staging.vettimes.com

Tag: Social Media

  • What is normal in the veterinary world?

    Teddy
    Teddy is poorly… 🙁

    As veterinary students (and probably later as vets), we have a very distorted view of “normal”.

    Exam season (for Glasgow) is now over, but during revision, the social media stakes noticeably increase. While many of my non-veterinary friends share photos of their piles of notes captioned “T-minus 2 weeks”, “Revision hell” or the like, in return they get photos of me gloved and gowned up or an “animal” (cuddly toy of some description) draped up (in tea towels) ready for “surgery”.

    This isn’t just me playing vet for their entertainment – these skills were assessed in our practical exams – but my friends still find it bizarre it counts as revision.

    The student halls I lived in during my first year had a high proportion of veterinary students, as they were sited very close to the vet school. Being in catered halls, we all ate dinner together, and soon there were a few “vet tables”. If we’d all come in from anatomy practicals, with no second thoughts about discussing the intricate details over dinner, it was no surprise no one else regularly ate with us.

    Even when you restrain from comparing the consistency of some body fluid or other to the pasta sauce you’re eating while out with friends, you’ll probably notice something in your hair that could easily be either blood or poo. If your friends notice, they’ll either laugh or be disgusted, but to you it’s just a normal occurrence after a day on a veterinary placement.

    IMG_1901
    Teddy has been prepped and draped, ready for “surgery”.

    Every so often, a comment snaps you back into the non-veterinary world and makes you realise we really are quite strange.

    While back home and studying, my five-year-old brother (in order to evade bedtime) decided to “help” me revise and was fascinated by a picture of a dissected lizard, which in his opinion was “a turtle with it’s shell taken off so you can see its insides”.

    Thankfully, he wasn’t too bothered by it, but I was slightly concerned about giving him nightmares.

    It’s easy to take the weird and wonderful world of veterinary life for granted, especially when you’re surrounded by like-minded people during term time. My family think I’m insane when I tell them I was watching postmortem videos at 3am on the day of my pathology exam.

    Aside from the gore, there is also the stress element. Every round of exams, various friends or family members ask how I’m doing. When I reply “terrible”, “convinced I’m going to fail”, “will get no sleep during exam week”, their response is “you always say that, and you’re always fine. Just get an early night”.

    When I relay this to my vet friends, the response is “what’s an early night?”

  • Cytology better than swabs for culture in cases of otitis externa

    This one’s a little controversial, but some evidence exists that taking swabs for culture from cases of otitis externa can lead to poor reproducibility.

    Swabs taken from the same ear may produce different isolates, and even when the isolates agree, they may have different (antibiotic) susceptibility patterns (Bloom, 2015; Graham-Mize et al, 2004; and Schick, 2007).

    Bloom (2015), therefore, suggested using rational topical therapy based on cytological findings was more valuable than using bacterial culture and sensitivity. He also only advised repeat cytology if the ear was not clinically resolving or neutrophils and bacteria were present on initial cytology.

    He only takes culture and sensitivity where rods are found on cytology, there are proliferative changes and the ear is responding poorly to therapy – a rare set of circumstances in Paul Bloom’s experience.

    This approach was supported by a study in which the authors evaluated whether any correlation was noted between topical antibiotic selection, in vitro bacterial antibiotic sensitivity, and clinical response in 17 cases of canine otitis externa complicated by Pseudomonas aeruginosa (Robson et al, 2010).

    VIDEO: How to properly swab an ear for aural cytology (source: YouTube).

    References
    Bloom P B (2015). Diagnosis of Otitis Externa in the Real World, Proceedings of the North American Veterinary Conference, Orlando, Florida: 944-953.

    Graham-Mize C A and Rosser E J Jr (2004). Comparison of microbial isolates and susceptibility patterns from the external ear canal of dogs with otitis externa, J Am Anim Hosp Assoc 40(2): 102-108.

    Robson D C, Burton G G and Basset R J (2010). Correlation between topical antibiotic selection, in vitro bacterial antibiotic sensitivity and clinical response in 17 cases of canine otitis externa complicated by Pseudomonas aeruginosa, (Abst). In 25th Proceedings of the North American Veterinary Dermatology Forum, 2010: 245.

    Schick A E, Angus J C and Coyner K S (2007). Variability of laboratory identification and antibiotic susceptibility reporting of Pseudomonas spp isolates from dogs with chronic otitis externa, Vet Dermatol 18(2): 120-126.

  • Crash prevention

    Airplane
    Image ©iStock.com/mevans

    Following the devastating news of the Germanwings crash last week, the co-pilot’s torn-up sick note and the early implication of mental health issues (later suspected to instead be eyesight-related), I witnessed a shocking flare-up of defence regarding mental health on social media.

    My gut reaction was of absolute disgust. Whether said sick note referred to mental illness or not, the co-pilot was not 100% mentally sound, otherwise he would not have deliberately crashed an aeroplane into the Alps, killing 149 innocent people.

    An article I read describing the rescue efforts to retain the pieces of the bodies (explosion on impact meant there were no bodies intact) was particularly distressing. And yet people preached online, directly referring to the plane crash, that people with clinical depression should be able to hold such jobs. I’m not advocating denying sufferers of severe mental health problems the right to work – but perhaps not in a job that could result in this sort of sickening situation. Can we have some context please?

    While a vet may not have it in his or her power to destroy innocent lives to such an extent as pilots, how does this translate? Vets have access to dangerous drugs that could have drastic consequences if used wrongly due to mental instability, and perhaps provide a more accessible option of suicide than the non-medical general public. They also carry responsibility during surgery or other procedures with the potential to act inappropriately with implications on the lives of animals in their care.

    Airplane seatbelt
    Image ©iStock.com/gong hangxu

    You wouldn’t necessarily get on a plane if you were told the pilot had severe clinical depression, so would you leave your dog requiring general anaesthesia with a vet who is?

    I think where the confusion has occurred is that word that gets thrown around too easily regarding mental health: “stigma”.

    There is a certain stigma regarding mental health, but instead of ranting about discrimination due to mental health, a step forward would be acceptance.

    One of the major factors in suicide within the veterinary profession is vets themselves not admitting they need help. In order to prevent professionals (in any sector) slipping through the net and putting on a brave face with unexpected devastating consequences, we need them to accept that they are unwell or stressed in order to take a step towards gaining help to get back on track.

    To do this in a veterinary context, we need to remove the fear of being prevented from practising. The words “fitness to practice”, even within vet school, send a ripple of fear through one’s skin. I’m aware of students who have deliberately concealed medical conditions from the faculty through fear of being thrown out. I can only imagine this is carried through to qualified vets, frightened of “being struck off”.

    It shouldn’t be that way.Germanwings logo #indeepsorrow

    The profession as a whole needs to work towards distinguishing clearly between taking a break from practice to get yourself better and being irreversibly banned from practising as a vet. We need to make it “okay” for vets to admit they need help to have any hope of reducing suicide, among other consequences of mental ill-health, within the profession.

     

  • Aural haematomas: an alternative to surgery

    It occurred to me the other day I hadn’t seen an aural haematoma for some time. Saying that, I now expect three to come along in Monday-morning surgery.

    I also recall a time when we immediately resorted to surgery as the primary treatment. However, lately we have drained the ear and injected dexamethasone into the space. If you do this, though, it is vital to inform the owner the ear will swell up again post-draining, but will resolve over the following week or so.

    As long as we are treating any concurrent otitis externa (if present), I have found this a very effective means of treatment and very valuable in elderly patients with co-morbidities.

    Greg Martinez DVM drains, injects and wraps an aural haematoma (source: YouTube).

    Note: Greg uses cortisone rather than dexamethasone.

  • Subcuticular sutures: a great idea in sensitive regions

    We routinely audit postoperative complications for our canine neutering surgery.

    Over time, it became clear we were seeing a few castration wounds come back in where the dog had licked both the wound and surrounding area, making it sore to the extent it was delaying healing. In some cases, additional treatment was required.

    We then wondered to what extent non-absorbable skin sutures were playing a role. Making the change to using absorbable skin sutures reduced our complication rate significantly – nuff said!

    How to bury knots at the start and finish of a subcutaneous suture. Video by John Inns via YouTube