Tag: pyometra

  • Commonly held beliefs that don’t do us any good, pt 2

    Commonly held beliefs that don’t do us any good, pt 2

    Belief #2: if you can’t afford to care for an animal then you shouldn’t have one

    You, young doctor or nurse – living in your privileged society of excess, with your years of study, working in an industry that exists largely to minimise animal suffering – have certain expectations of what “taking care of an animal” looks like.

    Of course, we should always strive to do the best we can for any animal in our care, but we need to learn to put judgement aside when an owner’s abilities don’t stretch to meet our expectations.

    Saying “if you can’t afford to care for a pet then you shouldn’t be allowed to own one” is a subjective and biased opinion.

    What defines an appropriate level of “caring for your animal” is based to a large degree on your background, prior experiences with animals and financial circumstances.

    Where is the line?

    Let’s agree that if someone takes an animal in your care, it is his or her responsibility to meet its basic needs – make sure it doesn’t starve, freeze or cook to death; don’t cause it unnecessary suffering through wilful abuse or neglect; and satisfy at least some basic emotional needs of connection, and freedom from fear and pain.

    Beyond that, where is the line?

    You could argue provision for core vaccinations should make the cut into what constitutes basic levels of care, but I can assure you many unvaccinated animals around the world live very happy lives.

    I’ve seen many colleagues spit venom about “careless owners” who “don’t deserve to own an animal” when a dog presents with a pyometra, so should we make neutering a minimum requirement of pet ownership?

    Should every pet owner have the means to pay for at least full bloods and an ultrasound? What about major life-saving surgery? An MRI? Chemotherapy? Specialist referral?

    If a line in the sand does exist, then it’s poorly defined – and, like the line between beach and ocean, it’s a line that will shift with every wave, tide, and storm.

    Collision course

    So, how does this belief hold you back?

    If you subscribe to this way of thinking, you’ll be on a constant collision course with a large part of the population. It’s a mindset that will set you up for daily antagonistic interactions with the people who present their animals to you, instead of creating those all-important relationships that were mentioned in part one.

    None of this will benefit your patients, your clients, or yourself. To put it simply: you’ll only make yourself resentful and miserable.

    Burden of care

    Where things do become complicated is when individuals expect a high level of veterinary care without being willing to pay for it.

    When the burden of care – and blame for lack of provision of its gold standard – are shifted solely on to the shoulders of the veterinary community, the relationship starts falling apart.

    This, of course, is rubbish – and should be treated as such.

    It’s a problem that vets who have the capacity to provide high levels of care will grapple with, and can be the topic of many more blogs.

    For the purpose of this post, let’s just say we should always aim to help – to the best of our abilities, and with a consistent level of caring and lack of judgement – any person who presents their animal into our care, despite their individual expectations and capacity of what constitutes a good level of care.

  • Seven – the magic number?

    Seven – the magic number?

    The veterinary community is changing. We are gradually moving towards a world of better work-life balance. Rotas vary massively from practice to practice, and even within practices, depending on particular species bias. One way some practices are adapting rotas is using a seven-day working week.

    The knee-jerk reaction is often negative – especially when we consider the seven-day week in relation to the NHS. We’ve witnessed the junior doctor strikes to negotiate better contracts. No doubt, some of us have experienced the NHS staff squeeze first-hand, having been presented with long waiting lists for diagnostics or procedures.

    Ludicrious?

    waiting
    A seven-day week for human medicine could lead to staff squeezes and long waiting lists, whereas Jordan Sinclair thinks the veterinary world is a better fit. Image © Picture-Factory / Adobe Stock

    With this in mind, the suggestion of a seven-day week for our human medical counterparts seemed ludicrous in the beginning – if staffing was an issue before, surely aiming to provide more services, such as routine procedures at the weekend, would only worsen the problem?

    Be that as it may, the veterinary profession is not the NHS. We are more attributable to private medical services, where work-ups can be done immediately, results reviewed and treatments provided much faster. While we, too, are in the midst of an employment crisis, each practice varies wildly and some remain fully staffed.

    Advantage

    For adequately staffed practices, the seven-day week can, indeed, be implemented to everyone’s advantage. This doesn’t mean everyone works more, it just means the rota has to be managed differently.

    An equine practice I’m aware of runs this rota. To my knowledge, the way it is implemented is some vets work alternate weeks – that is, seven days “on” and seven days “off” – while others work four days “on” and four days “off” in turn. Weekends are treated as a normal working day, so there are no more “weekends on call”, and the nights on duty are simply distributed within each vet’s working days. As you can appreciate, this means, for some staff, the days off are constantly shifting.

    This is just one example of how the seven-day working week can be implemented, and, ultimately, results in more availability for clients and more time off for the vets. However, this sort of rota would not necessarily work in all practices or fit in with all lifestyles. The workload would have to be sufficient to make it economically viable to treat weekends as normal days and the staff would have to assess whether this sort of rota would work for them.

    Work-life balance

    rota
    “Numerous ways exist to implement a better work-life balance, with the seven-day week being one of them.” Image © jolopes / Adobe Stock

    Many people value the traditional weekend, because it fits with non-vet partners’ working weeks, family or other weekend commitments, which is the main barrier to the introduction of this sort of service on a nationwide scale.

    The seven-day week doesn’t mean working seven days a week, every week. It simply means providing normal daytime services to the client seven days a week, with vets slotted into working hours accordingly.

    In a stressful professional work environment – taking into consideration on-call work and the 5:30pm pyometra surgery that keeps you working well beyond your alleged finish time – forward-thinking practices should be allowing their “full-time” vets adequate downtime: be that time off in lieu, a four-day working week as standard, and flexible working patterns or shifts, opposed to the traditional 11-hour days. Numerous ways exist to implement a better work-life balance, with the seven-day week being one of them.

    Retention solution?

    With the staff retention problem in the profession, it is imperative those practices still dragging their heels and working their vets into the ground take on board these ideas, and change their rotas for the better.

    Likewise, vets are struggling with their mind-bogglingly old-fashioned rotas should not stand for them – there are better options. If vets start voting with their feet, eventually, those workplaces stuck in the past, will have to adapt, otherwise they will find themselves even shorter of staff.

  • 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.

  • Accountability and responsibility: which causes more fear?

    Accountability and responsibility: which causes more fear?

    It’s very daunting standing in your first consult as a real, qualified vet – even if it is “just a vaccine”, which invariably turns into “actually, this has happened“, or “now you mention it“, and so on.

    But why is it we have that constant feeling of being on edge – more so than a few months previously, when we were still students?

    A noticeable shift certainly occurs to being an actual vet, rather than someone who always has a supervisor to have the final say, or take the brunt of the backlash of a mistake.

    However, is it the accountability or the responsibility worrying us the most?

    Pressing concern

    Mistakes
    Mistakes are inevitable, but rarely catastrophic. IMAGE: pathdoc/Fotolia.

    As soon as we swear the oath enabling us to register as veterinary surgeons in the UK on graduation day, we become accountable to the RCVS.

    In the past year, I have witnessed more than one speech telling us a) not to be scared of the college, and b) not nearly as many complaints, disciplinaries or registration removals occur as we think.

    Exact figures aside, the take-home message has been: if you don’t knowingly do anything wrong or illegal, the likelihood of serious consequences is very low. You can’t get struck off for making a simple mistake.

    The veterinary press, however, seems to over-represent those who are struck off or reprimanded; after all, you never hear about how many vets were not struck off this month or doing their jobs as they should.

    Perhaps this is where the unease stems from? And why the RCVS seems so keen to tell us these individuals convicted of misconduct are a very small minority of the profession?

    Are new grads really scared of the RCVS?

    Talking to my colleagues, the general feeling is we understand we won’t get struck off for making a mistake. However, if the fear has anything to do with our regulatory body, it’s more the confidence knock we would have as a consequence of having a complaint against us made to it.

    Of course, an element of worry surrounds being banned from practising as a vet, but I don’t think I would rank it top of the “things to be afraid of as a new graduate” list.

    Instead, in that list, I think responsibility carries a greater weight. As students, we were always supervised and, ultimately, the fate of an animal’s life never truly rested in our hands. Any decisions we made were either backed up or steered in the right direction by clinicians.

    Now, it’s down to us. Yes – other, more experienced colleagues should be in each practice with whom to discuss cases or reaffirm decisions, but when it comes to the consult room, you’re on your own.

    Experience is king

    Jordan
    Jordan, pictured during her final-year rotations.

    What if I miss a heart murmur? What if miss signs of glaucoma, a pyometra or a lump? The list goes on. What if I could have done more investigations earlier? What if I misdiagnose something and prolong pain because I didn’t prescribe the right treatment first time?

    These questions going on in our heads, coupled with a niggling feeling we have forgotten something or misread a dose, are the root of the fear. I believe this is what scares us, more so than the RCVS.

    The animals – and us inherently wanting to do our best for them – makes us worry. We worry our lack of experience could be at the expense of an animal’s health – or even their life.

    The only way to get past this is to gain that experience to have confidence in our decisions and learn from the mistakes we will, undoubtedly, make.

    My mum said to me this week: “This is the only time you’re ever going to feel like this,” and she’s right. (But don’t tell her I said that). Even if we start a new job in the future, we will have a lot more experience under our belts, so shouldn’t, in theory, feel as lost or scared as we do now.

    Being a new graduate vet is a unique position for a myriad of reasons and we need to embrace it. The fear that comes with this newly found responsibility will ease with time, and we can take our careers in whichever direction we choose.

  • I’d recommend early neutering

    Pyometra in a dog, seen during surgery. The uterus is distended with pus.
    Pyometra in a dog, seen during surgery. The uterus is distended with pus. Image by Joel Mills [GFDL, CC-BY-SA-3.0 or CC-BY-SA-2.5-2.0-1.0], via Wikimedia Commons
    Last week I removed one of the largest, most pus-filled uteri from a large breed dog that I have ever seen.

    I’m a bit long in the tooth now, but I still found the whole procedure a bit scary given the size and vascularity of the uterus – and this made me reflect on the benefits of early neutering.

    We routinely spay bitches in our practice from five months of age with minimal long-term complications, and it’s so much easier.

    I am aware that recent research indicates early neutering may have some long-term implications in certain breeds, but the procedure is so much safer in young dogs, and anything that prevents them developing pyometra in later life has got to be an advantage.