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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….

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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….

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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…

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Vets are now doctors (in a strictly veterinary sense, that is….)

Did you know that your vet is now a doctor? The Royal College of Veterinary Surgeons  has just changed the rules. Vets are not obliged to call themselves “Doctor”, but we now have the option to do so, if we wish.

Traditionally, vets were called “Mr”: the logic was that as “veterinary surgeons”, we fell into the same (slightly superior) category of medical personnel as medical consultant surgeons, who were also “Mr”. Dentists (dental surgeons) were also called “Mr” for the same reason.

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Euthanasia – one vets opinion.

People often tell me that they think putting pets to sleep must be the worst part of my job but in many ways, it is one of the easiest. Yes it is sad, letting a beloved animal go, but in the majority of cases we are doing it for very good reasons; releasing them from a life that has become more about pain and suffering than the joy it should be.

A couple of years ago it was time to put our family labrador to sleep. Molly had reached the grand old age of 14 and had been struggling with arthritis for many years. Although her mind was still willing, her body had let her down and no amount of drugs would help her to be able to walk again.

What was interesting was my mother’s attitude. She is a GP and admitted that in her job death can be seen as a failure, rather than a release. She agreed with my decision but it was a totally different mind set to the one she was used to.

When patients come towards the end of their lives, in many ways the decisions that doctors and vets take are very similar, it is just that vets have an extra option; euthanasia….

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Are vets more interested in the health of their patients or the money in their pockets?

I recently wrote a blog here titled “Debunking myths about “rip off” veterinary fees”, and since then, the subject of money has continued to be one of the banes of my life as a vet in practice.

My aim in life is to do a job that I enjoy, and to be paid a reasonable salary: for most people, that just means that you go to work, do your stuff, and come home at the end of each day. For vets, it’s different: every day, as part of our job, we need to ask people to give us money. Most of us would be delighted if this discomfitting task was taken away from us, but unfortunately, it’s an unavoidable part of our job description.

One recent case provided a good example of the type of daily dilemma that faces vets. An elderly terrier, Sam, had a small benign tumour on his flank. He was fourteen years of age, and his owner had been hoping that we might be able to leave the tumour alone: it’d be better to avoid a general anaesthetic unless it was absolutely necessary. When the tumour began to ooze blood, and Sam began to lick it a lot, we couldn’t leave it any longer so he was booked in for surgery. When booking the operation, I mentioned to his owner that it would be wise to take the opportunity to clean up his teeth, which were caked in tartar. And I gave a detailed estimate of the expected costs.

We took all the usual precautions to ensure Sam’s safety. He had a detailed clinical examination and pre-anaesthetic blood tests to ensure that he had no underlying illnesses that could make an anaesthetic risky. An intravenous line was set up to give him continual fluids during the procedure and to give us instant access to a vein if any emergency treatment became necessary. And a vet nurse was designated to hold his paw and to monitor him for every second of his time under anaesthesia, from induction until he was sitting up at the end.

Everything went well: the tumour shelled out quickly and easily, and a line of sutures closed the wound. I carried out a thorough descale and polish of his teeth, as planned. But it was then that the dilemma arose: beneath the tartar covering his teeth, it turned out that two of his molar teeth had large diseased areas. The gum margins had recessed, exposing large parts of the tooth roots. One of the teeth had serious infection, causing the tooth to be loose: it was easily removed. The other molar tooth was more complicated: one root was seriously diseased, but the other two roots were healthy. The tooth needed to be extracted, but it would be a tedious, time consuming surgical extraction, taking over half an hour, and requiring follow up x-rays to ensure that it had been done properly. This would involve an extra cost to the owner of well over £100. I had already given an estimate, and I didn’t feel that I could go ahead with this without permission.

While Sam was still anaesthetised, I asked a nurse to phone his owner to explain the situation. There was no answer on the home line, and the mobile number wasn’t working. What should I do now?

If I went ahead, I’d be carrying out unauthorised work on someone’s pet. If there were any unexpected complications, the owner could hold me liable. And as for the extra cost? Could the owner justifiably refuse to pay?

The safest legal approach would be to make a note of what needed to be done, and then to inform Sam’s owner that he needed a follow up anaesthetic in a few weeks, during which we’d tackle his dental issues. But I knew that it would be far safer for Sam to have the entire procedure completed during this first anaesthetic, and I knew that his owner would be unlikely to agree to pay for a second anaesthetic on top of this first one. So Sam’s dental issues would probably not be treated, and he would suffer as a consequence.

I made an “on the hoof” decision to go ahead with the dental procedure. It took even longer than I had anticipated, and I had to take a series of x-rays rather than just one. By the end, I was happy that Sam had been given the best treatment, but I was nervous about the owner’s response. Would she think that I had done this just as a way of extracting more money from her? What if she genuinely couldn’t afford more than the estimate that I had given her?

I felt so uncomfortable about the situation that I gave a significant discount on the extra work that I had done. Effectively, I ended up working my lunch hour for nothing because I felt so awkward about it.

But what else could I have done? In the interest of the dog, I could not have left painful, diseased teeth untreated.

What would pet owners feel if the vet presented them with a situation like this? Should you pay the full amount of justifiable extra work if it is unauthorised?  Do you trust your vet? Or do you feel that we are working more for our own interests than for the benefit of your pet?

 …

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Debunking myths about “rip off veterinary fees”

“Rip-off veterinary fees” were the subject of a recent poll on a vets-only website.
In answer to the question “How often does your practice receive complaints about the prices it charges?“, the results were:

  • All the time – 16%
  • Fairly often – 53%
  • Hardly ever – 30%
  • Never – 1%

So around 69% of vet clinics get regular complaints about their fees, and given that many people may feel irritated about fees without vocalising their concern to the vet, the true level of discontent is likely to be even higher. This is clearly an aspect of veterinary care that pet owners feel strongly about.

I always find this a difficult topic to discuss: as a vet, I can’t help feeling defensive, and it’s all too easy to write a self-justifying commentary. Sceptical readers may then brush off any of my explanations: “well, he would say that, wouldn’t he?”….

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A vet visits a Delhi slum: day two – educating young people about animal welfare

After an overnight flight from London, I was delighted to be welcomed to Delhi this morning by a remarkable lady who works on the coal face of the street dogs/rabies issue. Bondana Dutta (or Bondi, as everyone calls her) is the founder of a small but rapidly growing NGO charity called Alliance of Animals and People (AAP).

Bondana resigned as a regional director for CRY ( one of the major Childrens Rights NGO’s) to pursue her work with AAP, and she has brought many skills and strengths to her new role. She believes that the way to improve animal welfare in the slums of Delhi is to start with the children: if she can convince young people of the importance of valuing animals, the rest will follow naturally. The children will pester their parents to do more for animals, and in due course, they will mature into a new generation of adults who are strongly pro-animal.

As an introduction to the educational projects she’s created, I travelled with Bondi to one of her projects, in a slum in South-West Delhi.

The cross-city drive to the slum gave me a taste of the lunacy of Indian traffic: half a dozen lanes of a mad mix of vehicles (from cattle-drawn carts to tuktuks to cars to trucks) barging against each other to get ahead, beeping horns instead of using indicators, yet somehow, all keeping going and reaching their destinations.

We pulled up outside the slum, and walked in through narrow laneways past people sitting outside their homes in small groups. The weather in Delhi at this time of year is pleasant: 20°C with crisp clear sunshine rather than the humid 30°C plus of mid-summer. For people and animals alike, it’s a comfortable climate to be outdoors.

After walking a few hundred yards, we came to a fenced off courtyard in the middle of an open area: around fifty children were waiting for us there. This was Bondi’s community: children aged between five and fifteen who have signed up for regular classes in animal welfare. An AAP worker, a former teacher, was giving a class when we arrived. She acted as an interpreter (the children speak Hindu, with just a smattering of English) to allow me to talk to the children.

I asked a few questions and learned a lot: most of the children cared for street dogs which they view as their “family dogs”. They feed them a mixed diet of scraps, and they make sure that they are vaccinated against rabies and where possible sterilised. I asked about what should be done if a person was bitten by a dog: the children knew all about washing a wound thoroughly then seeking post-exposure rabies vaccination.

I then asked the children if they kept any other animals as pets – cats are popular (but they aren’t as visible as street dogs here), some children kept pet fish, and one girl disappeared for a few minutes, astonishing me when she returned cuddling her pet hamster, Pooni.

I stayed for half an hour talking the the children, and the end, they sang a song to me about the importance of looking after animals well. I came away feeling full of hope and optimism: in the three years that she’s been visiting this slum, Bondi has created a population of young people who care passionately about animals, and in the process, they are taking the necessary steps to ensure that they – and their pets – are protected against rabies.

The AAP model is only being used on a small scale at the moment – Bondi would like to have more full time employees to visit more slums running classes like this, but funds are scarce. Bondi has great vision, and with the right support, her dream of all Indian children being taught about the importance of caring for animals will come true.…

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A vet visits a Delhi slum: day one – an introduction to street dogs and rabies

I’m just a vet in small animal practice in Ireland, but for the next week, I’m going right out of my comfort zone: I am travelling to Delhi, to visit a slum, where I’ll be taking a look at the issue of street dogs and rabies.

Rabies is one of those diseases that just flits across the consciousness of most of us: we know it’s a terrible disease, and we feel blessed that it doesn’t exist in the UK and Ireland, but that’s about as far as it goes. The truth is that for many people and animals, it’s a daily curse.  Minor dog bites are common all over the world, especially in children. Most often minor first aid is all that’s needed: rarely, a visit to the doctor may be called for. Yet in most countries of the world, the threat of rabies in an additional worry.

If a child happens to live in India, that minor dog bite could have had desperately serious consequences. If he was lucky, he might be taken to a doctor to be given post-exposure anti-rabies vaccination. However, it’d be far more likely that this level of medical intervention would be unavailable to him. Nothing would be done other than basic cleaning of the wound. If the dog was carrying rabies, he would be infected, and in the following weeks, he would develop symptoms of rabies. He might have a fever or a headache at first, with an itching sensation at the site of bite. A few days later, he would develop anxiety, confusion and agitation. As the disease progressed, he would develop abnormal behaviour (such as fear of water), hallucinations, and insomnia. He would go on to suffer a terrifying death.

The most shocking aspect of rabies is that it is completely preventable. Vaccination of dogs in bulk programmes is inexpensive and highly effective: it can cost as little as 50c per dog. In comparison,the cost of a human being treated for rabies after a dog bite is around €40, which is over a month’s salary in the regions where rabies is common.

The World Health Organisation believes that mass canine vaccination programmes are the most effective measure for controlling rabies, and that vaccinating 70% of the dogs in an area where rabies is prevalent is necessary to control the disease in both humans and dogs. Targets are in place to have rabies eliminated from the planet by 2030 but this won’t happen unless we all start paying more attention to achieving this goal

In the recent past, mass dog vaccination programmes have allowed some countries to become rabies-free: there are many examples in South America. In Sri Lanka, this type of programme has reduced rabies deaths from more than 350 in 1973 to just 50 in 2010. Yet in over 150 countries around the world, death by rabies continues to be a threat to humans and dogs. Over 60 000 people die of rabies every year, with over 95% of them in Asia and Africa.

India is the country with the biggest rabies problem, with over 20000 people dying every year. So-called “street dogs” are part of the urban culture. They play an important role in the ecosystem by helping to deal with garbage: in areas where dogs have been forcibly removed, the local rat population has boomed, with bubonic plague then becoming a major public health problem. But street dogs also carry rabies.

The size and scale of India makes this problem seem impossible to solve: it’s the second most populous country in the world, with over 1.2 billion people (nearly 300 times the population of Ireland, or 20 times the UK). Despite the magnitude of the challenge, the answer is still simple: vaccination of 70% of street dogs against rabies, combined where possible, with sterilisation of dogs to prevent breeding. If you think of another comparison: 20000 people dying of rabies every year is the equivalent of  67 people dying in Ireland, or 1000 people dying in the UK. Can you imagine the public outcry if that was to happen? Why should we be any less outraged because the people dying happen to live in India?

I’m being hosted in Delhi by a charity called ASHA, which is primarily focussed on human health and education in the slums.  I have persuaded them to help me to investigate the severity of the rabies and street dog issue in one of their slums, and they are providing me with an interpreter to carry out a questionnaire. And the kind and passionate people at Mission Rabies have drafted a questionnaire for me to use.  In the space of ten days, I am not going to make much of a difference to anything, except perhaps to my own understanding of the issue, and my own desire to do something about it. If you read this blog for the next while, perhaps you’ll learn a bit too.

Rabies isn’t going to go away by itself: it will take the joint effort of many people with a wide range of skills from a variety of backgrounds. Could you be one of them?

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