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Category: Opinion

  • Time management

    Time management

    Whether you’re a student making your way through vet school or a practising veterinarian, nurse or technician, mastering time management is essential if you want to balance study, work and self-care.

    One of the most popular methods is the Pomodoro Technique, developed by Francesco Cirillo in the 1980s and named after his kitchen timer that was shaped like a tomato.

    The principles of the Pomodoro Technique can be broken down to:

    • Identify the tasks/goals you want to achieve. This can be anything from finishing a draft assignment, completing study notes, reading x number of journal articles, or finishing all your histories.
    • Break them down into shorter tasks (Pomodoros). It’s important to approach this reasonably. What can you realistically achieve in 25 minutes? Keep these tasks small so you don’t fall behind and lose morale.
    • Work on the task for 25 minutes. This is an intense work period where you’re completely focused, so switch your phone to silent and avoid distractions.
    • Take a break. At the end of the 25-minute period, leave your workstation and stretch, and get a drink. Do whatever you need to do to reset your brain and get ready for the next work stretch.
    • Limit distractions. Try to work somewhere peaceful where you won’t be distracted by anyone. However, if you are disturbed by someone, the Pomodoro Technique has you covered:
      • Inform: let them know what you’re doing.
      • Negotiate: give them a time when you’ll be free for them.
      • Call back when your Pomodoros are finished and you can give them your time.

    No tomato?

    If you don’t have a tomato shaped kitchen timer at the ready, you can set a countdown timer on your phone or computer, or there are a number of free apps available that utilise this technique and can help you manage your time:

    This technique is a guideline that you can adapt to suit how you study or work best. For some people, taking a regular break when they’re really focused on a task can be interruptive, in which case just reward yourself with a longer break when the task is complete.

    Break it down

    If the task is not something you particularly enjoy then you can break it down to 12-minute time slots. Often you’ll find that, once you get started, you can usually knock off two 12-minute time blocks.

    Time management is something we all struggle with, no matter what field we’re in. For those in the veterinary profession, getting to grips with your time management approach, and fighting procrastination and distraction impulses, can give you more control over your time, therefore your life and general satisfaction.

  • Tips for improving owner compliance

    Tips for improving owner compliance

    Owners love their animals and want the best for them, but despite seeking and spending money on veterinary care, they frequently fail to follow their vets’ instructions when it comes to medication.

    One 2003 study1 found owner compliance with vet instructions in 64% of cases, suggesting something is going very wrong.

    Common reasons given by owners include:

    • lack of trust in the clinician
    • failing to remember everything in the consultation
    • confusion and misunderstanding the treatment plan
    • lack of perceived value in treatment or health improvement
    • ability to administer treatment effectively

    Ensuring effective communication

    We need to empower our clients so they can adequately follow our instructions and help bring their pets back to health. Here are some things you can try.

    Empathy

    Owners who feel their concerns have been listened to are far more likely to follow veterinary advice; build a working relationship based on trust. Even something as simple as “this must be hard for you” goes a long way.

    Reflective listening

    Summarise what the client said and relay it back to them, to be on the same page. “So Fluffy started vomiting two days ago and now she’s not eating, is this correct?”

    Ask them to reflect back

    Asking clients for their understanding of the situation is particularly useful. It is surprising how much information can be lost due to information overload.

    “We just went through a lot of information, just to make sure we are on the same page, do you mind telling me what your understanding of the situation is?”

    Outcomes assessment

    You need to make sure the owner’s expectations and concerns are listened to and addressed. Make sure this translates to practical outcomes and specific treatment steps for the owner, and involve clients as much as possible.

    • “Can I ask, what concerns or expectations you have?” This is an open-ended question that asks clients to say what they are thinking.
    • Make sure the clients are able to administer the medications to their pets.

    Written instructions

    compliance
    Image © VadimGuzhva / Adobe Stock

    Avoid bombarding clients with information and write pertinent instructions down.

    Provide a typed discharge summary containing the key points or have a notepad and pen in the consultation room so you can write down key points and provide it to them (keep handwriting legible).

    What the practice can do

    Team work

    Get the entire practice team on board with compliance protocols; everyone needs to change how they interact with clients to improve compliance overall.

    Follow up

    Follow-up calls with clients to see how treatments are going and also to see if they have come across challenges that resulting in reduced compliance.

    Keep records

    Track the current levels of compliance > implement changes > track compliance again and see if changes were effective.

    Set realistic goals

    As an example, once a month the team could reflect on what they’ve done differently, practice reflective listening skills to sharpen communication skills and develop solutions to problems that have arisen.

    No I in team

    Veterinary medicine is all about teamwork – not just within the practice, but with your clients, too. Without teamwork at all levels we simply can’t provide the exceptional care for our patients we all want.

    If we make it a team priority, the patient is the one who benefits from all our efforts.

  • Baby, it’s cold outside

    Baby, it’s cold outside

    I’ve written at length about the dangers of heat and the sometimes unforeseen risks of walking your dogs during the hazy summer days, but now the cold has well and truly crept in, it is time to consider how we keep our puppies happy and healthy this winter.

    Toxins

    With the recent snow, we’re used to feeling grit and salt crunching beneath our feet when walking outside – but have you stopped to consider the effect that has on tiny paws?

    Irritation from salt can lead to dryness, irritation and cracking of the skin on dog’s footpads, and ingestion of the salt from excessive licking of those paws can lead to toxic levels of sodium in the blood, which can lead to dehydration and even kidney damage.

    Image by Harald Matern from Pixabay

    Another hazardous toxin incredibly prevalent at this time of year is antifreeze. This product contains the chemical ethylene glycol, which can lead to potentially fatal kidney injury if ingested. Clinical signs range from excessive drinking to vomiting and even seizures. So, if you’re concerned your animal may have been exposed, don’t risk waiting – take them straight to your vet.

    Cold snap

    The cold is perhaps the most obvious danger to our beloved pets at this time of year, but it can be easy to think that their fur coats make them adapted for this kind of weather. The fact is that, aside from certain breeds like huskies, we have actually been breeding the hardiness out of our dogs for more than one hundred years.

    Many breeds – especially those imported from descendants in hotter climates – are not cut out for harsh cold. According to the RSPCA, dogs shouldn’t be kept at any lower than 10°C for long periods of time, and studies have found that walking smaller, older or younger dogs (the latter of which naturally run at a higher temperature) can also be dangerous if the thermometer starts to creep towards freezing. You wouldn’t take your granny out in -1°C in just her cardigan, so maybe don’t take your geriatric pets for a walk either.

    Of course, animals still need exercise, stimulation and the opportunity to visit nature’s toilet, but it’s important to be sensible and prioritise walks during the warmest times of the day, and to layer up if your pet will tolerate it.

    Photo by Pavel Danilyuk from Pexels.

    Festive feast

    Finally, overfeeding is something I think many of us actually aspire to in the lead up to Christmas – but while it may seem mean to leave our pets out of the festive fun (because they do have very large, cute “feed me” eyes), abstaining from feeding them human treats can actually be the kinder thing.

    This isn’t just because of the dangers of chocolate and sultanas (which I’ve gotten up on my soapbox about many a time), but because even a tiny portion of human food can sometimes double the daily calories for our pets.

    Depending on whether you have a chihuahua or an active collie, your animal’s dietary needs likely range from around 150 to 600 calories a day. If the average sausage is around 200 calories, you can see how things can quickly add up. Obesity is one of the leading causes of disease in our animals, and it’s so easily preventable.

    Spread the love

    I would love to urge everybody to spread a little extra festive love towards their furry friends this festive season and keep them healthy and safe.

    Merry Christmas!

  • Dangers of festive gatherings

    Dangers of festive gatherings

    Christmas is a great time for family gatherings, but this does not necessarily mean it is a great time for pets.

    In fact, it can often be the opposite, with veterinary clinics seeing a major increase in patient numbers that come through the door.

    One common emergency we see at the emergency hospital during the festive season is dog fight and bite wounds. As vets, we have a duty of care to educate pet owners during this time, so they – and their pet – have the best Christmas possible and do not end up in the emergency room.

    Why do dogs fight and bite at Christmas?

    Usually during the festive period, family or friends increasingly gather to celebrate. Whether it is people coming into their home, or them being taken to someone’s home, this can be confusing and cause anxiety levels to rise.

    When a family member or friend brings a new pet into the house with an existing pet, it creates competition for food, space, affection and attention – and this can lead to dog fights. Even usually mild-mannered pets can easily feel threatened by a new pet entering their territory, and may lash out.

    Increases in noise, people, decorations and general chaos during the holiday season can cause stress and anxiety. For dogs protective of their domain and the people in it, this can be a difficult and uncertain time.

    Children not used to pets, and pets not used to young children, can also be a dangerous combination. Dog bites are a common injury sustained by children during the festive period and it could often be avoided.

    Solutions

    Although dogs are part of the family, it is important owners understand leaving their dog at home when they go to a festive gathering is not leaving them out, but protecting them and making sure they are more safe, comfortable and happy.

    If hosting a party, owners can shut their dog in another room away from the chaos and noise – they will be grateful to have a peaceful space. This is a must for a dog already prone to stress.

    Children and dogs should not be left alone and should be monitored at all times. If the dog starts to show signs of anxiety and stress, it should be taken somewhere it feels comfortable and calm.

    Owners can take their dog to their vet for a behavior assessment. Anti-anxiety medications could be considered in extreme cases, but this would be a last resort.

    Communicating messages

    We can educate pet owners in the lead-up to Christmas in many ways. We can offer thoughtful, engaging and informative advice and guidance.

    Some ways to communicate festive dangers to pet owners include:

    • infographics
    • videos
    • social media posts
    • posters in the hospital or clinic
    • blogs
    • email campaigns
    • discussing the dangers at check-ups and appointments
    • newsletters
    • flyers
    • special calls to clients with an anxious pet
    • education events, such as how to manage pets and children

    Here’s to a very merry – and safe – Christmas.

  • Nutritional healing power

    Nutritional healing power

    Nutrition is a key factor in a patients recovery; in fact, numerous studies show getting patients to eat as soon as possible or providing nutritional support early has several benefits:

    • Patients start to eat on their own earlier.
    • They are less nauseous once they start.
    • Reduced mortality.
    • Improved wound healing.

    All of these contribute to overall improved outcomes for the patient.

    Encouraging patients

    At Animal Emergency Service we treat the sickest of the sick so we work hard towards encouraging patients – just like the kitten pictured above – to eat as soon as possible. So, after they have recovered from their anaesthesia we make sure there are no contraindications, we address their nausea and pain, then offer food.

    It is best for the patient and feeding to use as much of the gastrointestinal tract as possible, meaning it’s better if they eat on their own, otherwise the next best thing is an oesophageal tube, followed by a tube into the stomach, such as a nasogastric tube.

    Focused approach

    So, in combination with the management of pain, nausea and the underlying illness, we first encourage them to eat on their own. We begin with offering an assortment of different foods, warmed up to increase aromas, or ask owners to try to feed their pet.

    If they are critically ill we will take a more focused approach with feeding tubes, as they are unlikely to eat on their own by themselves for several days.

    We feel a proactive approach to early nutrition helps get our patients home to their families earlier.

  • Leave no stone unturned

    Leave no stone unturned

    Although I have lots of clinical experience and have developed my diagnostic skills to a high level, at times I will be thrown a curveball, so I should never get complacent.

    Figure 2. The lymph node resection.
    Figure 1. The black lymph node.

    The more unusual cases are the ones I tend to enjoy most, as they really get my brain working and force me to look at every possibility – something I champion in my practice.

    An unusual case

    One particularly unusual case was of septic peritonitis – an inflammation of the peritoneal lining of the abdomen caused by a bacterial infection.

    Most commonly, this is due to perforation of the gastrointestinal tract, such as a foreign body, or ulceration or from some kind of abscess often secondary to neoplasia.

    Surprising findings

    Detection of bacteria found after performing a fine needle aspirate.
    Figure 2. Detection of bacteria found after performing a fine needle aspirate.

    We were unable to determine the cause of the bacterial infection in this patient via diagnostic imagery prior to exploratory laparotomy, but suspected it was due to some kind of gastrointestinal perforation due to dilated loops of hypomotile intestine.

    To our surprise, the only thing we found was this black lymph node at the ileocolic junction (Figure 1).

    We performed a fine needle aspirate and found bacteria under the microscope (Figure 2).

    The lymph node was resected, no perforation was present, the abdomen was copiously lavaged and a Jackson-Pratt drain was placed.

    This case highlighted perfectly the importance of leaving no stone unturned.

  • Is puppy yoga flexibly ethical?

    Is puppy yoga flexibly ethical?

    Is puppy yoga the new cat café?

    Is it a new passing trend or here to stay?

    Either way, as a student with a passion for both fitness and animals, I was initially intrigued. But I can’t help but have concerns for whether this practice is beneficial for all members of the class.

    Five freedoms

    Usually applied to the context of captive animals, the five freedoms can really be utilised to evaluate the welfare of any animal outside of its natural habitat (which, technically, every dog is).

    These being freedom from pain and disease, stress, discomfort and hunger, as well as freedom to express normal behaviour.

    My main concerns when it comes to puppy yoga would be stress, hunger and disease.

    If classes run back to back, younger animals that require more frequent feeds may miss out on vital mealtimes, and there’s always the worry some puppies included in these classes are too young to be removed from their mothers. Ideally, no puppy should be removed from the dam or weaned before eight weeks of age. In larger breeds, puppies can appear older than they really are, and some breeders or yoga studios may be motivated by profits to use pups that are slightly shy of this age limit.

    The danger here is that puppies don’t typically receive vaccinations until they’re eight weeks old, and if puppies from different litters are introduced when their mother-derived immunity is lowering, diseases can be transmitted very quickly. Most vets wouldn’t advise mixing a puppy with other dogs until at least two weeks after its second vaccines (at around 12 weeks old) to allow adequate immunity to develop.

    In regard to stress, anything new or novel can be stressful to a puppy (or any animal for that matter). Loud noises, strange smells and lots of new people all at once can also be very overwhelming and scary to puppies that are yet to be properly socialised.

    Socialisation

    The socialisation window for puppies is from when they are roughly one to three months old. During this time, the animal’s perceptions of the outside world and its stimuli are being shaped by its experiences, and once that window closes, it can be more difficult for biases towards certain stimuli to be changed.

    Since the majority of puppies used in yoga sessions are between two to four months old, on paper, the practice sounds like an excellent opportunity for animal lovers to exercise and unwind surrounded by adorable puppies, with the added benefit of those puppies being socialised to grow up more well-rounded and well-behaved pets.

    Unfortunately, however, socialisation is not an exact science, and while it is incredibly beneficial to introduce puppies to lots of different things during their socialisation window, it does not mean flooding them with lots of stimulus all at once.

    This is the really tricky part, because what counts as “overwhelming” to one puppy may be completely manageable to the next. Some animals may find a room full of new people and smells incredibly exciting, while others need to be introduced to new people one at a time, with plenty of opportunity to withdraw from the experience if needed.

    It can also be impossible to predict what type of puppy you have until you place it in that situation. While a lot of behavioural aspects in our pets can be traced back to environment and genetics, every animal is unique, and just because a litter comes from docile, friendly and outgoing parents, doesn’t mean the offspring will share the same traits.

    Ensuring every puppy’s experience of a yoga session will be adequate from a welfare perspective would take a very knowledgeable and conscientious screening process that some businesses may not know how to or be able to provide.

    Yoga “pants”

    I feel that puppy yoga is probably far from a black and white picture, with the level of puppy welfare and attention to their needs varying from practice to practice. For this reason, I think it’s definitely a good idea to do your research before booking a session – whether you’re a vet or not – to make sure you’re happy with where the puppies come from, if the establishment is aware of vaccine records (and so forth), and if the puppies are given adequate opportunity to rest and retreat from engaging with the customers if they wish.

    In the same way that in the veterinary profession we are now seeing the outcomes of puppies raised during the pandemic lockdowns, we may soon see the influence of puppy yoga in the next generation of pets.

    At the end of the day, it’s up to the individual consumer to decide if the practice is for them, or if ethical puppy yoga is a bit of a stretch…

     

  • Hypoglycaemia

    Hypoglycaemia

    Blood glucose is an important parameter that should be included in every “emergency database”.

    Hypoglycaemia is considered when blood glucose levels drop below 3.5mmol/L or 63mg/dL. Symptoms can start as being vague, such as lethargy and weakness, then progress to tremoring and seizures.

    One important point is that, in an emergency setting, although reduced food intake or starvation is written in text books, unless the patient is very young or a very small size it is not a common cause of hypoglycaemia.

    The liver has a fairly substantial capacity to continue to produce glucose during periods of reduced eating or starvation.

    Common causes

    Hypo
    A blood glucose meter showing a blood glucose level of 1.8mmol/L.

    The common causes of hypoglycaemia I see in an emergency setting are:

    • sepsis: bacteria consumes glucose
    • hypoadrenocorticism: lack of cortisol
    • insulin overdose: excessive intracellular shift
    • insulinoma: malignant insulin secreting neoplasia of the pancreas
    • hepatic insufficiency: reduce production

    Treatment is fairly straightforward and the impact is often dramatic – 0.5ml/kg to 1ml/kg of 50% dextrose diluted 50:50 with saline given slow IV over a couple minutes (to reduce the risk of haemolysis).

    As the list of possible causes shows, a one-off dose of glucose is often not enough.

    Glucose supplementation often needs to be continued as a 2.5% continuous rate infusion (CRI), with frequent blood glucose monitoring and adjustments made to the rate as necessary.

    The CRI will need to be continued, as the hypoglycaemia will often continue to occur until the primary disease process is identified and appropriately addressed.

    Emergency database

    It is not uncommon to read or hear the term emergency database. This contains a number of blood parameters performed, which include:

    • blood glucose
    • alanine aminotransferase
    • lactate
    • blood urea nitrogen
    • PCV
    • total protein or total solids
    • activated clotting time
    • acid-base balance
    • electrolytes
  • 5 tips to building client rapport

    5 tips to building client rapport

    Establishing client rapport is paramount to any consultation. Without client rapport, trust is difficult to establish and clients are less likely to follow your recommendations.

    rapport
    Tip #1: Never forget to greet the pet.

    We have seen a good deal of negative publicity regarding veterinary surgeons in the media, so now, more than ever, we need to build that trust from the moment the client and their pet walk into the room.

    Here are 5 tips to help you build rapport:

    1. Never forget to greet the pet. This should come naturally to most of us, but if it doesn’t, do it often so it becomes a habit.
    2. Ask open-ended questions that enable you to get to know your client and their pet. This will help you understand more about how their pet fits into the client’s lives and helps you understand their situation. Use more focused, close-ended questions for getting specific details later.
    3. Listen! Listening skills are very important. Try not to cut the client off and listen to their concerns. There is sometimes a disconnection between what you think your client’s concerns are and what they really are. If you are uncertain what their main concerns are, then ask.
    4. Empathy. We can sometimes forget what it feels like to be on the other side of the examination table. Place yourself in your client’s shoes and remember they love their pet enough to have brought it in to see you, and are counting on you to help get their pet better.
    5. Be honest, sometimes you don’t know what is going on. By establishing rapport, you can work together with the client to develop a plan that is best for their pet.
  • Are rabbits really ‘exotic’?

    Are rabbits really ‘exotic’?

    According to PDSA [PDSA Animal Wellbeing (PAW) Report 2022], rabbits are the third most popular pet in the UK behind dogs and cats. With an estimated 1.1 million pet rabbits in the country, that’s about about a tenth of the population of pet dogs and cats, which hover around the 9 to 10 million mark.

    So, if the pet ratio of dogs/cats:rabbits is 10:1, why isn’t this reflected in our teaching? Despite rabbit populations being endemic to the UK for more than a thousand years, they always seem to get lumped with guinea pigs and the cold-blooded pets like lizards and corn snakes when it comes to textbooks or university curriculums.

    I can confidently say my education on rabbit physiology and medicine has been dramatically less than 10% of what I’ve received for small animal medicine. Perhaps this is why many vets, especially new or recent graduates, feel more confident handing off any rabbit patients to the resident “expert” of the practice or even referring to an exotics specialist, rather than seeing it themselves.

    Accessibility

    It’s a sad truth that the less convenient education and health care are to access, the less people will reach for them. By extension, the less veterinary practices that advertise care for rabbits (and other exotics), the less rabbits are likely to be registered at a practice and receive regular preventive care.

    For example, as a native to the land of Kent, I only know of two or three practices that would call themselves “exotic specialists” and I know that, for a lot of rabbit owners, traveling half way across the county to visit one of these few practices would not be practical or plausible. Perhaps this is why, according to PDSA reports, at least 11% of pet rabbits receive no preventive health care, including vaccinations.

    rabbit
    Rabbits are a social species that has evolved to live in groups, not alone.

    Education

    The value of a veterinary consultation is not simply to talk through clinical signs or address a flea outbreak in the home, it’s a chance for owners to discuss management issues or to ask for general advice. When rabbits aren’t brought in for routine consultations, then discussions about their diet, husbandry and behavioural needs don’t get to be had.

    Some vets are already worried that the development of an annual rabbit haemorrhagic disease (RHD) booster rather than biannual is going to dramatically reduce rabbit welfare by halving the number of times these pets receive a clinical exam.

    Welfare

    Of course, like all “exotics”, there’s the argument to be made as to whether these animals are suitable pets in the first place. Personally, I feel that this is a moot point for the time being.

    The fact that more than 50% of pet rabbits are housed by themselves with no companionship speaks volumes about the lack of knowledge the general public possesses on how to care for these animals. However, with more than a million of them currently out there, they’re not going away anytime soon.

    The best we can do as professionals is educate our clients so welfare can be maximised as much as possible… and that starts with educating ourselves. I hope that in the near future the landscape of the veterinary degree can shift to better reflect the current demand for exotic vets – or at least rabbit vets.