Tag: doctor

  • How to survive insomnia

    Insomnia
    Insomnia can be incredibly frustrating – image ©iStock.com/YinYang

    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.

    tea-stain-freeimagesFor 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]
    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.

    counting-sheep_istk-carlacdesignDoctors 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.

  • Using a probiotic and antibiotic at the same time

    Probiotics vs antibiotics
    Image: source unknown

    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.

  • The Doctor debate

    Yes or no?
    Yes or no? Image ©iStock.com/benstevens

    One of the big discussion topics within the veterinary profession at the moment is the RCVS consultation on UK-qualified vets adopting the courtesy title of “Doctor”, or “Dr”.

    Given that the consultation closed on February 16, I may seem a bit late to add my two pennies’ worth, but I didn’t really know how I felt on the matter and wanted to assess the justifications before assuming a position on one side of the fence or the other.

    Reasons for and against

    There are valid arguments for both sides – and while those against the use of “Doctor” invariably shout louder with their opinions, there is an undeniable majority (at least across the veterinary student body) in favour of the change. In fact, a poll on the Association of Veterinary Students’ (AVS) Facebook page found 97% of respondents were in favour of adopting the title.

    The suggestion is that use of the title would bring vets parity with doctors and dentists in the UK, and also with veterinarians in the US, Australia, New Zealand and parts of Europe. It has also been suggested the change would see an increased respect for vets and help highlight the level of training required (which is of similar length and breadth of doctors and dentists).

    Those against the idea argue that human surgeons do not style themselves "Doctor" (due to a historical quirk that differentiates them from physicians) and so, as veterinary surgeons, we already are on a level playing field with our human counterparts. However, as those less surgically minded are quick to point out, vets are not just surgeons; we are GPs, radiographers, anaesthetists, midwives etc, and so our skill set expands beyond those constrained by this historical quirk. Additionally, in the US, vets are termed "veterinarians" rather than "veterinary surgeons", which makes this historical quirk inapplicable if the argument is simply down to semantics. Instead of achieving parity and clarity, some claim it would actually cause more confusion as vets are neither medical doctors or PhD holders (unless they have indeed spent another few gruelling years at university), although the relevance of this in a clinical situation is questionable – are clients or farmers really going to be too fussed about whether you have a PhD if you’re calling yourself "Doctor"? They’re probably more interested in whether or not you can heal their dog or calve a cow. To this end, giving vets the option to use the title may cause further confusion as not all veterinary professionals will necessarily take it up. So should we have this option, or should we stick firmly to an "all or nothing" approach to ultimately achieve true coherence and unity?

    A matter of trust

    I feel the reasoning with regards to increasing respect for vets and highlighting their level of training is weak – most people outwith the veterinary field actually think we undergo more training than we do (how many times have you been asked if you train for seven years?), and I don't believe respect comes from having a couple of extra letters before your name. Respect must be earned through demonstration of skill and – perhaps more relevantly – client trust. It is this aspect of trust I believe to be the most important justification against the use of the title, and perhaps the one that might just tip the balance for me to fall into the "against" crowd. [caption id="attachment_4659" align="alignright" width="300"]Rather than trying to force this respect, would we not be better off preserving the relationship and earning respect through trust? Image ©iStock.com/JackF Rather than trying to force respect, would we not be better off preserving the relationship and earning respect through trust? Image ©iStock.com/JackF[/caption] It is said the client-vet relationship is often far better than the patient-doctor relationship, with vets often getting to know their regular clients as well as the animals they bring in. Many clients see their vets as friends and so trust their judgement and take heed of their advice (how many times do you hear the question "what would you do if this were your dog?” ?). Rather than developing trust towards a friend, adopting the title "Doctor" may actually form a barrier (however unintentionally), causing an immediate distance between professional and customer due to subtleties such as the client feeling less inclined to be on first name terms with the vet. This would be the cost of the "respect" the title holds. Rather than trying to force this respect, would we not be better off preserving the relationship and earning respect through trust? My gut reaction to the suggestion was yes, of course I’d call myself "Doctor" given the choice – but I began to think a bit more carefully when the strong opposing statements had a substantial backbone to them. And then, on a very personal level, I remembered that I am "blessed" with a unisex name and, as such, always sign emails with a definitive MISS in front of it. For an entirely un-veterinary related reason, I might consider keeping the Miss/Ms just to avoid turning up at an interview to a confused look before the employer realises their mistaken assumption (yes, this happens more times than you would think). Alternatively, in an increasingly female-dominated profession where males may still be considered (however wrongly) to be superior, those two letters in front of my name may cause sufficient confusion to gain an interview I may otherwise have been denied based on gender... but that’s an entirely different debate.