Vet In Harness's blog

An amusing little thing...

The 'Veterinary Times' is not one of the august journals of our profession.  It's the veterinary rag, really.  Advertisement-funded and full of articles of dubious merit, and rants one one subject or another.  Still, I read it, because it lands on my desk once a week and it's something to do to pass the time while drinking a mug of coffee and waiting for afternoon surgery to start.

I thought I'd share with you a glorious typo in last week's VT.  Apparently an organisation called 'Worldwide Experience' is organising the 'Vets Go Wild' project, an opportunity for those final year veterinary students who can afford it, essentially, to go on a 16 day Safari in South Africa and call it EMS (Extra Mural Study).  According to the article:

"Veterinary experts will provide students with a mix of practical and theological learning in conservation-based veterinary medicine." [emphasis mine]

Made my day, that.

 

Well, we are honoured... and some rambling thoughts on happiness and mental health.

Last week, this blog was paid a visit by the erstwhile Josh himself (well, this is the Internet, so you can never be sure, but it seems plausible) thanking me for mentioning his book, and inviting me to read what other vets have had to say about it.  He has so far failed to take me up on my offer to read his book if he sends me a review copy, which is sad.  But not wanting to be unfair on him or his literary endeavours, I went off and read his reviews.  Very depressing reading they make, too.

I'm not going to argue against the assertion that many people in this job are somewhere on the spectrum from unhappy to frankly suicidal, that as a profession we suffer from higher than average rates of alcohol and other substance abuse, and that many vets frankly feel that they were sold a lie, that their work is simply not as satisfying as they were promised when they chose it, that their customers are often ungrateful for their work and resentful of their bills, their patients mostly want to bite or claw them, they spend a lot of their time dealing with pus and blood and shit, and that having got this far, they feel unable to back out, admit that it's not for them, and find something else to do with their lives.  Hell, I've had times like that.

The issue of depression and suicide in the profession is one that has been gone over many times by many different people.  It seems to me, thinking back over the people who were with me in my years at vet school, that we probably chose people for veterinary training who may not be that suited to the reality of the job after graduation.  In the UK, at least, selection for extremely tightly contested places is essentially on academic attainment, plus an interview in many but not all cases.  My classmates were, for the main part, very hard-working, driven, obsessive / perfectionist / idealist personalities, with a smattering here and there of brilliant types who appeared never to have to do any work (though, like many things, I suspect this appearance was often deceptive).  There really isn't any scope in the selection mechanism to select for people who cope, make do, are practical and enjoy solving gnarly problems without an ideal solution. 

Because it doesn't take long to realise that the job isn't about finding 'the answer' or 'the right solution' or deploying 'the gold standard treatment' most of the time.  The way I see things, it's about trying to tread the difficult line between the animal's best interests, the owner's desires (reasonable or otherwise), the financial constraints, and your professional responsibilities, while trying to avoid stepping too many of the generously scattered ethical and legal landmines.  And  as for the actual bread and butter of the job - it's not intellectual, it's practical and it's about interpersonal skills.  It's about coming up with an often alarmingly Heath Robinson Plan B when the Plan A you were taught at vet school fails in some exciting way.  It's about sensing and responding to owners unspoken, and often unconscious agendas, issues and twitches and somehow producing the best result you can under the circumstances, one that the owner is comfortable with, one that minimally compromises the animal (because, yes, that's often what you're left aiming for), and which meanwhile produces an income for the practice sufficient to keep your boss of your back.  And I love it, for all of that.  That's the challenge.  And I can see why a perfectionist, obsessive, idealistic type would find it completely impossible.

Against a background of all of that, we need to add in the fact that recent graduates are now carrying a mountain of student debt, one which will only get bigger as the 'top-up fees' university generation graduates, and which recent graduate salaries are simply not sufficient to service while providing a reasonable quality of life, not an unreasonable expectation after five or sometimes more years studying on a student income, and galling when you glance sideways and see newly graduated doctors earning upwards of 35k. 

As an aside, I'd love to know how the *attempted* suicide statistics for our profession stack up with other occupations.  I rather suspect that the ratio of successful to attempted suicides is rather higher for us than for accountants, say.  After all, I have the all the necessary means to a relatively painless and pretty much guaranteed-effective death in the boot of my car right now, if I wanted it.  I know of vets who have used it.

Are things similar in the US and other places?  I would love to know my readers' thoughts.  And Josh, I'd love it if you'd send me that review copy...

James Herriot (well, it had to happen one day!)

Some of you will have recognised this blog's namesake as one of the lesser-known James Herriot novels.  I think in common with many of my collegues, the Herriot books were a formative influence - though of course they tell you on no account to mention this on your UCAS form!  Doing a spot of Wikipdeia browsing this afternoon, I found a quote by Alf White (the man behind the Herriot nom de plume) which fairly sums up the way the industry has changed in the last 50 or so years since the Herriot books were based.

"Years ago, farmers were uneducated and eccentric and said funny things, and we ourselves were comparatively uneducated. We had no  antibiotics, few drugs. A lot of time was spent pouring things down cows' throats. The whole thing added up to a lot of laughs. There's more science now, but not so many laughs."

The quote is attributed to a piece in Time Magazine in 1992 by Jonathan Margolis titled "But It Did Happen to a Vet", a horrible title at the best of times and I haven't followed up the attribution so this being Wikipedia I can't vouch for it (a whole other argument, mind, I think Wikipedia is *wonderful*).  Rings true, though.

Pet Hates: The Shocking Truth About Pets and Vets

An aside - the Wikipedia piece on Herriot reminds me that there's a new book out which is causing some annoyance in the veterinary press, mostly from people who (like me) haven't bothered to read it.  Well, it seems likely to be a pile of dross, and we're busy people.  I certainly don't recommend you buy it, though I'm in no position to comment in detail.  It's called "Pet Hates: The Shocking Truth about Pets and Vets" by someone calling themselves 'Josh Artmeier'.  Nice anagram to hide behind, 'Josh'.  Mind you, I'm one to talk...

On career paths, moving on, kittens and textbooks.

I doubt anyone will really have noticed, but it's been a month and a half since I had anything to say for myself here.  On the off-chance that anyone reading here cares what I've been up to (or, indeed, that anyone is reading here at all!)  it's all change in Beth's world.  Very shortly I will be starting a new job, and moving away from mixed practice into small animal work.  Mainly dogs, cats, and rabbits, in other words, plus a few other pet-type-things, exotic animals and so on.  If it seems strange that I may be closing the door on over half my training this early in my career, my reasons are quite straightforward really. 

The mixed practice work I have been doing until now has been heavily small-animal biased, mostly as a consequence of being the most junior person in the practice and getting last-pick of the work.  The up-shot of this is more or less that despite doing mostly dog and cat work during the day, I still found myself on call being sent to colics, and dealing with lambings and so forth out of hours.  This really isn't a very good way to go about things, though a successful lambing is one of the great joys of veterinary work, and something I think I'll probably miss. 

The other aspect of wanting to make the move into small animal work is the question of the sheer volume of knowledge, not just that we have to have to graduate, but of constantly shifting new information, new techniques and new drugs with which we have to be familiar.  Mixed practice veterinary work is always going to be a compromise between depth and bredth of knowledge and competence.  For my own peace of mind I prefer to strive to be the best possible small animal veterinary surgeon I can be, rather than struggle to stay afloat spreading what meagre professional development time I have across every possible veterinary species.

Finally, a thought about mixed practice itself.  I suspect that in most parts of the UK mixed practice is not the future of the veterinary profession.  Already a great many mixed practices are either scaling down or giving their farm work up altogether.  The economics of farming in this country, and by extension of farm animal veterinary work, are not what you'd call favourable and in many cases, particularly where you have a reasonable density of livestock farms in the area, the most effective solution is specialist farm-animal only veterinary practices focusing heavily on health planning and preventative health care, significantly a consultancy role, and driving large distances to their clients rather than locally-based mixed practices providing essentially a fire-fighting service.   Meanwhile, the pressures of being a mixed practice in terms of staffing and the necessity of providing veterinary call-outs to farms at short notice throughout the working day (and night!) can detract from providing the best possible small animal provision, not to mention that in many cases the small animal work is expected to cross-subsidise frequently loss-making farm work.

Newborn-kittens

Anyway, enough of all that.  If you've read this far I'd like to reward you with a picture of some new-born kittens we delivered recently by caesarian section.  Very cute they were, too, and at suture removal mother and all three kittens were doing well.

Handbook of Veterinary Procedures and Emergency Treatment

Richard B. Ford

Finally, a book recommendation, on the very very very slim chance that anyone reading this is a clinical veterinary student - I have just discovered the book I *really wish* I'd had for my final year.  I cannot recommend "Kirk and Bistner's Handbook of Veterinary Procedures and Emergency Treatment" by Ford and Mazzaferro highly enough.  It has really immensely useful 'how to' guides to procedures from the simple to the really quite complicated, plus all sorts of useful reference guides including a really comprehensive guide to poisons and toxins, and the killer feature for a final-year text, differential lists for just about everything.  Paired up with the Merck Manual and a formulary, you've probably got just about everything you actually need as a small animal medicine reference, as long as you've got access to a veterinary library and a well-stocked copy-card! 

 

Small details that speak volumes....

The contents of my handbag (well, shoulderbag-thingy) as unloaded this evening:

One copy of the Veterinary Record, thumbed, dated February 24, 2007.
One box of Mr Kipling Lemon Slices (Twin packed for lunchboxes!) 2 for £2.
One paperback novel, Jasper Fforde 'The Well of Lost Plots' (v good, incidentally).
One pharmacy bag containing miscellaneous cold-management chemicals (Paracetamol, generic, 500mg x16, 'Non drowsy Sudafed decongestant tablets' (pseudoephedrine hydrochloride) 60mg x12, Ibuprofen, generic, 200mg x12.  All dog-eared with tablets missing).
One folding umbrella, black.
One Cadbury's Cream Egg.
One till receipt from the Co-op.
One piece of torn A4 paper with a client's address scribbled on it.
My mobile phone charger.
One jar of Carte Noire instant coffee, opened.

My life is so glamorous and exciting.

A note about veterinary and medical terminology.

Client:  "Yes, it's about my dog, he's got chronic diarrhoea."
Me:  "Oh, right.  How long has this been going on for?"
Client:  "Well, he was fine this morning."
Me:  *scratches head*

So, today, let's talk about words, and what they mean.  Because words mean different things to different people.  In my time at vet school, I learnt lots of new words.  Long words like 'erythematous' which I'd only ever use talking to another vet (it means 'abnormal redness of the skin' incidentally).  I also learnt that words we all use in day to day life have specific meanings in a medical context.  These meanings can be a narrowed-down form of what they're used to mean in day to day life.  But sometimes the standard usage has morphed to mean something almost opposite to the technical use.

'Chronic' then.  To my client, it means 'bad'.  To me, it means 'of long duration'.
'Acute' probably also means 'bad' to my client.  To me, it means 'of sudden (and probably recent) onset'. 
So, in techincal use, chronic and acute are more or less opposites of each other.  And my client's dog, in fact, has acute diarrhoea.

'Acute' is not the same as 'severe'.  'Severe' *does* mean 'bad'.  The opposite of 'severe' is 'mild'.  So, despite what some people thought at the time (mentionning no English-graduate journalist-types who really should have known better), SARS (Severe Acute Respiratory Syndrome) was a perfectly sensible, meaningful, and non-tautological name for the condition.  Despite the fact that in common usage 'severe' and 'acute' are used almost interchangeably.

Acute things can be either mild, or severe.  So can chronic things, though it's rarer that something is both severe and chronic, because if it's severe enough it will kill the patient before it gets the chance to be a chronic condition.  My client's dog had severe, acute diarrhoea.

I hope that clears things up a little!

Bird 'flu strikes the South West!

Two people have refused to let me see their budgies in the last couple of days.  The first, because they thought it was too cold to take a budgie outdoors (almost reasonable, though I suggested various ways in which it could be done, to no avail).  The second, because "If I take it outside to get here it might catch bird 'flu".  *Sigh*

In amongst all this, the practice support staff seem to have got the idea that 'Beth is the person to talk to about budgies'.  I don't want to be a budgie vet!  How do I make this stop?

A salutary seasonnal warning

Today I treated a five month old kitten who had spent ten minutes in a running tumble dryer.  In something of a minor miracle, when she arrived at the surgery with her (very distressed!) owners, she was a little bit hyperthermic, had some slight bleeding from her mouth and her tail was limp.  Her heart was racing and she was panting a bit.  After some chill-out time and some painkillers, she was back to normal, and even her tail had recovered function.  She was very, very lucky.  Kittens in tumble dryers very often die.

I'm surprised we don't see more of them, really.  On a morning like we had today (for those of you not in the South West, we had about 10cm of snow overnight, and it was bitterly cold by local standards) a tumble dryer with an open door could be a very enticing place for a kitten to sleep.  So, please, be careful (not just with tumble dryers - ovens (Agas and the like especially), washing machines and old fridges are just as dangerous) and keep places where animals could get trapped and injured closed and secured.

At least this was an accident, and not a misguided attempt to dry a cold wet animal.  And all's well that ends well.  Remember, towels and hair-dryers are wonderful inventions!

Ways to tell your working hours are antisocial...

When you have to scrape the ice of your car windscreen before you go to work, and again before you go home.

Deadly Bird 'Flu - A User's Guide

Or, "Everything you ever wanted to know about bird 'flu but were too afraid to ask."

On the weekend we found out that a Bernard Matthews' turkey rearing unit in Suffolk has suffered the first outbreak of H5N1 bird 'flu in farmed poultry in the UK, I think some hysteria-free information is in order.

So, what's this bird 'flu, anyway?

So called "bird 'flu" is more correctly Avian Influenza.  The Influenza virus is an Orthomyxovirus.  Avian influenza is an Influenza Type A virus.  Influenza A viruses can infect many other species, including humans, pigs, horses, mink, seals, and whales.  The bird 'flu we're currently concerned about is known as H5N1.

H5N... what sorry?

Influenza viruses are classified according to the precise form of two of the proteins found on the virus surface.  HA binds to the surface of target cells allowing virus entry, NA binds to and hydrolyses a component of the infected cell membrane to allow the progeny virus to escape at the end of the infection cycle.   There are 15 variations of HA and 8 of NA.  Particular viruses are named for their HA and NA proteins, hence H5N1 in this case.  Almost all combinations of HA and NA exist in wild birds, and in most cases the viruses are  genetically stable (do not mutate) and apathogenic (do not cause disease).

Apathogenic?  What's going on here, then?

Infection of new host species pushes a process known as antigenic drift - a succession of mutations affecting key proteins which affect the virulence (disease causing potential) of the virus.  Low Pathogenicity Avian Influenza (LPAI) outbreaks can see the mutation of the strain into a Highly Pathogenic Avian Influenza.  HPAI, and LPAI can be transmitted between birds, with LPAI more easily transmitted because infected birds remain alive and secreting the pathogen for long periods.  HPAI causes the rapid death of up to 100% of an infected group of animals, as we have seen recently in the Bernard Matthews' outbreak.

So, hang on, we're talking about an animal health issue here?

Yes, primarily.  The reason for the media panic about Deadly Bird 'Flu is a second habit of the Influenza viruses called Antigenic Shift.  Antigenic Shift can occur when two different influenza viruses infect the same host at the same time.  The genetic code of the two viruses gets jumbled up and new versions of the virus appear containing some of the genetic material from each virus. 

What's that got to do with this Bird 'Flu, then?

We've all heard about the cases (mostly in the Far East) of people dying of this H5N1 bird 'flu.  As the BBC News website put it today, these cases have essentially been restricted to those in 'intimate contact' with infected poultry (yeah, thanks for that image, Auntie Beeb!).  There have also been a few cases where people infected in this manner have gone on to infect family members, and these cases are described as 'horizontal transmission'.  It is clear, however, that H5N1 'flu as it stands isn't easily transmitted to people or between them.  The concern about epidemic 'flu is that the H5N1 strain we're seeing at the moment could either, via Antigenic Drift become more infectious to and between humans, or (probably more likely) meld with a human virus and produce a highly lethal, highly contagious human 'flu via Antigenic Shift.  A good whack of the current paranoia seems to stem from the perception that we're somehow  'overdue' an epidemic 'flu.  There's a whole 'nother can of statistical worms there that I'm not going to get into right now!

OK, so what has all of this got to do with me?

At the moment, the most likely answer is 'nothing', if you don't keep or work with poultry.  If you work commercially with poultry, you should be receiving official government advice.  As part of the vigilance programme the government would like you to keep your eyes open for dead birds while you're out and about.  If you find dead wild waterfowl (gulls, waders, ducks, geese or swans) DEFRA would like you to 'phone 08459 33 55 77 and let them know.

Can't I get vaccinated with this Tamiflu thingy?

*Sigh*.  The media have really got their knickers in a twist about this one.  Tamiflu is not a vaccine, it's an antiviral drug which it is believed might reduce mortality in cases of infection with influenza.  Relenza is another, similar drug.  The NHS is stockpiling both of these, and Tamiflu has been offered to people who were working with the infected flock or involved in the slaughter operation.  There's also the standard, seasonal 'flu vaccine.  There is no evidence, or rational scientific reason, to believe that this would protect you in any way from either this H5N1 strain or any of the infinite possibilities for what it might have transformed into should it become highly infectious to humans.  There are experimental H5N1 vaccines in production, but no guarantee that they would still have any effectiveness after whatever mutation event created an epidemic 'flu.

But, hang on, I've got half a dozen chickens in my garden!

If you have registered your flock with DEFRA (and, I can see why people with small flocks may have chosen not to undergo voluntary registration, given what a paperwork-and-faff machine DEFRA generally is!) you should be receiving advice in due course.   If you are in the Restricted Zone or Surveilance Zone for the present outbreak, then restrictions apply to how you can keep your poultry and on poultry movements.  For more information see the DEFRA website below. 

Outside the Zones for the current outbreak, common sense applies.  The most likely source of infection to farmed birds is the faeces of wild birds.  Keep your birds seperate as far as possible from wild birds.  Especially do what you can to prevent wild birds having access to the feed and water your poultry use.  Keep feed and water bowls clean and replace food and water regularly.  Feed and water indoors or under cover if possible.  If your poultry are kept in a fenced enclosure, a tarpaulin over the top may reduce the risk of wild birds contaminating the enclosure with their droppings.  Above all, be vigilant for signs of disease in your animals.  Apart from sudden death, symptoms of Infuenza in birds may include depression and inappetence, dramatic reduction in egg production and facial oedema (swelling) with swelling and cyanosis (blue-coloration) of combs and wattles.

Further information

http://www.defra.gov.uk/animalh/diseases/notifiable/disease/ai/index.htm - DEFRA's Bird Flu advice website.  Contains information for poultry keepers and members of the general public.  Includes detailed advice to poultry keepers and maps of the Surveilance and Protection Zones.

http://www.defra.gov.uk/news/latest/2007/animal-0203.htm - DEFRA's official press release on the Suffolk H5N1 outbreak.

http://www.hpa.org.uk/infections/topics_az/influenza/avian/default.htm - The Health Protection Agency's Bird 'Flu website.

http://news.bbc.co.uk/1/hi/health/3422839.stm - And if you want to be confused, read the BBC's "Q*A - Bird Flu".