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Tag: Stress

Don’t tar all dogs with the same brush
Pit bulls, mastiffs and German shepherds are some of the breeds regarded by many as being aggressive and dangerous.

In the same way some dogs are best known for shedding on beloved white furniture or having deep, dreamy puppy dog eyes, these breeds have an established reputation as dogs to be feared and not raised as pets.

Mirror image

A lot of the time, the prophecy is self-fulfilling. Dogs are incredibly intelligent and receptive animals, and unbeknown to a lot of owners, are highly tuned to our actions, expressions and moods – and will often act accordingly.

As pack animals they are programmed to respond to the emotions and vibes given off by others – meaning that if you’re feeling angry or agitated, just your tone of voice or the expression on your face could cause your dog to begin to feel the exact same way. It’s a mirror affect.

Last resort

Most dogs are not inherently violent; aggression is often a last resort in the face of fear, stress or anxiety.

The head vet at the local practice where I’ve volunteered for several years told me the first thing to do when presented with a frustrated owner, and an angry or aggressive dog, is to ask about its home life, not its genetic background.

According to the RSPCA, no evidence suggests one breed is more aggressive than another. However, it’s a much-debated topic and four dog breeds are prohibited in the UK:
- dogo Argentino
- fila Brasileiro
- pit bull terrier
- Japanese tosa
Selected traits

In university, at least, I’ve been taught no dog is born aggressive.

Mankind has been domesticating the canine for somewhere between 20,000 to 40,000 years, which has involved selectively breeding for certain traits, ranging from hair colour to docility. As a result, some breeds are easier to train than others or will react differently to scenarios that are stressful or confusing.

Of course, some breeds are better suited to households with children or to assisting the disabled, but no dog should be entirely defined or judged by its breed.

Socialisation

The argument of nature vs nurture is perhaps very prevalent for this debate.

The first 4 to 14 weeks of a dog’s life will define everything it considers normal – this is known as the “socialisation window”. For example, if, within this time, a puppy has never seen a certain breed of dog, or a large truck, they will find these stimuli stressful and may even behave aggressively around them.

The calmest and most well-behaved dogs are often down to a responsible breeder who took the time to familiarise themselves with many different people, sounds, smells and places, before passing them on to the owner. We’ve been told that, as clinicians, it will be our responsibility to encourage clients to do the same with their puppies before this invaluable time window runs out.

So many factors contribute to the character of a dog besides its breeding. It’s the job of vets to inform all dog owners of these in the hopes these negative stereotypes are, one day, put to rest.
February 22, 2019
Handling an Addisonian crisis – part 1
Addison’s disease (hypoadrenocorticism) is one of those annoying diseases that does not always play by the rules.

One of the main reasons is the clinical signs of Addison’s disease can be frustratingly non-specific and we don’t often see the classic “low sodium, high potassium” electrolyte changes we are attuned to noticing. Therefore, it is important to recognise the early signs, or have a set of clinical signs, history and biochemistry changes that trigger the Addison’s disease alarm bells.

Once diagnosed, we can look at the approach to stabilising a patient in an Addisonian crisis.

Clinical signs

The clinical signs of Addison’s disease can be vague and non-specific, these include:
- anorexia
- lethargy
- weakness
- gastrointestinal signs
- polyuria and polydipsia
A history of chronic intermittent vomiting and/or diarrhoea that resolves with symptomatic management would be one of the triggers.

Another trigger is the subtle changes in blood tests. These include:
- the absence of a stress hyperglycaemia in a sick patient (normal glucose or even a low blood glucose, for example)
- hypercalaemia (ionised) of any degree
- absence of stress leukogram
These changes are often seen in isolation, so don’t expect them to all be there at the same time. We see patients all the time with inappropriately normal or low blood glucoses with gastrointestinal signs that we later diagnose with Addison’s.

Hypercalcaemia – what’s the big deal?

Why hype up and down about normal or low blood glucoses? Because low blood glucoses are rarely caused by inappetence or gastroenteritis alone, and the body is pretty good at maintaining glucose within normal levels (except, maybe, for very young patients and some toy breeds). Any low glucose Addison’s should be considered, and a stress hyperglycaemia is so common in ill patients that its absence makes me concerned.

What is the big deal about hypercalcaemia? It is so tightly regulated that any elevation Addison’s is on the differential list. How does Addision’s cause these changes? Corticosteroids are released during stress or ill states, which result in a stress hyperglycaemia. They also play a role in the excretion of calcium in the urine, so preventing a hypercalcaemia.

What about the electrolyte changes, the hyponatraemia and hyperkalaemia? When these changes are present they make diagnosis much easier, but they are not always present, such as with “atypical hypoadrenocorticism”, so the absence of that classic change does not rule out Addison’s.

Next, we will cover the management of the Addisonian crisis.
November 21, 2018
Is the grass greener?

My classmates and I recently reunited at our beloved university to celebrate joining the profession as qualified vets around a year ago. While there we attended a CPD event based around managing difficult situations as a new grad, be that with clients, colleagues or bosses.

While the scenarios were entertaining, they also highlighted aspects of working life as vets that were very relatable, sparking a number of interesting discussions. Many issues were covered, but the most significant points were certain legal or business aspects of veterinary work rather than clinical ones.

Contractual obligations

“Some vets are finding themselves drawing the short straw when it comes to holiday entitlement.” Image © dragon_fang / Adobe Stock

For many of us, our first job as a vet will also be our first full-time, salaried job. As such, many new grads may be unsure of their basic minimum legal entitlements, such as holidays, sick leave and contracts, and, therefore, will not necessarily realise if they are receiving these.

Almost one-third of attendees, despite having been graduated for well over a year, still had not received a contract – much to the shock of the representatives from the various veterinary organisations running the session. I, too, find it incredulous some practices deem themselves impervious to certain legal requirements.

This is perhaps one of the ways in which corporate practices actually have the upper hand on independents – they tend to be better at the paperwork side of things and, even though the contracts can often be vague, they are present. This does not, however, make them any less likely to take advantage of the absolute minimum benefits that can be offered.

More for less

For example, the legal minimum holiday allowance is calculated in weeks. For some of my colleagues who work a four-day week, this means their holiday entitlement seems outrageously small, even if it is, in fact, correct when counting the weeks.

What is not taken into account is many of those who work a four-day week will work longer hours on each of those days, which means they’re still working a 40-hour week. Because of this, and despite working the same amount of hours, some vets are finding themselves drawing the short straw when it comes to holiday entitlement.

The veterinary profession is unique in many ways, but that does not make veterinary employers exempt from their legal responsibilities or from trying to allow employees to have a good work-life balance.

Second time around

There is so much variation within the profession, with some practices hitting the nail on the head when it comes to looking after their vets, while others work them into the ground and wonder why they have an issue with staff retention.

It is issues like these that contribute to the loss of young vets from the profession so quickly after graduating.

While many of my university friends are happy in their current roles, a lot (myself included) are already in their second roles, due to problems or changes in circumstances with their first jobs – and, while some of us feel confident about a long-term veterinary career, some are already considering the options for diversification after getting a bit of experience in clinical practice.

A glimpse of the other side

“Many of us have partners, friends or family in other professions who seem much better off financially, socially and physically that it becomes impossible not to wonder whether the grass is greener elsewhere.” Image © michaklootwijk / Adobe Stock

Many of us have partners, friends or family in other professions who seem much better off financially, socially and physically that it becomes impossible not to wonder whether the grass is greener elsewhere. While we do have an extraordinarily variable and interesting day job, the stress and poor remuneration compared to other roles makes you wonder whether it’s really worth it.

I look at my friends who work flexible hours and can accrue almost double the amount of holiday time I get by working only a couple of hours extra a week (which vets inevitably do anyway without time in lieu or overtime pay). They can book last minute holidays and take sick days with no questions asked – all without feeling they are putting everyone else under pressure when they do. They are often less qualified (sometimes with no qualifications at all), yet earn more, have far better pension packages, guaranteed pay rises and bonuses.

Yet, some veterinary employers can’t even hoof a contract together within an acceptable time frame.

The good, the bad and the understaffed

Some veterinary employers are on the button; they have realised the way to keep staff is to give them comparable benefits and treat them like humans, not just robots with no life outside work, but unfortunately a lot aren’t.

I appreciate the nature of our work makes it unpredictable, that we do have to work late sometimes, that we can’t all be allowed time off at the same time, and, in some respects, it simply isn’t comparable to some other jobs. But when talking to some of my veterinary friends this weekend, I was genuinely angered at the raw deals some of them seem to be getting, and infuriated some practices still get away with treating professionals this way.

It does seem to be getting better, though – slowly, but surely, the profession is being dragged into the modern way of working, and practices that continue to dig their heels in will soon find themselves without any staff.

October 1, 2018
Reflecting on the good moments

As me and my (non-vet) partner sat down for a rare mid-week breakfast together, I made an offhand comment about “having” to vaccinate 15 puppies that day.

“What do you mean ‘have to’?” was his response. “Most people would love that, and you get paid for it.”

I considered this – and, while I’m more of a kitten person than a puppy person, who doesn’t love puppies? It‘s the little things like this we, perhaps, take for granted.

Sharing the joy

All too often, as vets, we focus on the negatives: the long hours, on call, the stress of trying to keep to time when everything goes belly up, the emotional strain, the difficult clients, surgical complications, mystery cases with unanswered questions… the list goes on.

In the midst of it all, while we‘re able to show enthusiasm during the puppy or kitten vaccine consult, sharing the owners’ joy is soon forgotten when it is swiftly followed by a few challenging consults or clients.

At the end of a couple of stressful working weeks (for a number of reasons), I found some peace having formulated a plan for a couple of complicated medical cases and finally convincing a difficult client to get on board with a particular treatment.

Living the life

It‘s the little things, such as vaccinating puppies, vets, perhaps, take for granted. Image © Gorilla / Adobe Stock

It’s easy to get wrapped up in the vet lifestyle – researching cases when you get home at night (and even when you don’t), not being able to sleep because, subconsciously, you’re trying to work out the best course of action for one of your patients.

Rattling off the list of procedures or appointments for the day will just seem the norm to other vets, but take a step back and remove the “vet blinkers” and actually think for moment about what we do.

If you talk to any non-vet friend or family member about your working day, they often show seemingly exaggerated enthusiasm or squeamishness. It’s tempting to brush this off, but it’s usually genuine. From their perspective, our “normal” work can be fascinating.

Everyday heroes

We may not be saving lives in a dramatic fashion every day (or maybe you do), but, as vets, we get to help a number of animals on a daily basis and, as a result, their owners.

This can be done in what feels like the smallest of gestures sometimes; as much as we may resent the notorious anal gland appointment, what that actually involves is giving a poor dog (or cat) almost instantaneous pain relief.

While I don’t think any vet will particularly enjoy an anal gland appointment, my point is to look at the bigger picture: what may be mundane to us does actually make a difference to the individual – our day-to-day routine work is far more interesting than a lot of other jobs.

Let it go

Being a vet is mentally and physically draining at times, but no day is the same and we will always have stories to tell.

So, if you’ve had a bit of a crap week (or haven’t), take a moment to think about what you’ve actually done in the past few days and enjoy the good moments – whether that’s the puppy vaccination or draining the really satisfying cat (or, in my case, cow) abscess. Then think of the clients who have been thankful for your help (even those who don’t show it) and let go of the bad moments in between.

September 19, 2018
Corporate vet school
The announcement of a corporate veterinary group’s collaboration with the new Keele University/Harper Adams veterinary school struck a few chords, and seemingly opened a figurative can of worms that (like their literal parasitic counterparts) just doesn’t sit well in my gut.

A few points to consider here, the first of which I have written about before, although not about this particular arrival on the vet school scene.

More vet schools needed?

Do we need more vet schools? The short answer, in my opinion, is no. The employment crisis in the veterinary industry as it stands is multi-faceted – pluck a reason out of the air and it almost certainly has some impact on why practices are begging for vets:
- compassion fatigue
- poor working conditions
- work-life balance
- salary
- lack of long-term prospects
- Brexit
- client pressure
- under-supported young vets
I could talk about any one of these reasons at length (and have done), but, for the purposes of discussing the above gem of veterinary news, I will focus on the last point: support for new graduates or young vets.

Vicious cycle

“This lack of support leads to high stress levels, young vets becoming fed up and looking elsewhere for a different career that provides them with the mental stimulation they desire, but with better support, hours and pay to go with it.” Image © Michael Brown / Adobe Stock

Some practices are excellent at providing a nurturing environment for young vets, but many are not and often not through any fault other than lack of staff.

This lack of support leads to high stress levels, young vets becoming fed up and looking elsewhere for a different career that provides them with the mental stimulation they desire, but with better support, hours and pay to go with it – thus the vicious cycle of extremely talented young people leaving the profession after a few years begins.

Problem solver?

Will opening more vet schools help the staffing problem? No. It is a short-sighted, temporary solution to fill a gap nobody seems to be able to plug. But the more graduates that accept jobs from practices who ideally wanted an experienced vet and can’t source one, the worse the retention problem will become. It is unfair on both parties to take on a new grad if a practice does not have the resources to sufficiently train and help them through their first few years.

To solve the retention problem, the profession needs to improve working conditions and encourage vets to stay, not just find more avenues to farm out new grads to try and bridge the gap.

Are corporates good for the profession?

I could (and probably will) discuss corporates at great length, but there is no clear answer for them being good for the profession. Having been stung with the sore end of the corporate tail once before, I’m inclined to say no, but that would be based on my experience of one particular practice. Conversely, I have colleagues who work for corporate practices that seem to be very well run and provide a great environment for learning.

My opinion is not fact and, to keep it short and sweet, is summarised below:
- The idea behind corporate practices is often well meaning, but does not always work when put into practice. For example, the graduate schemes sound great, but only work if they are implemented correctly on an individual practice level.
- Some corporates are extortionately priced compared to independents – there is a fine line between charging appropriately and taking the biscuit. This is likely exaggerated because many independents have been selling themselves short for years; however, it is not okay to triple prices in a week when an independent practice is taken over. All it does is feed the myth that vets are only in it for the money.
- Long-established corporately owned practices seem to have better client satisfaction than practices newly acquired under a corporate brand as the shock of takeover, staff changes and price increases are long gone.
- Corporates aim to provide better working hours (a four-day week, for example) and flexible working patterns, but, again, this varies on an individual basis.
- The hand of many partners in independent practice has been forced as the profession continues to change. Young people do not have the disposable cash to buy into partnerships, as was the tradition. Corporates have taken advantage of this by buying out those wishing to retire without any new blood coming through.
Corporate practices can vary wildly even within the same group – much of it comes down to the individual practice, as with independents. As much as corporates offer many benefits with their nice shiny contracts, many independents match or better these. Likewise, an independent or corporate practice can be an equally catastrophic place to work in if managed badly at the practice level.

Now, to the elephant in the room…

Should a corporate group be running a vet school hospital?

Is a corporate running a vet school hospital any different from the outsourced rotation format of the other newest veterinary schools – Nottingham and Surrey – whereby they have no on-site university clinic, but rotations are undertaken in nearby hospitals?

“The hand of many partners in independent practice has been forced as the profession continues to change. Young people do not have the disposable cash to buy into partnerships, as was the tradition.” Image © MHChristine / Adobe Stock

The concern with new veterinary schools popping up and proposing this sort of final-year teaching is the associated practices are then less available to provide EMS placements for local students. The purpose-built corporate hospital that is to be partnered with the new veterinary school avoids this particular hurdle in part, at least (there’s no mention of an equine hospital or farm clinic), but is it still a good idea?

Remaining impartial

It comes down to whether the corporate presence is going to be ingrained into the teaching. Will the graduate scheme offered by the group be heavily recommended? Would the business structure and branded drugs be taught to the students?

At university, we were always told to learn drugs not brand names to remain impartial. Would that impartiality be maintained appropriately in a hospital that uses own-branded drugs and whose bigwig advisory boards dictate which products should and shouldn’t be offered?

Encouraging research into all available treatment and diagnostic options is a key aspect of learning and practising evidence-based medicine on rotations.

Familiarity breeds

Even if no direct corporate emphasis exists, surely the undercurrent is going to sway the students into applying for jobs in sister practices under a graduate scheme.

As a new grad, you are bewildered by everything and getting a heads-up on even the smallest of obstacles can make a huge different to your day in the first few weeks. Therefore, simple things, such as the practice management system used in every practice the group owns, may be enough to sway the decision between accepting one of two jobs, simply because using a system you’ve gotten used to on rotations will make your life that bit easier during day-to-day practice.

Conclusion

It remains to been seen if a corporate partnership with the new vet school will be a success for the students under their care and the profession as a whole, and I’ll withhold judgement for now.

However, with predictions corporate takeover will saturate at 70% of practices in the profession, it is undeniable the veterinary landscape is moving further adrift from its once independent roots as the corporate giants continue to tighten their grip.
August 1, 2018
Being a millennial vet

Millennials are stereotypically considered lazy, entitled and always wanting something for nothing. And having previously discussed the many advantages of employing new graduates (and, therefore, millennials), this sort of labelling angers me.

The choices our generation makes are not due to lack of work ethic and naiveté about the future, but rather a reflection on the hand we have been dealt by society.

Recent statistics show the average baby boomer had to save for 3 years for an average-sized house deposit in comparison to the predicted 19 years it would take for millennials to do the same. By the age of 30, the number of millennials still renting is double that of their predecessors in “Generation X”.

At my age, my mother owned a house, had her first child (yours truly) and had been married. I can’t even comprehend the possibility of being able to afford one of those things at this stage in my life, let alone all of them.

We may prioritise our meagre disposable income in different ways, but, despite all the jokes, our love of avocados and lattes are not the reason we can’t afford to get on the property ladder. (For the record, I can’t stand avocado).

Unyielding abyss

It is excruciatingly impossible, says Jordan, to save enough in today’s financial climate to even consider a house deposit. Image © zimmytws / Adobe Stock

It is excruciatingly impossible to save enough in today’s financial climate to even consider a house deposit, while pouring money into the unyielding abyss of renting.

One of the biggest snags in the rental black hole is the deposit and associated agency fees. Shortly after leaving university, I had to magic £1,500 out of somewhere to rent a place close to my first job (and that’s a lot when your bank account hasn’t been above zero since you started uni).

Six months after that, I was faced with having to do the same again because I quit that job.

As vets, we bang on about being happy, having a supportive first job and leaving if it’s not right. That’s all very well, but what if you’re trapped financially?

I didn’t give much thought to my financial situation at the time because I was too unhappy to carry on. While I think it was ultimately the right decision for my mental health, I would carefully consider my situation before doing it again – two months of no salary left me in a very vulnerable position, and if it had been much longer, I would have been in serious trouble.

Luckily, I was offered accommodation for my second job, which was an enormous help, taking the burden of having to find a deposit again off my mind. This is one of the benefits of being a vet as a millennial – very few other jobs would offer a house as part of the package.

If you have to repeatedly uproot and keep forking out for rental deposits every time your circumstances change, it’s easy to appreciate how quickly you can find yourself in a mess.

And for me and my classmates, this is while holding down a respectable job with supposedly “good pay” for someone of the same age. But is the pay all that “good”?

Non-vet friends

My non-vet friends earn varying amounts dependent on their careers or jobs, but these certainly include plenty of non-professionals earning far more than me. However, multiple factors need consideration here.

Those who didn’t go to uni have six years of “work experience” and climbing their respective career ladders more than me. Those who did go to uni have a two or three-year head start, which is significant in certain industries.

While it’s understandable they have had more time to progress in the world of work, that doesn’t entirely quieten the resentment at having put so much money, blood, sweat and tears into a professional degree without the remuneration to reflect that.

And while we may have a decent starting salary in comparison to other graduate roles, we are very quickly overtaken.

The ceiling salary of the GP vet is a much-discussed topic, with an increase in salary seen early on, but thereafter very little difference is seen, despite further years of experience. In the current financial climate, the traditional partnership route becomes less and less tangible for the millennial veterinary graduate.

I struggled to be approved for a credit card, and with the very real possibility of never owning a house, I wouldn’t dream of asking for a loan for the kind of money needed to buy into a practice – and I think I’d be laughed out of the bank if I tried.

For my generation, the type of career, and therefore salary progression, is just not what it has been for previous generations.

Enjoy life in present

Perhaps this is why we value work-life balance more than our predecessors – for them, they worked hard in their early careers because there was a light at the end of the tunnel, being partnership.

Many of my millennial colleagues don’t even consider that as a possibility, with many of us not really knowing what we want to do long-term career-wise, and so we take each day as it comes, not just trying to survive, but striving to enjoy life in the present.

Millennials are all in the same boat – still young adults driving battered cars with bleak property-buying prospects. Image © Deyan Georgiev / Adobe Stock

It deeply upsets me that vets are still perceived as rich money-grabbers. I am not a rich vet, I’m just a millennial, struggling to make headway in an economy set up to put young people on the back foot.

The difference between me and my desk-bound friends, however, is I have the privilege to do a job that I love, and while it comes with all manner of stress, it’s worth it for being able to care for someone else’s beloved pets.

At the end of the day, though, millennials are all in the same boat – we’re still young adults driving battered cars with bleak property-buying prospects.

We didn’t choose to inherit this situation. We’ve drawn the short straw in the birthdate lottery, so all we can do is live the millennial lifestyle and enjoy our lattes and avocados.

May 3, 2018
New year, new me

January brings with it an onslaught of well-intentioned gym memberships, diets and resolutions that often get forgotten fairly rapidly.

For me, my “happy new year” was tainted with uncertainty, as I had made the scary decision to leave my first job as a new graduate vet – quite literally forcing the “new year, new start” cliché on myself.

This decision was not made lightly. In fact, if I had listened to my gut feeling that things weren’t right, I probably would have left much earlier, but I stuck it out for five months. I had to be sensible – I had rent to pay. But, similarly, I was not going to stay any longer at the cost of my sanity.

Time to take action

Many of my new graduate friends also struggled at their respective workplaces to begin with, so I couldn’t help but think maybe it was just supposed to be hard. But as they all settled, and I seemed to just get more wound up with my situation, I began to accept it wasn’t right.

So, what were my options?

Address my employment concerns

Despite being advertised as a truly mixed practice, I found myself working as a TB tester virtually every day, which became unrewarding and a huge hindrance to my personal development as a vet.

I tried to address the situation, but was met with non-committal responses, such as: “Well, we are very busy with TB at the minute.” No offers of sharing it out were made, considering myself and another new graduate were carrying out all the testing. In fact, I ended up organising the whole practice’s TB equipment, paperwork and bookings.

The other issues I had were also met in a similarly non-helpful manner.

Go above the powers that be

One of the (few) advantages of working for a corporate group is you can go above the powers that be.

Although this provided a friendly listener on the end of the telephone, it didn’t actually achieve much after helping me explore the options of transferring to another practice within the group. As I was still looking for a mixed role, it came to a dead end pretty swiftly.

Hand in my notice

I was very aware my notice period tripled after I had worked at the practice for six months, so I had the choice of leaving before the six months were up or being stuck for at least nine months.

I did try addressing my employment concerns and going above the powers that be first, but I think I knew all along that, in the end, I was going to leave; it was just a question of when – before or after six months, considering the notice period, and before or after I had found another job?

Choice made for me

In the end, some timely external circumstances forced my decision – my landlord informed me he was selling his house, so I would only have a few months left of the lease anyway.

Once I came to the realisation I needed to leave, I felt relieved. This was ultimately short lived as I then faced the question of what to do afterwards – I even started to consider whether I actually wanted to look for another vet job.

But I didn’t have to look far to find some inspiration – my university friends were very supportive of my decision to leave my practice, but their stories of their own experiences were reassuring. The key was finding the right practice and being able to enjoy being a vet rather than seeing it as the stressful, unfriendly job with long hours it’s often portrayed as.

Negative into a positive

I began the job search slightly before handing my notice in – I think as a safety net, as I was still very apprehensive about being caught out with no work. I was also very concerned about how not having spent very long in my first practice would look to potential employers – would they think I couldn’t hack the pressure and gave up too easily?

My first interview this time around, however, was a massive confidence boost – my worries were ill-placed as my decision to leave my practice was only viewed as a positive move; that I was being proactive in my career development and not putting up with an environment in which I wasn’t progressing.

When more interviews and then job offers started emerging, I found the confidence to not only hand in my notice, but also to turn down offers that weren’t right for me.

Disguised desperation

We regularly hear about the shortage of vets in the veterinary press, on Facebook, through word of mouth and, for those working in understaffed practices, via first-hand experience. But nothing confirmed the veterinary employment crisis more than the poorly-disguised desperation some practices exhibited when I enquired about vacancies.

Yes, I was a little more desirable than a new graduate fresh out of university because I had worked for a few months, but I was still virtually a new graduate. If anything, I felt my skills had regressed since graduation because my confidence had been knocked so severely in my first role.

But I did know how to consult, interact with clients, break bad news, and offer and carry out euthanasia with the client in the room. These are the things you don’t really learn until you qualify; the small things that make a difference between being a startled- looking graduate in your first week being asked “is it your first day?” by a client, and a recent graduate who can give a calm impression of confidence and knowledge (even when you’re a little unsure).

It took me a while to convince myself I’d be employable enough to be picky, but with a few offers under my belt, I entered the new year jobless, but knowing so many practices out there were looking for vets.

It did, however, still take a considerable amount of moral fibre to swallow my pride and go to the job centre to sign up for jobseeker’s allowance. This was not without an added push from my ever-knowledgeable other half, who bluntly said: “You’ll be paying into it for the rest of your life, so you may as well claim it while you can.”

Daunting, but rewarding

Although it was daunting to quit one job without having something else lined up, it was the right thing to do and, inevitably, things worked out in the end. With a bit of patience and perseverance, I have now found what I think is the right job.

Although I can’t quite squash the niggling feeling it could all go wrong like the previous one, I like to think I’ve learned something from that disastrous experience, and am feeling much more optimistic.

After much reflection, I think I was just very unfortunate with my first role and a number of factors occurred that I could never have foreseen.

Take advantage

For many people, despite the new year clichés, January becomes a time of reflection. I’m not too sure about “new year, new me” but I’ve certainly ended up with “new year, new job”.

If you aren’t happy in your job, don’t be afraid to take the leap – especially if you’re a new graduate. It is so important your first job is right for you, otherwise it could scar you, and ultimately ruin your entire veterinary career.

It isn’t worth the stress of staying where you are unhappy – so many jobs are out there. It is, as they say, an “employee’s market” at the minute – take advantage of it.

January 16, 2018
SNAP cortisol test
While hyperadrenocorticism is not an uncommon incidental finding in patients presenting to our emergency clinic, hypoadrenocorticism is a lot less common. Or, possibly, more frequently underdiagnosed.

Textbook clinical presentations combined with haematology and biochemicial changes can make diagnosis straightforward, but not all patients will present with all the classic signs.

The SNAP cortisol test is a quantitative ELISA test that measures the level of serum cortisol in dogs.

To complicate things further, hypoadrenocorticism is the great mimicker of diseases; it is often impossible to arrive at a definitive diagnosis without knowing the cortisol levels.

The SNAP cortisol test allows clinicians to determine cortisol levels in-house – a blessing to those of us who work out-of-hours – but is not without its limitations.

Suspicious signs

Patients with hypoadrenocorticism often present with vague and non-specific clinical signs, but certain clinicopathological changes help raise the suspicion:
- a decrease in sodium-to-potassium ratio (below 1:27)
- azotaemia
- an inappropriately low urinary specific gravity, despite evidence of dehydration or hypovolaemia
- a leukogram unfitting to the degree of illness of the patient (a “reverse stress leukogram”- neutropenia, lymphocytosis, eosinophilia)
- anaemia
- hypoglycaemia
- hypercalcaemia
Although most Addisonian patients will not present with all these signs – especially those in the early stages of disease or those with atypical Addisonian disease (glucocorticoid insufficiency only) – any patients showing any of these haematology and biochemicial changes should have hypoadrenocorticism ruled out as part of the diagnostic plan.

Imperfect ELISA

The SNAP cortisol test has been advertised as an in-house assay to aid the diagnosis, treatment and management of both hyperadrenocorticism and hypoadrenocorticism, although the quality of the result is not perfect. This quantitative ELISA test measures the level of serum cortisol in dogs.

In one study¹, the SNAP cortisol test appears to have a good correlation with an external laboratory chemiluminescent assay test; however, in 12.8% of cases (5 of 39 patients), the SNAP test result could have led to a different clinical decision regarding the management of the patient.

Since long-term Cushing’s management relies on reliable, repeatable cortisol level detection, this high level of discrepancy is unacceptable, especially when more accurate alternatives are available at external laboratories.

Still useful

Despite this, it is still very useful helping to assess for the presence or absence of hypoadrenocorticism, especially in an emergency setting.

I use the SNAP cortisol to measure the resting cortisol level. If it is below 2ug/dL or in inconclusive range (between 2ug/L and 6ug/L), but the clinical picture suggests hypoadrenocorticism, I would perform an adrenocorticotropic hormone (ACTH) stimulation test and send samples to an external laboratory. If it is well above the inconclusive range, I would not perform an ACTH stimulation test.

In summary, I think the SNAP cortisol test can be useful in helping assess for hypoadrenocorticism, but would still recommend performing an ACTH stimulation test and running the samples externally.

However, use it with caution for hyperadrenocorticism diagnosis and its long-term management – especially when more accurate and economical alternatives are available.
June 27, 2017
It’s good to talk…
The issue of poor mental health in the veterinary profession as a whole is becoming more recognised, and has sparked the launch of initiatives such as Mind Matters and Vetlife’s helpline service. But what about vet students specifically?

Despite not being selected for the sports teams she tried out for initially, Jordan (mounted) got on to the riding team during her second year at Glasgow.

When I was applying for vet school, I remember numerous people told me the hardest part is getting in… well, they lied. Having now spent five years at Glasgow, I can’t even comprehend why they would spread that awfully inaccurate myth.

My first inkling this oft-repeated phrase was totally unfounded came during one of our first lectures where my entire second year of A-level physics was summed up in an hour – and the pace only continued to pick up from there.

Difficult beginnings

Along with the personal struggles of moving away to university (in my case, 300 miles from home), not being selected for the sports teams I tried out for and the social pressures (feeling I had to take part in things despite feeling exhausted and wanting to sleep), it was hard.

I also had a sense of emptiness – having worked my entire life towards getting into vet school, once I got there, it was like: “Now what?”

I began to wonder whether veterinary was really the right career for me and, in the first term, seriously considered leaving.

No alternative

One of the main things that kept me there was the simple fact I didn’t know what I would do instead. I took my car back with me after Christmas, which helped with logistical issues, and started an evening creative writing class that gave me the opportunity to get away from vet school and vet students every so often.

By the summer of first year, I still wasn’t convinced I would stay. I hinged my fate on exam results, deciding I wouldn’t have the motivation to resit them because my heart wasn’t in it.

Jordan and the team of volunteers with Bolivian NGO, Comunidad Inti Wara Yassi.

However, I passed, and bundled myself on to a plane to South America to undertake some EMS in the Amazon rainforest. My time in Bolivia was incredible and rekindled a long-forgotten passion.

After that, my vet school experience shifted massively. I suddenly loved being a vet student – I got on the riding team, became more involved with the social side of vet school and continued my love of writing through getting involved with the Association of Veterinary Students.

I was the definition of the “work hard, play hard” vet student, but it was all about balance – the negatives of being a vet student were being outweighed by the positives.

Serious doubts

I still wasn’t particularly enthused by the course and merrily carried on because I was coping. Besides, a veterinary degree didn’t have to culminate in a veterinary career.

Every exam period was a rite of passage to get to the next year. Before Christmas, one year, we had nine exams in eight days – I think I averaged two hours’ sleep a night that week, but we got on with it. Everyone moaned together and everyone came out the other side, one way or another.

Nobody is immune – even at later stages in the course, those students who were high achievers and never seemed phased by anything started having doubts – serious “I’ve been to discuss where my degree stands if I drop out now” doubts.

By fourth year, I’d reached a level of acceptance that, since I’d got this far, I may as well carry on.

A sense of equilibrium

I started final year rotations absolutely terrified, but took comfort in the shell-shocked looks reflected in my classmates’ faces on the first morning of medicine rounds in the small animal hospital. We were all in the same boat.

Yet, finally, I found my stride; I have absolutely loved final year. For the first time in five years, I didn’t regret my life choices and found myself thinking “this is exactly what I want to do”. I was fascinated by medicine and felt a real sense of achievement of actually doing things for myself, such as taking consults and performing surgery.

Again, some of my peers hit their “walls” during final year, but we got them over it.

Another nugget of advice “they” tell you is final year will fly by. That one, I’m afraid, is not a lie – I can hardly believe I’m sat here with 12 months of rotations behind me, already facing finals and job applications.

All in the same boat

Jordan eventually “found her stride” during final year rotations.

Everyone has a wobble at some point and thinks “why am I doing this to myself?” The important thing is to remember other people are probably feeling the same way.

Mine was very early on, when everyone else seemed to be loving life, and I felt so alone. I felt like I would let my family and friends down if I dropped out, so felt too ashamed to say anything. However, when I eventually voiced my feelings, it transpired a lot of people were thinking the same.

A lot of support is out there now, which can be accessed in different ways. Each university will have a formalised counselling service and many vet schools now have a peer support system in place – this has been a huge success at Glasgow.

Meanwhile, Vetlife offers confidential telephone support to vets and vet students alike if you need an impartial, anonymous ear.

Feelin’ good

Glasgow recently held “Feel Good February”, a month of events and activities to raise awareness of these services and promote good mental well-being around the vet campus, part of which involved defining the problem at Glasgow specifically.

The Glasgow University Veterinary Medical Association revealed the results of a survey, which showed:
- 62% of current vet students felt stress had a negative impact on their everyday life
- 89% felt it was normal to feel stressed during a veterinary degree
This normalisation of stress can lead to students feeling they should be able to deal with it, but that the inability to cope will not translate well to life as a vet. It’s a very tough course for a number of reasons, including the workload that was described by our professor, Ian Ramsey, as “savage” in an STV interview.

However, this perception students should be stressed leads to an inability to speak out, for fear of seeming weak and “not cut out” for veterinary.

So worth it

I cannot imagine where I would be now if I hadn’t carried on with my veterinary degree. I’m so grateful friends and family supported me through everything and I made it to the point of starting a veterinary career knowing wholeheartedly this is what I want to do.

If you’re thinking of dropping out, please talk to someone – I can guarantee they’ve felt the same at some point. And if you’re having a particularly tough rotation or coming up to exams, power through and help each other – it’ll be worth it in the end!
April 15, 2017
Eating disorders and the veterinary profession

The general public associates the word “anorexia” with the eating disorder characterised by refusing to eat to lose weight, which, in human medicine, has the more specific name of “anorexia nervosa”. As vets, we use the word the term “anorexic” in the slightly different sense of being a clinical sign our patients exhibit – defined as “a lack or loss of appetite”.

Is the veterinary profession practising what it preaches when it comes to nutrition?

When referring to vets themselves, however, these definitions blur together a little, but I believe many vets frequently exhibit clinical signs that may or may not be part of an eating disorder.

While there is a lack of hard evidence or figures for eating disorders within the veterinary profession, it is estimated 10% of UK veterinary students suffer from eating disorders (not limited to anorexia nervosa), which is higher than the figure for the general UK population, which sits at 6.4%. (vetlife.org.uk).

Another branch

We are all made very aware of the mental health statistics and suicide risk of vets, and eating disorders are another branch of that tree.

Despite the lack of evidence to back up the theory, based on anecdotes alone, I’m willing to bet eating disorders, or even intermittent “anorexia” (the clinical sign), are more prevalent in qualified vets than the general population.

I’ve lost count of the number of times I’ve been on EMS and spent the entire day in the car with the same vet, going from call to call and not seeing them eat once.

I’m probably on the other end of the scale; I tend to get indigestion and heartburn from excess stomach acid production if I don’t eat regularly enough, so I tend to stress about the next time I’m going to eat (which turns into a vicious cycle because those symptoms also develop as a result of that stress). Therefore, I always try to ensure I have a packed lunch so I never get caught out.

On the road

Veterinary professionals on the road can often find themselves picking up fast food, which will be of long-term detriment to their health.

The number of ambulatory equine or farm vets who don’t appear to carry food in their cars is astounding.

They often rely on getting time to stop for food – which, inevitably, results in them not eating for the whole working day or picking up unhealthy fast food or snacks, which isn’t really much better.

When discussing my observations with fellow students, many of them have similar tales, and the problem is not limited to ambulatory practice.

While many vets and nurses in small animal practice will have a slightly more routine structure to their working lives, there’s always the odd mad day, week or month when they just can’t seem to grab a minute to supply their digestive system between consults, surgeries and emergencies.

Despite my own claim of always being prepared to avert such situations, sometimes they’re unavoidable.

I’ve found myself a few select times during rotations when I’ve been so rushed off my feet, trying to get everything done or see clients, that I haven’t eaten lunch until well after 4pm. Then, it’s likely I’ve got to that stage of being “past hungry”, but, as it is at that point I normally get headachey and feel a bit weak, I force something down despite not really wanting it any more.

Can’t or won’t?

Now, there’s a subtle difference between anorexia (a “lack of appetite”) and physically not having a chance to eat despite the grumbling in your stomach and the agonising knowledge there’s a pretty decent lunch waiting in the fridge in the next room – but it’s a fine line.

If a client has been waiting 20 minutes for you already, surely another two won’t hurt while you inhale a sandwich? Are vet staff just too busy to eat sometimes or are they not finding the time themselves? No matter how stressed and busy you are, you should still be able to satisfy the basic human right of being able to eat.

I believe the problem of the profession not eating properly is a combination of possible eating disorders, stress related anorexia and the working environment.

Take responsibility

Finding time to eat is crucial, says Jordan, for the health of both the profession and its patients.

I have previously expressed my opinion of the poor work-life balance within the UK veterinary profession, and ignoring rest breaks that are a legal requirement in almost any other field – while not entirely to blame – certainly doesn’t make it easy for vets to look after themselves.

On the other hand, vets need to take personal responsibility for their own health and find time to eat during the working day – if you don’t look after number one, you won’t be providing optimal care to your patients.

As much as skipping one meal might seem like a short-term solution to helping a patient that little bit sooner, it will be at the detriment of your clinical ability in the long term.

Evidently, this is not a clear cut problem and, as such, there’s no fix-all solution.

However, I think vocalising these issues is a good starting point if we wish to become a more healthy, sustainable profession in the future.

November 2, 2016