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Tag: Ocular disorders

The blind leading the blind
As part of one of our small animal rotations, I spent a couple of days with the ophthalmology service at the University of Glasgow Small Animal Hospital.

Recognising common eye conditions and being able to localise lesions was uncharted territory for Jordan before her time with the ophthalmology service. Image: thenineworld / fotolia.

Not exactly the most clued-up on eyes, I was going in almost blind. I had an idea of common eye conditions and how to manage them, but recognising them and being able to localise a lesion in an eye was uncharted territory.

After a mind-boggling tutorial in which we tried to drag physics from the depths of our brains (A-levels were five years ago), consults began – and with them, ocular examination after examination after examination.

By the end of day one, despite my brain feeling fairly frazzled, I felt I could locate roughly where in the eye a problem was and begin to deduce differentials, or at least know which chapter of the book to look in.

We discussed the differences between referral and first opinion practice. One of the main reasons eye conditions are misdiagnosed or missed is simply lack of time in the consult room.

For example, if you have a five-minute consult and want to do a Schirmer’s tear test, half the time is already taken.

Several components exist to a thorough ocular examination, with some better than others at identifying certain conditions or highlighting certain anatomical regions of the eye.

One important thing I took away was you can still achieve a good examination with limited equipment – in our case, we found a broken otoscope the ideal instrument for distant direct ophthalmoscopy.

Guide Dogs patient

So it came to one of the final patients on our final day – a bubbly golden retriever about to begin formal training to become a guide dog. By this point, we thought we could accurately identify basic conditions, but didn’t want to believe what we found on his lenses. When asked for the diagnosis, I hesitantly answered “cataracts” for two reasons:
1. The cataracts themselves looked different to others we’d seen – they had a triangular shape with a clear area in the centre, making them not entirely opaque.
2. This young dog’s career as a guide dog would come to an abrupt end with this diagnosis.
However, a breed predilection exists for hereditary cataracts in retrievers and the Guide Dogs staff member who was accompanying the puppy walker – the person who fosters a puppy before they enter formal training – was not shocked by the news, having experienced the condition several times previously.

While the dog still had fairly good vision at the minute, it would have to be withdrawn from training.

Several options exist for guide dogs withdrawn for health or behavioural reasons – they can be put into another work sector, such as the police or other assistance dog programmes like buddies for disabled children. Otherwise, they are rehomed as pets – hopefully our golden friend will find a new family shortly.

Having looked into the Guide Dogs scheme a bit more, it’s astonishing how much work and money goes into the training and upkeep of a guide dog.

They are a fantastic aid to people with impaired or no vision and, while it was disheartening to see a dog that wouldn’t tick the health boxes for continued training, I could appreciate the vet’s role in the process.

Eyes may always be a tricky area of veterinary medicine, but I don’t think I’ll miss a triangular cataract from now on.
December 6, 2016
The consequences of making a mistake
Beef farms in Scotland can be quite picturesque.

Fertility work makes up a large proportion of cattle veterinary work in the UK and, after spending a month on the farm rotation at university, I can appreciate the importance of getting it right – and how hard it can be.

Experienced large animal vets make it look easy – they scan the uterus and ovaries, and decide what drug to give to aid getting the cow in calf, all in a minute or two.

In the meantime, I’m still fumbling about trying to palpate what, I think, may be the uterus or ovaries while the cow squeezes and gradually cuts off the circulation in my arm until I can barely feel my fingers.

Meanwhile, the vet has zipped through several cows already.

When things go wrong

What happens if you misdiagnose a pregnant cow as negative and administer prostaglandin, or give a cow steroids without realising she’s in calf?

On one fertility visit this week, we discussed when things go wrong. For example, what if:
- you misdiagnose a pregnant cow as negative and administer prostaglandin (PGF_2α)?
- a vet gives a cow steroids for any number of reasons without realising she’s in calf?
The outcomes of both of these scenarios are almost inevitably abortion, which can have a number of repercussions on the farm – and, potentially, the vet.

Negligence or misconduct?

Many new graduates are terrified of being called up for “fitness to practice” for making a mistake such as those aforementioned. However, during a Veterinary Defence Society (VDS) workshop at the SPVS Lancaster weekend earlier this year, it was emphasised a difference exists between negligence and misconduct in the eyes of the RCVS.

What I took away from this session was, in simple terms, negligence involves making a mistake – such as missing a diagnosis, giving the wrong treatment accidentally, eliciting side effects from something due to missing something in the case history – whereas misconduct is actively doing something you know you shouldn’t – such as trying to cover up a mistake, lying or misleading a client.

Mistakenly giving PGF_2α to a pregnant cow would be classed as negligence and, on the whole, the VDS would have your back; the farmer may receive some compensation for his losses, but the incident wouldn’t tarnish your career. In the same situation, misconduct would be denying you had administered any treatment.

In short, you won’t get struck off for easily made, one-off mistakes, but you may if you lie about them.

In the news

Our conversation about accidentally aborting cows led us to discuss the case of Honey Rose, the optometrist convicted of gross negligence manslaughter. News reports vary, but, from what I can gather, she failed to diagnose papilloedema (swollen optic discs) in an eight-year-old boy, which would have been an indication of the hydrocephalus he died of five months later.

It is reported she claimed to have been unable to examine his eyes properly because he had photophobia – a claim considered false by the judge. However, she had also failed to look at retinal photos taken by a colleague, on which the papilloedema was evident.

Going by the RCVS’ rules, missing the diagnosis or not looking at the retinal photos would be negligent. However, denying she’d been able to carry out a thorough examination, despite written records suggesting otherwise, would be misconduct.

Rose was found guilty of gross negligence manslaughter and was handed a two-year prison sentence, suspended for two years, and a 24-month supervision order, and was ordered to complete 200 hours of unpaid work.

In your defence

As vets, we have the VDS to help us in these situations – and, while it would be truly awful to make a mistake resulting in an animal’s death, we would not be at risk of imprisonment.

Doctors and dentists also have defence societies that will fight their corner, but optometrists? To my knowledge, an equivalent does not exist – and this was the first case of an optometrist convicted of manslaughter in the UK, which added to the complexity of the legal battle.

The death of a little boy is devastating, but, as medical professionals know, death is a risk with many procedures, no matter how small the risk may be. It’s frightening to think jail could be a consequence for those in the medical profession.

So, while I gradually lost the sensation in my right arm as I tried to reach an ovary of the 10th cow in a row, I mulled this over and realised I was extremely thankful for the safety net the VDS provides and would not take working with animals for granted.

After all, if I’d decided to be a doctor instead, I could be rummaging around in another human’s back end rather than a cow’s!
- For further details of the Veterinary Defence Society and its services, visit www.thevds.co.uk
October 19, 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
Lost and found: why microchipping is a must
Doogle’s plight found its way into the hallowed pages of The Hinckley Times.

One of our cats – Doogle, a home-loving feline who rarely sets foot outside the garden – recently got himself caught under my mum’s car, only to drop out when she’d driven along a few streets and run, startled, across the fields toward the next village.

Posters, local press coverage and Facebook shares resulted in a few potential leads on his whereabouts (we’d localised him to 2-3 miles from home) but, as a cat that doesn’t normally roam far, we never thought he’d find his own way back. The only comforting factor was the knowledge he was microchipped – should someone find him and take him to a rescue centre or vet, he’d be returned to us.

Cats vs. dogs

As cats tend to stray (or get lost), the advantage of microchipping them is clear, but it isn’t a legal requirement. It will, however, become law in England and Scotland for dogs to be microchipped from 6 April 2016. This change in the law means that all dogs must be chipped by 8 weeks of age and the appropriate details registered to the chip must be up to date.

Unfortunately, while we did have Doogle microchipped, we realised we hadn’t registered our contact details with the microchip company, despite him being 18 months old and having been chipped as a kitten.

This is something many dog owners will have to consider in line with the new law: if an owner does not keep the dog’s information up to date on a relevant database, or the dog is unchipped, a notice may be served giving 21 days in which to rectify the situation. If they still fail to comply, a fine of up to £500 can be issued or the dog may be seized and microchipped.

Raising awareness

Doogle managed to make his way home without the aid of microchip technology, but not all pets are so lucky.

Ignorance is no excuse, so we must make clients aware of the new regulations, and in some cases, the exemptions:
- Working dogs that have their tails docked in accordance with the Animal Welfare Act 2006 are allowed an extended time limit of 12 weeks before they must be chipped (this applies to England and Wales only – tail docking is entirely banned in Scotland).
- Implantation can also be delayed if a vet believes it could adversely affect a dog’s health. In these cases, the vet must certify this is the case and state the expiry of the exemption, by which time a chip must be inserted.
The introduction of the law will help trace inherited defects, tackle puppy farming and promote responsible dog ownership, not to mention the peace of mind that chipping gives owners should their pets be lost or stolen.

Much to our disbelief, Doogle managed to find his own way home two weeks after he first went missing, so we never relied on his microchip for him to be returned, but we can now appreciate the relief of knowing it’s there (with the correct details registered) if he ever disappears again.
- Source of microchipping information: www.thekennelclub.org.uk/microchippingfactsheet
January 30, 2016
Indian adventure taught me to embrace the madness

One of the many non-academic challenges of becoming a vet is learning to cope with things not going to plan – to expect, or at least accept, the unexpected.

“We had planned to arrive in Agra to see the Taj Mahal on the one day a week it was closed…”

It may seem cliché to say travelling opens your eyes to different ways of life and changes you as a person, but the truth is it does prepare you for when the s*** hits the fan.

My friend and I had arrived in India with some trepidation; both of us had had busy summers and so very little time to consider what lay ahead.

We spent two days seeing some sights and travelling to our final destination, which was a feat in itself. India is just absolute mayhem.

Going to Goa

We had already circled Mumbai with a taxi driver who had no idea where he was going, returned to the hostel in the nick of time to grab our luggage for an onwards flight, only to be dropped off at the wrong airport and realise we had got our flight time wrong (though, thankfully, in our favour), before settling into our apartment in Goa, ready to start our EMS placement.

Having struggled to get in touch with the hosting charity, it finally arranged for a driver to pick us up on our first day. Therefore, on arrival at the shelter the final thing we expected was to be sat down by the board members of the charity, questioned and told they had no placement for us; we were subject to some miscommunication, goodbye.

Change of plans

Startled, with panic rising, we were shipped off to another charity 30km away to see whether they could offer us an alternative (which, after hours of discussion, they couldn’t).

After two days of frantic emailing and frustrating phone calls (with both parties struggling to understand accents) we found a saviour and abruptly departed Goa to fly to Delhi to squeeze in a few more sights before starting over.

This was also not without its challenges – we ended up directing two rickshaw drivers using maps on a phone, as they had both agreed to take us but, in reality, had no idea where our destinations were.

We battled the infamous Indian sleeper trains and had planned to arrive in Agra to see the Taj Mahal on the one day a week it was closed (again, calling for a swift diversion of plans). We had also been scammed on flights and made a total hash of accommodation bookings, having had to make so many last minute changes.

EMS saviours

“We battled the infamous Indian sleeper trains…”

Almost at the end of our tethers, we finally arrived in Jaipur to start our quickly organised placement at the charity Help In Suffering, which had completely saved our skins in terms of finding a suitable EMS placement that would count towards our degrees.

When it seemed like nothing else could possibly go wrong, something inevitably did. Nevertheless, we pulled each other through and overcame several unexpected challenges, despite being very close to just getting on the next plane home.

Although we had some extra hurdles, I think travelling in India at all is a total minefield for anyone, but you just have to accept the disorder and embrace the madness.

It may have started out (and continued for a fair while) as a total nightmare, but I definitely think we will both be better prepared for mishaps and abrupt, last minute changes in future veterinary practice – after all, we have this to reminisce over and think “it could be worse – at least we’re not stranded in India.”

September 15, 2015