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Category: Students

Eating disorders and the veterinary profession

The general public associates the word “anorexia” with the eating disorder characterised by refusing to eat to lose weight, which, in human medicine, has the more specific name of “anorexia nervosa”. As vets, we use the word the term “anorexic” in the slightly different sense of being a clinical sign our patients exhibit – defined as “a lack or loss of appetite”.

Is the veterinary profession practising what it preaches when it comes to nutrition?

When referring to vets themselves, however, these definitions blur together a little, but I believe many vets frequently exhibit clinical signs that may or may not be part of an eating disorder.

While there is a lack of hard evidence or figures for eating disorders within the veterinary profession, it is estimated 10% of UK veterinary students suffer from eating disorders (not limited to anorexia nervosa), which is higher than the figure for the general UK population, which sits at 6.4%. (vetlife.org.uk).

Another branch

We are all made very aware of the mental health statistics and suicide risk of vets, and eating disorders are another branch of that tree.

Despite the lack of evidence to back up the theory, based on anecdotes alone, I’m willing to bet eating disorders, or even intermittent “anorexia” (the clinical sign), are more prevalent in qualified vets than the general population.

I’ve lost count of the number of times I’ve been on EMS and spent the entire day in the car with the same vet, going from call to call and not seeing them eat once.

I’m probably on the other end of the scale; I tend to get indigestion and heartburn from excess stomach acid production if I don’t eat regularly enough, so I tend to stress about the next time I’m going to eat (which turns into a vicious cycle because those symptoms also develop as a result of that stress). Therefore, I always try to ensure I have a packed lunch so I never get caught out.

On the road

Veterinary professionals on the road can often find themselves picking up fast food, which will be of long-term detriment to their health.

The number of ambulatory equine or farm vets who don’t appear to carry food in their cars is astounding.

They often rely on getting time to stop for food – which, inevitably, results in them not eating for the whole working day or picking up unhealthy fast food or snacks, which isn’t really much better.

When discussing my observations with fellow students, many of them have similar tales, and the problem is not limited to ambulatory practice.

While many vets and nurses in small animal practice will have a slightly more routine structure to their working lives, there’s always the odd mad day, week or month when they just can’t seem to grab a minute to supply their digestive system between consults, surgeries and emergencies.

Despite my own claim of always being prepared to avert such situations, sometimes they’re unavoidable.

I’ve found myself a few select times during rotations when I’ve been so rushed off my feet, trying to get everything done or see clients, that I haven’t eaten lunch until well after 4pm. Then, it’s likely I’ve got to that stage of being “past hungry”, but, as it is at that point I normally get headachey and feel a bit weak, I force something down despite not really wanting it any more.

Can’t or won’t?

Now, there’s a subtle difference between anorexia (a “lack of appetite”) and physically not having a chance to eat despite the grumbling in your stomach and the agonising knowledge there’s a pretty decent lunch waiting in the fridge in the next room – but it’s a fine line.

If a client has been waiting 20 minutes for you already, surely another two won’t hurt while you inhale a sandwich? Are vet staff just too busy to eat sometimes or are they not finding the time themselves? No matter how stressed and busy you are, you should still be able to satisfy the basic human right of being able to eat.

I believe the problem of the profession not eating properly is a combination of possible eating disorders, stress related anorexia and the working environment.

Take responsibility

Finding time to eat is crucial, says Jordan, for the health of both the profession and its patients.

I have previously expressed my opinion of the poor work-life balance within the UK veterinary profession, and ignoring rest breaks that are a legal requirement in almost any other field – while not entirely to blame – certainly doesn’t make it easy for vets to look after themselves.

On the other hand, vets need to take personal responsibility for their own health and find time to eat during the working day – if you don’t look after number one, you won’t be providing optimal care to your patients.

As much as skipping one meal might seem like a short-term solution to helping a patient that little bit sooner, it will be at the detriment of your clinical ability in the long term.

Evidently, this is not a clear cut problem and, as such, there’s no fix-all solution.

However, I think vocalising these issues is a good starting point if we wish to become a more healthy, sustainable profession in the future.

November 2, 2016
The consequences of making a mistake
Beef farms in Scotland can be quite picturesque.

Fertility work makes up a large proportion of cattle veterinary work in the UK and, after spending a month on the farm rotation at university, I can appreciate the importance of getting it right – and how hard it can be.

Experienced large animal vets make it look easy – they scan the uterus and ovaries, and decide what drug to give to aid getting the cow in calf, all in a minute or two.

In the meantime, I’m still fumbling about trying to palpate what, I think, may be the uterus or ovaries while the cow squeezes and gradually cuts off the circulation in my arm until I can barely feel my fingers.

Meanwhile, the vet has zipped through several cows already.

When things go wrong

What happens if you misdiagnose a pregnant cow as negative and administer prostaglandin, or give a cow steroids without realising she’s in calf?

On one fertility visit this week, we discussed when things go wrong. For example, what if:
- you misdiagnose a pregnant cow as negative and administer prostaglandin (PGF_2α)?
- a vet gives a cow steroids for any number of reasons without realising she’s in calf?
The outcomes of both of these scenarios are almost inevitably abortion, which can have a number of repercussions on the farm – and, potentially, the vet.

Negligence or misconduct?

Many new graduates are terrified of being called up for “fitness to practice” for making a mistake such as those aforementioned. However, during a Veterinary Defence Society (VDS) workshop at the SPVS Lancaster weekend earlier this year, it was emphasised a difference exists between negligence and misconduct in the eyes of the RCVS.

What I took away from this session was, in simple terms, negligence involves making a mistake – such as missing a diagnosis, giving the wrong treatment accidentally, eliciting side effects from something due to missing something in the case history – whereas misconduct is actively doing something you know you shouldn’t – such as trying to cover up a mistake, lying or misleading a client.

Mistakenly giving PGF_2α to a pregnant cow would be classed as negligence and, on the whole, the VDS would have your back; the farmer may receive some compensation for his losses, but the incident wouldn’t tarnish your career. In the same situation, misconduct would be denying you had administered any treatment.

In short, you won’t get struck off for easily made, one-off mistakes, but you may if you lie about them.

In the news

Our conversation about accidentally aborting cows led us to discuss the case of Honey Rose, the optometrist convicted of gross negligence manslaughter. News reports vary, but, from what I can gather, she failed to diagnose papilloedema (swollen optic discs) in an eight-year-old boy, which would have been an indication of the hydrocephalus he died of five months later.

It is reported she claimed to have been unable to examine his eyes properly because he had photophobia – a claim considered false by the judge. However, she had also failed to look at retinal photos taken by a colleague, on which the papilloedema was evident.

Going by the RCVS’ rules, missing the diagnosis or not looking at the retinal photos would be negligent. However, denying she’d been able to carry out a thorough examination, despite written records suggesting otherwise, would be misconduct.

Rose was found guilty of gross negligence manslaughter and was handed a two-year prison sentence, suspended for two years, and a 24-month supervision order, and was ordered to complete 200 hours of unpaid work.

In your defence

As vets, we have the VDS to help us in these situations – and, while it would be truly awful to make a mistake resulting in an animal’s death, we would not be at risk of imprisonment.

Doctors and dentists also have defence societies that will fight their corner, but optometrists? To my knowledge, an equivalent does not exist – and this was the first case of an optometrist convicted of manslaughter in the UK, which added to the complexity of the legal battle.

The death of a little boy is devastating, but, as medical professionals know, death is a risk with many procedures, no matter how small the risk may be. It’s frightening to think jail could be a consequence for those in the medical profession.

So, while I gradually lost the sensation in my right arm as I tried to reach an ovary of the 10th cow in a row, I mulled this over and realised I was extremely thankful for the safety net the VDS provides and would not take working with animals for granted.

After all, if I’d decided to be a doctor instead, I could be rummaging around in another human’s back end rather than a cow’s!
- For further details of the Veterinary Defence Society and its services, visit www.thevds.co.uk
October 19, 2016
My various reasons for running
Maintaining a work-life balance can be difficult within the veterinary profession, unless you actively make an effort to do non-vet things.

Although a “poor runner” Jordan is taking on a half marathon in aid of two charities close to her heart.

Joining a sports team or other society requires a certain level of commitment (depending on the level), and this can be helpful to keep a frequent scheduled period of “escape time”.

Another good way to motivate yourself to do “other” things is to set a personal target to aim for.

Procrastination aid

Several months ago, in the middle of fourth year exams, I think I was subconsciously craving any method of occupying time that didn’t involve staring at a textbook – so, in my revision-frenzied madness, I signed up for the Great Scottish Run Half Marathon.

Just filling in the application and perusing training plans gave me a few sweet minutes of procrastination at the time. But after exams had been and gone, and final year rotations loomed, I started to question what an earth I’d gotten myself into.

I’m a poor runner at the best of times, sporting an age-old ankle strain and intermittent shin splits – the furthest I think I’d run before beginning training was 5km (about seven years ago, when I was considerably fitter) – but I gritted my teeth, donned the ankle support and shin splint tape, got a decent pair of trainers and set out on a run.

Staying motivated

Despite my misgivings, by following a training programme almost impeccably, I’ve gradually been building stamina and have surprisingly avoided aggravating my shins.

Now, having nearly finished the training, and with the half-marathon only two weeks away, I can appreciate how much having a target to aim for has helped me keep fit throughout my first few rotations – and with many of them being the sort of rotation notorious for having long hours, it would be so easy to miss out on exercise.

In addition to keeping motivated to exercise, the main aim of my insane challenge (for me anyway) is to raise money for two deserving charities with which I have personal connections.

Determined to finish

Help In Suffering has helped keep the people of Jaipur rabies-free for 14 years.

The first charity is The Air Ambulance Service, which saved my life five years ago when I fell from a horse and sustained near fatal injuries.

The other charity, Help In Suffering, runs a neutering clinic in India where my friend and I gained valuable skills last year, having been let down by another placement and stranded in an unknown country. This charity’s vital work has kept the people of Jaipur rabies-free for 14 years.

I still hate running, but I’m glad I’ve tried to overcome the challenge to support these fabulous charities. While I know it’s going to be tough on the day, I’m determined to cross the finish line and not let down my supporters who have so generously donated.

If you would like more information about the charities, or to donate, please visit my sponsor pages below:
- Air Ambulance – justgiving.com/jnsinclair
- Help In Suffering – justgiving.com/hisrunning
September 19, 2016
The consigned colleague conundrum

Many universities put veterinary students into groups for final year rotations, in which they remain for the year. Others keep students in the same group for the majority of rotations and shuffle them around for selectives only.

However, selective rotations at the University of Glasgow run throughout the year and, to accommodate as many of the students’ choices as possible, we have a different group of students for every rotation.

Another difference between the universities is whether students have a choice with regards to the group of people they are put with.

Familiarity breeds…

Original image © grgroup / fotolia.

Some universities allow students to name one or two people they would like to be in groups with (if possible), or even name students they really don’t want to be in groups with – all in the strictest confidence, of course.

We don’t get a choice at Glasgow, but scope exists to swap groups, once the rotation timetable is released, if you change your mind about selectives or want to avoid someone in particular.

Is one method superior to the others? Being in the same group for the year could result in a strong team who know each other really well and play to each other’s strengths and weaknesses. But, on the other hand, it could also easily become tiresome if niggling annoyances build up throughout the year.

Where students are able to suggest colleagues they would like (or not) to be grouped with, the likelihood of begrudging fellow students in your group could be minimised, but, ultimately, isn’t likely to be eliminated entirely.

Hobson’s choice

Should we get a say, though? In the real world of work (now only nine months away) we aren’t likely to get a choice about who we work with, unless a very strong first impression is made that would make you either very keen to take a job or extremely put off.

Ideally, we need to be able to work with a range of different people – those we do and don’t like – in a professional context and keep personal grievances out of the workplace. Realistically this can be difficult, but we may as well start learning how to do that now.

I think changing groups every rotation provides a balance between being thrown in with people you may not know very well (or like very much) and not being stuck with them for an extended period of time; each of our rotations are four weeks in duration.

So far, I’ve really enjoyed getting to know people I’d previously barely, if ever, spoken to and, in some cases, building solid new friendships. I’m obviously biased because I love Glasgow, but I think we’ve nailed the system perfectly.

August 31, 2016
Communication is key

Recently, I have been engaged in a battle with my internet provider and – ignoring the fact I’ve been without the world wide web for a month – no one seems capable of doing anything about it.

If avoiding angry customers is the aim, communication is key, says Jordan.

Despite these grievances, it’s actually a) the communication factor and b) lack of desire to please the customer annoying me most.

Over the years I’ve worked in retail, and I have been a waitress, during which I was expected to bend over backwards for the customer for fear of garnering a complaint.

I even remember training sessions where we were shown graphs showing the number of complaints received versus words of praise, and how likely the customer would be to spread the word regarding bad service compared to good.

The gist of it all was to not anger anyone because bad news travels fast… and this is just as applicable in the veterinary profession.

The customer is always…

Contrary to the popular saying, the client is most definitely not always right, and as the point of a veterinary consultation is for us to impart our professional knowledge gained through – long and thorough – training, we are obliged to possess pretty fantastic communication skills.

Yes, having to tell a client their beloved pet died unexpectedly during routine surgery is a bit different to being put on hold for the umpteenth time because the advisor on the phone hasn’t read the account record properly, but the underlying principle is the same – so good communication is essential.

As vets, continuity isn’t always possible, but if you have an unknown client on the list you would be expected to brush up on the history and have a vague idea of why they’ve made an appointment. Anything less would be unprofessional – so why do other businesses think this is acceptable?

Strength in numbers

Is there anybody listening?

For these international corporations, the single customer is just a drop in the ocean – losing a few hundred quid a year when I cancel my contract is just pennies to them, and no matter how much of a fuss I kick up, realistically, it won’t touch their reputation.

For vets, however, it’s different – any complaint not only reflects badly on the individual involved, but on the practice and also the profession.

We cannot afford to lose the trust of our clients over silly things like calling a male dog “she” or not spending a few minutes reading through the patient’s notes before they walk into the consult room.

Poor communication is one of the most frequent reasons a complaint is made to the RCVS, and I suspect this is why the vet schools now have a much bigger focus on communication – to help us hit the ground running and (hopefully) avoid such negativity.

Practise makes perfect

Communication skills come with experience, and while they aren’t classically thought of as something that can be taught, we can be armed with certain tools to help us communicate more effectively.

The practical communication skills sessions we’ve had over the years involving actors have been an ideal way of letting us practise dealing with “difficult” clients before being in that situation for real. And now, in our final year, we’ve transitioned into taking our own consults, either with the clinician keeping an eye on us or confirming our findings afterwards and asking the client any questions we may have forgotten.

Being a vet encompasses so much more than clinical knowledge and surgical skills, and my recent phone arguments with various technical support advisors have made me appreciate just how highly trained we are in terms of communication – and that’s something we should aim to maintain to continue to be respected as professionals.

August 17, 2016
Change for the better

The UK veterinary profession is suffering.

While a documented shortage of graduates does not exist as in previous years, significantly less fuss has been kicked up about the announcement of the new Aberystwyth-in-conjunction-with-RVC vet school, compared with the opening of the Surrey Vet School in 2014.

Surrey vet school: a bolt from the blue?

Is this because we knew Aberystwyth was in the pipeline so are not shocked by the announcement, or has the profession kept quiet because we do need more vets?

The problem is not a lack of graduates, but a lack of “experienced vets” and a shortage of vets staying in the profession after a few years of graduation.

This begs the question: why?

The simple answer is, as shown in last year’s “Voices from the future of the veterinary profession” survey conducted by Vet Futures, the profession, in its current state, does not meet expectations of those entering it.

Essentially, we feel undervalued, underpaid and overworked, and lack a sense of life outside veterinary.

Undervalued

The profession has an image problem, in many respects. It is becoming more commercialised, not just because of corporate takeover, but because clients expect more.

We seem to be moving away from the respected professionals who have dedicated their lives to helping animals and, as such, are praised for performing little short of a miracle in medical and surgical feats, and towards the providers of a service that, if not absolutely perfect and costs next to nothing, will only be complained about and bad-mouthed to other customers and competitors.

Sadly, the economic climate has caused much scaremongering, bringing vets to the absolute disposal of the pet owner for fear of losing clients and, therefore, not being able to balance the books.

I feel very strongly part of the reason our services are so undervalued is the NHS (See Jordan’s July 2014 blog post, “I Blame the NHS“).

The everyday person has no concept of how much medical procedures, diagnostics and therapeutics cost. I’ve done the research – prices for private medical care are found fairly easily, but NHS costs? Nigh impossible.

So how can we blame the public for not having a clue how much a radiograph costs? The public perception of veterinary in this country needs to change and I don’t think it will without transparency on human medical costs in conjunction with our veterinary ones.

Overworked

“I struggle to see how many full-time vets’ hours fall within the legal limit,” says Jordan. Image © alarts / Fotolia.

Depending on the kind of practice you’re in, or going into, the relative feeling of being overworked will differ. I realise my points won’t apply to every practice in the country and this is sweeping general opinion on the UK profession as a whole. However, I struggle to see how many full-time vets’ hours fall within the legal limit.

The legislation is complex, with loopholes in the Working Time Regulations 1998 (WTR) possibly allowing certain practices to skirt round some of the “rules”, such as the designated 11-hour consecutive rest break in each 24-hour period and the minimum 24-hour rest break in each 7-day period.

On-call work is difficult to classify, but, in essence, the signing of a workforce agreement (probably as part of an employment contract) means the employee is agreeing to to provide out-of-hours cover that impinges on these designated rest breaks.

Some final year rotations at university I know are well beyond the limits set by the WTR (although the legality is sketchy since we’re not employed while we’re students).

“It’s not a nine-to-five job,” was a comment given with regard to rotation hours. That’s tough love: you’re going to be worked into the ground when you qualify, so you may as well get used to it now. But why? Why can’t veterinary be a nine-to-five job? It certainly is in other countries.

The profession is changing and I really hope this is the kind of change that comes about nationwide. With the increasing popularity of outsourced out-of-hours cover and shift work, why can’t a vet clock off at 5pm, enjoy some exercise, cooking, social activity, whatever and come back to work refreshed the next day ready to put in 110%?

Achieving work-life balance

We have numerous talks at uni about mental health awareness and the importance of work-life balance. But how is it possible to achieve a work-life balance if you’re working from 8am to 8pm and, even on the nights you’re not on call, you essentially only have time to grab something to eat and sleep.

What kind of life is that?

“It’s all very well lecturing us on being conscious of having a work-life balance, but what if it is beyond our control?” Image © DOC RABE Media / Fotolia.

It’s all very well lecturing us on being conscious of having a work-life balance, but what if it is beyond our control, as in so many cases?

I know for a fact, if the profession remains stuck in its ways, I will become just another statistic and leave the UK, if not the profession entirely, within a few years.

Don’t get me wrong, I have loved my rotations so far and the sense of fulfilment when I’m actually getting a handle on things is excellent, but I know I will resent my job if it does not allow for some enjoyment outside of veterinary.

But will it ever change? I think something has to give soon, or the profession will find itself in dire straits before long. How would change come about? If we wait for one practice or chain to provide a great work-life balance and rely on the trend to catch on, I think we’ll be waiting a lifetime. But what if the regulations changed?

I don’t really want to talk about Brexit (I’m sure a little piece of me dies inside every time that word is uttered), but the potential change to employment law (which has mainly been derived from the EU) could allow for changes specific to medical professions to protect us from “burnout”.

Overtime pay should exist in the veterinary world, as it does in any other “normal” job, allowing for those maniacs who want to work 24 hours a day to do so at their leisure (or those who need the extra cash), but not at the detriment to those who don’t wish to. Working out a vet’s base salary as an hourly basis is just depressing. And it shouldn’t be.

I keep hearing phrases such as “the profession is changing” and “it’s an exciting time”. I genuinely hope that is the case and we become the progressive generation we like to think we are, and drag the profession kicking and screaming with us into the modern world of enjoying life outside veterinary and moulding our careers around our lives – not the other way around.

July 30, 2016
How to anaesthetise a reindeer

I’ve written before about omnicompetency, but the word is mostly used in the sense of vets being able to work in mixed practice and tackle the veterinary care of horses, dogs, cats and farm animals in the same day – certainly, the first thing to come to mind would not be a reindeer.

However, on my recent equine placement, the staff were met with quite the challenge when a reindeer was referred in.

“Reindeer aren’t something you’d expect to see every day in practice,” says Jordan.

With a history of acute coughing/regurgitation, the reindeer in question had a suspected food impaction in the cranial oesophagus. Conscious radiographs and an ultrasound scan (he was a very well-behaved reindeer) confirmed suspicions of foodstuff, but it didn’t seem to be in the oesophagus.

Collaborative anaesthesia

The equine team – with help from one of the farm vets and some phone calls to other colleagues and practices that had dealt with reindeer before – came up with an anaesthetic protocol and proceeded to surgery.

The reindeer was induced with ketamine and xylazine before a gastroscope was used to try to visualise the larynx and trachea.

There appeared to be a diverticulum or outpouching from the oesophagus at the level of the larynx, which is where the food impaction had settled.

This discovery triggered a discussion as to whether our findings could be normal in some reindeer – similar to the Zenker’s diverticulum in people – since its appearance suggested a congenital, rather than acquired, defect.

A gastroscope was used to aid placement of an endotracheal tube and the reindeer was, subsequently, maintained under anaesthesia with isoflurane. He was positioned carefully in consideration of the rumen and ventilated throughout the procedure, which was to incise into the pouch using a lateral approach and remove the impacted food material.

Back to his reindeer games

He recovered well from the anaesthesia and was happily bounding around a paddock before long, eating some specially imported moss provided by his owner.

Reindeer aren’t something you’d expect to see every day in practice, but it was a great example of how veterinary knowledge can be adapted and applied to new situations, with the added benefit of working together with others with varying levels of experience to come up with a solution.

June 30, 2016
Standing surgery

On my latest EMS placement at an equine hospital, I’ve seen a number of surgeries – some done under general anaesthesia (GA) and others under standing sedation.

After getting over the fact a horse can stand half asleep while having its face drilled into and not really seem to care, I started wondering about the pros and cons of both approaches.

“Sinus surgery to remove a bony mass – that is me in the pink scrubs holding the head,” says Jordan.

Generally, standing sedation is accompanied by less haemorrhage and, therefore, increased visibility – in sinus surgery, for example. It also eliminates many risks associated with general anaesthesia. However, asepsis may be harder to maintain (for example, if the horse moves and the surgical site comes into contact with something that isn’t sterile, such as the stocks).

Lower costs

For the client, procedures conducted under standing sedation would be much cheaper than the costs incurred from general anaesthesia.

During general anaesthesia, atelectasis contributes to the risks from an intraoperative point of view, as well as myositis and cardiac concerns (of which the risk can be considerably reduced by the use of acepromazine in the premedication protocol).

A risk of injury also exists during recovery and knockdown, such as worsening incomplete fractures or other self-inflicted wounds, which can, to some degree, be prevented by carefully assisted knockdown and paying careful attention during recovery with the use of ropes.

Achieving optimal sedation for standing surgery can, in some cases, be difficult. For example, the horse must be adequately sedated, but not so much it is swaying; this can be an issue for intricate surgeries, but may be more of a problem for diagnostic imaging (such as MRI or bone scintigraphy).

In these cases, I have seen morphine used – opposed to the usual sedative culprits, such as detomidine, butorphanol and xylazine – and it seems to achieve sedation without so much swaying.

Choosing correct method

The choice of standing sedation versus GA depends on the type of surgery required, but a number of procedures can be done using either method.

Last week, I saw tie-back surgeries (prosthetic laryngoplasties to correct laryngeal hemiplegia) done both ways, which made for an interesting comparison. The standing tie-back was considerably quicker, taking into account the time for knockdown and recovery, as well as surgical time.

Both tie-backs were followed by a laser hobday procedure (ventriculoectomy), meaning both procedures were conducted under the same sedation in the standing horse, whereas the tie-back performed after GA had to be followed later the same day, after the horse had recovered sufficiently to undergo standing sedation for the laser.

The second tie-back was a repeat of a previously failed procedure, hence GA was chosen to allow removal of the first prosthesis.

The standing technique is still being tweaked, but, despite reports of postoperative infection in more cases than ideal, the easier access to the laryngeal cartilages while standing – and the avoidance of further risks associated with GA – contribute to continued work to perfect this method.

Some surgeries, however, can still only be done properly via GA. Colic surgery, for example, requires significant abdominal access and, often, examination of the gastrointestinal tract. It is also highly recommended septic joint surgery and lavage is conducted under GA to ensure optimal sterility on closure of the joint.

Conclusion

Having now seen both types of surgery in the horse, it’s astonishing how quick standing surgery can be, and how much goes into the preparation and recovery for GA – even for the shortest of procedures. In one surgery, division of the aryepiglottic fold, causing epiglottic entrapment, took a matter of minutes – if you didn’t count the couple of hours total taken for premedication, knockdown and recovery from GA.

The choice very much depends on the procedure, and is assessed for each case. I do, however, think the advantages to standing surgery are significant and look forward to seeing more standing techniques developed in the future.

June 13, 2016
The beginning of the end of vet school

Exams passed, Jordan can walk the halls of Glasgow’s small animal hospital without feeling like an imposter.

As regular readers of this blog may have noticed, I was a little apprehensive about starting my final year at veterinary school…

Having already been in the small animal hospital for two days, we finally received our results – confirming I and many of my fellow classmates had passed our exams and could now wear our final year jackets without guilt and walk around the hospital without feeling like imposters.

However, despite now knowing we had qualified to be in the hospital, it still felt like we had been thrown in the deep end.

In at the deep end

My first rotation was emergency and critical care, with the first part being internal medicine. The first couple of days were spent frantically researching the background of patients coming in for appointments, bumbling through clinical exams and brushing up on my rusty practical skills.

It was my first time taking consults alone and, after missing out key questions the first few times, I eventually got into the swing of things and made fewer mistakes.

Image: seregraff / Fotolia.

Despite feeling like I didn’t know anything to begin with, I at least managed to scrape together a few sensible ideas when clinicians tried to worm differentials out of us. It has been a steep learning curve, changing the way of thinking entirely to apply things to a real patient in front of you, which usually has not read the textbook.

OOH my goodness

Just as I was beginning to feel comfortable with medicine, we swapped to out of hours – which, against my presumptions, turned out to be a really enjoyable week.

I adjusted to nights far easier than I expected and was powering through until one particularly long night when a bulldog came in with a suspected gastric dilatation volvulus (GDV).

This was the first genuine emergency we’d been involved in and stress levels were running high. Having rapidly set up fluid boluses, taken radiographs to confirm our suspicions, checked lactate levels and run in-house bloods, we went through to theatre. After a very long night of surgery and having warned the owner of an extremely grave prognosis, we were delighted to see said bulldog looking bright and happy the following evening, eating and pulling us down the corridors to the runs outside.

Not all GDVs end with such a happy ending, as we had learned earlier in the week – a dog that underwent the surgery at its own vets came to us for overnight care in ICU and, after a rocky night of a supraventricular tachycardia that we struggled to keep under control, crashed the following morning, was resuscitated successfully once, but could not be saved when it crashed again minutes later.

Hearts, not brains

Coming from nights straight back into days, however, was much harder and I felt like a zombie for the first day of my cardiology week.

On the subsequent days, when my brain was working again, I was able to make a bit more sense of echocardiography and gain a better understanding of some conditions and the tray menu options available.

I also learned a bit more about the genetics of Bengal cats and found trying to heart scan a cat that’s only two generations away from a leopard cat can be quite challenging (and may involve chasing said cat around the ultrasound room for some time, following an artful escape act).

This year isn’t going to be a picnic, but, although I already feel exhausted, if last month is anything to go by, it will be an enjoyable one.

May 17, 2016
Behind the scenes at Fitzpatrick Referrals

Two years ago, I received an email to confirm an EMS placement at a certain well-known veterinary practice in the south of England.

Fitzpatrick Referrals: arguably one of the most recognisable practice premises in the UK. Image taken from the VBJ Practice Profile.

In my head, the placement remained far off until – three days after one set of exams ended and four weeks before another set – it seemed to sneak up on me far quicker than expected.

Brain slightly frazzled from exams, but orthopaedics (hopefully) fresh in my mind, I found myself pulling into the car park of Fitzpatrick Referrals.

Making sense of things

Being such a large and busy hospital, the first few days were a bit manic, with lots of new faces and protocols to get used to. To be honest, just finding my way back to the staff room was quite a challenge.

As my first time in a referral hospital, there were notable differences from first opinion practice, and the sheer number of surgeries the vets would get through in one day was impressive.

I was able to see a lot of surgery, which helped make sense of the numerous abbreviations our orthopaedic lectures presented, for both the conditions and procedures – an FCP corrected by PUO or the options of TPLO or TTA for CrCLR meant very little until I was able to see the procedures and understand a little more why they helped correct the particular conditions.

(If you’re still wondering: FCP = fractured coronoid process; PUO = proximal ulnar osteotomy; TPLO = tibial plateau levelling osteotomy; TTA = tibial tuberosity advancement; CrCLR = cranial cruciate ligament rupture).

Standard versus innovative

Noel Fitzpatrick: veterinary visionary? You be the judge.

The above are among many other “standard” referral procedures carried out at other referral orthopaedic hospitals throughout the country. There are, of course (as seen on television), other surgeries Noel carries out. Whether these are considered groundbreaking, experimental or too much is open to interpretation, but they are certainly unique to the “Supervet”.

Noel himself is clearly very passionate and believes wholeheartedly his innovations provide the best options in the world for his patients.

Many other vets would disagree. Many believe he goes too far; that the prolonged recovery and rehabilitation time for heroic procedures are not justified in patients that live in the moment and cannot perceive the future advantages temporary discomfort may bring.

Having been “behind the scenes”, I’m still not sure where I stand on these heroic procedures, but am certain the ethics must be considered on an individual case basis, as is done at Fitzpatrick’s – for example, limb-sparing surgery was decided against in a case of osteosarcoma in which survey chest radiographs showed metastasis.

Camera shy

Undoubtedly, Noel is an extremely clever bloke who has dedicated his life to providing animals with the best orthopaedic technology possible, but his methods will always remain controversial.

The placement was certainly a worthwhile and very different experience. The stationary cameras around the practice were easy to ignore, but observing a surgery that was being filmed, with the surgeon re-explaining the procedure for the third time at a different angle, not so much.

A very definite highlight was scrubbing into a TPLO and being handed the bone drill, to my utter terror and delight at the same time. I’m not sure the novelty of putting a screw into a dog’s leg will ever wear off.

May 16, 2016