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  • EMS: life, death and lost holidays

    EMS: life, death and lost holidays

    EMS is something I haven’t touched on too deeply, which is odd considering how much of a vet student’s life it takes up.

    For those not familiar with the term, EMS stands for extra-mural studies: work experience conducted outside of university term time.

    Each vet school organises its EMS slightly differently, but at Bristol we’re required to complete a total of 12 weeks preclinical work experience over the first two years of our course (“preclinical” essentially meaning anything from shadowing a vet nurse in practice to shovelling manure in a stable). It’s basically to get everybody up to speed where animal handling skills are concerned, regardless of individual animal backgrounds. Levelling the playing field as it were.

    As a second year student, this is the world I’m living in and, since I completed roughly 12 weeks of work experience to get into university in the first place, as you can imagine, EMS has become a big part of my life, and roughly a third of this year‘s summer holidays.

    Pros and cons

    There are highs and lows to every aspect of uni, but it can be difficult not to let the sheer volume of extra work that needs to be done get to you. Vet students, after all, have some of the highest numbers of contact hours among their cohorts, up there with medicine and dental students, who are also required to carry out extra non-curricular work when the majority of the student body are taking three or four months off.

    But it’s important to remember there’s a reason for it, and although you’re not yet aiding diagnoses or learning neutering techniques, preclinical EMS teaches you a lot of skills you’ll need to have by the time you first step into practice, such as patience with and confidence around animals.

    It can also help prepare you for the harder aspects of the job, and that’s really what I want to address here.

    muck heap
    “Preclinical EMS essentially means anything from shadowing a vet nurse in practice to shovelling manure in a stable,” explains second-year vet student Eleanor Goad. Image © Nigel Baker / Adobe Stock

    There at the end

    Working on a farm for any decent period of time will allow you to become familiar with two things: life and death.

    Death is a part of the veterinary career that’s easy enough to understand as a concept, but far more difficult to teach in practice; vets face the death of patients regularly enough that their mental health as a profession rivals that of human medicine for being so staggeringly low. In my mind, it’s definitely an area of our education that could be improved upon, but the trouble is it’s so difficult to do.

    For example, I have been volunteering at my local practice for almost seven years and yet I have never seen an animal euthanised. This isn’t for lack of opportunity but, rather, a case of respecting the owner. I’ve had to leave many a consult once the bad news is broken, regardless of the level of training because, quite understandably, having your animal euthanised is a very personal and emotional experience that you wouldn’t want a stranger observing – especially one with an open notebook and poised pen.

    The (other) problem with death

    The trouble is, giving patients the space they want and deserve might not be in their best interest in the long run – especially if it goes on to produce a generation of veterinarians who’ve never seen euthanasia until a whole three or four years into their training.

    Nobody wants some trainee hovering over such a private and, often, devastating moment – I know I certainly wouldn’t – but if the procedure is to be done with the same level of maturity, professionalism and understanding as it demands, this takes observation and learning, like anything else.

    This is one of the reasons why I think EMS plays such a vital role in shaping young vets outside of the lecture theatres and in the real world.

    Perfectly placed

    My latest placement is on a pig farm, and despite being one of the most enriching and enjoyable weeks I’ve completed so far, it has hit me, emotionally and personally, in way I had not anticipated.

    I’ve spoken before about how working with livestock intended for human consumption is different from working with cherished pets (and it definitely is), but an animal is still an animal and, especially when you’re starting out, it can be difficult to acclimatise to the professional separation the job often entails.

    That said, I’m incredibly glad for my experiences over the past week and in every placement I’ve been lucky enough to visit. Farmers and veterinary professionals alike offer up so much of their time and experience to help you improve your own skill set in ways you never even knew it needed. You grow in ways you didn’t expect and your opinions change a little bit each day in light of everything new you learn.

    On paper, EMS might sound like a lot of lost holiday time and long days of manual labour but, in reality, you only get out what you put in. And what you get out is often invaluable.

  • Developing a mutually agreed plan

    Developing a mutually agreed plan

    A cuddle was not enough for this patient (see top image) – he clearly wanted to use me to get a better vantage point and sharpen his claws at the same time.

    It’s a bit hard to develop a mutually agreed agenda with a cat, but have you ever stopped to consider whether, as a veterinarian, you do that for your clients?

    Making an ass of u and me

    We assume our clients know what’s going to happen, right?

    We start with a history, then a physical examination, then develop a plan, and so on – but this assumption is frequently incorrect, and our clients often don’t know what’s going to happen.

    Communicating the agenda is a powerful tool in letting pet owners know what is going to happen next – and when it is delivered in an appropriate way, it allows them to have a say in the plan.

    Is it okay?

    So, how do we develop a mutually agreed plan? We communicate it and ask if it is okay.

    For example, “Is it okay if we talk for a couple of minutes first about what has happened then we will have a look over Fluffy?”, as they could be thinking “Why are we talking and not looking at my sick pet?”.

    Another example is when you want to do a full examination first before looking at the sore leg. Some clients may be thinking “why is the vet looking at his mouth, it is back left leg!” – ask: “Is it okay if I check Fluffy over first and then I will look at her sore leg at the end? I just want to make sure everything else is okay.”

    Explaining the next steps

    When you communicate the agenda, you are informing the clients what is going to happen next. This reduces uncertainty and feelings of anxiety; and helps build trust and rapport as you are being clear, open and honest, and you are inviting them to have input.

    This is one important tip for building a partnership with your clients in the consult room, but is also applicable to all staff members and their interactions with clients.

  • How to take feedback like a champion

    How to take feedback like a champion

    Feedback can be difficult to take on board, especially if you are not accustomed to receiving it. But it is a powerful tool that speeds up your growth.

    Don’t be threatened by it… embrace it

    You have to flick the switch in your head consciously, because you need feedback to grow professionally.

    Therefore, open your arms and breathe it in. This is not always easy, but you need to start somewhere.

    It can fast track your professional development

    We have our blind spots – we may think we are doing well, but, in reality, may be rubbing people the wrong way or upsetting people.

    A great personal example:

    I thought I was great to work with in surgery because I did not yell or throw things at people. I am also usually outgoing. However, when I am concentrating in surgery, I don’t speak. Through feedback, I found out this was very unnerving for colleagues – they thought I was unhappy with them. This blew my mind.

    Disconnect… or view yourself as a product

    If you find it difficult to receive feedback – or if it always feels like it gets the better of you, and you feel anxious, angry or upset (and any associated negative feelings) – then distance yourself from it a bit.

    Take a step back personally and view yourself as a product. This has helped me.

    If you had a product you were selling, wouldn’t you want feedback to make sure it was good? Thinking of yourself as a product makes you want to ensure you are the best for your job, role or responsibilities.

    How to get feedback

    It is easier if you ask for feedback before an event or task – for example, before delivering a presentation or going into a meeting. Asking for feedback afterwards means you are ready for it and the person giving you feedback will feel safer providing it.

    Also, don’t be attached to the outcome. Feedback is great, whether positive or negative – and you grow more effectively with negative feedback.

    Overwhelmed?

    If you get feedback and are about to feel overwhelmed… breathe.

    Breathe it in, slow your roll and control your emotions as they do not serve you – feedback serves you.

  • Keeping pets happy in the heat

    Keeping pets happy in the heat

    The English summer, though tardy as usual, has finally arrived – and while this is cause for celebration among humans, I thought it best to share a few words of caution about keeping our furry friends equally happy as the temperatures rise.

    Around this time of year, vets get a surge of patients coming in with signs of heat stroke, sunburn and dehydration – conditions that can often be prevented with just a few changes to routine and a little extra care.

    Unfortunately, dogs can’t sweat through their skin as we can, and rely predominantly on panting, drinking and radiating heat via their noses and paw pads to keep them cool. For this reason, a number of factors should be considered when it comes to making sure your pet is comfortable and healthy in the hotter months.

    Heat hints

    Looking for signs of panting and lethargy are good ways to tell if your pet is getting uncomfortable, but a good rule of thumb is: if it’s too hot for you in shorts and a T-shirt, it’s probably too hot for your dog in his permanent fluffy jumper.

    If your dog requires a muzzle, try to find one that allows it to drink and pant, to help it regulate its own temperature.

    On days at the hotter end of the spectrum, it’s also a good idea to walk your dog during the cooler hours – such as in the morning or evening/late afternoon – rather than at midday when the pavements are hottest, as cement and gravel that is too hot can burn its foot pads.

    Five second rule

    Blue Cross recently posted about a “Hot Day 5 Second Rule” for judging whether it’s too hot to walk your dog. It advises to stand on the pavement barefoot and if it’s too hot for you to bear after five seconds then it’s also too hot for your dog’s feet.

    It’s not just dogs, though – cats only sweat through their paws, so they, like dogs, will often choose shadier spots and/or sprawl themselves out over the coolest place in the house or garden they can find.

    However, unlike dogs, cats only use panting as a last resort, so if you see your cat panting, it’s a definite indicator you need to help it cool down. If your cat prefers the indoors then by making sure your house is ventilated and cool, with lots of water in supply, it should be pretty self-sufficient, as cats often are.

    If you have an outdoor cat, restricting its access to the garden on the hotter days of the year may seem cruel, but it is probably the best thing for it – especially if you’re intending on leaving the house, and won’t be around to let it in to drink and take shelter if it needs to.

    Hot exotics

    I haven’t seen a lot mentioned online about caring for your exotic pets in a heatwave, so I thought I’d briefly touch on it here. Of course, I’m not an expert, and if you wanted professional advice on how to properly care for your snake, lizard, bird and so on then asking your local vet is definitely the best course of action.

    However, small factors exist that people tend not to think about, such as turning off the heat mats and/or lamps in your reptile cages, as they’re not always needed when the external temperature is suitably high. Making sure cages aren’t in direct sunlight, but also aren’t in a draught, can be a fine line, but is also imperative.

    This goes for bird cages as well, and it can also help keep the cage cool to keep it lower to the ground (since heat rises) and, of course, provide plenty of water – both for drinking and bathing in certain bird species.

    Subtle signs

    We all want the best for our pets, and it can be easy to forget their needs are often different to ours in subtle, but important, ways. Knowing the signs of when your pet is happy and when it is not is the best way to help prevent issues such as heat stroke and lower the number of cases seen in practice.

    And, as always, if you’re unsure what signs to look for, or what precautions to take at any time of year, don’t hesitate to make an appointment with your vet to get some helpful advice.

  • Que será, será

    Que será, será

    What will be will be: this mantra is one of a handful of things that kept me sane during university exam season.

    Exam stress has definitely taken its toll, and, one week after finishing, I am still none the wiser as to what day it is or whether I’m coming or going – but that’s the price you pay for memorising everything from organ locations to the proportion of “medium” sized chicken eggs in the UK (38.5%, apparently, for those of you who might be curious).

    Exams are a trying time for anyone, no matter your degree, or, in fact, your level of education; I remember GCSEs putting me through my paces.

    Aftermath

    I’ve already written a lot about exams and their stresses. But, right now, I want to address a different kind of stress – a whole new hurdle to jump when really, in all fairness, you just deserve a break – results day.

    In truth, no matter how horrendous my exams ever were, nothing ever succeeded in keeping me up at night like results day. Hours and days and weeks of effort, sweat and most likely a few tears, all culminating in what will inevitably feel like a very anticlimactic, but nevertheless staggeringly significant number of digits on a page (not even a physical page at that when you reach university).

    Ben & Jerry’s
    “You deserve that pot of Ben & Jerry’s (or five)” – Photo © Sarah Richter / CC BY-NC-ND 4.0

    It’s a real reminder of how much you must love your course, and, in my case, how much I want to be a vet. After all, there’s no point going through all that, alongside a few weeks of mandatory poop scooping, more affectionately known as extramural studies (EMS) if the light at the end of the tunnel isn’t worth it.

    Treat yourself

    But enough about exams, what do you do afterwards?

    The term “self-care” is thrown around a lot these days, but I think it’s just as important to treat yourself after exams as it is right before and during. What you just did took time and sacrifice, and, however your results turn out – whether they reflect the effort or not – you should still be so proud of that effort.

    You deserve that pot of Ben & Jerry’s (or five), that night out with your friends, or night in, slobbing around in your PJs and a face mask, watching all the Netflix you’ve deprived yourself of for the past month.

    Have faith

    Yes, results day is a scary prospect and not something to forget about completely, but the fact is, once exams are over, you’ve done what you can, and whatever will be will be.

    I find this thought rather comforting; although, for others, I know it’s somewhat frustrating. It takes a lot to relinquish control, especially when it’s something you’ve worked so hard for, but it’s important to have faith in yourself and to take the well-earned rest that is the summer holidays.

  • Always on: a new perspective

    Always on: a new perspective

    It was a couple of weeks before I set off for Bristol and an uncertain, but exciting life on the vet course that my mother – who’s been a member of the medical field for many years – began pointing out various dogs and cats to me as we passed them, stating that, once I began studying medicine, I would never look at these animals in quite the same way.

    They would be patients, not just pets, she reminded me. In the same way she herself subconsciously clocked subtle signs and symptoms in the people she interacted with day to day, not even meaning to look for things a person without the same training or knowledge would ever think to look for.

    At the time, I was dubious. To my mind, a cavalier King Charles spaniel would always be, to me, an adorable cavalier King Charles spaniel. Two years on, I can, perhaps begrudgingly, admit to her she was right.

    A blessing and a curse

    I think one of the greatest strengths of any medical profession – their extensive and almost unfathomable reserve of knowledge – is also their greatest curse.

    There’s a reason they say doctors and nurses make the worst patients – it’s most likely because when you‘re drilled over your 5-year to 6-year course – whatever your poison – to consume gargantuan amounts of knowledge about anatomy, physiology, microbiology and how it all goes wrong, when it comes to your down time, you can’t just switch that off.

    There’s no way to know all you need to know between 9am and 5pm, and then just un-know it until you need it again the following morning. Knowing everything that can and could go wrong is perhaps one of the plethora of reasons why medical staff – human and veterinary – suffer from stress the way they do.

    Can’t help but think about…

    To put this into context for you, I am a lover of fluffy breeds and, aside from empathising with them a little over the hotter months, I didn’t ever think too much about them in the way of anything remotely pathological.

    Now, though, I can’t help but catch a glimpse of what is undoubtedly a very well-cared for animal without thinking about the dermatitis, the ear mites, the conjunctivitis…

    I don’t want to be thinking about that, I can assure you. I’d much rather be thinking about the adorable dog I’ve just witnessed – but take it from me, it’s a really hard thing not to do; much like being told not to think about elephants and then finding yourself only thinking about elephants.

    Wealth of knowledge

    Don’t get me wrong; I love having this ever-growing pool of information at my fingertips. But is the knowledge of every disease or parasite I could ever contract slightly stressful? Yes. Is the act of learning all of these also somewhat stressful? Also yes.

    But learning all this is half the reason any of us decided to become vets, doctors, nurses and so on in the first place. There’s a lot of good that can be done with it. For starters, I was completely unaware of the medical issues surrounding brachycephalic breeds until my first year on the vet course. If vets don’t know the worst that could happen, how can they advise owners on how to prevent or manage it?

    One of the greatest responsibilities of medical practitioners is to educate; to pass the knowledge on. It will be a part of your life in a much wider capacity than just your career, so it’s not something to be scared of, but taken advantage of.

  • Head versus heart

    Head versus heart

    For those, like myself, who started off wanting to be a vet from a very young age, it was most likely with the sweetest of intentions: wanting to take care of animals (particularly the cute ones), wanting to help people – just wanting to make everything okay.

    More than a decade on, I’d like to think those are still three solid goals I’ll carry with me throughout my career. But as my journey towards that career continues, I’m beginning to learn not all problems have an easy solution and, a lot of the time, you have to choose your professional opinion over your personal one.

    Sense of community

    Since I first stepped foot on a dairy farm, I’ve fancied myself as a farm vet. This was initially fuelled by a new found love of cows, but, over time, was reinforced by a fondness for the farming community and respect for those who worked within it. When I discovered that, despite the profession being largely dominated by women, most vets within the agricultural sector are male, I think it just spurred me on more.

    Though I may still choose to pursue this path some day, my concept of what it means to be a farm vet has drastically changed over the past two years of my vet course.

    I’ve touched on the fact before that treating working animals is a far cry from small animal practice. Of course, we’re still driven by the same desire to protect animal welfare, comfort and respect; but when you’re dealing with animals that are part of somebody’s livelihood (which are essentially an asset of a business) you also have to juggle costs and efficiency – and, in some cases, make a hard choice you wouldn’t have to make if the animal in front of you was, say, a golden retriever.

    Weighing the options

    That’s not to say evaluating costs isn’t a regular part of small animal practice. In my local practice I’ve seen more than a few cases where owners are forced to have their pets euthanised because they simply couldn’t afford the treatment.

    It’s also a matter of thinking what’s best for the animal, even if the owners do have the funds. Chemotherapy, for example, is incredibly expensive. If an owner wants to opt for this treatment, the first opinion vet must still consider whether the animal would ultimately benefit or suffer from the treatment, even if life was prolonged.

    Do the right thing

    Judging quality of life is a job that spans the medical fields of both humans and animals. The difference is vets have the legal right to euthanise when they feel the suffering outweighs the good.

    This, I think, will always be the ultimate battle between head and heart for any vet – the inherent will to prolong and protect life, weighed up with the knowledge of what, in that specific situation, is the right thing to do.

  • A vet’s role in an environmental crisis

    A vet’s role in an environmental crisis

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

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

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

    Food industry

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

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

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

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

    Turning the tide

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

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

    Sustainable diet

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

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

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

  • Create rules when you can’t remember everything

    Create rules when you can’t remember everything

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

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

    DSC04162_non-feat
    Gerardo Poli with colleague Alex Hynes.

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

    For example…

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

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

    About rules

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

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

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

  • Staying motivated

    Staying motivated

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

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

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

    What’s it all for?

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

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

    How bad do you want it?

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

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

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

    Getting sidetracked

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

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

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

    The epiphany

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

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

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

    Remind yourself

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

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

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