Have you ever wondered how easy (or not) it is for our clients to administer prescription topical ear therapy to their companions?
I would suggest this may be further complicated by data sheets that provide instructions such as “apply 8 drops once daily”.
Paul Bloom at the North American Veterinary Conference advocated filling the ear with topical medication at the prescribed number of times daily to address the risk of treatment errors leading to the exacerbation of perpetuating factors (Bloom, 2015).
Reference
Bloom, P.B (2015) Diagnosis of Otitis Externa in the Real World, Proceedings of the North American Veterinary Conference, Orlando, 2015.
Following the devastating news of the Germanwings crash last week, the co-pilot’s torn-up sick note and the early implication of mental health issues (later suspected to instead be eyesight-related), I witnessed a shocking flare-up of defence regarding mental health on social media.
My gut reaction was of absolute disgust. Whether said sick note referred to mental illness or not, the co-pilot was not 100% mentally sound, otherwise he would not have deliberately crashed an aeroplane into the Alps, killing 149 innocent people.
An article I read describing the rescue efforts to retain the pieces of the bodies (explosion on impact meant there were no bodies intact) was particularly distressing. And yet people preached online, directly referring to the plane crash, that people with clinical depression should be able to hold such jobs. I’m not advocating denying sufferers of severe mental health problems the right to work – but perhaps not in a job that could result in this sort of sickening situation. Can we have some context please?
While a vet may not have it in his or her power to destroy innocent lives to such an extent as pilots, how does this translate? Vets have access to dangerous drugs that could have drastic consequences if used wrongly due to mental instability, and perhaps provide a more accessible option of suicide than the non-medical general public. They also carry responsibility during surgery or other procedures with the potential to act inappropriately with implications on the lives of animals in their care.
You wouldn’t necessarily get on a plane if you were told the pilot had severe clinical depression, so would you leave your dog requiring general anaesthesia with a vet who is?
I think where the confusion has occurred is that word that gets thrown around too easily regarding mental health: “stigma”.
There is a certain stigma regarding mental health, but instead of ranting about discrimination due to mental health, a step forward would be acceptance.
One of the major factors in suicide within the veterinary profession is vets themselves not admitting they need help. In order to prevent professionals (in any sector) slipping through the net and putting on a brave face with unexpected devastating consequences, we need them to accept that they are unwell or stressed in order to take a step towards gaining help to get back on track.
To do this in a veterinary context, we need to remove the fear of being prevented from practising. The words “fitness to practice”, even within vet school, send a ripple of fear through one’s skin. I’m aware of students who have deliberately concealed medical conditions from the faculty through fear of being thrown out. I can only imagine this is carried through to qualified vets, frightened of “being struck off”.
It shouldn’t be that way.
The profession as a whole needs to work towards distinguishing clearly between taking a break from practice to get yourself better and being irreversibly banned from practising as a vet. We need to make it “okay” for vets to admit they need help to have any hope of reducing suicide, among other consequences of mental ill-health, within the profession.
I had the privilege of attending the North American Veterinary Community Conference in January. The experience provided me with a number of top tips, which I thought I would pass on to you in the coming few weeks.
For those of you who are skeptical of the role professional experience plays in establishing evidence, many authors accept that not all evidence is derived from academic sources, for example, Schon (1984) and Bolton (2000) to name just two. I have still included reference to the appropriate sessions to keep those of you happy.
Have you ever pondered when treating cases of diarrhoea with an infectious origin as to whether there is any point in using a probiotic at the same time as a course of antibiotics? Well yes, you can.
I attended a joint session hosted by Mike Lappin and Stan Marks. Although it is not possible to say definitively for all probiotics and all antibiotics, Dr Lappin has conducted work to show the strains in Purina Fortiflora are unaffected by metronidazole at doses up to 20mg/kg. Good to have this confirmed, as this is a strategy I often use.
References
Lappin M and Marks S (2015). Quench the Stench: Strategies for Control of Diarrhea, North American Veterinary Conference, Orlando 2015.
Bolton G (2000). Reflective Practice: Writing and Professional Development, Paul Chapman Publishing, London.
Schon D (1984). The Reflective Practitioner: How Professionals Think in Practice, Basic Books.
It occurred to me the other day I hadn’t seen an aural haematoma for some time. Saying that, I now expect three to come along in Monday-morning surgery.
I also recall a time when we immediately resorted to surgery as the primary treatment. However, lately we have drained the ear and injected dexamethasone into the space. If you do this, though, it is vital to inform the owner the ear will swell up again post-draining, but will resolve over the following week or so.
As long as we are treating any concurrent otitis externa (if present), I have found this a very effective means of treatment and very valuable in elderly patients with co-morbidities.
Greg Martinez DVM drains, injects and wraps an aural haematoma (source: YouTube).
Note: Greg uses cortisone rather than dexamethasone.
We routinely audit postoperative complications for our canine neutering surgery.
Over time, it became clear we were seeing a few castration wounds come back in where the dog had licked both the wound and surrounding area, making it sore to the extent it was delaying healing. In some cases, additional treatment was required.
We then wondered to what extent non-absorbable skin sutures were playing a role. Making the change to using absorbable skin sutures reduced our complication rate significantly – nuff said!
How to bury knots at the start and finish of a subcutaneous suture. Video by John Inns via YouTube
A very itchy, erythematous young boxer with very sore ears came in to my consult room.
A normally very docile chap, it really resented having topical treatments applied to its ear canals.
It turned out he was passing stools three to four times a day (two is more normal) and showed signs of gastrointestinal disturbance on an intermittent basis.
Thinking we were heading in the direction of atopic disease, I instigated a food trial, with my personal favourite, Purina HA. Three weeks later, we had a different (much better) dog.
Amazing – particularly given only 25% of cases respond within the first three weeks of a trial. Now I have to persuade the owners we should do a re-challenge to confirm our diagnosis.
At the end of this month (March), my year group has to submit their choices for final year selectives.
Over the coming week we will have a number of presentations on the different options to help us decide – which will no doubt cause further confusion.
For a number of us, fear has ensued. Others (perhaps the older or postgraduate students) feel excitement as the light at the end of the tunnel seems one step closer. But for everyone, the initial introductory presentation served as a reminder that the “real world” is not that far away.
As with most things in vet school, people hear different things and rumours based on half-truths spread like wildfire. Lecturers and mentors contradict each other, with some advising you to pick options you think you’ll enjoy regardless of future career choice, while others claim you must pick specific options if you have any hope of becoming a particular type of surgeon or clinician.
The options we can select are in addition to the core final year rotations that everyone must undertake, and cover a number of areas. These include further practice in food producing animals, equine and small animals, as well as many “niche” areas such as pigs, poultry and fish.
And along with many of the selective options comes the attractive opportunity for travel.
Following the introduction to the selectives, the question “what do you want to do?” (swiftly altered to “what do want to do when you graduate?”) was thrown about, ultimately making many of us consider for the 1,000th time what we actually want to do after vet school.
During work experience, I changed my mind from farm practice to definitely-not-farm-practice, to definitely-not-only-small-animal to something involving orthopaedic surgery. However, during vet school, the idea of farm and equine has grown on me – although I understand the likelihood of finding mixed work encompassing mainly equine and farm is fairly small.
While working on a stud yard last summer, I think I changed my mind daily about equine work depending on the vet-client interactions and whether I think I could tolerate horse owners day in, day out.
Even now, the more EMS I do, the more I feel I need more experience in different areas to make an informed choice about the direction of my career.
I also do not see myself in clinical practice in the UK for a great deal of time, and instead want to work abroad and ultimately switch path to marketing and publishing. If only you could map out your life that finely and it all work out to plan…
The only thing I know for certain is that I will change my mind at least another 10 times before graduation.
Have you ever been presented with a cat you are certain has hyperthyroidism, but you can’t prove it?
It is losing weight, but is eating ravenously, has a rapid pulse and, on occasions, has a palpable goitre – but can you detect an elevated total T4? No way!
Despite sometimes testing two or three times, its total T4 sits firmly within normal range.
The answer to this is to get a free T4 done – and lo-and-behold, this often confirms hyperthyroidism.
They are key to the future of the profession, but what are the next generation of veterinary surgeons looking for from their first job?
To find out, The Veterinary Business Journal headed up to SPVS’ “Your First Job” graduate seminar in Lancaster.
FACTFILE
NAME: Zara Chowdhury
AGE: 22
COLLEGE: RVC
FIRST SALARY EXPECTATION: £25,000 a year
MY FIRST JOB: “I want to move into mixed practice where I will get the experience I want, but also the day-one support I need.
“There are lots of fears of course, and that is natural. Apart from the various clinical concerns, I am not looking forward to the financial side of things, pricing things up wrong and things like that.
“We have not done any business extramural studies. We have had a few business lectures, but it is something I would have liked more of – particularly earlier on in my course, so it would be good to get some kind of induction in the business side of things.”
WORK/LIFE BALANCE: “This is important to me, but I know I have to be flexible to get on.”
WHAT DID YOU GET FROM THIS EVENT? “It has helped a lot to see the various options laid out in such an accessible way.”
FACTFILE
NAME: Fiona Laurie
AGE: 21
COLLEGE: University of Glasgow
FIRST SALARY EXPECTATION: £20,000 a year
MY FIRST JOB: “I grew up on a farm, so I have always wanted to move into mixed practice.
“Hopefully that job will provide broad experience on the clinical side, but it will be very important to me to see that I will be supported in the right way.
“Coming from a farming background, I have grown up knowing the importance of getting it right from a business perspective, but I would like to be shown the protocols and the pricing structures and have the computer systems all explained to me properly.”
WORK/LIFE BALANCE: “If the rota was really bad I would look elsewhere, as having balance is important to this generation, but we are all coming into this job with our eyes open and I am not scared of hard work.”
WHAT DID YOU GET FROM THIS EVENT? “Free wine and a lot of ideas about the diversity of career options open to those getting a veterinary degree.”
FACTFILE
NAME: Alexander Kilgore
AGE: 27
COLLEGE: RVC
FIRST SALARY EXPECTATION: US$60,000 to US$70,000 (£35,000 to £41,000) a year
MY FIRST JOB: “I want to move straight into first opinion, small animal practice back in the United States, where the money is better.
“Ideally, in a supportive environment with a mentor to help me grow and develop as a vet and as a business professional.
“For me, there isn’t enough emphasis on the business management side of things, but I think there is more that students could do to make themselves more business-savvy.”
WORK/LIFE BALANCE: “This is a big deal, I have no problem doing out-of-hours, but I certainly don’t want to be working on a crappy rota for crappy pay.”
WHAT DID YOU GET FROM THIS EVENT? “It has shown me there are plenty of other career options in this field – particularly in industry and the military.”
FACTFILE
NAME: Alice Griffiths
AGE: 25
COLLEGE: University of Cambridge
FIRST SALARY EXPECTATION: £25,000 a year
MY FIRST JOB: “Will be working with small animals for a boss sympathetic to the fact I still have a lot of learning to do. I want some responsibility, but at the same time I will want guidance when needed.
“We have had a few talks about the financial side at university, so I feel I know what will be expected in that direction, but some sort of written guidelines on the business side of things would be great.”
WORK/LIFE BALANCE: “The more hours asked of me, the more important it would be for me to get some flexibility in those hours – I still need to have a life.”
WHAT DID YOU GET FROM THIS EVENT? “It’s a great chance to meet my peers from other universities and to pick up some really good ideas from the speakers here. I am just surprised by how few people decided to come.”
I’ve come across a couple of cases of Sarcoptes this winter. Both cases were young dogs with intense pruritus – one on his face and the other around the triceps region.
Although both owners were rather sceptical, both dogs responded very rapidly to therapy with imidacloprid/moxidectin (Advocate, Bayer).
In our neck of the woods, I tend to try trial therapies first as we have a high urban fox population, but perform ELISA blood tests for Sarcoptes in dog cases with persistent signs.
I occasionally do skin scrapes but rarely, if ever, find mites!
