Animals affected by fires + Have your say: the future of the veterinary profession

Phil poses in his vet gear.

This week has been an absolutely tragic week for those living on the South Coast, Central Coast and around the Blue Mountains affected by some of the worst bushfires Australia has seen in years. SAT extends its deepest sympathies to those who have lost their homes and those whose pets perished. The Australian Veterinary Association has provided resources for veterinarians treating animals for burns (click here) and some tips for pet owners on protecting their animals from natural disasters (click here).

The future of the veterinary profession

Too many vets? Not enough vets? Vet salaries too low? Vet fees too high? Technology too far behind? Advancing at too fast a pace? More training in emergency and zoonotic diseases required? Too many vet schools?

These are all questions being discussed in relation to the future of the veterinary profession (they're also being discussed in relation to many other professions including medicine and dentistry). So what is the impact on individuals within the profession and what is the future of the profession itself?

The Australian Veterinary Association's New South Wales division is hosting an open forum at the Menzies Hotel in Sydney CBD on November 21 on the future of the veterinary profession.

The panel will include represenatives from the Australian Veterinary Association, the Veterinary Practitioner's Board, Industry and Academia and promises to be lively.

They're extremely interested in hearing from new graduates, as well as both AVA members and non-members alike.

To download an RSVP form click here. I know everyone's calendar starts to fill up this time of year (hopefully its full of dates with your dog!) but if you're really interested in the future of the veterinary profession this looks like a good place to start.

Three things I learned: urinary incontinence in dogs

Bosca and Phil queue for the gents.

Urinary incontinence is not uncommon in canine patients, but it can be extremely frustrating for affected dogs and owners alike. This week I attended a webinar given by BruceMackay hosted by the Australian Small Animal Veterinary Association (ASAVA). Not only is Dr Mackay a specialist in canine internal medicine, but he owns two dogs who suffer from (controlled) urinary incontinence, which gives him extra cred in this area.

In very basic terms, urinary incontinence occurs when there is too much or too little bladder or urethral tone, which can be due to a range of reasons including neurological to hormonal.

According to Dr Mackay, two things that are easily omitted during physical examination are palpation of the urethra (on rectal examination you should be able to palpate it travelling over the brim of the pelvis) and neurological examination (including looking at anal and tale tone and peri-anal sensation.

The session provided a nice refresher on incontinence, for which there are many differentials including:

Pathological process/disease type	Disease conditions
Anatomical/congenital	Ectopic ureters Pelvic bladder (short urethra syndrome) Vaginal stricture/stenosis Urethrovaginal fistula Patent urachus
Infectious/inflammatory	Bacterial or fungal cystitis
Neoplastic	Transitional cell carcinoma
Metabolic	Renal insufficiency/failure Diabetes mellitus/diabetes insipidus Hyperadrenocorticism/hypoadrenocorticism Hepatopathy Cystoliths
Toxic/pharmacologic	Glucocorticoids Diuretics Phenobarbital/potassium bromide
Degenerative	Urethral sphincter mechanism incompetence
Neurological	Lower motor neuron disease/peripheral neuropathy Upper motor neuron disease Dysautonomia

To this list I think it is important to add behaviour (some dogs will leak a bit of wee when they are excited, some will do it when they are anxious) and training (some dogs just aren't toilet trained...and some owners aren't always aware of the need to let their dogs out to pee regularly!). 

Haematuria often indicates a UTI but may also indicate prostate disease in male dogs.

The bladder and urethra are supplied by the hypogastric, pelvic and pudendal nerves. Damage to these nerves (for example from trauma or spinal tumour) may lead to urinary incontinence. Some studies have found a positive association with tail docking and many breeds prone (eg old English sheepdogs, German shepherds, Rottweilers, Weimaraners etc) are breeds which are traditionally docked – though tail docking has been banned in Australia for some time).

According to Dr Mackay, a thorough work-up for UI involves a CBC/MBA/UA + urine sediment exam and culture and sensitivity to rule out the majority metabolic and infectious causes. Imaging (sonography, plain and contrast radiographs, cystoscopy and urodynamic studies) may be warranted, especially in the work up of ectopic ureters.

Even so ectopic ureters can be challenging to diagnose as ureters are pulsatile and one can’t always easily see where these are entering the trigone of the bladder. One might need to used CT, vaginograms (Dr Mackay performs these if intravenous urography fails to yield a diagnosis) or fluoroscopy to catch these. Dr Mackay provided a detailed description of his techniques for these examinations.

One thing I learned is that in Australia at least, golden retrievers are over-represented when it comes to ectopic ureters and often these animals have “megaureters” which are thickened and torturous. As it seems with most terrible conditions of the urinary tract, females are more commonly afflicted than males.

Another thing I learned is that Aspergillus can cause a form of diabetes insipidus and affected dogs need to be on azoles for life.

Of course the most common cause of urinary incontinence by a mile is urethral sphincter mechanism incompetence (USMI).

There are oestrogen receptors located in the urethral mucosa, blood vessels and muscle. Oestrogen promotes tone in these structures. Oestrogen deficiency therefore is associated with reduced urethral tone and atrophy of urethral vasculature. Pressure from within the urethra exceeds that exerted by the urethra, and incontinence results.

Often the first sign of urinary incontience is that a dog wets the bed.

USMI is reported in up to 20 per cent of speyed dogs, with the average age of onset around 2.9 years – and largely breeds more likely to be affected (dogs over 15kg are 7x more likely to be affected). Current literature suggests that age of desexing is not a significant risk factor.

The treatment of choice is phenylpropanolamine (PPA), an alpha-adrenergic agonist which directly stimulates the urethral sphincter, at 1.1-1.5mg/kg PO TID initially, weaned down to the lowest effective dose. [In the good old days, before it was used widely for illicit purposes, pseudoephedrine was used for this purpose quite successfully].

Potential adverse effects include agitating, vomiting, panting, mydriasis, hypertension, tachycardia, bradycardia and seizures – but most dogs tolerate this well and the majority (Dr Mackay says around 75-85%) are well controlled on this medication.

Synthetic oestrogen (i.e. diethylstilboesterol or DES) is an alternative because this upregulates expression of alpha receptors. Around 50-65% of dogs have resolution of signs. This drug is often frowned upon due to the potential for bone marrow dyscrasias. Within the group (over 150 webinar delegates) only two vets had seen this – both around 20 years ago. [Interestingly, such dyscrasias are more likely to occur when oestrogen is administered after a mismating or when males suffer from oestrogen-secreting sertoli cell tumours]. The dose is around 1mg/day for 5 days then 1mg/week.

Some dogs require a combination of PPA and DES to control incontinence – at least initially. They have a synergistic effect in both upregulating (DES) and stimulating (PPA) alpha receptors.

These struvite cystoliths were passed by a schnauzer with incontinence. She also had a UTI.

Incontinent male does can be treated with PPA but prostate disease must be ruled out first. They can also be given testosterone cypionate (2.2mg/kg IM q 30 days) but ironically this can cause prostate disease – and aggression. Dr Mackay mentioned a case involving a male poodle with incontinence whose signs were resolved with physiotherapy alone. I hadn't realised this was an option.

When medical management doesn’t work, surgery is often required e.g. colposuspension or implantation of a hydraulic inflator, or, less invasive, urethral bulking agents. The latter provide relief of symptoms for a limited time as they flatten out after a while, opening the lumen of the urethra. Collagen was the substance of choice but as this is no longer available in Australia, “Bulkamid” is used instead.

One more thing I learned is that dogs with ectopic ureters can have concurrent USMI. That can be both a diagnostic and treatment challenge and may the reason that some dogs fail to respond to treatment.

How to find a missing pet

The PetSearch team on the job.

Anyone who has ever lost a pet knows how distressing it is. Veterinary clinics receive hundreds of calls each year about missing pets, most of which are reunited with their owners. Some are located within a matter of hours (the cat was in the wardrobe all along! The dog nipped next door to sample offerings from the BBQ etc.) but others require a bit of detective work.

SAT interviewed Lee who works at PetSearch, a company dedicated to finding lost pets as quickly as possible.

What is PetSearch and how does it work?

Pet Search was established 22 years ago to centralise the way lost and found pets are processed, there are so many different pounds and shelters and information is often not shared across different facilities or services, so using pet search as a central hub enables us to search more thoroughly for a lost pet across the whole of Australia. We have since developed to being a resource that people use to get guidance and tools to search for a lost or stolen pet. Signs, flyers, advertising are all parts of searching for a lost pet and when done right gives a person a better chance of finding their pet. An owner on their own has a 5-20% chance of finding their pet, using Pet Search they can have up to a 85% chance. We are also a licensed pet detective service working on stolen pet cases.

How did you get involved in helping the owners of lost pets?

I started working at Pet Search a bit over 8 years ago, when my friend lost her dog and used PetSearch to find him. She was so happy, she told me about it and knowing I loved animals, we both asked to help out. Initially we worked as volunteers helping out to redesign the database used and then I went on in employment capacity searching for lost pets.

In your experience, what are the major reasons for pets to go missing?

This varies depending on the type of pet e.g. dogs – most likely accidental disappearances e.g. gates left open, storms. For cats, most commonly locked in somewhere, territorial issues with other cats. For birds, it is most commonly the cage fell over or someone opened a door when the bird was flying free. 

Owners can door knock and put up posters. What can services like Pet Search do to improve the chances of finding a lost pet?

This varies depending on the type of pet, how long they have been missing, where they have gone missing and a whole bunch of other variables and also what the family of the lost pet wants us to do to find them. The first thing we do is profile a pet. We ask lots of questions about personality, history, circumstances etc. to determine what may have happened and what we need to do to find them. We can have up to a 75% success rate for dogs, cats and birds, snakes, rabbits and ferrets can have up to a 85% success rate. Services can range from just providing phone guidance or designing a poster or flyer to doing an intersection alert with staff members holding large signs at a major thoroughfare or even using a trap or amplified listening device.

[You can download a sample questionnaire for a lost cat profile here - the detail is impressive].

Listening device to detect pet sounds.

In my experience owners often assume that their animal is permanently lost after 2-3 days. In your experience, how long does it take to find a lost pet?

This is probably the thing that makes us most sad. Too many people give up searching for their lost pet after a couple of days, it is very hard to convince someone to reinvigorate their search if they have mentally moved into a grief avoidance stage because searching for a pet does take a mental toll on someone and keeps the grief process going, the not knowing where they are or that they are ok is the hardest part of searching for a lost pet. On average it takes about 2-3 weeks to find a lost cat or lost dog, 3 months to find a lost bird, 3-4 weeks to find a lost ferret or snake [Ed: my friend Glenn told me he lost a pet snake at his place a few years ago. When I go over for dinner I set with my legs crossed on the chair in case I locate the aforementioned snake]. The length of time it takes to find a pet also varies depending on so many factors e.g. the weather (it takes longer to find a dog and cat in the winter as there are less witnesses out and about), in September and October it takes longer to find a lost cat in these months and there are more lost cats in these months compared with any other month of the year.

What skills do you need to reunite owners with pets?

Understanding lost pet behaviour and how this differs from a pet’s normal behaviour, body language (both human and animal), analytic skills to assess probabilities, look at all the factors of a case and assess what is needed, questioning training – used when talking with witnesses or people who have seen a lost pet, up to 80% of phone calls are false leads, we know of many cases where an owner has been out all day and night following up leads that were not anything like their lost pet, if they had asked the right questions it could have saved a lot of exhaustion. Must have a love of pets, an understanding of what it means to have a pet and lose them. All of our staff have experienced losing a pet and this is one of the most important things to understand because many of our clients are distraught and feel alone, they need to know that someone understands how important their pet is to them, it is not just a dog or a cat or a bird, it is a family member that is missing.

Can you tell us about some of your more memorable finds?

We are ecstatic with every lost pet that gets home, even the ones that get home without needing our help, but we have some ones that stick in my memory – e.g. the blue tongue lizard we reunited because the owner had put a pink collar on him and a couple of days later we got a call from a person who had found a blue tongue lizard with a pink collar and thought it was unusual. Also a staffy that escaped from Sydney airport was seen running around the train line for a couple of weeks, she ran from everyone who tried to catch her, even her owners. Over this period we established her pattern of movements, established a feeding routine with some of the staff of Qantas and one day after about 4 hours of sitting near the train tracks using calming body language, establishing trust and then a bit of friendship we managed to pick her up and carry her back to the car and drove her down to her family in Wollongong. Also, another story that shocked even us was when we reunited a galah that went missing in Mascot and we found it in Orange about 5 months later.

Are some periods busier than others?

Pet detectives need to be comfident searching any terrain.

Do you have more reports of missing pets in summer or after fireworks? September and October are the busiest 2 months of the year for lost pets – storms, holidays, more people gardening and opening up sheds and garages, more construction work happening, cat & bird breeding season all change behaviour of people and their pets, this is followed by the Easter period and then Christmas, then anytime that has fireworks.

What steps can owners take to prevent a pet from going missing in the first place?

Preparation is the key, many people say “my dog can’t get out as we have high fences” or “my cat is indoors so doesn’t need to wear a collar”, but when the unexpected thing happens e.g. fences blowing down or a break and enter at home, these pets become lost just like any other pet. An estimated 40% of dogs and cats will go missing in their lifetime, and with more and more people adopting pets from rescue groups and pounds, people need to keep in mind that most of these pets have escaped or wandered away from home which is how they ended up in the pound and a pet that has a history of getting lost is more likely to do it again.

Technology allows us to better protect our pets from theft now more than ever and this is our list of things that reduce the chances of a pet going missing or being stolen. Keep in mind most pet theft is an opportunity crime not a planned crime, take away the opportunity and you reduce the risk.

All pets:

• Microchip your pet
• set up cctv cameras around your property with a recording function to identify thieves [Ed: I had a client who did this and watched from work in horror as her beagle puppy ran through her koi pond then dried himself on her bed].
• Ensure your neighbours know you and know your pet so if they see your pet has escaped or is running or flying away they can tell you about it.
• take lots of photos of them regularly. This is one of the most important things to have when a pet goes missing, too many people only have photos of their pet when it was a puppy or kitten, or in the case of some birds people don’t have any pictures of them, so this is a struggle to find these pets as humans are attracted to images and visual posters, without pictures it is an uphill battle to get people to search for a lost pet.
• If your pet is being minded by someone when you are away, have a conversation with them about what to do if your pet goes missing or is sick. We regularly search for pets that go missing from pet sitters, boarding facilities, friends, family and even vets, and these people often don’t have information like a microchip number, whether the pet is desexed and don’t have any photos of the pet, and when we ask them to contact the owner, they are often too afraid to do it, and this leads to delays in getting a lost pet home. Whereas if they had a conversation about it beforehand they would have felt more comfortable with getting in touch with the owner. We hear again and again from owners “I wish they had told me sooner, as I could have helped”. We have had cases where a dog was sitting in the pound for 2 weeks because the minder didn’t want to call the owner while they were away, whereas if the minder had called the owner, they could have given them an email or faxed authority to get the dog out of the pound earlier. I am still surprised how many minders don’t even know who the pet’s regular vet is. 

Specific advice for a few types of pet.

Dogs:

• Have a collar & tag on your pet with a 24 hour contact number (we recommend Boomerang ID)
• Microchip your pet
• Desex your pet
• Chain/padlock all gates
• Check fencing regularly for holes, missing palings
• Leave your dog inside your home when you are not there
• Have a gps tag on your dog which alerts you when your dog leaves your home
• Don’t leave your dog in car or tied up outside shops 
• Tattoo your dog – this is not unusual in the US but in Australia it is few and far between. You can get your dog tattooed in his/her ear, on the inside of their leg or their belly. You can get a phone number or your name or we have had it suggested by a client that you get your tax file number as this should lead directly to you no matter where you are and no matter if you change your phone number or address but make sure you write TFN before the number so people are aware of what it is. 

Cats & ferrets:

• Have a collar & tag on your pet with a 24 hour contact number (we recommend Boomerang ID)
• Microchip your pet
• Desex your pet
• keep your cat indoors and/or with an outdoor enclosure.
• Check fencing regularly for holes in window screens or loose fittings
• Leave your cat or ferret  inside your home when you are not there
• have a locator attached to your cat or ferret (not a gps as these are not suitable for cats at this stage in technology)

Birds:

• padlock your birds cage when you are not there, also if you are cleaning the cage, try to do it in an enclosed room e.g. garage or laundry so if the cage falls and your bird escapes it is still contained.
• Microchip your pet.
• join a bird club and put a club leg ring on your bird – a club ring is listed on the club’s registry and can be checked if a stray bird is found. This is not the case for non-club rings. 
• Check your bird's enclosure regularly for holes or loose fittings
• Have a sign near the doors to your home saying “free flying bird, please keep door closed” 

How can vets help reunite owners and lost pets better?

Report all found pets to PetSearch and ask anyone who has lost a pet to call PetSearch. Understanding the law is also an important part of working with stray animals. We can come to a team meeting or education session to answer any questions on the laws surrounding lost and stolen pets and what needs to happen. In regards to stolen pets, we are advocates of the vets get scanning program to scan all new pets coming into a vet practice for a microchip and confirming ownership, this identifies if the pet is with the rightful owner and also protects the vet from treating an animal without the rightful owners permission.

For more infoformation visit http://www.petsearch.com.au/ 

Three things I learned: staging heart disease in dogs

Cavalier King Charles Spaniels are at higher risk of developing congestive heart failure secondary to mitral valve disease. 

Heart disease and heart failure are common in companion animal practice, particularly in canine patients. So I am always interested to hear someone's take on heart disease. Dr Rebecca Stepien, from the University of Wisconsin, recently gave a webinar on Diagnosis and Staging of Canine Heart Disease: Deciding When and What to Treat, hosted by Boehringer Ingelheim.

She presented a nice review of the epidemiology, namely that chronic valvular heart disease (CVHD) accounts for around 70 per cent of cases, with dilated cardiomyopathy (DCM) accounting for 8-10 per cent. In Dr Stepien’s area, heart worm disease accounts for 13 per cent of canine heart disease. Around 80 per cent of heart disease (ie DCM and CVHD) will cause left sided heart failure. 

Mitral valve disease is more common in small breeds, especially terrriers, cavaliers and miniature poodles, while DCM is more common in Doberman pinschers, boxers, bulldogs, mastiffs, newfoundlands.

According to Dr Stepien, ANY dog (small or large) can have valvuar disease but small dogs are unlikely to have DCM.

She emphasised the distinction between heart disease, that is a physical or functional abnormality of any part of the cardiovascular system, and heart failure, where low cardiac output or sodium/water retention leads to clinical signs.

Heart disease does not typically require treatment but does require monitoring, ie it is pre-clinical (the exception is Doberman pinschers where onset of heart failure (HF) is delayed with administration of pimobendan.

Clinical signs of heart failure include dyspnoea, cough, exercise intolerance, fatigue, collapse/syncope and cold extremities. BUT a cough in an animal with HD may be due to left atrial enlargement. Coughing due to LA compression of the airways is a sign of cardiomegaly, not HF per se.

On physical examination these animals often have a heart murmur (n.b. very young athletic dogs can have a non-pathologic murmur), gallop rhythm pulse abnormalities (e.g. weak pulse), jugular distension and abdominomegaly (due to hepatomegaly and/or ascites).

I liked Dr Stepien's logical approach to thoracic radiographs in dogs with HD and HF. Left atrial enlargement is always present in HF. If heart disease is present you see chamber enlargement without pulmonary infiltrates and no vascular engorgement.

According to Dr Stepien, the radiographic signs of HF, in the order in which they appear, are:

1. LA enlargement (also with HD)
2. infiltrates in the caudo-dorsal lung fields
3. infiltrates in the caudo-ventral lung fields
4. infiltrates in the cranial lung fields 

-     With treatment these resolve in the reverse order, ie from 4-1.

Staging HD is important to determine when intervention is required, and because it is a progressive disease. She talked about staging heart disease.

Stage	Underlying disease	Clinical signs
A	High risk but no known injury (eg breed predisposition)	No clinical signs
B1	Minimal remodelling	No clinical signs
B2	Significant remodelling	No clinical signs
C	Structural injury	Current or past clinical signs
D	Structural injury	Refractory signs

According to Dr Stepien, once dogs are diagnosed as in heart failure and treated accordingly, they typically stay out of failure for 6-9 months before they have a problem and may live out two years with aggressive monitoring and treatment. (In my experience it varies significantly between dogs).

She also talked about treatment according to stage which I found useful.

Staged treatment

Stage	Treatment
A	Client education/screening programs
B1	No therapy
B2	Controversial whether to treat or not. Definitely treat Doberman DCM with pimobendan.
C	Triple therapy: diuretic + pimobendan + ace inhibitor, +/- spironolactone, anti-arrhythmics – digoxin? Beta blocker?
D	ACEI +spironolactone+pimobendan+digoxin ?beta blocker? Arterial vasodilator? Rescue nitroprusside/dobutamine

Give someone you love germs & vaccination of zoo animals

The GIANTmicrobes family.

This is a non-sponsored post and I take no responsibility for anyone who goes on an online spree afterwards. This week I was working on a group presentation on dermatophytosis (aka ringworm) when one of my colleagues suggested that we might need a plush model of said organism to illustrate a point.That lead to a visit to the GIANTmicrobes website (here) which lead to the purchasing of Trichophyton mentagrophytes (for the dermatology nerds out there, no, they didn't have M. gypseum or M.canis)...but before I could make it to the checkout I had to look at the Christmas tree decoration microbes...then I remembered a friend who had gastro and added some E.Coli to my trolley...

The E.Coli GIANTmicrobe. "Everyone is welcome at a BBQ...or are they...?"

This isn't my first encounter with this microbe family. A few years ago I gave a microbiologist friend herpes for Christmas. (Oliver originally saw a market for doctors, teachers and students, but the plush germs have been embraced by nerds everywhere. They're even something of a romantic prop - you can buy a heart shaped box containing herpes, pox, papilloma virus, chlamydia and pencillin. You'd really want to make sure your intended recipient is the kind of science geek who would be enamoured with this selection of STIs rather than the kind who might take it literally).

The GIANTmicrobes company is about 12 years old and started by an entrepreneurial bloke called Drew Oliver. The idea came to him when his daughter was sick. A lawyer by trade, but always interested in science, Oliver wondered why no one had come up with a friendly and fun way to explain germs to kids. So he made her the common cold and boom - GIANTmicrobes was born. 

Toxoplasmosis (I love the distinctly feline eyes). Note the striking resemblence to the magnified image of the microorganism.

The zombie-like crazed eyes on the rabies microbes are a nice touch.

There are now more than 100 microbes available, many of veterinary interest (rabies, botulism, mad cow, fleas, heartworm, mange, salmonella etc.)

Heartworm. The real thing is a bit thinner but the heart gives him away.

I'm also rather partial to this sensational neuron (spruced up for graduation).

A brain cell for the graduand in your life?

Speaking of infectious diseases, the University of Edinburgh has paired up with MSD Animal Health to put together a Zoo Mammal Vaccination Database. Given that most vaccines in zoo mammals are off-label its really important to pool the available data. Vets can register and search the database but also contribute information. To register, browse the data base or submit a report visit www.zoovax.com 

Compassion fatigue: interview with Rebekah Scotney

Rebekah Scotney with a canine companion.

Phd candidate Rebekah Scotney has a long history in the animal industry and has worn many hats. I learned about Rebekah's work through the Getting2Zero Summit and wanted to ask her more about compassion fatigue.

Hi Rebekah. Tell us a bit about yourself?

I graduated from the University of Queensland in 1993, taking my first position within the School of Veterinary Science shortly thereafter. I am an Associate Lecturer, an experienced Veterinary Technical Officer, qualified Veterinary Nurse and Workplace Trainer and Assessor.  I am passionate about teaching and life-long learning, lecturing extensively in all areas of companion animal welfare, husbandry and behaviour.

I have a strong background in animal welfare, behaviour and ethics, having been a member of one of UQ’s Animal Ethics Committee’s since 1997. With more than 15 years’ experience in animal facility management, I am the Director of the Clinical Studies Centre (CSC) within the School of Veterinary Science, a $16m purpose built, companion animal facility for which I was pivotal in the design and consultation phase. The CSC is the only one of its kind in the southern hemisphere and boasts the highest standards of animal housing, care and welfare.

I have a keen interest and also lecture widely in the areas of compassion fatigue, stress and emotional intelligence in the animal industry and am currently completing my PhD in this field.

What is compassion fatigue and what are the signs?

It is hard to describe in only a few lines what compassion fatigue (CF) is. However, in simple terms it has been described as the ‘negative’ aspects of working as a care-giver or the ‘cost of caring’. It is described in people who are exposed to the trauma and suffering of others or, of those in their care. 

Many people are familiar with the terms Post Traumatic Stress Disorder (PTSD) or Secondary Traumatic Stress (STS). Both of these are or can be components of the ‘negative effects’ of caring and can be a major contributing factor in the development of CF. Another term that is so often used interchangeably with CF is ‘Burnout’. It is important to understand that CF and Burnout, whilst they might ‘feel’ the same and the symptoms or signs are very similar, are NOT the same thing. 

Burnout results from the stresses that arise from our interactions with the workplace (environment, policies, procedures, workload etc.) whereas CF evolves specifically from the work that we do, the relationship between ourselves and the patient (or client). We can often change our work environment or the policies or we can change jobs and that will alleviate the burnout. However, if we are suffering from CF, we can change jobs but the CF will follow…

When discussing the signs of CF it is important to remember that there can be both emotional effects and physical effects. Not everyone will react or be effected in the same way.

Some of the emotional effects can include:

-          Stress

-          Grief

-          Anxiety

-          Anger

-          Frustration

-          Betrayal/Guilt

-          Self-doubt

-          Detachment

-          Emotional dysfunction

Some of the physical side effects can include:

-          Exhaustion

-          Broken sleep

-          Nightmares

-          Weight loss/weight gain

-          High BP

-          Nausea

-          Lethargy

Generally CF and Burnout come as a couple – they are often present in sufferers at the same time. It is important to be aware that both types of stress are cumulative and if not addressed, will lead to extreme cases of physical and emotional exhaustion.

How did you come to be interested in compassion fatigue?

I first became aware of CF many years ago, in what I consider my former life (pre-CF awareness). There was a period of a number of years where I was tasked with euthanasing companion animals that were considered a surplus to society. I would dutifully carry out this task, twice a week, every week, to the utmost of my ability; professionally, competently and most definitely compassionately. 

In hindsight, I look back and remember how distressing this was from day one but it would be many years before I realised the actual toll it was taking on me emotionally and physically. The penny finally dropped that something was terribly wrong when one morning I broke down in the middle of my kitchen because I couldn’t decide what I wanted for breakfast! The simplest of decisions and I couldn’t see my way to making it! The sheer panic I felt inside was so debilitating. Wow, that was a powerful message!! 

I went to see the health nurse and then was sent to see the doctor who diagnosed depression and put me on some pills. These worked well enough to even out the moods but they certainly weren’t addressing the problem. I believed for a long time that it was the euthanasia that was causing my ‘depression’ and so I began to research to see if there was any evidence of others being effected in the same way. There was not a lot in the way of literature out there and it took about 6 months of research trying to gather as much info as I could to get me back on track.

This is when I decided to make it my mission to get more awareness out into the industry. What I have learnt over the years is that the act of euthanasia is only a portion of what contributes to CF, there are many internal and external factors that can also contribute. These include attributes such as a person’s own personality type, sensitivity to suffering, level of connection/attachment and their personal support system. The emotional climate of a person’s work setting, the level of exposure to death and grief, time constraints, red tape, limited finances and resources and so forth. Some of these we can have control over and others we do not. It is how we deal with the factors, and our response to any given traumatic situation that can help us combat CF. Combating CF is about taking mental and emotional self-care seriously and, being proactive in our own self-care programs.

Do you know how common compassion fatigue is in the veterinary/animal industries?

In Australia, there is much anecdotal evidence of CF in the animal industry but there have been no empirical studies that actually define the extent to which CF is present. The animal industry is extensive in itself, for my mind, it includes; veterinary, animal management, rescue and rehoming and, the fields of biomedical science and research. Everyone that works in these areas does so because they love animals, they are compassionate and caring in nature – a common attribute of all CF sufferer’s. Charles Figley (2006) stated, ‘only compassionate, empathic, loving and caring people suffer from compassion fatigue – the very people who are so vital to the animal – care field’.

Can compassion fatigue be treated? If so how?

CF can be treated but better yet, it can be prevented!

Treatment is multifaceted and what works for one person may not work for the next. However, the most beneficial step every person working within the animal industry can take is recognising that CF does exist and ensuring that they have an awareness of the signs and symptoms. Not only for oneself but also for ones colleagues. It is about acknowledging your own internal and external contributing factors as well as recognising the triggers that may set off a painful emotional response in us. 

Triggers can be anything from a smell, a noise or even a time of year. Being aware of our triggers gives us the opportunity to be as prepared as possible for when they occur. There is no quick fix or wonder drug that can treat CF, the only way through CF and to heal from painful and traumatic loss or experiences is to recognise, honour and express our pain while remaining proactive in our self-care.

Combating CF, I believe, consists of 3 parts:

• Coping – the quick fix
• Healing – a process of self-reflection with long term benefits
• Prevention – long term strategies and self-care plans

Ten points to focus on:

1. Learn about grief and mourning
2. Focus on your successes (big and small, what made/makes you feel good on any given day/week – COMPASSION SATISFACTION!!)
3. Have a positive attitude and be involved (you can and do make a difference)
4. Ensure you have good work/life balance
5. Be able to say ‘NO’ (which will help with point 4!)
6. Be realistic (know your limits, can’t solve all the problems – do your best: it IS good enough)
7. Initiate workplace communications (formal and informal debriefing)
8. Get help when you need it (medical, emotional, spiritual)
9. Take a break!! (few minutes, LUNCH, few days & holidays!)
10. Work together as a team (debrief, decompress, support each other, focus on goals – makes for a strong defence against CF)

Its a tough subject. How do you recharge or wind down when you've been working in this area?

It’s all about having that self-care plan. Things that relax and unwind you; painting, running, listening to music, spending time with your own animals, your family, your friends. Whatever HEALTHY activity that you derive pleasure from, do it, make the time. Be open and honest with yourself and keep stock of your mental wellbeing whether that be through written reflection and the use of a journal or through other means.

Do you have any tips for veterinarians or veterinary students on dealing with compassion fatigue, or inoculating themselves against it?

Awareness is the key and having a good support network.

What would getting to zero (euthanasias of "surplus" animals) mean to you?

Getting to Zero for me would mean that our mechanisms for educating the public and industry are working. That all of us, as a pool of national rescue and rehoming resources, are finally working together. Pulling in the one direction, focusing on the same goal – zero euthanasia of healthy, adoptable animals.

If you want to read more about the Getting2Zero Summit, check out our interview with Dr Lila Miller on shelter medicine here, our interview with Diane Chua on the extent of the "surplus" pet population in Australia here, and interview with animal trainer Dr Cecile Ashen Young here.