A tie-over dressing. Image source: VNT:CPD, Sept 2008 – “Wound care and management” by Alison Young DipAVN(Surgery), RVN.
One of my colleagues showed me a technique we found to be a really useful aid to wound management.
We all know open wounds can take ages to heal by second intention, depending on wound size, infection, blood supply and a patient’s health. My colleague recommends tie-over bandages are used until the wound is no longer infected and can then be closed without tension.
Tie-over bandages provide a method for stretching and lengthening the local skin to facilitate wound closure. The amount of skin relaxation obtained depends on the location of the wound and the local skin character. Maximal stretch is usually noted within 2 to 3 days after placement of tension on the skin.
Tie-over bandages are also useful for securing bandages in areas that are difficult to incorporate into a regular bandage, or to reduce tension on primarily closed wounds (mast cell tumours, for example).
I also came across an article (Tobias, 2015) on just this subject that stated: “The laces are tightened 2 to 3 times a day to gradually increase tension on the skin. Most animals require sedation and analgesics during bandage changes for the first 3 to 5 days. If wounds are effusive or the laces are tight, the lacing material usually must be cut to change the bandage.”
I have limited experience of this technique, but it is definitely one worth considering in cases with difficult areas to bandage.
I have found acupuncture really helps some of my chronically painful canine patients, usually due to arthritis, but also in some cases of back pain too.
I have to say I usually use this as an adjunctive, rather than sole therapy, but often with good effect.
Evidence certainly exists in human medicine to suggest this helps (Witt et al, 2005). However, for some reason I have a mental blank and sometimes forget this as a possible therapy where dogs are not fully, or completely, responding to more traditional medications – and I would suggest this is well worth a go.
We are lucky enough to have a veterinary surgeon in our area who practices acupuncture and we are very grateful for his efforts.
References Witt C, Brinkhaus B, Jena S et al (2005). Acupuncture in patients with osteoarthritis of the knee: a randomised trial, Lancet 366:136–143.
It’s examination time and vet students across the UK are frantically trying to fill their heads with long, complicated words they can’t even hope to spell.
With exams comes stress (which can manifest in many different ways), but as a professional bad-sleeper I wanted to share some advice on surviving an old adversary of mine: insomnia.
Loosely, insomnia means “poor sleep” and could mean anything from having trouble dropping off to waking repeatedly throughout the night.
If you see a doctor complaining of chronic sleep deprivation, they’ll give you a lovely printout describing “the science of sleep” and some advice along the lines of:
Don’t drink caffeine after midday.
Switch entirely to decaffeinated tea/coffee.
Get up and do something if you haven’t fallen asleep within a certain amount of time.
Read in bed.
DON’T read in bed.
Don’t look at a TV or laptop screen for at least half an hour before sleeping.
Make sure the room isn’t too hot.
Take a relaxing bath before bed.
Use your bedroom only for sleep.
Don’t eat too much or little before trying to sleep.
Do some exercise throughout the day (but be careful with timing – the gym “high” after a workout can sometimes keep you up too).
Do eye exercises to tire your eyes.
Try breathing exercises to aid relaxation.
Try natural remedies.
Try writing down your thoughts.
Sleep wearing earplugs.
Try to clear your mind with meditation.
…and probably many more.
Having battled insomnia for the best part of 10 years, I have tried all of the above with varying degrees of success. With that in mind, here are some of my personal findings.
For me, cutting down on caffeine is completely out of the question, especially at exam time. I drink a lot of tea and my body is used to it; I will often have a tea just before bed and sleep just “fine” (for me, that is). That said, I have tried cutting down and switching to decaf, but it doesn’t make a difference and, quite frankly, tastes foul.
At exam time, I tend to switch to a combination of coffee, Pro Plus and energy drinks in order to say awake following a bad night of sleep. But the main point is to know your limitations – don’t take two Pro Plus at 8pm if you’re not used to caffeine and then expect to be able to sleep straight away at 11.
My main problem is that I overthink things, and once I have thoughts racing through a brain that can’t switch off, I’m in for a night of no sleep. However, I’m much better at managing my sleep now than I was a few years ago, and I think the main reason for this is that I aim for less sleep.
While there are a multitude of studies that claim “X amount of hours is the optimum”, I’ve found I sleep more fully the less hours I get. If I stay up until 1 or 2am and completely crash, the sleep I do get is generally of a much better quality – and it’s far better than trying to go to bed at 10pm and only achieving three hours of sleep because I’m simply not tired enough.
For me, quality of sleep is more important than quantity. I know some people swear by nine hours sleep, but for me, five or six is about normal, so find your personal optimum and work with it – don’t try and force yourself to comply with an “official” optimum recommended by some study or other.
But what about those killer nights when sleep will just not come?
Bach’s Rescue Remedy can work wonders for some people suffering from insomnia. Image courtesy The Italian Voice, via Flickr [CC BY-2.0]When I first experienced bad sleep, I used to write down my thoughts, no matter how nonsensical or ridiculous they might appear should anyone ever read them. This helped a lot as a way of channeling them and “emptying” my brain a bit.
More recently, I’ve been using the natural Rescue Remedy. I wouldn’t say its an absolute quick fix for everyone, but it does work wonders for some people. My partner has always slept soundly but recently suffered a bout of stress-related insomnia. After a few drops of Rescue he was out like a light every night!
If you’ve had a bad night’s sleep, the worst possible thing you can do is sleep in in the morning or nap during the day.
Tempting as it may be, the quicker you kick your body back into a normal sleep pattern, the better. It’s far better to force yourself to stay awake than nap in the afternoon and find yourself wide awake the next night too.
I often go through a few weeks of “normal” sleep and then have a few nights when I get about an hour at most. But if I force myself to stay awake during the day, after three or four horrendous nights, my body/brain crashes and restarts itself into it’s normal rhythm. You’ll be surprised how well you can function on less sleep than usual.
Doctors will only prescribe sleeping tablets if you’ve tried absolutely everything else, but even then I’m sceptical – I’ve tried them before and they simply don’t work for me, so if it does come to this, don’t expect miracles.
Insomnia can be incredibly frustrating and often upsetting for those not used to it – and often, for those who just have the odd bad night, something from the list of recommendations given by a doctor may work.
My final bit of advice would be that, when insomnia does strike, try not to get frustrated – you’ll only go round in circles and get yourself even more wound up. Just hold on to the fact that your brain has to rest at some point, and sleep will come, even if not as sufficiently as you’d like for a few days.
One of the pleasures of having completed my dermatology certificate is that I get to peer down a microscope at cytology preps a fair amount.
Now, if you’re anything like me, you’ll have become frustrated with Diff-Quik preps (particularly if you are using tape strips and all three solutions) as the strip becomes soggy and opaque, making it hard to examine.
A handy tip I learned from a specialist dermatologist working in the States was to just use the blue/purple stain, pop a drop onto a slide and then stick your strip over the liquid and slide. Leave this a few minutes and examine as usual.
This is quick and allows easy identification of cocci and yeast microorganisms under the microscope.
However if it’s cells you’re interested in – in, say, suspected cases of pustular disease – I’d suggest you still go through the full staining process.
I do a fair amount of dermatology in our practice, so I use the microscope on a regular basis. I recently came across these top tips to keep your microscope in good working order, so thought I’d share them.
Keep the scope clean. Twice-daily cleaning is ideal – along with cleaning whenever the scope is used. In addition, it’s helpful to have the scope professionally cleaned and lubricated once or twice a year. It will make a huge difference in the functionality of your instrument.
Keep the scope covered when not in use. All hospitals tend to be dusty and have hair floating about, which can damage the scope.
Use a different microscope for faecal examinations. Faecal solutions (sugars, salt solutions, etc) are quite caustic if they come in contact with the microscope lens or get “spilled” onto the slide platform.
Adjust the scope (at least once daily) for Köhler illumination. This will help to “focus” your scope for use.
However, after reading through these, I realise it’s a case of “doing what I say and not what I do” – so I’m off to give the microscope a good clean!
References
Noxon J O (2015). Cytology and Cultures Successful Tips and Techniques to try tomorrow, Small Animal and Exotics Proceedings of the North American Veterinary Conference, Gainesville, Florida.
With the general election fast approaching, there’s been a big push to encourage 18 to 25-year-olds to vote, since a huge proportion of us didn’t last time.
I’m not well versed in the intricacies of politics, but general consensus among young people after the last election was disappointment with regards to the tripling of university tuition fees.
This time round, the topic seems to have been swept under the carpet a bit, with Labour promising to reduce them again (but not quite as low as they used to be) and UKIP promising to abolish them for degrees in certain fields. But little has been mentioned on the matter by the other parties.
What does it matter to us anyway? We’re already at uni, with our fees fixed from our enrolment date. So perhaps it doesn’t, and perhaps the young voters, already in further education, should prioritise other issues when musing over the various policies.
But students, often skint (especially at this time of year, with eight days until Student Finance comes in – not that I’m counting), like to know they’re getting their money’s worth. Instead of standing in a supermarket, deliberating whether its okay to spend an extra quid on branded cereal, maybe we should think about what we’re paying for in the long term.
Whether we’re paying nothing (the Scottish), £3,000 (friends in my school year were the final students to have these fees), £9,000 (most undergraduates now) or even more as postgraduates, is it worth it?
You could discuss the philosophy of investing in your future, and whether spending so much on education will be worth it for a fulfilling career, higher wages or being able to achieve the dream of being a vet, but what about the face value? Per year, term or even day, what do we get for our money? A lot. That’s what.
Vet students get 9am to 5pm, five-days-a-week contact time with lecturers who are leaders in their respective fields
Some of us may be paying a staggering total of £45,000 for tuition alone, but what is that paying for? Almost 9am to 5pm, five days a week, contact time – and not just with anyone. Many of our lecturers are leaders in their respective fields; extremely experienced clinicians with more letters after their names than the alphabet itself. Plus practicals – labs, dissections, animal handling/examination and clinical skills sessions.
Without putting a price on practical sessions, it already sounds like we’re getting a fair bit for our cash, especially when you compare our course to a non-science degree, such as English or history. These often comprise just a few hours’ teaching a week, and yet can cost the same as the veterinary degree.
Involvement in the organisation of Association of Veterinary Students Congress earlier this year opened my eyes to the cost of basic equipment for practical sessions, such as needles and syringes.
One particularly costly element was paying for the actor for a communication skills section of one of the practicals. The veterinary school employs these actors for teaching purposes because they contribute to a more realistic scenario than just practising communication with our classmates.
As such, when we had a revision practical, with boxes of syringes, catheters, blood tubes, fluid therapy giving sets and fluid bags left out for us to practise as much as we needed, I couldn’t help but feel that the veterinary degree is one of the best value for money.
This one’s a little controversial, but some evidence exists that taking swabs for culture from cases of otitis externa can lead to poor reproducibility.
Swabs taken from the same ear may produce different isolates, and even when the isolates agree, they may have different (antibiotic) susceptibility patterns (Bloom, 2015; Graham-Mize et al, 2004; and Schick, 2007).
Bloom (2015), therefore, suggested using rational topical therapy based on cytological findings was more valuable than using bacterial culture and sensitivity. He also only advised repeat cytology if the ear was not clinically resolving or neutrophils and bacteria were present on initial cytology.
He only takes culture and sensitivity where rods are found on cytology, there are proliferative changes and the ear is responding poorly to therapy – a rare set of circumstances in Paul Bloom’s experience.
This approach was supported by a study in which the authors evaluated whether any correlation was noted between topical antibiotic selection, in vitro bacterial antibiotic sensitivity, and clinical response in 17 cases of canine otitis externa complicated by Pseudomonas aeruginosa (Robson et al, 2010).
VIDEO: How to properly swab an ear for aural cytology (source: YouTube).
References
Bloom P B (2015). Diagnosis of Otitis Externa in the Real World, Proceedings of the North American Veterinary Conference, Orlando, Florida: 944-953.
Graham-Mize C A and Rosser E J Jr (2004). Comparison of microbial isolates and susceptibility patterns from the external ear canal of dogs with otitis externa, J Am Anim Hosp Assoc40(2): 102-108.
Robson D C, Burton G G and Basset R J (2010). Correlation between topical antibiotic selection, in vitro bacterial antibiotic sensitivity and clinical response in 17 cases of canine otitis externa complicated by Pseudomonas aeruginosa, (Abst). In 25th Proceedings of the North American Veterinary Dermatology Forum, 2010: 245.
Schick A E, Angus J C and Coyner K S (2007). Variability of laboratory identification and antibiotic susceptibility reporting of Pseudomonas spp isolates from dogs with chronic otitis externa, Vet Dermatol18(2): 120-126.
Demodex gatoi is an unusual cause of pruritus in cats, but given the challenging nature of establishing a diagnosis in cats (Hobi et al, 2011) it is well worth ruling out this parasite as a possible cause (Moriello, 2015).
Karen Moriello reports finding this more oval, rather than cigar-shaped, form of Demodex more frequently in faeces (by faecal flotation) than on skin scrapes due to the cat grooming and ingesting the mite.
The good news is that, if we do find the mite, it is possible to treat (off licence) with Advocate Cat once weekly for six weeks.
References
Hobi S, Linek M, Marignac G et al (2011). Clinical characteristics and causes of pruritus in cats: a multicenter study on feline hypersensitivity associated dermatoses,Vet Dermatol, 2011.
Moriello, K.A. (2015). Itchy Cats: Evidence Based Diagnosis and Treatment, North American Veterinary Conference, Orlando 2015.
In a previous blog, I alluded to the feminisation of the profession. Here, I speak very carefully to avoid confusion of this with feminism.
I’m not going to preach equal rights or pick holes in generalisations, but the facts are unavoidable: feminisation of the profession is happening and we need to find the best way to embrace this.
57% of practising vets in the UK are women[1.Source: http://vetfutures.org.uk/resource/vet-futures-literature-review/], and this balance looks set to tip even further in the female direction. However, I don’t feel this accurately reflects the male presence in veterinary education, which is significantly lower.
Less than a quarter of students embarking on their veterinary degree in 2012 were male and – upon discussion with other students – it is evident that some schools are worse than others.
So why is the gender imbalance significantly worse in education than in veterinary practice?
It has been shown that men are likely to stay in the profession for longer than women, with more women than men opting for part-time work, so the suggestion that males are being put off the degree because it is seen as a less “manly” career choice seems a bit absurd to me – especially as sexism is still extremely prevalent, despite the female shift.
In one of my interviews for veterinary school, it was suggested the reason males are declining in veterinary education is simply because females are outperforming them academically and so they just aren’t achieving the grades needed to make the offer for a place at vet school.
You can speculate as much as you want to try and discover the reasons why, but feminisation is happening and the profession is changing as a result. Corporate chains of veterinary practices are increasing in number, bringing with them rock bottom prices that individual James Herriot-esque practices can’t compete with. But is the attraction of part-time work and “normal” working hours that the corporates offer more attractive, especially to vets (particularly female, but also male) with children?
I think many of the fairytale illusions that some of us entered the veterinary world with are long gone. The profession is changing rapidly, and must continue to do so in order to accommodate for things like feminisation and increasing graduate numbers.
While corporate practices may be a short term aid, and potentially offer a better work-life balance, I don’t think they are the ultimate answer.
If I am being perfectly honest, dentistry has never filled me with excitement.
That said, attending a number of sessions on dentistry at the North American Veterinary Conference this year was fascinating and convinced me of the value of buying a dental x-ray machine.
Goldstein (2015), to name but one speaker, evaluated the use of radiography in assessing dental conditions in cats and convinced me of the need.
In another talk the value in assessing canine lesions was discussed (Lewis, 2015) – definitely something to bring up at our practice’s next clinical effectiveness meeting.
References
Goldstein, G.S. (2015). Dental pathology case presentations, clinical and radiology: interactice discussion of what’s new, North American Veterinary Conference, Orlando 2015.
Lewis, J.R. (2015). Interpreting canine dental radiographs: learning what you were never taught, North American Veterinary Conference, Orlando 2015.
![Bach's Rescue Remedy can work wonders for some people suffering from insomnia. Image courtesy The Italian Voice, via Flickr [CC BY-2.0]](http://www.vettimes.co.uk/app/uploads/2015/05/rescue-remedy-flickr.jpg)
