Friday, August 2, 2013

Interview with Vet School's Susie Clohessy

Saving lives already: Dr Susie Clohessy, one of the stars of Vet School, with a kitten she rehomed.  "My housemates and I found it really hard to give him away".
If you're hooked on the ABC's show Vet School, you'll be pleased to know that the second episode screens tonight. SAT interviewed Vet School's Dr Susie Clohessy this week to get some behind-the-scenes insight.


What year were you in when the show was made, and where are you now?

I was in my final year of the vet course when the show was filmed. Since graduating I moved with two good school mates to Melbourne where I was lucky to land an amazing job as an emergency veterinarian in large multi clinic emergency veterinary hospital. The clinic has absolutely amazing facilities, I had phenomenal colleagues, a diverse case load, and importantly as a new graduate, support. I had to make a really hard choice though recently to move on from this role. I am thinking of doing some travel later in the year and see where the wind takes me.

Susie and her colleagues were the subject of "Vet School" during the fourth and fifth years of their studies.
What made you decide to become a vet - and are you still doing it for this or these reasons or has your motivation changed over time?

I always remember loving my family pets and generally having an interest and an affinity for animals. I remember the conscious thought however of wanting to be a vet was when my first dog became very sick. I was quite young at the time and I don't remember details but I remember how lovely the vet looking after her was and how compassionate she was with our family pet but also with us. Anyway I was really young but it struck a chord and I remember wanting to be a vet from that point. As I got older I realised I loved science based subjects at school particularly physiology which is obviously so much of a medical based degree and I love problem solving so it is a great career combining lots of great things. 

Can you tell us about any significant humans in your life and  how they have helped you through vet school?

Goodness me, so many! My family and friends were a massive part of getting me through vet school, particularly the final years. Fourth year is a lot of content and fifth year oodles of contact hours, most people wouldn't believe. Luckily I have such a great support network and friends that were pretty cool about me being MIA for periods at a time during semester. The veterinary degree is unlike most and I think until you know someone and see them battle through it you have no idea what it takes for a vet to get to graduation and some of the sacrifices that are made, particularly in the final years.

Being in fourth and fifth year is gruelling, but you had the added scrutiny of TV cameras. How did that affect you? 

Oh gosh, I realise I am not meant for TV! There was me on camera versus my rotation mates who seemed like naturals. Fifth year is just kind of nuts in general so it added some extra hilarity. It was a pretty fun addition to the years dynamic actually and it certainly has made for a memorable final year on top of everything else.

What was the highlight of being involved with the production?

I have some of the most hilarious stories being part of the production -  so many "Oh shivers, thats on camera" moments! I liked seeing what it takes to get something like a documentary made. Here we were studying to finish so we could work as vets and having people film it, just a bit surreal. I really liked getting to know the crew members, they were such interesting people and had worked on some cool projects - it always great hearing about someone else's career.

How has the veterinary degree changed you as a person?

Gosh in a million ways. I think the Murdoch veterinary course is an amazing course. Over the years with all the different things you do it develops your confidence in decision making and problem solving skills. It has a focus on client communication/empathy which is important, as so much of vet medicine is being able to empathise and chat with the owners in order to make a plan for the animals. 

I think I have always been a good communicator (perhaps sans TV cameras,we'll see) but heaps of facets of the course allow you to further develop these and as a vet is one of your biggest assets! Vet students are innately hard working, but there are significant man hours put into pursuing the course and it has certainly made me unafraid of hard work. I know if you put in the hard yards it will  pay off. I can't quite put my finger on exactly how it has changed me, but I know I have grown in more ways than one through doing the course at Murdoch and I certainly wouldn't change that!

Getting through those final years is one part of the journey. What is the next step for you and how well prepared do you think you are?

My next step.. I'm a little in limbo at the moment. I have just moved back to Perth and settling back in. I have absolutely no idea - as I said before since graduating I have had a blast working but I'm just going to see where the wind takes me.

Vet training tends to be highly demanding, full-on, all-encompassing. How do you wind down?

Hobbies and friends are so important. I play a bit of sport and since working started flying trapeze with a group of fun people and a few other bits and pieces. I also have friends who are not impartial to a vino or two! Not enough can be said in maintaining life balance. Make sure you try keep doing one or two of your favourite things, sport and travelling during semester breaks were mine.

Are there any good vet books, websites or resources you recommend?

VIN is a really good online resource for those odds and ends questions and weird drug doses. Nelson and Couto's Small AnimalInternal Medicine book is a good one and being in emergency (and my manager Gerry will love this) I read Silverstein and Hopper's Manual of Small AnimalEmergency and Critical Care. They were probably my two bibles in my first year out.

Finally, now that you have been through fourth and fifth year, what is your advice to third year vet students? 

Just have fun. A lot of people go through and will tell the years below them that its gruelling and hell. And certainly it will be some tough years of study but have fun. Vet school is full of amazing people - peers and supervisors - and also heaps of great opportunities. Don't sweat the small stuff and just have fun, you've done the hard yards getting in! I'd also make sure you get some practical experience before and during your degree as you'll be better off later having had exposure to a clinic environment. I also think its important to understand what the industry is like, which is why clinic exposure is a good idea and also make sure you ask lots of questions to the practice managers, vets and nurses while on prac so you have realistic expectations of what it is to be a vet - it is an incredibly rewarding profession, but there are certainly a few issues within the industry.

Episode 2 airs tonight on the ABC.

Thursday, August 1, 2013

Three things I learned: veterinary anaesthesia

surprised cat
Did you realise that anaesethetic morbidity and mortality is slightly higher in cats?
Anaesthetist Dr Sanaa Zaki presented a webinar on “The Changing Face of Small Animal Anaesthesia” as part of the ASAVA’s 2013 webinar series.

Dr Zaki referred to recent studies of anaesthetic mortality in humans which ranged from 85 to 467 deaths per million in human patients (in developed and developing countries respectively, from 1990s-2000s) vs an average of less than 1 per cent in veterinary studies.

The vast majority of complications and mortalities (>50 per cent) occurred in the post-op period, within the first three hours of recovery from anaesthesia.
Not surprisingly, monitoring and pulse oximetry is associated with reduced risk of anaesthetic mortality.

Higher mortality is associated with pocket pets and cats (interestingly, those which were intubated and on IV fluids had a higher risk – but I wonder if this is because these were likely sicker cats in the first place?).

According to Dr Zaki, “There are no safe drugs, there are only safe anaesthetist. Any drug in unskilled hands can be quite dangerous – even those with a good safety margin”.

Given the higher risk of cats, much of the talk was focused on feline patients. So here's what I learned.
  1. Cats may have mydriasis for up to nine hours following administration of opioid analgesia. During this period they may have impaired vision and don’t appreciate bright lights. It also lasts longer than the analgesia provided. (On a slightly related note, methone CRIs definitely have a cumulative effect – a trend I’ve noted – and should be weaned down within 12-24 hours).
  2. In cats, light anaesthesia may be safer than heavy sedation. For very feisty cats Dr Zaki uses tiletamine/zolazepam at 2-3mg/kg + methone at 0.1-0.4mg/kg IM.
  3. I’ve not used sevofluorane before, but apparently it works MUCH quicker than isofluorane and its easy to overdose cats this way if one is not very careful.


At the end of the talk Dr Zaki provided an excellent review of analgesia. I like the way she talked about different types of pain, distinguishing physiological pain (in proportion to the degree of the stimulus and a warning sign to the body) from inflammatory pain (initiated by tissue damage, doesn’t serve a useful purpose) and neuropathic pain (due to specific injury to neuronal tissue and modulation of the pain pathway). There is a ye olde school belief which comes up at veterinary conferences intermittently which is that post-op pain is good because it forces the animal to rest. 

Most veterinarians know this is not the case, but Dr Zaki made a point of reminding everyone anyway - and I am sure her patients are very grateful.

Wednesday, July 31, 2013

Handling "difficult" cats

So I don't have photos of hissing cats. Turns out that when cats are hissing and puffed up like this they don't appreciate their photo being taken. And I'm generally preoccupied trying to calm them down. Instead my colleague from the Cat Protection Society  is modelling this awesome Cat Versus Human tee (you can see the original designs here).

Hell hath no fury like a frightened/angry cat. I have to laugh internally anytime someone says "why are you worried, it's just a cat!". Well, cat bites are serious, they hurt, and they are responsible for some of the most impressive injuries I've seen in vet practice. I've been bitten by a crocodile (clarification: it was a baby) and that was nothing compared to a cat bite.

But the bigger negative of dealing with stressed out cats is the impact of the stress on that cat, and the other cats in hospital. Once they get wound up its hard for them to relax, all handlng becomes challenging and their experience of the veterinary hospital must be just awful. 

And as vets we absolutely don't want that! There are some cats who are just so terrified in a veterinary environment that nothing you do will calm them down. Some judiciously used anaesthetic agents may be appropriate in these cases. Its safer for the patient and the veterinary team. BUT...one might argue that there is no such thing as a "difficult" cat per se, there are only difficult encounters. Changing the way we behave may change the way we respond and prevent escalation into full-blown feline chaos.

So if you're up for learning more about how to handle difficult cats, until December 31 you can view Dr Sophia Yin's webinar on Low Stress Handling of Difficult Cats.

The thing I like about this most is that Dr Yin considers the vet visit from the cat's point of view, and also considers the potential impact of the veterinary environment on the animal's stress levels. (A warning...some video of the examples of poor handling of cats will be upsetting, especially to anyone who has not seen a cat really stress out before).

I'm fortunate to work in a very cat friendly practice where our team is trained to handle cats calmly. I'm a big believer in synthetic feline facial pheromones and the use of top-loading cat carriers (el cheapo cat carrier designers out there have a LOT to answer for! but that's another topic).

If you are interested in making your clinic more cat friendly, see also the Feline Advisory Bureau's guidelines for creating a cat-friendly practice here. This is such an important topic that I am going to discuss it in more detail shortly. Meantime enjoy learning how to minimise stress when handling your feline patients!



Tuesday, July 30, 2013

Useful veterinary books: The Pocket Book of Practising Tips for Vets

The authors of The Pocket Book of Tips for Practising Vets at their book launch.
Everyone says that veterinary practice is an art more than a science - and most lectures, textbooks and information sources tend to deal formally with the science. 

That can contribute to the shock one feels when one graduates. There one was, doing a professional degree, feeling somewhat in control...now one is effectively a first-year apprentice. Experienced practitioners know some really useful things, often because they have gleaned them from the school of hard knocks.

But those things - those clinical pearls - can be life saving. Its nice not to have to personally go through the death-defying (or not) experience that those who went before us did to achieve this knowledge.

The Pocket Book of Tips for Practising Vets is a beautiful collaboration between a team of GP vets who got together and brainstormed some of these clinical pearls.

When I interviewed them for The Veterinarian Magazine they told me that the idea had come from a continuing professional development presentation by Alan Jeans, who decided to talk about "the ten most useful tips I’ve learned to make practice easier." 

Everyone realised they had their own and so added them...pooling over 200 years of veterinary experience (between 6 vets - not one ancient vet!). They asked for more tips through the veterinary times then had a book on their hands - which the Veterinary Benevolent Fund printed.

Its a beautiful example of a collaboration that I think we need more of.

Its a nice, thin very readable volume. No one person will find every tip useful, but there were plenty that I found helpful. Chapters are divided according to general tips, tips specifically for new graduates, on-call tips, surgical tips, technology tips, small animal tips, farm animal tips, equine tips, working with small animal client-tips and working with farmer tips.

“I reckon most experienced vets will read ten tips they want to try out, and will probably end up using five of them – that’s good value at two pounds a tip,” Jeans told The Veterinarian Magazine. “Obviously there is a lot more in there for new graduates.”

I asked him to pick a favourite, but that was a tough call.

“For sheer usefulness in a potential panic situation, number 69 stands out – hope I never have to use it,” he said.

(Tip number 69 provides a plan of attack in the case of an ovarian pedicle bleed during a bitch spey).

I liked tip 2: “Recognise a ‘no win’ situation. Avoid giving yourself grief when the initial prognosis is grave (nature rules us, not vice versa). In these situations recognise your professional role of offering guidance, comfort and ‘hand holding’”. And number 46: When arranging to meet a client out of hours, always agree a definite time; some people have very odd ideas about what ‘come straight down to the surgery’ means. It can be very stressful waiting at the surgery for a long time, particularly if you have other calls coming in." Oh yes.

When the book was launched the BVA ran a competition for the best tip. The winner, provided by Phil Kenward, was “do not allow the owner’s diagnosis of his problem to worry or influence you before you examine the animal yourself.”

How many times do owners demand a diagnosis over the phone, when in fact their description leads us to form a completely different opinion than the one we do when we perform a physical examination?

I am hoping very much that a second edition is on the cards.

If you do buy the book (£10 from the VetLife website) you are supporting a very worthy cause: the VBF provides information and support for veterinarians struggling with mental health issues, professional stress and debt. Along with the VetLife website, the VBF provides a 24 hour helpline, a health support program and financial support to veterinary surgeons and their families in times of need. 

Reference

Jeans A, Cousin A, Macdonald N, Macfarlane J, Rowe N and Williamson K (2012) The Pocket Book of Tips for Practising Vets. Veterinary Benevolent Fund.

Monday, July 29, 2013

Stress in vet practice

Okay. So its hard to find a photo of "stress" in the workplace, mostly because if someone is stressed they're likely to get even more so if you take a photo of them feeling their worst. Instead I've chosen to showcase these awesome cupcakes, brought to us from My Little Cupcake, because they are a stress antidote (for vets, not their patients).


In working on a project with colleagues Susan Mathew (Sydney University) and Jenny Moffett (Ross University) I came across an excellent article by David Bartram and Diana Gardner on coping with stress aimed at veterinarians.

They made the observation that veterinary surgeons are trained to problem solve, which serves them well in practice. BUT…we also may try to solve problems “beyond the point at which this is possible.” Furthermore, we don’t always appraise stressful situations appropriately. I know myself that I experience stress as a somewhat nebulous entity, often failing to slow down and work out systematically what I am specifically stressed about.

The article provides a framework for appropriately assessing stressful situations.

Coping strategies can be characterized as problem-focused (approaches aimed at addressing the problem causing stress) or emotion-focused (changing the way we feel about a situation, or regulating the feelings that arise from stress such as anxiety). Its a nice way of explaining ye olde advice: give me strength to change the things I can, and accept those that I can't.

People go wrong when they use problem-focused strategies when a situation is unchangeable (for example, when an animal has died despite our best efforts) or rely on emotion focused strategies when a situation can be changed (an unfavourable performance review by an employer).

The problem is that, according to the authors,
“we may exhaust ourselves trying to change things we aren’t able to, while missing the opportunity to change those things we can.”
They give numerous examples of problem-focused strategies that might be used, including:
  • Create a plan of action
  • Concentrate on the next step
  • Seek advice from others
  • Ask for help with or delegate tasks
In contrast, emotion focused strategies could be things like:
  • Spending time with pets
  • Maintaining a healthy diet and exercise regime
  • Seek emotional support
  • Accept the situation
  • Compare oneself to others who may be worse off

It’s a simple but incredibly helpful approach, because most problems in practice involve both practical and emotional elements.

Their approach is to identify a specific stressor or problem, for example, interpersonal conflict in the practice.

The aim is then to identify changeable aspects of the problem, for example unclear job description or ambiguities about responsibilities. Potential solutions are identified and listed, then prioritized.

Unchangeable aspects of the situation are identified, for example key personality traits of the persons involved, time and discomfort in dealing with the matter.

Emotion-focused options are identified and listed, then priortised. If that doesn't work, the cupcakes might! 

How do you deal with stress in practice?

Reference
Bartram D and Gardner D (2008) Coping with stress. In Practice 30:228-231.

Other related articles:

Bartram D and Boniwell I (2007) The science of happiness: achieving sustained psychological wellbeing. In Practice 29:478-482.


Bartram D and Turley G (2009) Managing the causes of work related stress. In Practice 31:400-405