgent at this stage. The “suck and see” approach, by treating symptomatically or “just letting it run its course”, is appropriate for these patients (e.g. an unexplained episode of vomiting or diarrhoea).
Red – not necessarily life-threatening but the patient needs diagnostic tests ASAP or admitting to the surgery for supportive/palliative care (e.g. suspected parvo, 10/10 lameness).
This simple system helps students (and vets) assess the severity/urgency of conditions seen in the consult room there and then, whether they have a diagnosis or not.
Importantly, he also said you can’t have two “ambers” in a row – if a patient sent away with symptomatic treatment returns a week later with no improvement, you must take further action and start testing.
There’s a limited amount that can be done in a 10-minute consult and the key is to be able to make a quick judgement on what the next step is during that time.
Even if you don’t have a diagnosis, prognose, prognose, prognose!
Low-level laser therapy (LLLT) is a rapidly growing adjunctive therapy in companion animal practice.
Low-level laser or cold laser therapy is a non-invasive procedure that uses light to stimulate cell regeneration and increase blood circulation, thus helping damaged tissue to repair.
LLLT can be used to treat dogs with arthritis, tendon or soft tissue injuries, and to promote wound healing.
Most lasers are programmable to a range of frequencies in order to treat many different types of problems in dogs.
It’s always a real pleasure welcoming new graduates to our practice team, and we have been very privileged to employ two excellent vets in the last couple of years.
As well as regular coaching sessions, we’ve also introduced an informal mentoring arrangement with an experienced (non-management) veterinary member of our team. This is very informal and what goes on – other than knowing they meet fairly regularly – I have no idea.
However, the feedback I’ve received is positive from both parties and, with the now-increasingly documented challenges faced by new vets in developing professional skills in their early years, this will hopefully go some way to helping.
Consider routine ear cleaning in chronically waxy ears.
When I attended the North American Veterinary Conference back in January, I was surprised to hear one of the dermatologists say he did not recommend cleaning ears [in chronic cases].
That being said, I’ve heard other specialists espouse the virtues of routine cleaning from upon high.
I’m a great believer in the rule of “if it ain’t broke, don’t fix it”, but I do see atopic dogs that develop significant build up of wax – and routine cleaning with my favorite ear cleaner twice weekly just keeps the use of prescription drugs to a minimum and increases the interval between flare ups.
So, my tip for this week would be to consider this in certain cases.
Despite expecting a purely equine placement, I’ve had a bit of a crash course in camelids over the past two weeks.
As alpacas and llamas continue to increase in popularity throughout the UK, more and more first opinion vets are having to apply their knowledge from other species to these slightly odd creatures.
Having had no previous experience with either of them, even just handling and trying to read their behaviour was a bit of a challenge.
Being social animals who get extremely upset when alone, one in-patient (a llama) was accompanied by two of his friends to minimise stress levels.
Sadly, said llama didn’t make it, but his acquaintances were able to travel home together, considerably less stressed than a lone llama forced to leave its dead friend behind.
Drugs done different
I also accompanied two of the vets to go and castrate eight alpacas, which thankfully went smoother than expected. In addition to learning the procedure itself – which is very similar to castrating a dog, apart from leaving the incision open and only using local anaesthetic – I learned how some drugs must be used differently in these animals. For example, lidocaine has to be mixed with sterile water rather than used straight.
Luckily, we had plenty of help and most people involved were experienced handlers, which made the whole operation run fairly smoothly, even if everyone did get splattered with blood and alpaca spit.
I found out the hard way that alpacas have extremely powerful legs and sharp claws, having had one narrowly miss my face but leave a considerable scratch along my neck, and another tear straight through a pair of very hardy waterproof trousers, in addition to leaving me with numerous bruises.
The point of an alpaca
What’s the point of an alpaca?
Having also been to castrate a llama that day, this sparked a discussion about the purpose of camelids in this country.
Llamas are sometimes kept as guard animals for flocks of sheep, and alpacas for their wool – but, other than being expensive pets or “field ornaments”, what is the end market for breeders?
A breeder present for the mass emasculation expressed his support for castration since, as the popularity of these South American natives grows, so does the number of unwanted individuals.
This discussion on the welfare of unwanted animals reminded me of Princess Anne’s suggestion that a UK horse meat market would decrease the number of unwanted horses.
Could the same be said for camelids? Would an alpaca meat market in this country help the problem, and would it ever take off anyway? Being a very lean meat, I think there could be a market in a nation of people yearning for a healthy lifestyle.
Having visited South America in 2013, I’ll admit I was more inclined to try alpaca steak than another of their native dishes – and believe it far more likely to take off in the UK than guinea pig.
VBJ editor James Westgate speaks to Niall McFerran about the advantages of selling own-brand products from your veterinary practice and how working with The Soft Chew Company can make this a reality.
As well as my veterinary role, I also work part time for the Open University Business School, tutoring the first year of its master’s degree in business administration (MBA).
I recently attended a staff event and thoroughly enjoyed chatting to the academic staff there. However, I couldn’t help but reflect on the fact I was introduced as “Graham the vet” rather than as a tutor – evidence of the high esteem of our profession perhaps?
On another note, I recently came across three acquaintances who have left the profession, which I personally think is sad, but it has to be said they all seem very happy with their choice.
My point here is that, as much as I love being in veterinary practice, I also really love tutoring and I think it has contributed to my wellbeing. So my personal top tip here would be to enjoy doing something non-veterinary too. Perspective is great!
