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Tag: Stress

  • The revision roller coaster

    The revision roller coaster

    At this stage of the year, it’s hard for me to write about anything but revision. So, for those of you reading this as a means to escape, I can only apologise. At the same time, if your idea of time off from studying is reading my work-related articles, then I think we need to have a little sit down and a talk about healthy revision outlets…

    With my last ever university exams (yeah, like, ever!) rearing their heads, I’m finding my own is a bit of a jumble.

    The last several weeks before the big day can often feel, at least for me, like a bit of a roller coaster ride. There are ups and downs; terrifying “grip the handlebar” kind of moments; and occasional points where you reach the top, clear the clouds and see everything below you with level-headed clarity – and then the whole thing starts again from the beginning.

    Happy birthday to me?

    First of all there’s the build-up. Personally, I think the build-up to exams can be worse than actually taking the things.

    As somebody with a birthday plonked squarely in early May, this has led to the anniversary of my birth becoming somewhat bittersweet over my past 20 (yes, 20) years of education. I’ve even had friends and classmates willing me not to age, just to fend off the dreaded exams.

    If you’re lucky, it will have been a good year since your last exams, so it’s almost easy to tell yourself it can’t really be as bad as you remember it, and sure, you’re here to tell the tale!

    So what’s all the fuss about? Besides, it’s months away, right… right?

    Then the realisation hits you that those months have melted away into a measly finger-countable number of weeks. This is the feeling akin to the hard “thunk” of that metal seat belt bar strapping you in before the roller coaster ride. You’re locked in now, and the only way is onwards.

    Image © Anna / Adobe Stock

    Highs and lows

    Like with any good roller coaster, the journey of revision is marked by a series of highs and lows. You can sometimes spend a day or two feeling really very good about yourself, quite smug actually, especially in the early swathes of revision while your brain juices are still flowing nicely.

    “Wow”, you think to yourself. “I remember everything I read today. It may have taken 13 years of exam practice, but I think I’m getting the hang of this revision malarkey after all”.

    Then a day comes when you wake up and it feels as though everything you once knew has fallen out of your ears overnight. Your brain feels like a clogged artery and the juices just can’t quite make their way round the bends. Paragraphs, facts and figures can start to swim together. Do horses lay eggs? Do chickens neigh?

    It can feel like five years’ worth of content is trying to make it’s way to the forefront of your mind all at once, with no polite or mannerly order.

    Image © Jacob Lund / Adobe Stock

    Stay in control

    The important thing, I find, in order not to let the roller coaster get the better of you, is to make everything else in your life as smooth a ride as possible. Obviously, this is easier said than done, I’m no fool. Life will always throw things at you, especially when you feel like you already have enough on your plate, but start by controlling the things you can.

    Remember the basics:

    • Sleep.
    • Eat.
    • Hydrate.
    • Practice self-care.

    Treat yourself to that leftover easter chocolate, keep making plans with friends as something to look forward to, and let yourself clock off for a couple of hours before bed.

    It all matters

    It has been scientifically proven that increased levels of stress actually reduce our ability to take in new information – which is, ironically, something on this year’s syllabus – as do lack of sleep, under-eating, dehydration and depression.

    Trying to revise under any of these conditions is like fighting with one arm behind your back, so never forget that what you do outside of your revision schedule is just as important as what’s in it.

  • To resect, or not to resect…

    To resect, or not to resect…

    To resect or leave in a piece of intestine that is concerning you is a common source of stress when performing exploratory laparotomies.

    In many cases, this is straightforward; in some, it can be difficult to decide.

    The risk is if you leave in a piece of intestine and it devitalises, then leakage of intestinal contents into the abdomen occurs, leading to septic peritonitis – the situation we all dread.

    Criteria

    In this post, I cover some criteria I use to assess intestinal viability.

    These are all subjective criteria that require familiarity with what is normal, as well as good judgement, to be reliable; however, they are the only realistic criteria available for general use.

    Arterial pulsations in the mesenteric arteries that are feeding the affected areas

    This is the most important criteria, and it can be the most reliable criterion for assessing intestinal viability.

    It goes without saying – if there is no blood supply, there is no oxygen being delivered – resulting in tissue death.

    Intestinal tissue color

    It is important to remember the colour can change quite dramatically in a short period of time.

    Once an obstruction has been removed, perfusion to that area will be restored and the colour can change rapidly. Tissues that are dark in colour can turn dark red then bright red with time.

    Often, I give the section of questionable intestine time after I have removed an obstruction to see what colour it changes to. If the tissue is black or grey and does not improve, I would consider resection.

    Wall texture

    This can be a difficult thing to appreciate, but it can be helpful to compare a healthy segment of intestine to the affected segment of intestine.

    When you squeeze and roll a piece of healthy intestine between your thumb and index finger, it should feel thick and springy, whereas intestine that has lost viability can feel “thin”.

    Peristalsis

    The presence of peristalsis can be helpful and is a good sign. The absence of peristalsis is not an automatic indicator of poor intestinal viability, as it can take some time for motility to return in severe cases.

    Partial thickness incision

    Finally, a small partial thickness incision can help if you are really stuck.

    If there is effective blood supply to the tissues then the blood should be normal and bright red in colour, as it is oxygenated; poor blood supply will mean the blood will remain dark and blue tinged, indicating poor oxygenation.

    Concerning signs

    The criteria that makes me very concerned – and would make me lean towards resection – include:

    • black, grey discoloured intestine
    • absent arterial pulsations
    • absence of peristalsis
    • thin wall thickness
    • dark, deoxygenated blood from a partial thickness incision

    If I have concerns and it will not result in a significant loss of small intestinal length, I would remove the intestine rather than leave it in.

    If you are removing large segments, I would wait longer to see whether time and blood supply will help improve the health of the intestinal tract enough to feel comfortable leaving more of it in.

  • Dangers of festive gatherings

    Dangers of festive gatherings

    Christmas is a great time for family gatherings, but this does not necessarily mean it is a great time for pets.

    In fact, it can often be the opposite, with veterinary clinics seeing a major increase in patient numbers that come through the door.

    One common emergency we see at the emergency hospital during the festive season is dog fight and bite wounds. As vets, we have a duty of care to educate pet owners during this time, so they – and their pet – have the best Christmas possible and do not end up in the emergency room.

    Why do dogs fight and bite at Christmas?

    Usually during the festive period, family or friends increasingly gather to celebrate. Whether it is people coming into their home, or them being taken to someone’s home, this can be confusing and cause anxiety levels to rise.

    When a family member or friend brings a new pet into the house with an existing pet, it creates competition for food, space, affection and attention – and this can lead to dog fights. Even usually mild-mannered pets can easily feel threatened by a new pet entering their territory, and may lash out.

    Increases in noise, people, decorations and general chaos during the holiday season can cause stress and anxiety. For dogs protective of their domain and the people in it, this can be a difficult and uncertain time.

    Children not used to pets, and pets not used to young children, can also be a dangerous combination. Dog bites are a common injury sustained by children during the festive period and it could often be avoided.

    Solutions

    Although dogs are part of the family, it is important owners understand leaving their dog at home when they go to a festive gathering is not leaving them out, but protecting them and making sure they are more safe, comfortable and happy.

    If hosting a party, owners can shut their dog in another room away from the chaos and noise – they will be grateful to have a peaceful space. This is a must for a dog already prone to stress.

    Children and dogs should not be left alone and should be monitored at all times. If the dog starts to show signs of anxiety and stress, it should be taken somewhere it feels comfortable and calm.

    Owners can take their dog to their vet for a behavior assessment. Anti-anxiety medications could be considered in extreme cases, but this would be a last resort.

    Communicating messages

    We can educate pet owners in the lead-up to Christmas in many ways. We can offer thoughtful, engaging and informative advice and guidance.

    Some ways to communicate festive dangers to pet owners include:

    • infographics
    • videos
    • social media posts
    • posters in the hospital or clinic
    • blogs
    • email campaigns
    • discussing the dangers at check-ups and appointments
    • newsletters
    • flyers
    • special calls to clients with an anxious pet
    • education events, such as how to manage pets and children

    Here’s to a very merry – and safe – Christmas.

  • Is puppy yoga flexibly ethical?

    Is puppy yoga flexibly ethical?

    Is puppy yoga the new cat café?

    Is it a new passing trend or here to stay?

    Either way, as a student with a passion for both fitness and animals, I was initially intrigued. But I can’t help but have concerns for whether this practice is beneficial for all members of the class.

    Five freedoms

    Usually applied to the context of captive animals, the five freedoms can really be utilised to evaluate the welfare of any animal outside of its natural habitat (which, technically, every dog is).

    These being freedom from pain and disease, stress, discomfort and hunger, as well as freedom to express normal behaviour.

    My main concerns when it comes to puppy yoga would be stress, hunger and disease.

    If classes run back to back, younger animals that require more frequent feeds may miss out on vital mealtimes, and there’s always the worry some puppies included in these classes are too young to be removed from their mothers. Ideally, no puppy should be removed from the dam or weaned before eight weeks of age. In larger breeds, puppies can appear older than they really are, and some breeders or yoga studios may be motivated by profits to use pups that are slightly shy of this age limit.

    The danger here is that puppies don’t typically receive vaccinations until they’re eight weeks old, and if puppies from different litters are introduced when their mother-derived immunity is lowering, diseases can be transmitted very quickly. Most vets wouldn’t advise mixing a puppy with other dogs until at least two weeks after its second vaccines (at around 12 weeks old) to allow adequate immunity to develop.

    In regard to stress, anything new or novel can be stressful to a puppy (or any animal for that matter). Loud noises, strange smells and lots of new people all at once can also be very overwhelming and scary to puppies that are yet to be properly socialised.

    Socialisation

    The socialisation window for puppies is from when they are roughly one to three months old. During this time, the animal’s perceptions of the outside world and its stimuli are being shaped by its experiences, and once that window closes, it can be more difficult for biases towards certain stimuli to be changed.

    Since the majority of puppies used in yoga sessions are between two to four months old, on paper, the practice sounds like an excellent opportunity for animal lovers to exercise and unwind surrounded by adorable puppies, with the added benefit of those puppies being socialised to grow up more well-rounded and well-behaved pets.

    Unfortunately, however, socialisation is not an exact science, and while it is incredibly beneficial to introduce puppies to lots of different things during their socialisation window, it does not mean flooding them with lots of stimulus all at once.

    This is the really tricky part, because what counts as “overwhelming” to one puppy may be completely manageable to the next. Some animals may find a room full of new people and smells incredibly exciting, while others need to be introduced to new people one at a time, with plenty of opportunity to withdraw from the experience if needed.

    It can also be impossible to predict what type of puppy you have until you place it in that situation. While a lot of behavioural aspects in our pets can be traced back to environment and genetics, every animal is unique, and just because a litter comes from docile, friendly and outgoing parents, doesn’t mean the offspring will share the same traits.

    Ensuring every puppy’s experience of a yoga session will be adequate from a welfare perspective would take a very knowledgeable and conscientious screening process that some businesses may not know how to or be able to provide.

    Yoga “pants”

    I feel that puppy yoga is probably far from a black and white picture, with the level of puppy welfare and attention to their needs varying from practice to practice. For this reason, I think it’s definitely a good idea to do your research before booking a session – whether you’re a vet or not – to make sure you’re happy with where the puppies come from, if the establishment is aware of vaccine records (and so forth), and if the puppies are given adequate opportunity to rest and retreat from engaging with the customers if they wish.

    In the same way that in the veterinary profession we are now seeing the outcomes of puppies raised during the pandemic lockdowns, we may soon see the influence of puppy yoga in the next generation of pets.

    At the end of the day, it’s up to the individual consumer to decide if the practice is for them, or if ethical puppy yoga is a bit of a stretch…

     

  • Laryngeal paralysis

    Laryngeal paralysis

    This patient was brought to us for exercise intolerance, breathing difficulty and loud airway sounds.

    The patient has laryngeal paralysis. This is where the muscles controlling the arytenoids cartilages do not work and leads to failure of opening of the arytenoids during inspiration.

    Most commonly seen in middle-aged large breed dogs, it can occur acutely, but more often it is a chronic problem exacerbated by heat or stress. The cause is often unknown, but it can be caused by trauma or lesion to the cervical region or some kind of neuropathy, such as myasthenia gravis or tick paralysis. Diagnosis is based on visualisation of the arytenoid cartilages failing to abduct during inspiration under light anaesthesia.

    Treatment

    The management of the acute presentations include oxygen and sedation (butorphanol) to improve airway dynamics – with or without active cooling triggered by heat and with or without anti-inflammatories (dexamethasone) to reduce swelling secondary to airway turbulence.

    Patients in severe respiratory distress, anaesthesia and intubation may be required for a short period. Long-term management involves either surgery, such as laryngeal tieback, or conservative management strategies that involve weight loss, avoiding exercise and being kept in a cool environment.

  • Abdominal ultrasound, pt 3: scanning procedure

    Abdominal ultrasound, pt 3: scanning procedure

    I cannot stress enough how crucial it is to develop a systematic approach to doing ultrasounds. Not only will this approach help develop an anatomic mind map, it will also safeguard you from accidentally overlooking organs.

    Suggested scanning procedureWhen examining each individual organ, the same theory applies. This will ensure you look at each organ in its completeness, reducing the chance of an abnormality being missed.

    The only way to improve your ability to track through organs is by repetition; repeating and practising the same manoeuvres over and over again. In time, you will notice you will be able to detect subtle changes you wouldn’t have been able to before.

    Suggested scanning procedure

    Starting at the bladder and moving anti-clockwise:

    1. bladder
    2. prostate/uterus
    3. left kidney
    4. left adrenal
    5. spleen
    6. liver
    7. gall bladder
    8. right kidney
    9. right adrenal
    10. stomach
    11. duodenum and pylorus
    12. pancreas
    13. small intestine
    14. large intestine
    15. lymph nodes
      • mesenteric lymph node
      • iliac lymph node
  • Blood gas analysis, pt 4: respiratory acidosis and alkalosis

    Blood gas analysis, pt 4: respiratory acidosis and alkalosis

    Assessing the respiratory component is simple. A quick glance at the partial pressure of carbon dioxide (PCO2) level can tell you whether a respiratory acidosis or alkalosis is present.

    If the PCO2 level is elevated (respiratory acidosis) then either a primary respiratory acidosis is present, or it is the result of a compensatory response to a metabolic alkalosis.

    Similarly, if the PCO2 level is low (respiratory alkalosis) then it could either be a primary respiratory alkalosis, or compensation to metabolic acidosis has occurred.

    The respiratory component should always be assessed before the metabolic component, due to the ability to respond to pH shifts almost immediately. This, therefore, is a more accurate reflection of the patient’s clinical disease.

    Respiratory acidosis – increased CO2

    Respiratory acidosis occurs anytime the patient is hypoventilating and not eliminating CO2 appropriately.

    As hypoventilation can be associated with hypoxia, these patients are often critical and require immediate interventions.

    Causes of respiratory acidosis include:

    • drugs (depress respiratory centre, relax thoracic muscles)
    • neuromuscular disease (for example, tick paralysis, botulism and snake envenomation)
    • upper airway obstruction
    • pleural disease (for example, pneumothorax, pleural effusion and diaphragmatic hernia)
    • gas exchange disorders (for example, pulmonary thromboembolism, pneumonia and pulmonary oedema)

    Respiratory alkalosis – loss of CO2

    Respiratory alkalosis occurs when a patient is hyperventilating – excessive loss of CO2 causes the pH to increase.

    The health effect of this is usually minimal, since, in most cases, the effect is secondary and correction of the underlying cause usually resolves this problem. The exception is when respiratory alkalosis is a primary disorder. This is usually quite rare, but can occur with brain stem trauma where the respiratory centre is affected.

    Causes of respiratory alkalosis are:

    • hyperventilation (for example, fear, pain, stress, anxiety and hyperthermia)
    • neurological (for example, head trauma/neoplasia involving the respiratory centre)

    Anticipating changes

    Correctly identifying the primary disorder is essential for anticipating the changes the patient is likely to experience. This will help identify the underlying disease, and is essential for patient monitoring and disease management.

    In the next blog, we will discuss assessment of the metabolic component.

  • How the vet degree has shaped my plate

    How the vet degree has shaped my plate

    Before coming to university, I never really gave much thought to the life or journey of my food before it ended up on my plate; I wasn’t well informed on the topics of air miles, methane production or abattoir welfare standards.

    If you had asked me if I wanted to make sure the foods I ate were ethically sourced, had a low carbon footprint, or had once lived a healthy and happy life, I would have said “of course” – all of these things mattered to me on a subliminal level, but I don’t think I really grasped how any of these concepts were within my control.

    Welfare

    Animal welfare makes up such a large part of the veterinary course from the very first year, so it’s no wonder so many students are vegetarian or vegan by the time they graduate. I must admit that my Easter Sunday lunch was a little hard to swallow after my first-year lambing placement… and one week on a pig farm certainly had me seeing my Christmas pigs in blankets in a whole new light.

    The vet course provides a window into the side of meat production the public will never access – and may not even want to.

    In an ideal world (where every animal has a full and healthy life devoid of stress, discomfort or suffering before it is killed), I would have no qualms about eating meat, but the sad truth is that’s just economically and logistically unviable – at least for now.

    But welfare isn’t as cut and dried as people might think. Take cows, for example: if you picture a happy cow, it’s probably roaming around in a field, right? Well, frustratingly, fields have many disadvantages – offering parasites, botulism and rogue pieces of metal, while providing no protection from the elements, nor a means for the farmer to moderate their food intake to ward off laminitis, hypocalcaemia and a bunch of other welfare issues.

    “One week on a pig farm certainly had me seeing my Christmas pigs in blankets in a whole new light.” Image © HQUALITY / Adobe Stock

    The environment

    Along with owning a pair of flared jeans, or developing calves of steel thanks to the endless hills, you didn’t go to the University of Bristol unless you’ve developed a complex over your carbon footprint.

    One of the simplest ways to be more environmentally friendly is to eat less meat, but many studies are showing that a global move to veganism/vegetarianism is not the answer for our ever-growing population. A lot of land just isn’t suitable for crops, and rice farming already makes up more than 10% of global methane production.

    Again, if we were looking for an ideal scenario, it would be to eat less meat, sourced locally and sustainably, and to value it enough to pay a price that would allow farmers to invest in greener technologies.

    Student budgets

    Working on farms at all levels of the course gives vet students an appreciation for how much farmers care about their animals, and how hard they work to balance that priority with sustaining a business. Even if you’re sceptical about the meat industry, there is always the option to do research into the farms and butchers that are close to you.

    Frustratingly, making good choices from both a welfare and environmental perspective can be much pricier than the alternatives, and this has been one of my own drivers for decreasing my meat consumption during my uni career. Despite this, I still try very hard to make informed choices, and when I do buy meat I aim to prioritise quality over quantity wherever possible.

    In very small, but meaningful ways, change is shaped by the decisions and purchases we all make, and understanding the steps that brought the ingredients from the farm to your plate fosters a respect and appreciation for what you are eating, beyond just its taste.

  • Social media, pt3 – choosing the right platform

    Social media, pt3 – choosing the right platform

    Understanding which social media platform will work for your practice really depends on your key audience and the type of content you want to share.

    Loads of social media platforms exist and I sometimes find I’ve just got the hang of one, only to be encouraged to try a new one. It’s easy to get caught up in the next big thing, but considering we also need to do our demanding jobs, it is important we get it right and don’t waste our time.

    Each channel is different, so should be used in different ways. My advice is keep it simple and master a few channels, rather than doing most of them.

    Social media bunting

    Choosing and using the right platform

    To help find the best social media platform for you, start by asking yourself these four simple questions:

    Why?

    It is important to ask what the overall motivation is. Each platform has its preferred type of audience and style; therefore, look at what you want to achieve and go with the platform that can offer the best return.

    Do you want to increase traffic to your website, increase search engine optimisation (SEO), create a community with clients, or reach new people? Once you know your social media goals, the platform you should be using will become obvious.

    Also, give each platform time. They take time to grow – especially organically.

    Which?

    facebook eye
    “Facebook is by far the largest social media platform and is great for reaching the pet and veterinary communities,” says Gerardo.

    Research each platform to identify which one offers the biggest audience reach, how easy is it to reach them and what style – photos, text, video or blogs, for example – works best.

    Facebook is by far the largest and great for reaching the pet and veterinary communities. Plus, content remains on there – like a mini website – for years. Other channels such as Instagram, Google+ and Twitter have a quicker and more visual approach, but content gets old very quick. Google+ and Twitter are also good for improving SEO, so they are worth considering for your strategy.

    LinkedIn is tailored more to business-to-business, Tumblr for blogging and Reddit as a discussion forum. If you want to engage with a younger demographic then Snapchat and Instagram are best, while Pinterest has more female users.

    We have found it is better to focus on a couple of platforms with equal benefits on engaging with our audience, reaching local pet owners, and increasing web traffic and enquiries.

    When?

    clockThink about when you will be posting. Look at each platform to see when people are online – before work? After work? At lunch?

    If you find your audience is online outside of work hours then, to take the stress out of it, go for platforms with a simple scheduling tool, such as Facebook, so you can schedule posts in advance – saving you having to think about things each day.

    Only commit to what you can – a post every day may sound good, but in reality, it may be a stretch too far. Do two or three posts a week to begin with and alternate days on each channel. That way, you will have content live on most days of the week.

    Also, it is important to think about how many users will have access to each platform, how will you monitor who is responsible for what, and who will be responding to comments and messages.

    How?

    Focus your time. It is worth investing a little time to understand what the platform can really offer – if you can, watch tutorials, read blogs or ask an expert.

    With Facebook, once I really looked at what it could do versus what we were doing, I found we were not taking advantage of its full potential.

    Most social platforms are constantly updating and evolving what they offer, so keep up to date and make sure you get the most out of them.

    Also, if you find one platform isn’t working out, don’t be afraid to close the account.

     

    • Next week, we will be looking at the all-important content and how to get it right.

     

  • PCV/total solids: getting the most from simple test

    PCV/total solids: getting the most from simple test

    The PCV and total solids (TS) test is simple, yet informative – but is often misinterpreted or underused.

    Table 1. Changes that can be found on a PCV/TS and possible causes (click to view).
    Table 1. Changes that can be found on a PCV/TS and possible causes (click to zoom).

    It is important to remember all test results need to be interpreted in light of the patient’s history, presenting clinical signs and general physical examination findings.

    The various changes that can be found on a PCV/TS, and the possible causes, are detailed in Table 1. Many of the differentials can be included or excluded based on the history, clinical signs and examination findings.

    Misconceptions

    I would like to highlight some common misconceptions I find with PCV/TS interpretation.

    A normal PCV/TS means the patient cannot be dehydrated

    The concept all dehydrated patients will have an elevated PCV/TS is inaccurate. Patients will have to be severely dehydrated to see an elevation in both PCV/TS.

    Dehydration should be based primarily on physical examination findings, not based primarily on PCV/TS results.

    A patient with a normal PCV could not have lost blood as the PCV should be low

    Patients can have acute whole blood loss, which is not reflected in the PCV at presentation. This could have been caused by a number of reasons – for example:

    • the extravascular fluid has not yet shifted down the hydrostatic pressure gradients
    • the patient has not ingested water since the time of blood loss
    • IV fluid has not been given to correct the hypovolaemia

    Once the fluid shifts, the patient drinks water or IV fluids are administered, the PCV/TS will drop due to haemodilution.

    An elevated PCV means the patient is dehydrated

    PCV tubes
    PCV tubes.

    This is probably the most common change I see in my patients – and it is not because they are all dehydrated.

    The most common cause of this change is stress-induced splenic contraction. The spleen stores red blood cells. Under the influence of adrenalin, the smooth muscle in the spleen contracts and the stored red blood cells are pushed into circulation.

    The next most common cause would be haemorrhagic gastroenteritis, where a fluid shift into the gastrointestinal tract has occurred.

    Assessment of the serum colour can also provide valuable information. White or lipaemic serum can cause artifactually high TS. Haemolysed serum with a low PCV can indicate a haemolytic anaemia.

    Next time you perform a PCV/TS, look at Table 1 and consider the other differentials for your results.