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Tag: Stress

  • Euthanasia (part 2): caring for the patient

    Euthanasia (part 2): caring for the patient

    Last month we discussed the importance of caring for clients during the process of euthanising their much-loved pet. This month, we focus on your patient.

    The goals of euthanasia are always to make it as painless, fearless and stress-free as possible for the patient.

    Pain relief

    Most patients presented for euthanasia are either suffering from chronic, terminal or traumatic disease.

    The first thing I like to do is ensure the patient’s pain is managed. This usually means providing opioid pain relief. Methadone is my opioid of choice. Butorphanol provides minimal pain relief, but is excellent for mild sedation.

    Next, if your patient is in shock, you need to try to alleviate some of it through IV fluid resuscitation. This is important as poor circulation will slow the process when you administer the euthanasia solution.

    Calm and stress-free

    One of the most important goals in the euthanasia process is to have the patient as calm and stress-free as possible.

    If the patient is stressed or anxious, some sedation may be required. Diazepam or acepromazine are good choices, depending on the condition of the patient, of course, and, together with the opioid you have administered already for pain relief, will help calm the patient. Try to avoid using medetomidine as a sedative in all but the most fractious of patients, as it causes peripheral vasoconstriction that will make IV catheter placement difficult.

    The aim of sedation is to relax your patient as much as possible without rendering them unresponsive to owners when it is time to say goodbye. This can be tricky as every patient responds differently to sedation, so you must make a point of warning owners the sedation may make their pets very sleepy.

    IV catheter

    Where possible, I avoid performing euthanasia without first placing an IV catheter. It makes the delivery of the euthanasia so much smoother. Including an extension to the administration line also allows you to stand a little away from the patient and their owners to give them a little privacy while you administer the euthanasia solution.

    Once your patient is sedated and an IV catheter placed, I set up comfortable bedding in the room where I will perform the euthanasia and bring the patient to the room. The amount of euthanasia solution I have with me always exceeds how much I think I will need; the last thing I want is to have to leave the owner and patient to get more euthanasia solution.

    Once I have administered the euthanasia solution, I check the heart and once that stops completely, I then tell the owners their pet’s heart has stopped, which they understand as their pet has passed.

    Performing euthanasias is the one of the hardest parts of our job, but also a privilege we hold as vets, so I hope my tips will help make the process easier for you, your client and, most importantly, your patient.

  • Euthanasia (part 1): caring for the client

    Euthanasia (part 1): caring for the client

    Euthanasia is a big part of our work as veterinarians. Working in an emergency setting, it is something I have to face on every shift.

    It doesn’t get any easier no matter how many times I have to do it, but I have fine-tuned my approach over the years so each euthanasia process runs as smoothly as possible, with minimal additional stress to both patient and client.

    This month, I will talk about taking care of your client.

    Communication is key

    dog and owner
    Euthanasia is a big part of our work as veterinarians.

    The most important aspect of taking care of your client in this difficult time is to make sure you really focus on communicating clearly, effectively and, most importantly, with sincere empathy.

    First, I listen to their concerns, and why they have made the difficult decision to euthanise their pet.

    Quality of life decisions can be a very grey area, and sometimes what you think may be manageable as a veterinarian can be a huge quality of life concern for a pet owner.

    A prime example is osteoarthritis in older dogs. You may assess them as being clinically well except for some difficulty walking, but the client sees their pet every day and notices the struggles they go through.

    Euthanasia is a difficult conclusion for them to come to and, in most instances, I will defer to the client when it comes to assessing the quality of life of their pet.

    Quality assessment

    One way I help clients assess their pet’s quality of life is by asking them about a few aspects of it, including:

    • Can your pet do the things that make them happy?
    • Do they spend more days sad, depressed and ill compared to the number of days they are bright, happy and eating?
    • Is your pet in pain? Is this pain manageable?

    Confirmation

    Once a client has expressed they want to euthanise their pet, I always try to confirm three things:

    1. That they have actually decided to euthanise their pet. I frame the question like: “So, my understanding from our conversation is that you have made the decision to euthanise Fluffy today?” Sometimes, when you ask this question, the client reveals they have not actually come to that decision yet, which means you will need to backtrack a little and guide them through the decision process again.
    2. Whether they would like to be present for the euthanasia.
    3. How they would like us to handle the after care.

    I also always try to manage all documentation and finances before the euthanasia so the clients will be in a position to leave immediately after the procedure, meaning they can begin to grieve rather than have to do paperwork. The only exception to this is when the patient is in a critical condition, meaning euthanasia cannot wait.

    Explaining the process

    Try not to perform the euthanasia in your consult room or in the main treatment areas – if you have a private room for euthanasias, that is the most ideal. This is important especially if the client comes back in the future with another pet or a new pet. They often find it difficult to walk into your consult room and be reminded of the euthanasia of their beloved pet.

    I like to give clients some time to spend alone with their pet to say their goodbyes in private. When I come back into the room, I start by explaining the process of the euthanasia, covering the following things every single time:

    • Euthanasia is an overdose of an anaesthetic agent
    • dog collarThe process is quick – 10 to 20 seconds
    • It is completely painless
    • The pet doesn’t close their eyes afterwards
    • The pet can have a couple deep breaths and muscle tremors
    • The pet can release their bowels and bladder (especially important to warn of this if the clients want to hold their pet)
    • Lastly, if their pet came into the hospital in shock and obtunded, where I have fluid resuscitated them, meaning they are now more bright and alert, I warn the clients that despite their pet looking better, the underlying disease remains the same.

    Once the euthanasia is performed, I again ask if the client wants to spend a little more time in private with their pet. Finally, when the client leaves, they typically will say “thank you”.

    Whatever you do, do not say something like “my pleasure” or “you’re welcome” like you would for a vaccination consult – this is a natural response, but would be a terrible faux pas. I simply say “I’m very sorry for your loss. Take care for now and let us know if we can help in any way”.

    Next month, I will talk about taking care of your patient throughout the euthanasia process.

  • Focus on GDV, part 2: releasing the pressure

    Focus on GDV, part 2: releasing the pressure

    Last week we covered IV fluid resuscitation and pain relief. This week we will go into more detail about gastric decompression.

    stomach tube
    Passing the stomach tube inside the roll down into the oesophagus (click to zoom).

    Gastric decompression can be achieved in two ways:

    1. trocarisation
    2. stomach tube (orogastric tube) placement

    The decision on which method to use depends on many factors – personal preferences, past experiences and clinical protocols, to name a few.

    So, which one is best? A retrospective analysis of 116 gastric dilatation-volvulus (GDV) patients (Goodrich et al, 2013) found both methods of gastric decompression had low complication and high success rates, and either technique is acceptable.

    If one method fails to achieve gastric decompression, the other can be tried.

    How to decide

    Personally, I use either or sometimes both. Which one I choose first depends on the situation. My decision-making process goes something like this:

    Not clinically obvious or mild GDV

    These are often diagnosed based on supportive radiographic findings as history and presenting clinical signs making me suspicious of a GDV.

    I would always try to pass a stomach tube in these patients first, as the tube is passes easier when the gastric distention is milder. Although this procedure generally requires prior opioid analgesia administration to help reduce the stress, it can achieve rapid and lasting decompression of the stomach.

    I often leave the tube in throughout stabilisation, just prior to induction of anaesthesia for surgical correction of the torsion. The tube allows continual release of gastric gases that can accumulate again rapidly if the tube is removed prior to surgery.

    Obvious or severe GDV

    The abdomen in these animals is often distended and tympanic. I will perform trocarisation in these cases first, as passing a stomach tube in these patients is often unsuccessful. It allows rapid gastric decompression, which is particularly important in cases with evidence of respiratory compromise.

    After the trocar is no longer releasing gas, I will then pass a stomach tube. At this stage, it is often easier to pass the stomach tube once the gastric pressure has been reduced. Once again, I often leave the tube in during stabilisation.

    How to perform

    Stomach tube

    • The main risk is rupture of the oesophagus or gastric wall.
    • Pre-measure and mark the tube from the mouth to the level of the last rib.
    • Use a roll of adhesive bandaging material as the mouth gag. I prefer to use Elastoplast as it has an incompressible plastic core and the diameter is just large enough to fit our largest diameter stomach tube.
    • Unwrap approximately 30cm of Elastoplast before placing the roll of tape inside the mouth.
    • Wrap the tape snugly around the muzzle to prevent the dog from opening its mouth and dislodging the roll.
    • Lubricate the tube to reduce frictional trauma to the oesophagus.
    • Pass the stomach tube through the core of roll and into the mouth. You will feel a dead end at the level of the lower oesophageal sphincter, where the volvulus has torsed the oesophagus.
    • Apply gentle constant pressure and, most times, the tube will pass through into the stomach. Sometimes a puff of gas can be heard and felt from the aboral end of the tube when it enters the stomach. The tube can also be palpated when the stomach is decompressed.
    • The tube is taped to the muzzle to prevent dislodgement and the aboral end placed in a bucket to allow fluid to exit via gravity and siphon.
    • If it does not pass, reassess to see if trocarisation is required to relieve some pressure in the stomach

    As mentioned above, I generally leave the stomach tube in while continuing to stabilise the patient and prepare for surgery. Gas can rapidly accumulate in the stomach and cause rapid deterioration if the tube is not left in. The tube is removed just prior to induction of anaesthesia.

    tape
    Placing a roll in the mouth to prevent biting down on the stomach tube.

    Trocarisation

    • The main risk is hitting the spleen while trying trocarisation. To avoid this, identify the most tympanic site by palpation, or use the ultrasound to confirm the absence of the spleen.
    • A 3in, 14g catheter is usually sufficient.
    • Clip and surgically prep a 10cm by 10cm area where you intend to place the catheter.
    • Insert the catheter to the hub and remove the stylet.
    • Although local anaesthetic in the area is ideal, you will not have time to do this in most cases – especially the very unstable ones. Also, since I administer pure opioid agonist intravenously to most confirmed GDV cases on presentation, local anaesthetic is not required.
    • Remove the stylet and gas should come blowing out under pressure.
    • Once the gas flow starts to slow down, gently apply inward pressure or pressure on the dilated stomach, which helps ensure the stylet does not fall out of the stomach and as much of the gas is removed as possible.

    >>> Read Focus on GDV, part 3: surgery tips

  • When is a dog not a dog?

    When is a dog not a dog?

    Every vet has their niche, speciality or personal interest. I think I’m slowly finding that mine may be located somewhere in the gastrointestinal (GI) system; as the daughter of an endoscopy nurse I like to think I’m following in the family footsteps.

    I was really enjoying my lectures on the topic until we reached the point of hiatal hernias.

    The unfortunate cognitive dissonance of veterinary medicine is that the more interesting or objectively “cooler” the case, the more likely it is often incredibly sad from the perspective of the patient.

    Vet geek

    In this case, I personally was finding the concept of a sliding hernia pretty “cool” (don’t judge, I’ve been out of the game for a year and I’ve missed nerding out over-vetty stuff), until I learned that the majority of brachycephalic dogs suffer from the condition.

    The mechanism behind this being that, in an effort to breathe through an actively collapsing airway, a brachycephalic dog can effectively create such a negative pressure that it sucks its stomach through its diaphragm and into its thorax.

    The worst part of this is that it’s suspected the majority of cases are subclinical (or, at least, subclinical to the owner), as the main clinical signs associated with nausea, such as drooling and lip smacking, are characteristic of short-nosed breeds anyway.

    Less love?

    I wonder if a pilot finds it impossible to enjoy a flight? Even if you stuck him in first class with a martini, the Friends box set, comfy slippers and a sirloin steak on the menu, would he be able to switch off, or would he find his mind focusing on minute turbulence? Would he keep checking the altitude, or picturing the cockpit, wondering: “What on Earth is going on up there?”

    Can a pilot enjoy just being a passenger? Image © xixinxing / Adobe Stock

    Along a similar vein, by the time I finish vet school I wonder if I will ever be able to truly enjoy a dog in the way I used to? If somebody had presented me with the fluffiest, most adorably friendly puppy in the world the day before I’d started first year, I’d have been ecstatic – I may even have passed out from happiness.

    Not just a puppy

    Now, don’t get me wrong, I’m never NOT going to love being handed a puppy, but it’s not just a puppy anymore.

    • Has it been vaccinated?
    • Was its mother healthy?
    • Did the breeder socialise it effectively, or will it forever have a fear of bearded men in funny hats?
    • Is there a cleft palate behind those tiny teeth?
    • Are there worms lurking in that adorable pot belly?

    It’s like my subconscious races to take a history in every animal – even if they’re not a patient!

    Natural versus artificial selection

    As a constant reminder of my disturbing lecture notes, while tutoring GCSE biology I regularly cover the topic of “natural versus artificial selection” with my students. This includes covering the staggering feet of man’s journey over the past 1,000 years to convert the wolf into anything from a small bear to something that fits in a handbag.

    Each time I teach this topic I find myself fighting the urge to be overly pious, knowing no exam will ever ask them to list the ways the pug is destined to a snorting existence or why the dachshund can’t jump onto his owner’s lap for fear of shattering his spine.

    I feel including that sort of thing in the syllabus could certainly go a long way – and perhaps the best way to promote healthy dogs is with re-education from the ground up. But is that my responsibility? More importantly, is it the responsibility of vets in general?

    Flawed from birth

    With some owners (especially breeders), mentioning any predispositions or hereditary conditions of their dog is akin to attacking their personal brand.

    Some people are “dog people”, while some are very passionately and unequivocally only “pug people” or “sausage dog people” or “golden people” – and it’s generally a struggle not to cause offense when telling an owner their animal is slightly overweight, let alone that their pride and joy is genetically predisposed to be flawed from birth.

    Image by ExplorerBob from Pixabay

    Do better by your pet

    The frustrating thing is that if owners knew the risks to their particular pup then prophylactic management could really make a difference to these animals’ lives.

    Not walking brachycephalic breeds on hot days, keeping the weight off of larger dogs to take the stress off of their joints – prevention is always better than cure, and if we can’t prevent the breeding and purchasing of puppies with a gene pool so shallow only a gnat could drown in it then at the very least we should be aiming to prevent suffering and promoting comfort.

    Balancing act

    The danger, as always, is that if you tell an owner what they don’t want to hear too many times, they won’t come back. So, the balancing act lies in maintaining the client-vet relationship so as to ensure animal welfare, while not being too pious or condescending.

    This is equally important in day-to-day life. Being able to switch off is a must for any professional to maintain mental health, yet it’s sometimes hard to stay quiet when your friend mentions their aspiration to own 50 sausage dogs.

    My question for you is, does a vet ever stop being a vet, and is a dog ever really just “a dog”?

  • Temporary catheters in obstructed FLUTDs: buying time with a blocked cat

    Temporary catheters in obstructed FLUTDs: buying time with a blocked cat

    Obstructive feline lower urinary tract disease (FLUTD) is a common presentation in both general practice and emergency settings.

    Every clinician has his or her own approach to treating and managing a cat with obstructive FLUTD signs. Working in an emergency setting, once I have confirmed an obstructed bladder via palpation, I focus on trying to relieve the obstruction as quickly as possible.

    The first step is obtaining consent from the client to administer pain relief (an opioid IV or IM), place an IV catheter, collect blood for biochemistry, electrolyte and blood gas analysis, and temporarily relieve the obstruction.

    At our hospital, we achieve temporary relief of the obstruction generally within 15 minutes of patient arrival.

    Process

    blocked cat
    Obstructive feline lower urinary tract disease is a common presentation in general practice.

    We do this in three steps:

    1. Assess the tip of the penis, occasionally a crystal/mucus plug is all that is blocking the penis.
    2. If this is not the case, I pass a pre-lubricated 22g IV catheter tip (without the stylet) into the penis with a 10ml syringe, containing 0.9% NaCl, connected for hydropropulsion. In the vast majority of cases, this helps to dislodge the urethral blockage enough to enable some urine to pass (urination suggests active urination by the cat).
    3. Once urine is flowing, I pass a 12cm or 14cm rigid catheter, tape it to the tail and leave it in place to allow constant drainage.

    If the 22g IV catheter does not relieve the obstruction, I would use a rigid catheter and progressively advance it up the urethra while hydropropulsing with the saline the entire time. Once unblocked, then I will tape it to the tail as aforementioned.

    Quick Tip: Once you have the catheter in the tip of the penis, pull the prepuce straight out to straighten the penis and thus the penile urethra. Otherwise, the bend in the penile urethra may hinder the passage of the catheter.

    Benefits

    The benefits I see of placing a temporary urinary catheter include:

    • immediate relief to the patient and reduces their stress levels
    • provides a sample for urinalysis
    • allows you time to run through the diagnostic and treatment plan in more detail with clients
    • buys you time to stabilise the patient for their anaesthetic later to place a closed system indwelling urinary catheter and then bladder lavage

    Quite often, your patient would present unwell enough that you should have no issues (resistance to) passing this temporary urinary catheter, provided you have given pain relief on presentation.

    In fractious patients, I usually forgo the temporary catheter and focus on stabilising the patient. The aim is to have them stable as soon as possible for sedation or a general anaesthesia to place a longer indwelling urinary catheter.

  • Isoflurane and oxygen: the dangers of 2 and 2

    Isoflurane and oxygen: the dangers of 2 and 2

    It is a common practice to place all patients on 2% isoflurane and 2l/min oxygen flow rate, but blanket isoflurane saturations and oxygen flow rates can be dangerous.

    2 and 2
    Take time to consider your anaesthetic approach.

    Without a doubt, the majority of patients seem to do just fine at these levels; but every patient is different, and simply placing all patients on 2% isoflurane and 2l/min oxygen may be introducing an easily avoidable risk into anaesthesias.

    Isoflurane

    Isoflurane can cause severe effects such as hypotension and respiratory depression, so 2% isoflurane may be too high – especially for patients that are critically ill or have been premedicated with sedatives/anxiolytics.

    In these patients, the isoflurane can be safely titrated down while monitoring the patient’s reflexes and vitals. Consider administering IV pain relief instead of turning up the isoflurane levels if the patients are too “light” and responding to pain. Examples include a low dose pure-opioid.

    It is important to titrate its use like any other anaesthetic agent, maintaining an appropriate level of anaesthesia while minimising potential side effects.

    Oxygen

    It is common to use a standard 2l/min oxygen flow for all anaesthetics regardless of the type circuit, but this will not meet the oxygen requirements for larger patients. It is best practice to work out the appropriate flow rate amount using an oxygen consumption chart.

    I cannot stress enough the importance of taking the time to consider your anaesthetic approach in patients, especially compromised ones such as those with renal/hepatic disease or circulatory deficits.

    Titrating anaesthetic agent levels can increase the stability of your patient under anaesthesia and significantly reduce the life-threatening complications.

  • Blood smears – make them a routine test

    Blood smears – make them a routine test

    Blood smear evaluation is an often overlooked, but very important, aspect of an in-house haematology.

    With the advancement in haematology analysers that can now detect reticulocytes and even band neutrophils, some practitioners are beginning to rely solely on the numerical data alone in evaluating the patient’s blood.

    Leukaemia
    Patient with elevated white blood cells caused by leukaemia (click to zoom).

    The art of blood smear interpretation is on the decline. However, it is an extremely valuable skill that must be practised and perfected and really should be part of every in-house haematology.

    Plus points

    What are the benefits of being good at blood smears?

    • Identifying a regenerative response, looking for reticulocytes (polychromatophils).
    • Looking for other possible causes of an anaemia – such as Heinz bodies, infectious microorganisms or spherocytes, which can indicate an immune-mediated haemolytic anaemia.
    • Confirming thrombocytopenias, as frequently platelet clumping can be reported as a thrombocytopenia.
    • Assessment of the nature of a leukocytosis. High leukocyte counts do not always mean infection. Neutrophilia can be caused by both elevated immature and mature neutrophils. Determining the nature of neutrophilia can provide crucial information in identifying the underlying cause and if the patient is coping or not. Apart from infection, other causes can include stress, corticosteroids and neoplastic leukaemias.
    • Normal leukocyte counts do not always mean the patient is okay. Patients can have severe left shifts, but normal leukocyte counts.

    Practice makes perfect

    Blood smear evaluation begins with becoming accomplished at producing great diagnostic smears. This takes practice; poorly performed smears can be non-diagnostic and frustrating to assess for both yourself and an external pathologist.

    A few tips on the technique:

    • Use a very small drop of blood. If you have picked up too much blood with the “spreader” slide, lift off and start the smear away from that drop of blood.
    • Angle the “spreader” slide about 30°. The bigger the angle, the shorter your smear.
    • Push the “spreader” slide forward.
    • The smear should end at about half to three-quarters of the way down the slide and must have a “feathered edge”.
  • Connection: steps five and six

    Connection: steps five and six

    The right intentions, a friendly smile, a warm introduction and appropriate touch – four easy ways to help you foster connection with your clients, as described in the previous post.

    This part will look at two more common-sense strategies to help you forge fast bonds with your clients and ensure problem-free consults: finding common ground with your client, and using humour to expedite connection.

    Common ground

    Like it or not, us humans like to belong to a “tribe”. We’re very quick to judge a stranger as “one of us”, or “one of them”.

    Hopefully we’re all fighting against our biases, but it’s very likely parts of your subconscious mind is still making snap judgements about those around you, including your clients – and that your clients are making similar judgements about you.

    It’s in everyone’s best interest if you’re able to find common ground with your clients, to put you on the same “team”. When a client can relate to you around one or two shared interests, your level of connectedness will instantly jump up a few notches.

    Sometimes you’ll get lucky with an obvious commonality – like a shared background, an accent, or a T-shirt from a favourite sports team. Case in point: whenever I hear a Welsh accent in a consult room I point out the fact I lived in Wales for three years earlier in my career and tell them how much I loved it there. This ridiculously small incidental bit of shared history almost always assures that the client in question will insist on only seeing me in future.

    Other times you have to dig a little bit by asking a few questions about their work, their children, their hobbies, their holiday… anything you can bond around. And if all else fails, you can be certain you have at least one thing in common – animals, and in particular their animal.

    A sincere comment about their pet, or even just the breed of pet, shows you are paying attention and suggests you care. You don’t even have to lie – no need to go on about how lovely little Lucifer is after he’s tried to slash your eyes out; instead, an anecdote about your angry cat, or another patient, or why Lucifer is so angry, or about how hard it must be to get him in his cage at home…

    Any shared experience will lubricate the path to connection almost as much as a glass of wine lubricates a social event.

    Humour

    Here’s another hack straight into the workings of the limbic system of those around you: humour makes people feel good. It buffers stress and increases intimacy by reducing cortisone and adrenaline levels, and increasing the activation of the dopaminergic reward system.

    People who are seen as humorous are perceived as more intelligent and trustworthy. Research shows it even makes you appear more attractive.

    You may think a visit to an emergency vet clinic is no laughing matter, but even in the midst of a crisis very few situations exist where it’s not possible to find a little bit of humour, even if it is bittersweet.

    Besides the obvious comedic gold that surrounds rectal thermometers and the shamelessness of most animals (okay, maybe not cats), humour can be found in just about every situation. Yes, even euthanasias can offer opportunities for an appropriate remark or anecdote – perhaps about the animal when it was younger or a shared memory with enough nostalgic humour to increase the warmth in the situation without detracting from the gravity of the situation.

    Added benefit

    The jokes will not be lost on your own brain. The same feel-good chemicals that you’re inducing in your clients will be hitting your neurones and improving your own sense of well-being.

    Most vets who still love being vets after a decade or more in practice will cite “having fun” at work as one of the most important safeguards against burnout.

    • The next post will take a deeper dive into what I think is the most important tool for good client relationships and a happy career in veterinary science: Empathy.
  • Connection: steps one to four

    Connection: steps one to four

    Offering a handshake may be off the menu for now, but introducing yourself and smiling help create a connection with clients. Image © glisic_albina / Adobe Stock
    Offering a handshake may be off the menu for now, but introducing yourself and smiling help create a connection with clients. Image © glisic_albina / Adobe Stock

    In the previous post I told you about my mnemonic to help me remember the seven tools we can use to help us connect with our clients: IS IT CHE(esy).

    Intention, Smile, Introduction, Touch, Common ground, Humour and Empathy.

    Let’s look at the first four.

    Setting your Intentions

    Is it easy to always be the kind of person who people instantly warm to and trust? Especially by the end of a long day when you’re doing your 27th consult? But does that 27th client deserve the best of you as much as everyone who came before?

    Sometimes this is hard work – and, like all work, you have to decide to commit to it. This will come easily at times, but other times you will constantly need to reset your intentions to remind yourself of how you want to be before you start each new interaction.

    This decision will show in your demeanour and shine through in your voice, and register loud and clear in the subconscious of the client within seconds.

    Smile

    This may sound trite, but a lot of science exists behind smiling. The contraction of your facial muscles into a smile is an involuntary reaction stimulated by the release of endorphins in your brain when it receives a pleasurable impulse. But this is where it gets interesting – this process also works in reverse.

    The contraction of the facial muscles involved in smiling feeds back into the brain and causes the release of more endorphins. In other words, while feelings of pleasure will cause a smile, a smile also causes feelings of pleasure.

    Chicken and egg, right?

    The second important thing to know about smiles is that they are contagious. When we see a smile, our brains want to mirror what we see – so we smile. And what happens when we smile?

    Introduce yourself

    If our goal is to connect, then starting your interactions by at least telling your clients who you are sounds too simple to even have to say. Yet many of the client complaints I’ve dealt with include comments about clients not knowing who they saw – or even worse, about them not knowing they ever saw a vet.

    How are people going to connect with you if they don’t even know your name?

    Also, remember to be clear to the client about your role in the care of his or her animal. For example: “Hi, I’m Dr Hubert. I’m the senior vet on shift, and I’ll be taking care of Fluffy tonight.”

    Touch

    At the time of writing this, in 2020, shaking hands is officially off the menu. Which is a shame, because appropriate touch is a very easy hack to increasing feelings of connectedness.

    Physical touch has been shown to reduce stress hormones and cause a release of oxytocin, which directly increases feelings of connectedness – you’re drugging the person into liking you.

    Touch, as a tool, can go beyond the handshake. Of course there is a fine line between “warm” and “creepy”, but appropriate touch at appropriate moments can mean a lot to your clients.

    A quick squeeze of the forearm or a momentary hand on the shoulder can reassure and foster connection faster than anything you can say. It’s a simple reminder to both you and the client that we’re human.

    • The next post will continue the connection hacks with the next two tools: Common ground and Humour.
  • The person behind the grades

    The person behind the grades

    This year has thrown a lot of annual landmarks into disarray, and A-levels were no exception; my heart went out to all the students this month whose results days did not go entirely to planned.

    It has been three years since I went, heart in mouth, to receive my own dreaded envelope.

    Even when I’d already learned that I’d been accepted by Bristol vet school just an hour before, it didn’t feel real until I saw those grades for myself on a physical piece of paper, so I can only imagine the anguish of children all over the country who did not get the same experience.

    All the difference

    The Government’s decision to roll back the downgrading of thousands of A-level results has left me grateful and relieved, because the fact of the matter is, if I had been sitting in the class of 2020 rather than that of 2017, I don’t think I would have made it to where I am now.

    Back in 2017, I received D grades in both my mock exams for chemistry. It was a jarring experience and pushed me to dedicate all my efforts into getting the A grades I needed for when it really counted.

    Without the patient, supportive and hands-on help I received from my teachers in the months between my mocks and the real exams, I would never have gotten that A. If you asked me to get the same results without that support, and through the stress and uncertainty of a global pandemic, I think I may have burst out crying.

    Meaningless mocks

    The thing to keep in mind is, I don’t think that second scenario would have made me any less capable of being a veterinary professional, yet I would have been denied that future.

    This article is not meant to be political because, of course, no perfect solution exists; for a time as unprecedented as this, there could never possibly be one. I can, however, tell you that, using my own past as evidence, mocks no more define a student’s ability or aptitude than GCSE or A-level grades define that student.

    The difference between a B and an A can be as simple as a good or bad night’s sleep before an exam, the ability to afford a tutor or the home life a student returns to even after the best day’s schooling in the world.

    Diversification

    Another reason I’m so glad for the Government’s change of heart is because I wholeheartedly believe that every course and profession – especially professional ones like veterinary medicine – is bettered and made stronger by having a diverse body of people from a variety of backgrounds.

    The veterinary course is sometimes accused of being “elitist” – I think because of the work it takes to even gain an interview. When you factor in travel costs, work experience opportunities and academic support, the door becomes closed to more and more people.

    Diversity.
    With veterinary courses sometimes accused of being “elitist”, Eleanor is pleased by the Government’s change of heart because she believes every course and profession is bettered and made stronger by having a diverse body of people. Image © fizkes / Adobe Stock

    What makes a vet?

    I have also spoken before about how I don’t believe academic ability is all that it takes to make a good vet.

    People skills, compassion, determination, resilience and a level head are all things that individuals need to take with them into any professional vocation. An understanding of science and maths is undeniably important, as is the ability to retain large quantities of information, problem solve and reason.

    But if you focus on the grades alone, you only see half the person – in the case of this year, maybe even less.

    Recognising value

    I hope the changing grades for those with their hearts set on a place on a veterinary or human medicine course this year did not come too late. As some of the most over-subscribed courses, places are filled almost instantly.

    I also hope every university recognises both the uniqueness of the times and the value of the person behind each results sheet.