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Tag: Degree

Standing surgery

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

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

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

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

Lower costs

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

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

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

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

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

Choosing correct method

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

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

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

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

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

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

Conclusion

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

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

June 13, 2016
Omnicompetence – maybe not so foolish?

The first of April brought with it the usual abundance of amusing online articles, tweets and blogs, only claiming credibility until midday – and the veterinary community was no exception.

Sun Life’s “courtesy pet” joke didn’t have vet student Jordan fooled for a minute.

Some April Fools were obvious hoaxes – such as Sun Life’s courtesy pet scheme, offering owners a replacement pet in place of their beloved while away at the vets – while others were a little harder to interpret, such as BEVA’s announcement of a privately funded equine vet degree – or maybe that’s because I was still half asleep and it was the first one I’d seen before realising the date.

Food for thought

Although it was cleared up at midday that BEVA president Mark Bowen was not due to become dean of the first UK equine-only vet school and that the nine traditional degrees would remain the only ones available, it did provoke some thought about whether it would be such a bad idea after all.

While plans for a traditional five-year omnicompetence approach, followed by a further three years of equine-only study, seemed a little far-fetched (fourth year has nearly finished me off – I certainly don’t think I’d hack eight years at vet school), many veterinary schools around the world use a condensed version of this model.

For example, Utrecht University in the Netherlands follows the format of a three-year bachelor’s degree for all species, followed by a three-year master’s degree aimed solely at one species/area (with the exception of 20 weeks). The University of Leige in Belgium compromises in that the fifth year is spent rotating through clinics for all species and half of the final (sixth) year is spent in one area in particular, with a choice of small animal, farm or equine.

Omnicompetence or specialisation?

The question of omnicompetence or specialisation is highly debatable and seems to go around in circles in the UK. Earlier career specialisation would be favoured by some who know, undoubtedly, they never want to see a cat, dog or rabbit again after vet school – likewise for those who shudder at the thought of an emergency caesarean and an angry farmer.

Early specialisation as an equine vet could mean you’ll never find yourself taking a blood sample from a lion. Image courtesy Shamwari Conservation Experience.

But what about those like me, who, after a considerable amount of vet school already under his or her belt and a variety of EMS placements (good and bad), when posed with the question “what sort of practice do you want to go into?” still can’t come up with anything more eloquent than: “Umm… mixed?”

The advantage of omnicompetence is that, in theory, graduates should leave vet school equipped with the knowledge and skills to address most cases in general practice in any field/species, deal with emergencies and know who or where to refer a patient to if the case is beyond his or her abilities.

Early specialisation could change this to the extent an equine or farm graduate asked “can you just look at my dog” may end up looking a bit silly.

Everything changes

Circumstances also change and accidents do happen. A vet may end up sustaining an injury while working with horses or livestock that could prevent him or her from doing so in the future, so a species-specific degree could force him or her to leave clinical practice altogether.

Similarly to the “new vet schools” debate, it is feared introducing species-specific degrees may reduce job availability for graduates who have taken the traditional educational pathway, making the equine sector, in particular, even more “elitist”. Ultimately, this could potentially drive the profession away from the concept of mixed practice altogether.

Master of one?

More like our medical counterparts, we could lose our “Jack of all trades” status and end up being highly specialised instead, which does, of course, have its advantages, but leaves those of us who want a bit of variety and flexibility in the dark.

For me, omnicompetence is definitely the right starting point for a veterinary degree, but I know others have very different opinions. I did, however, enjoy the brief social media debate before a communal sigh of relief.

My personal favourite April Fool this year, however, was the University of Glasgow’s announcement the university tower would be reopening as a public helter-skelter (see video below) – and I’m still disappointed it isn’t true.

April 20, 2016
RCVS council election manifesto: Stephen May

STEPHEN MAY

MA, VetMB, PhD, DVR, DEO, DipECVS, FHEA, FRCVS

Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA.

T 01707 666270

M 07768 288711

E smay@rvc.ac.uk

PROPOSERS: Sue Dyson, Andrew Harrison

I graduated from the University of Cambridge in 1980. After spending time as large animal house surgeon (intern) at the University of Liverpool and in general practice, I undertook further training in equine surgery and diagnostic imaging, at Liverpool, subsequently gaining diplomas in veterinary radiology and equine orthopaedics. I then studied for a PhD at the RVC, followed by a return to Liverpool as lecturer in equine orthopaedics.

I was recruited to the RVC in 1993 to rebuild the equine clinical services and promote equine research, subsequently becoming head of the farm animal and equine clinical department, the college’s vice-principal for teaching and deputy principal. In these roles, I was challenged to expand the college’s educational vision from a school for veterinary surgeons to one for the whole veterinary team, at first degree, postgraduate degree and CPD levels.

My broader contributions include being chairman of the Higher Education Academy Panel involved in the award of National Teaching Fellowships. I am currently senior vice-president of the European Board of Veterinary Specialisation and a past president of the European College of Veterinary Surgeons. I have chaired the RCVS education committee, its CertAVP sub-committee and legislation working group, and served on the disciplinary and standards committees.

Manifesto

My passion is the education of future veterinary surgeons and their well-being. I have felt privileged to serve as chairman of the education committee, contributing to development of the RCVS requirements for veterinary degree programmes and the CertAVP, and as chairman of the working group that created the new royal charter. However, our work is never complete.

If re-elected, I am keen to champion “the scholarship of primary care” and turn the focus on education aimed at developing expertise in primary care practice, the initial destination for most UK graduates. Our understanding of the fundamentals of clinical reasoning has progressed, but the distinction between hospital-based and primary care reasoning processes needs to be made, so all can be reassured excellence is not measured by the automatic use of a panel of diagnostic tests. It is important the “expert generalist” is fully recognised in the revised criteria for the RCVS Fellowship.

The new charter has provided powers to properly recognise the whole veterinary team. Vet Futures has highlighted the public need alongside our responsibility for animal welfare. Therefore, we must work together to ensure any delegation within the Veterinary Surgeons Act is matched to the skill set of those supporting veterinary services. This will be a task for RCVS council, whatever shape it may take.

I have considerable experience of committee chairmanship in the public and private sectors, as well as governance reviews in two other organisations. Therefore, I feel I have the skills and experience necessary to help move the profession forward in these challenging times.

As someone who has loved the different roles I have played during my veterinary career, I look forward to making my continued contributions to safeguarding the public, our profession and the animals to whom we have collectively dedicated our lives.

March 24, 2016
RCVS council election manifesto: Melissa Donald

MELISSA DONALD

BVMS, MRCVS

Otters View,
Purclewan Mill, Dalrymple, East Ayrshire KA6 6AN.

T 01292 560083

M 07921 384852

E melissadonald88@gmail.com

PROPOSERS: Alison Lambert, Freda Scott-Park

I started as a food animal intern at Iowa State University, having graduated from Glasgow (1987). After two children, my first full-time position was in a traditional mixed two-person practice in Ayrshire.

For the next 25 years, I helped develop the practice to become a 100 per cent small animal, forward-thinking, customer-focused, five-vet business. I became the new graduate mentor for the practice and developed a special interest in small animal dentistry.

In 2004 became an A1 Assessor for nurse training (now clinical coach), and later RCVS practical OSCE examiner for VN exams.

Outside of work, I have my family to keep me grounded, several dogs, cats and sheep. I enjoy running, swimming, cooking, reading and have started writing children’s books. My husband and I have also run a 1,500-acre beef/sheep hill farm.

In 2012, I set up our local “parkrun”, being event director until 2014, and enjoyed being a volunteer at the Commonwealth Games in Glasgow 2014.

I am a past president of Ayrshire Veterinary Association and represented Ayrshire on BVA council, also serving on its members’ services group committee. I am a BVA and BSAVA member and have voted in nearly every RCVS election since I graduated.

Manifesto

The veterinary profession continues to evolve as it has always done over its long history. I feel this is a really exciting time to be involved in the RCVS, with the Vet Futures project going into its next stage of actioning the recommendations made. Change is only frightening if it is unknown and with this we have some degree of control.

I am pleased with the new updated practice standards scheme, which feels more like a useful tool to general practice rather than a regulatory “award”. It is also more client friendly and I hope more practices make use of the system to promote themselves, thus improving minimum standards.

My experience with mentoring school, veterinary and nurse students (our future) over the years has allowed me to open their eyes to all the career options they have, as well as the reality about the hard work, stress, student debt and mental health issues they will encounter to some degree. But I also feel vets should be supported throughout their careers, not just as new graduates, and this should be looked at.

The RCVS council needs to be made up of 24 diverse veterinary surgeons as it strives to represent the broad range of services vets provide. I have the experience to help with this. It also needs a good age and gender mix.

We have a wonderful profession we are all passionate about, and I am as proud today of being part of it as I was when I graduated.

I humbly seek your vote. I am an enthusiastic person with a half-full approach to life and almost 30 years’ general practice experience. I now have the time to fully commit to this important role.

March 24, 2016
Finding the words
I’m a bit of a grammar Nazi, so getting involved in editing has been a lot of fun.

I enjoy writing about my experiences, but I also enjoy reading about others. I’m also a bit (or a lot) of a grammar Nazi, so getting involved in editing over the past couple of years at university has been a lot of fun.

I started by subediting the University of Glasgow’s student newspaper and proofreading emails/letters for fellow students on the organising committee for a charity event, before taking on the role of editor for the student vet magazine (JAVS), which goes out to all UK veterinary schools.

This is something I love doing, but it does have its downsides – and it sometimes feels like trying to draw blood from a stone. The past few editions of JAVS have seen a serious deficiency of contributors, but each one has been saved by my persistent chasing of articles, rallying people I know have an interesting story to tell, and reassuring those who’ve been asked to write but lack confidence in their ability.

Now this begs the question: why do veterinary students not want to write?
- Are they too busy and see it as pointless extra work that won’t be recognised or count towards their degree?
- Are they worried about not producing an item good enough to publish?
- Do they lack confidence in their linguistic abilities?
While the vet degree is insanely busy and students will count every precious moment of free time they have, there are considerable advantages to having a piece of writing published – be that in print or on the internet.

Getting your name out there

“Writing for a student publication is a great start in order to get into the swing of things without strict word counts or other constraints.”

It’s surprising how far an article or blog post can reach. People with seemingly nothing to do with the veterinary profession or, alternatively, those higher up in the profession may see them.

Social media provides a particularly excellent platform for getting your work out there – many of the student written articles published on the AVS (Association of Veterinary Students) Facebook page have received “likes” or comments from BVA and RCVS presidents.

For those looking to publish in the future, whether through research or journalism, writing for a student publication is a great start in order to get into the swing of things without strict word counts or other constraints.

Even if you have no interest in writing as part of your career, having your name on an article can have other advantages. Who knows, maybe in a few years your future employer may have been intrigued by something you’d had published – which could make the difference between being asked to interview or not.

Spread the word

Sharing ideas with other students allows writers the opportunity to pass on information that could benefit other parties as well. For example, if someone undertakes EMS with a charity he or she feels is a particularly worthwhile cause and needs extra help, writing an article to raise awareness could give the organisation a huge boost. It will also make fellow students aware so they could go and have the same great experience as others before them.

Even sharing hints and tips for other things vet related might help other students avoid common mistakes or guide them more smoothly through the maze of the veterinary degree.

Don’t be scared

“Don’t be scared. Bite the bullet. Put pen to paper (or fingers to keyboard) and just go for it,” says Jordan.

It has been suggested many veterinary students don’t want to write because they don’t think they have anything interesting to say, or worry their finished piece won’t be good enough for publication – and I appreciate writing doesn’t come naturally to everyone, but that’s where I come in.

I can’t magic up the entire content for a whole magazine, but if students give me some ideas to work with – regardless of how scrambled they may be – they can be edited into fully formed articles.

It may be that self confidence is the issue, but don’t worry, everyone has to start somewhere. Your first attempt wont necessarily be the next Harry Potter phenomenon, but I guarantee that most veterinary students do have interesting experiences or ideas to talk about – so don’t be scared. Bite the bullet. Put pen to paper (or fingers to keyboard) and just go for it.

Getting published can open a lot of doors you didn’t even know were there, so I would encourage every veterinary student to try to get their names out there. After all, the veterinary world is smaller than you think, and you never know who might be reading.
October 30, 2015