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Giving medication to pets: a necessary but challenging task

Giving medication to pets is not easy. In a typical case of a dog with a skin condition, I may send the owner home with three types of tablets to be given twice daily for ten days. As I write up the final details of the patient’s file, I sometimes reflect that I have sent the owner away with a challenging task to complete.

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A Christmas story from a vet on call & a reminder that if you do have a pet crisis over the holiday, a vet is always there to help

It was Christmas morning. The phone rang at 6.30am. It was the Barrs of Lauder Hill. ' Sorry about this, but we've a heifer stuck calving'. I was in my car within 10 minutes, and carrying out the Caesarian operation to remove the calf within half an hour. The Barrs welcomed me into their farmhouse afterwards for a Christmas breakfast. The calf had been a strong, healthy bull calf, and the farmers were delighted with their Christmas present. We were settling down to enjoy the full glory of a Scottish farmhouse breakfast when my bleeper sounded. It was only 8.30 a.m. and already another emergency had to be dealt with - a calf with bloat 15 miles away, at the Buchanans in Melrose. By lunchtime I had seen a horse with colic, six calves with acute pneumonia, a dairy cow with severe mastitis and a dog with a sudden onset choking cough. The afternoon was just as busy, and I was finally able to sit down with the family at seven in the evening. Two hours later there was another call to another difficult calving. Veterinary surgeons have an obligation to provide a full time emergency service for animals in need of their care, all year round, 24 hours a day. If an animal is in distress, then help is needed - illnesses and accidents do not know that it is Christmas Day. The mixed veterinary practice where I worked in the Scottish Borders was busy - there were six vets. We worked an 'on-duty' roster, with duties shared equally between all of the vets, so at least a hectic Christmas day was only experienced once in six years. And the Christmas Day service was certainly not taken for granted by anybody - everybody who telephoned spent as long apologising for disturbing the vet as they did explaining the problem with their animal. Small animal veterinary practice is less frantic out-of-hours compared to large animal. People tend to stay at home on Christmas Day, so pets are generally safely indoors, curled up by the fireside. There are still unpredictable emergencies - from bitches whelping to dogs having epileptic fits to cats collapsing from kidney failure. In the past decade, many small animal vets have referred their emergency work to dedicated Emergency Clinics, where vets and nurses are employed specially to work all the time during after-hours periods: their “working day” means night time and bank holidays. If you phone your local vet, you will be given clear advice on the arrangements for emergency service. Most vet clinics are closed for routine service on Christmas Day and Boxing Day. This year, the fact that Boxing Day is a Saturday means that the bank holiday is taking place on Monday 28th December, so many vets do not start back with routine clinics until Tuesday 29th December. If you aren't sure whether or not your vet is open, visit their website or Facebook page, or phone the normal clinic number. If you are not transferred directly to the vet on call, there will be an answer machine message giving you details of opening hours. The first day back after Christmas tends to be a busy time, with a build up of cases that have accumulated over the holiday break. There are some typical seasonal cases that we expect to see at this time of year. First, there is the 'turkey tummy syndrome'. People do not like to feel that they are leaving their pets out of the Christmas celebrations. Dogs and cats enjoy eating turkey, and many people make up a Christmas Dinner for their pets, using leftovers from the family celebration. Animals' stomachs are not well adapted to dealing with a sudden flood of an entirely new foodstuff, and the consequences are often a severe tummy upset soon after Christmas. Second, there is the 'Walking It Off' syndrome. Many people feel an urge to expend some energy after Christmas Day - so what better way to do this than taking the dog for a walk. The result is that hundreds of dogs congregate in popular dog walking areas. Inevitably there are the usual incidents, such as dog fights, dogs lacerated by sharp objects in rivers and animals involved in road accidents. Public holidays can be busy times for vets. The important message to remember is that if you do have an animal in real distress, your vet is never closed. And if the vet has to do a house call on Christmas or Boxing Day morning, a Christmas breakfast will always be appreciated! For peace of mind over the holiday period, if you are not sure whether your pet needs a visit to a vet, the Symptom Checker can also help!
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Is that “veterinary nurse” really a veterinary nurse?

Language and terminology is important. Our society recognises this fact, and in some walks of life, you cannot call yourself by certain terms unless you are appropriately qualified. The medical field is the area where so-called “protected titles” are most prevalent: there's a long list from “music therapist” to “dietician” to “clinical scientist” to “physiotherapist” and “paramedic”. If you read the list, you'll be surprised, and I suspect that you'll be reassured too: it's good to know that when you go to see a “hearing aid dispenser”, under law they must be properly trained and qualified. There are serious penalties for people who try to set themselves up as one of these practitioners when they are not entitled to do so: anyone using one of these titles must be registered with the Health and Care Professions Council, or they may be subject to prosecution and a fine of up to £5,000. Interestingly, not all professional titles are protected. The words “doctor” and “nurse” have been in general use for hundreds of years to describe a variety of people, and so they are not specifically protected. The title “doctor” is used far more broadly than just for medical doctors, with a number of professions (including dentists and now vets) using it as a courtesy title, as well as people who hold academic doctorates, such as PhDs. Similarly, the title “nurse” is not protected: as well as medical nurses, it's used by nursery nurses in nursery schools, and sometimes by veterinary nurses. The fact that the terms “doctor” and “nurse” are not protected can lead to issues where the public can be mislead by individuals who use the terms to their advantage (such as a person who is an academic doctor trying to pass themselves off as a medical doctor). For this reason, the terms “doctor of medicine” and “registered nurse” are protected titles, but for the public, arguably this is not sufficient to avoid confusion. There are some professions that would like to have protected titles, but for various reasons, this is not possible. Anybody can call themselves an “engineer”, a “scientist” or a “surveyor” because these terms are said to be in such widespread use. These professions have had to add prefixes to their titles to try to minimise confusion, such as “incorporated engineers”, “biomedical scientists” or “chartered surveyors”. Only properly qualified and registered vets are allowed to call themselves “veterinary surgeons”, but there is a major anomaly in the veterinary world: anybody, even without training or qualification, is allowed to call themselves “veterinary nurse”. The veterinary nursing profession has so far had to use the protected title “registered veterinary nurse” to be used exclusively by properly trained and qualified nurses, but there's a strong argument that this is not enough. Most readers, I'm sure, would agree that if they were dealing with someone calling themselves a “veterinary nurse”, they would assume that the person was qualified. Unless something changes, it's very likely that unscrupulous individuals will use this confusion to their advantage, misleading people into believing that they are qualified. What has to change? Clearly, the term “veterinary nurse” needs to be made a protected title. The Royal College of Veterinary Surgeons, the British Veterinary Association and the British Veterinary Nursing Association all believe that this is necessary. They are asking Parliament to change the law to protect the title “veterinary nurse”, and they need as much help as possible to achieve this. Please sign the official petition to register your support. The aim is to get 100,000 signatories which will trigger the issue will be considered for a formal parliamentary debate. The petition is currently at 20,594 signatures and the petition closes on 14th February 2016 so time is running out. The engineering profession tried a similar tactic to protect the word “engineer” last year, but the attempt failed after their petition only reached 6176 signatures. It makes clear sense that the term “veterinary nurse” should be trusted as the recognised name for a skilled, trained and qualified profession. If you agree, please sign this petition now, and ask as many as possible of your friends and contacts to do the same. Please follow this link to the petition. The RCVS has also produced a short animation stating the reasons behind the petition:  watch this by clicking here. Animals are the ones who will benefit from "veterinary nurse" being protected: so if you care, take action now.
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Why would an experienced vet go back to college? Here’s why…

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The university course leading to a degree in veterinary medicine and surgery is by necessity a hard-working, information-packed five years. The focus has traditionally been on accumulating facts, with the presumption that other aspects of being a vet can be learned later, when life in practice has commenced. As a result, there has sometimes been a perception (which may or may not be true) that new graduates can be over-academic, with a tendency to be impractical.

An innovative response to this criticism has been established at many vet schools, with a concept known as the “Practitioner-in-Residence” . An experienced veterinary surgeon leaves their own practice for a period of ten weeks, to spend time at the Veterinary College, teaching students about “real life”. A few years ago, I was lucky enough to fill this role at my own local vet college.

My teaching duties had various aspects. Every morning, I consulted as a normal vet, seeing “real life” cases with on-looking students. However the pace was different to my usual busy lifestyle in private practice. Instead of examining fifteen patients in a morning, I might see only one or two, with every aspect of the case scrutinised in fastidious detail. Students were involved as much as possible, asking questions and taking part in discussions.

In the afternoons, I took part in tutorials with small groups of students. We discussed the cases seen each morning, and we debated the pros and cons of various investigations and treatments. A member of the university staff provides the viewpoint of the academic vet, and I was then asked about what I would do in practice. Sometimes there was no difference in approach, but at other times my approach would differ. “Real life” clients do not always want the standard academic route. Some tests may give information that is of interest to the vet, but that may not make a significant difference to the treatment of the animal. Such tests can be expensive, and pet owners often have a limited budget. My input to these tutorials aimed to help students understand more about how they would be expected to treat animals in the world of private veterinary practice when they qualified.

The tutorials also focussed on other aspects of life in veterinary practice. What should students look for in their first job? What sort of facilities and equipment should they expect to find? How do you tell the difference between boss who is a friendly, helpful mentor, and one who might be a hot-tempered intolerant slave driver? What sort of stresses will the young vet be under? How can they minimise them? Vets have one of the highest rates of suicide in modern society, and young vets need to be told about this. It can be difficult to live a balanced life, with focus on both work and leisure, but it’s important.

My life as a “practitioner-in-residence” was very different to my normal routine. I spent lunchtimes in the university library reading the latest veterinary journals. I attended early-morning seminars held by visiting experts. I took part in departmental meetings with the academic team. It was like having a taste of an entirely alternative life, and I thoroughly enjoyed it.

But I did miss aspects of my normal life. I missed the social chat with my clients. I missed those animals that I have learned to know as individual characters over the years and who have become my friends.

If there was one single message that I wanted to give to those students, it was this: “Veterinary practice is an enjoyable, sociable, stimulating, exciting job – get qualified, get out there, and enjoy it!”

 
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Old cat, young cat: a bittersweet episode in the life of a companion animal vet

Mrs Kennedy was an elderly widow, whose only companion was a small seventeen year old cat called Puss. Mrs Kennedy had phoned me because she thought that Puss had broken her leg after chasing another cat.

I wasn’t expecting anything too serious. Cats commonly hurt themselves while fighting with each other. An owner may think that the leg is broken, but in most cases the problem is a simple cat bite abscess, which can be easily treated. However, this time it was different. The owner was right.

Mrs Kennedy explained how a neighbouring cat had sneaked into the kitchen, and Puss had leapt up to chase it away. Immediately afterwards, she’d started limping, and since then she had barely moved from her bed.

When I touched Puss’s shoulder I could feel heat and swelling, and when I gently probed deeper, I could feel the rough ends of broken bone. I asked a few more questions, and it turned out that Puss had been drinking more than normal for a few months, and she had begun to be fussy about her food. She had also started to vomit occasionally. The pieces of the jigsaw began to fit together, and I explained it to Mrs Kennedy.

Puss is very elderly and at this stage in her life, her body is gradually failing her. Her main problem is that her kidneys have stopped working properly, which is why she has developed an increased thirst and a poor appetite. As a result of her kidney failure, her bones have become very fragile. Unfortunately, advanced kidney failure in a seventeen year old cat is not easily treated. And worse again, a broken bone in a cat like Puss cannot be fixed. At this stage, all of her bones will be as weak as egg shells. If she carried on, Puss would continue to suffer from further broken bones during normal activities.”

Mrs Kennedy sadly shook her head. “ So it’s time to say goodbye.” She knelt down beside her cat, and gave her a last, long hug. I gave the painless injection, and Puss quietly passed away, as her owner whispered into her ear.

Mrs Kennedy told me how Puss had originally been a wild stray cat. She had finally been tamed after months of coaxing her into the kitchen with food. She had been Mrs Kennedy’s closest friend, but she would never have another cat. She was elderly and she could not bear to think about what might happen if she died herself. I tried to tell her that somebody would look after her cat, and that this could be arranged in advance, but she just shook her head again. I felt very sad as I left her house.

Two weeks later, I received a call from someone who had a half-tame feral kitten in their garden. They were moving house, and they didn’t know what to do with it. An idea occurred to me. I collected the kitten, and drove on to Mrs Kennedy’s house. When she answered the door, I smiled and I said that I had something that might interest her.

Mrs Kennedy could not take her eyes off the kitten in the basket beside me. “He is just like Puss used to be –the poor frightened creature. Bring him inside”. She went to her kitchen cupboard and took out a tin of cat food. I stood back, as she spooned the food onto a plate, and opened the cat basket. The kitten licked the food hesitantly, and then began to eat heartily. As he ate, Mrs Kennedy chucked his cheek gently. He looked up at her, and to my surprise, he purred. A new friendship had begun.

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