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Tag: National Office of Animal Health (NOAH)

  • An unrecognised reliance on technology

    An unrecognised reliance on technology

    It’s surprising how much we rely on the internet and associated technologies. In fact, you don’t quite realise how much it helps until you find yourself without it.

    I experienced a weird widespread internet fault. I’m not sure if it was localised to to my geographical area, but, for a few hours, neither my mobile data would work on my phone or the internet on the practice computers (although I’m not sure if they were just being their usual painstakingly slow dinosaur selves) – even the clients were commenting there seemed to be a data blackout.

    Regardless, it made my consulting morning surprisingly more challenging.

    First appointment

    Repeat aglepristone injection for mismating

    I go to check the protocol as I know the timings are different to when given for pyometra. The BSAVA app crashes four times on opening before I accept defeat and find a bound copy of the formulary.

    I then realise things are listed by drug name rather than brand name and draw a blank. I try to open the NOAH website on the consult room PC, but this inevitably crashes the internet browser. Of course it does.

    Suddenly the name aglepristone is dragged from the depths of my brain and I leaf through the formulary once more. That wastes nearly the whole appointment time before I even manage to find the drug, draw it up and give it.

    Second appointment

    "When your consults are only 10 minutes, that extra couple of minutes in each one adds up and very quickly I found myself getting behind, and, therefore, more stressed." Image © WavebreakmediaMicro / Adobe Stock
    “When your consults are only 10 minutes, that extra couple of minutes in each one adds up and very quickly I found myself getting behind, and, therefore, more stressed.” Image © WavebreakmediaMicro / Adobe Stock

    Potential re-admit from the previous day

    The computer freezes while trying to print consent forms. Luckily it’s a fairly straightforward admit for fluids/treatment and the client knows the drill. I hand over to the ops vet and leave her to work out doses.

    Third appointment

    A transfer from the out-of-hours provider

    After skim reading the long history (that consists mainly of numerous phone calls back and forward as to whether the owner could get the collapsed dog in the car), I finally get to the point and call the client in.

    The dog is bouncing and back to normal, apart from a stonker of a heart murmur. Cardiology is not my strong point and after a lengthy discussion about starting medication, and much faff flicking through the compendium trying to remember various side effects, I manage to convince them to trial medication.

    Fourth appointment

    Vaccination

    Yay, no formulary needed.

    Fifth appointment

    Medicine check

    One client thinks her dog has gained weight since being prescribed a particular medication. I highly doubt this is the cause of weight gain, but say I will quickly (or not so) check the data sheet.

    I reach for the NOAH Compendium (when I manage to locate a paper copy) rather than the formulary, because I can’t for the life of me spell the active ingredient. On skim reading the page, can’t find anything about weight gain or appetite, but it’s not as clear cut as the lovely “clinical particulars” or “contra-indications and adverse reactions” tabs on the website. I close the book.

    The client seems to be in a rush, but wants to discuss lowering the dose (are you serious? Could you have not said that while I had the page open?). I flick through and eventually find the page again, and work out the dose as they’re practically running out of the door.

    Sixth appointment

    Pregnant bitch

    The owner asks about worming and once again I leaf through the compendium to find the protocol, only to realise we don’t have that formulation in stock.

    Of course I’ve shut the book – but, before I find the right page again, one of the fantastic receptionists has materialised a bottle from somewhere and is flashing the data sheet in front of me for reference.

    Seventh appointment

    NOAH's 2018 compendium
    As she had no internet, Jordan turned to the NOAH’s Compendium for guidance, with varying results.

    Dog bitten by a ferret

    Small wound, possibly infected, but the dog is very wriggly. I prescribe Amoxyclav – one of the few things I instinctively know the dose of – and meloxicam (definitely no books required to work out that dose).

    Eighth appointment

    Puppy diarrhoea

    Can you give young puppies probiotic paste? Back to the book…

    It’s not listed in the compendium, and the box doesn’t indicate a minimum age – normally I would check the product website… Sigh. I search for the other vet to ask what feels like the 100th stupid question today. So it went on…

    No time to lose

    The point is, I didn’t realise quite how much using the internet on my phone sped up my consults. A 10-second search on an app turns into a couple of minutes leafing through a book for a drug dose. When your consults are only 10 minutes, that extra couple of minutes in each one adds up and very quickly I found myself getting behind, and, therefore, more stressed.

    I can’t retain numerous drug doses in my head – or at least don’t trust myself to rely on memory for many of them except the most common ones – so maybe this dependence on technology is more of an issue for new grads than more experienced vets who seem to be an encyclopaedia of drug doses.

    I was thankful this hadn’t happened on a large animal day – as someone with a terrible sense of direction, I would definitely have been stuck in the middle of nowhere with no Google Maps to get me home.

  • How to survive your first weeks as a new grad

    How to survive your first weeks as a new grad

    You’ve done it – five long years of hard work and study have paid off and you’ve graduated as a fully fledged vet. Welcome to the veterinary community.

    And it is just that – a community of people who’ve all been there and had a first day as a vet. You’ll find that everyone (meaning more senior vets than you, which is basically any vet) is happy to offer what I consider “well-being” advice, such as “don’t be too hard on yourself, you will make mistakes” or “don’t be afraid to ask if you don’t know”.

    Now, while this sort of advice is true, I don’t think it’s practically helpful for getting you through those first few weeks. No matter how much positive encouragement you receive from other vets, you will probably still be terrified for your first day/week/month.

    Practical advice

    "Familiarise yourself with the drugs in the dispensary. At uni, you learn drug names, now you’re in practice you will have to learn the brands."
    “Familiarise yourself with the drugs in the dispensary. At uni, you learn drug names, now you’re in practice you will have to learn the brands.” Image © JackF / Adobe Stock

    Having been there only a year ago, I have some practical tips and tricks to help get you through the day during those first few weeks:

    In-practice consultations

    • Make sure you know where things are kept in the consult room, so you don’t have to open every drawer in front of the client to find the syringes on your first consult.
    • Likewise, familiarise yourself with the drugs in the dispensary. At uni, you learn drug names, now you’re in practice you will have to learn the brands.
    • Make a note of the vaccination protocol used at the practice and the most common recommended flea/worm treatments (such as those on the pet health plan, if your practice has one).
    • Note down anything you may want to look up quickly, particularly premed doses. Depending on how your practice works, nurses may draw up premeds and have vets check before giving them, which can sometimes just be a waft in the vet’s direction for assertion – don’t panic and agree just because you don’t know what the dose is off the top of your head.
    • Keep a health plan or puppy/kitten package leaflet handy for when clients ask about them.
    • The stethoscope is one of the most useful tools for allowing yourself time to think without the client bombarding you with questions.
    • ALWAYS leave something essential outside of the consult room (a thermometer, fluroscein or tear test strips, for example). This gives you an excuse to leave the room have a flick through a book or ask another vet (don’t do it too many times in one consult).
    • If it’s something you want another vet to look at, most owners respond well to getting a second opinion. Alternatively, take photos “for comparison” then go and show another vet (be careful here – you need permission from the owners and check your practice policy regarding GDPR. You may be okay to use a work phone/camera, but not a personal one).
    • If you want to remove the animal from the owner – either to get another vet to look or for thinking space – ask if you can go and get a nurse to help restrain.

    Being on-call/farm visits

    • Open things before your first equine/farm visit (gloves, lube, etc) to avoid awkwardly trying to rip open boxes while the farmer is waiting.
    • Save dropped pins on Google maps or your satnav for your main farms or big equine clients. Again, work within GDPR, which may only allow this on work phones.
    • Make a cheat sheet for the car detailing drug doses for the most common things you use on farm – to avoid the inevitable mind blank resulting in an inability to do simple mental maths while staring at the bottle of Pen and Strep with the farmer staring at you. I made one for a 300kg/500kg/750kg size horse for quick reference.
    • If you need to call a colleague for advice while on farm, make an excuse to go back to the car. I would go to examine the animal first with minimal kit (just a stethoscope, for example) then, if necessary, make a call when I had to go back for a thermometer or relevant meds.
    • Make a note of who to contact regarding out-of-hours, door codes and alarm codes – and make sure you have practice keys.
    • Be prepared to be tired. It doesn’t last forever, but working as a vet is very tiring to begin with – don’t make too many plans for week nights or weekends for the first couple of weeks to allow you to relax when you get home.
    • Plan easy, quick meals so you don’t end up ordering a takeaway every night.

    General advice

    • Have a pocket-sized notebook and pen at all times, and hold on to that pen for dear life. Pens have a habit of wandering in vet practices.
    • Take a look at one of my previous blogs on language (Fake it ’til you make it) for some handy phrases to help assert your ability when you don’t really have a clue what’s going on.
    • "Plan easy, quick meals so you don’t end up ordering a takeaway every night."
      “Plan easy, quick meals so you don’t end up ordering a takeaway every night.” Image © serguastock / Adobe Stock

      Have a couple of books handy for quick reference when you need a memory jog. I use 100 Top Consultations in Small Animal General Practice and Gerardo Poli’s The Mini-Vet Guide for small animal, but I hear good things about the “Nerdbook” as well. For equine, I find the Handbook of Equine Emergencies great for quick reference on the go, along with the Saunders Equine Formulary.

    • Make lunch in advance to start with. It may be that you always get a lunch break, but sometimes things are manic, so ensure you have food to keep you going.
    • Take part in any work social activities and get to know your team – it will make the working day much more fun if you get on with those around you.
    • Book a holiday for three months time. You will need it.

    Handy resources

    Make use of the vast range of apps and websites out there. Here are some I found really helpful:

    • BSAVA app for the formulary (it’s quicker to search drugs than flicking through the paper formulary).
    • BEVA apps – which features drug doses, certain procedures and joint blocks.
    • NOAH Compendium – there isn’t an app (at the moment), but the mobile version of the website works well. Open the NOAH website on your computer before a consulting session starts – practice computers are notoriously slow and I guarantee it will freeze when you’re desperately trying to do a quick search for doses while the client is waiting.
    • Norbrook app – for drugs not on NOAH.
    • BHA Vaccination Date Calculator for horses saves a lot of time when working out vaccine validity.
    • MSD Vet for the Merck manual.
    • Vet Calculator for various calculations, particularly the heart rate counter.

    While the word “survive” carries negative connotations about veterinary practice (and I have previously discussed how this sort of language can be harmful), I do think you feel like you’re firefighting in those first few weeks.

    There’s no doubt it is a steep learning curve, but I’m confident you’ll come out the other side and thrive on the challenges of being a new grad.

    Good luck and enjoy finally being able to say you’re a vet.