staging.vettimes.com

Blog

SNAP cortisol test
While hyperadrenocorticism is not an uncommon incidental finding in patients presenting to our emergency clinic, hypoadrenocorticism is a lot less common. Or, possibly, more frequently underdiagnosed.

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

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

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

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

Suspicious signs

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

Imperfect ELISA

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

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

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

Still useful

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

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

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

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

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

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

The SNAP FeLV antigen/FIV antibody test.

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

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

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

FeLV prevalence

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

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

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

FIV prevalence

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

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

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

Combination test

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

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

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

Summary

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

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

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

June 19, 2017
Preconceptions

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

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

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

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

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

Old-fashioned ‘values’

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

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

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

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

Midlife crisis

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

I didn’t really know how to answer that…

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

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

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

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

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

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

The Giardia SNAP test.

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

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

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

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

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

High negative predictive value

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

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

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

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

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

Stay with me…

Standard diagnosis

The pancreas-specific lipase test.

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

Ruling it out

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

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

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

False positives

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

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

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

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

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

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

Irrelevant

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

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

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

Surviving during semesters

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

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

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

Stuck in the middle

IMAGE: rutchapong / Fotolia.

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

Wrong!

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

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

Measured maintenance

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

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

The political parties are isolating young people and students for various reasons, and part of me believes it’s because they don’t understand what we want or need. We need to stop obsessing over tuition fees and ask the students themselves why they are struggling.
June 2, 2017
Race place terms and conditions
Competition to win one race entry to the 2017 Simplyhealth Great Birmingham Run Half Marathon.

CLOSING DATE for entries is 11:59 on Friday 30 June 2017.

By entering the prize draw, entrants agree to be bound by the following terms and conditions:

The winner will be chosen at random, providing they answer the following question correctly: Q: What is the race distance for the 2017 Simplyhealth Great Birmingham Run Half Marathon?

The winner will receive one guaranteed race entry to take part in the 2017 Simplyhealth Great Birmingham Run Half Marathon, which will be held on Sunday 15 October 2017.
1. Entries must be made via the vettimes.co.uk website.
2. Open to United Kingdom residents over the age of 18 years only. Proof of eligibility must be provided upon request. Only one entry per person.
3. Offer not open to employees of Simplyhealth Professionals, event partners, sponsors or anyone else connected with the promotion.
4. The prize that can be won is: One guaranteed race entry to the 2017 Simplyhealth Great Birmingham Run Half Marathon, to be held on 15th October 2017, with reasonable travel expenses covered. Entry must be taken in 2017 and cannot be deferred until 2018.
5. The prize does not include anything other than that specifically mentioned in paragraph 4 above.
6. Travel Expenses: Simplyhealth Professionals will cover your reasonable travel expenses to and from the event. Details of any rail/bus/taxi/fuel/parking costs for which reimbursement is sought can be claimed for from Simplyhealth Professionals
7. The winner will be notified after the competition has closed by Simplyhealth Professionals. The winner will be notified by 17:00 on Friday 14th July 2017.
8. No responsibility is accepted for entries that are illegible or lost, delayed or damaged electronically or online during the promotion. Entries that are not submitted in accordance with these terms and conditions and/or that are delayed, damaged, incomplete, altered, and illegible or otherwise defective will be disqualified.
9. The prize is non-transferable. There is no cash alternative.
10. Simplyhealth Professionals will provide a website link to the official Great Run registration process. This must be completed by Friday 4th August 2017. Failure to complete the registration process by Friday 4th August 2017 will result in the winner forfeiting the prize.
11. The Promoter, Simplyhealth Professionals, reserves the right to feature the name, image and location of the prize winner in any future marketing materials, website publications, promotions and/or prize draws.
12. The Promoter’s decision is final.
June 2, 2017
The 7 stages of revision

Finals are imminent, so my colleagues and I are going through the annual rite of passage more commonly know as “revision hell”.

Let’s break down the various stages… I think I’m at around number 5.

1. Denial

A couple of days into your revision, you’re thinking of the long weeks between now and the exam – you’ve got ages, it’ll be fine.

You’ve done two hours of “reading” today – most of which was probably spent trying to find the right set of notes, ordering your highlighters into an appropriate rainbow effect and googling funny cat videos.

You deserve a break – after all, in a few weeks you’ll be snowed under and won’t have the luxury of time to do other things and enjoy life outside the imprisonment of your degree.

2. Panic (stage 1)

This is probably somewhere around a couple of weeks into “proper revision”.

You’ve still got a few weeks left, but, be honest, you probably haven’t been massively productive so far. You’ve looked at a calendar, maybe drawn up a timetable, looked at the list of topics to cover… and absolutely crapped yourself.

3. Bargaining

Shortly after panicking, you try to work out how you’re realistically going to tackle this.

“If I cram 10 lectures worth of notes into half an hour, I should be able to cover the course in time,” you reason.

Maybe at this point, you’re already deciding which topics to bin and, instead, go for a “strategic approach”, which involves trying to work out questions likely to be asked. However, in the time you spend looking up past papers, asking people a year older what they were asked and trying to calculate what hasn’t come up in a while, you probably could have just read about those diseases and conditions you are sacrificing.

You also waste a lot of time looking up the elusive course information documents you definitely should have found a long time ago, but were not really listening when advised to do so in your final year induction lecture.

You desperately work out which parts of the exam you have to pass, where you could make up marks, and the worst possible mark or grade you could get and still pass.

This doesn’t really change your outlook at all.

4. Past caring

You feel like you haven’t seen daylight for days or worn anything but “comfy clothes” for a while, while the diet/fitness regime has gone down the toilet.

You’ve been locked in this hell forever and still feel like you have forever left (probably about two weeks). You’ve lost all motivation and just want it to end now.

5. Panic (stage 2)

Anytime from a week to a few days before, panic sets in again.

Okay, you really have to get your act together. It’s now or never – you’ve got five years worth of stuff to learn in four days… sounds reasonable?

But you don’t have time for a full-scale breakdown. This panic stage tends to be more productive and actually kicks your lazy butt into action. Get the caffeine on board and get on with it.

6. Hysteria

The combination of exhaustion and your brain feeling like total mush results in a drunk-like hysteria. Something that probably isn’t that funny makes you cry with laughter; a diaphragm deep bellow, as if you’d forgotten how to laugh or be happy.

You realise you’ve probably gone a bit mad, but don’t even care – the end is in sight.

7. Acceptance

Whether it’s the night before the exam as you close the books and try to get a good night’s sleep, or as you walk into the exam room buzzing from the seven Red Bulls you downed in the past four hours off the back of yet another pre-exam all-nighter, you will finally reach a point of acceptance. There’s nothing more you can do now except stay awake long enough to finish the paper your degree depends on.

It’s all very well when people who’ve likely never sat a veterinary exam offer you extremely unhelpful and unrealistic advice – such as “drink green tea instead of coffee”, “get lots of sleep” and “take regular breaks” (jeez, if I took a break every 15 minutes, it would take 20 years to get this degree) – but you’ve got this far using whatever “unhealthy” method works for you, so believe in yourself. It’s the last push now and you’ll never have to sit an exam again (maybe).

Anyway, I’d better get back to my cocktail of Pro Plus, chocolate and Earl Grey.

Good luck!

May 16, 2017
The art of veterinary medicine

So, with less than three weeks until finals, my friends and I have finished rotations. Some of us have had job interviews and some have accepted job offers. This is all getting a bit real…

Supposedly, we’re ready to take on the outside world as real vets. We’ve got heads full of knowledge and hands that have meticulously repeated sutures, catheterisations, and injections to maintain muscle memory. But what we haven’t got is experience.

Sure, we’ve consulted while on rotations and, before that, we had communication skills tutorials, and although these were realistic – with very good actors screaming at you for losing their hypothetical cat out the practice window or bursting into tears as you explain that their dog died under anaesthetic – they just aren’t quite the same.

Gaining experience

Any consultations we have done on rotations have been fairly straightforward, with the vet in the background to interject or, at least, within shouting/pager distance to check anything you’re unsure of.

We have been involved in high stakes situations where things have gone wrong or an animal’s life has depended on the treatment and care we’ve contributed to – and as much as rotations are aimed at making you think and make your own decisions, you’re always steered in the right direction, or someone intervenes before you do something momentously stupid.

We may feel like we’re carrying a good deal of responsibility at times but, at the end of the day, it hasn’t been our necks on the line.

Cash concerns

“We are assigned a number of tasks throughout final year that make us consider cost […] but you never really have to have that conversation with the owner as such.” Image © Andy Dean / Fotolia.

And what about money? A lot of our consulting in final year is done at charity clinics, where the treatment is often free or very cheap. This means treatment options are much more limited, so you learn how to approach things on a budget, but you never really have to have that conversation with the owner as such.

Any consults done at the university’s small animal hospital are referrals – many of which are long-standing patients coming in for rechecks, so the owners have already been dealing with the insurance or have sorted payment with the reception staff.

We are assigned a number of tasks throughout final year that make us consider cost, such as discussing the costs of anaesthesia and treatment options for certain conditions, or pricing farm visits in first opinion practice. But again, it isn’t really us, the students, making the final decisions based on the client’s budget.

In at the deep end

So we’ve got the veterinary science bit nailed (well, hopefully – finals pending). But going into that first day as a qualified vet is going to be nerve-wracking for everyone, and that’s when the education will really begin. That’s where we will learn the things no one can really teach you, nor can you pick up until you are the vet making the final decisions – your neck on the line.

No one can teach you how to hold your tongue when the client opposite you is being completely irrational, or how to keep your composure when another breaks down in tears over the death of a pet, which you are really quite emotionally invested in too.

Having the internal battle with yourself over what the ideal diagnostic or treatment protocol would be, versus what is realistically affordable, becomes something of an art – there’s no formula or calculation to work out the best approach. As for actually having the responsibility on your own shoulders, and not falling apart when things go wrong, that takes resilience.

These are all things that will come with experience. It will be a steep learning curve, I’m sure, but essential if we’re to embark on the journey of life after vet school and master the art of veterinary medicine.

April 30, 2017
It’s good to talk…
The issue of poor mental health in the veterinary profession as a whole is becoming more recognised, and has sparked the launch of initiatives such as Mind Matters and Vetlife’s helpline service. But what about vet students specifically?

Despite not being selected for the sports teams she tried out for initially, Jordan (mounted) got on to the riding team during her second year at Glasgow.

When I was applying for vet school, I remember numerous people told me the hardest part is getting in… well, they lied. Having now spent five years at Glasgow, I can’t even comprehend why they would spread that awfully inaccurate myth.

My first inkling this oft-repeated phrase was totally unfounded came during one of our first lectures where my entire second year of A-level physics was summed up in an hour – and the pace only continued to pick up from there.

Difficult beginnings

Along with the personal struggles of moving away to university (in my case, 300 miles from home), not being selected for the sports teams I tried out for and the social pressures (feeling I had to take part in things despite feeling exhausted and wanting to sleep), it was hard.

I also had a sense of emptiness – having worked my entire life towards getting into vet school, once I got there, it was like: “Now what?”

I began to wonder whether veterinary was really the right career for me and, in the first term, seriously considered leaving.

No alternative

One of the main things that kept me there was the simple fact I didn’t know what I would do instead. I took my car back with me after Christmas, which helped with logistical issues, and started an evening creative writing class that gave me the opportunity to get away from vet school and vet students every so often.

By the summer of first year, I still wasn’t convinced I would stay. I hinged my fate on exam results, deciding I wouldn’t have the motivation to resit them because my heart wasn’t in it.

Jordan and the team of volunteers with Bolivian NGO, Comunidad Inti Wara Yassi.

However, I passed, and bundled myself on to a plane to South America to undertake some EMS in the Amazon rainforest. My time in Bolivia was incredible and rekindled a long-forgotten passion.

After that, my vet school experience shifted massively. I suddenly loved being a vet student – I got on the riding team, became more involved with the social side of vet school and continued my love of writing through getting involved with the Association of Veterinary Students.

I was the definition of the “work hard, play hard” vet student, but it was all about balance – the negatives of being a vet student were being outweighed by the positives.

Serious doubts

I still wasn’t particularly enthused by the course and merrily carried on because I was coping. Besides, a veterinary degree didn’t have to culminate in a veterinary career.

Every exam period was a rite of passage to get to the next year. Before Christmas, one year, we had nine exams in eight days – I think I averaged two hours’ sleep a night that week, but we got on with it. Everyone moaned together and everyone came out the other side, one way or another.

Nobody is immune – even at later stages in the course, those students who were high achievers and never seemed phased by anything started having doubts – serious “I’ve been to discuss where my degree stands if I drop out now” doubts.

By fourth year, I’d reached a level of acceptance that, since I’d got this far, I may as well carry on.

A sense of equilibrium

I started final year rotations absolutely terrified, but took comfort in the shell-shocked looks reflected in my classmates’ faces on the first morning of medicine rounds in the small animal hospital. We were all in the same boat.

Yet, finally, I found my stride; I have absolutely loved final year. For the first time in five years, I didn’t regret my life choices and found myself thinking “this is exactly what I want to do”. I was fascinated by medicine and felt a real sense of achievement of actually doing things for myself, such as taking consults and performing surgery.

Again, some of my peers hit their “walls” during final year, but we got them over it.

Another nugget of advice “they” tell you is final year will fly by. That one, I’m afraid, is not a lie – I can hardly believe I’m sat here with 12 months of rotations behind me, already facing finals and job applications.

All in the same boat

Jordan eventually “found her stride” during final year rotations.

Everyone has a wobble at some point and thinks “why am I doing this to myself?” The important thing is to remember other people are probably feeling the same way.

Mine was very early on, when everyone else seemed to be loving life, and I felt so alone. I felt like I would let my family and friends down if I dropped out, so felt too ashamed to say anything. However, when I eventually voiced my feelings, it transpired a lot of people were thinking the same.

A lot of support is out there now, which can be accessed in different ways. Each university will have a formalised counselling service and many vet schools now have a peer support system in place – this has been a huge success at Glasgow.

Meanwhile, Vetlife offers confidential telephone support to vets and vet students alike if you need an impartial, anonymous ear.

Feelin’ good

Glasgow recently held “Feel Good February”, a month of events and activities to raise awareness of these services and promote good mental well-being around the vet campus, part of which involved defining the problem at Glasgow specifically.

The Glasgow University Veterinary Medical Association revealed the results of a survey, which showed:
- 62% of current vet students felt stress had a negative impact on their everyday life
- 89% felt it was normal to feel stressed during a veterinary degree
This normalisation of stress can lead to students feeling they should be able to deal with it, but that the inability to cope will not translate well to life as a vet. It’s a very tough course for a number of reasons, including the workload that was described by our professor, Ian Ramsey, as “savage” in an STV interview.

However, this perception students should be stressed leads to an inability to speak out, for fear of seeming weak and “not cut out” for veterinary.

So worth it

I cannot imagine where I would be now if I hadn’t carried on with my veterinary degree. I’m so grateful friends and family supported me through everything and I made it to the point of starting a veterinary career knowing wholeheartedly this is what I want to do.

If you’re thinking of dropping out, please talk to someone – I can guarantee they’ve felt the same at some point. And if you’re having a particularly tough rotation or coming up to exams, power through and help each other – it’ll be worth it in the end!
April 15, 2017