Since it aired on Tuesday evening, almost every client to come into my consulting room has been asking me what I thought of BBC1's 'Pedigree Dogs Exposed' (BBC press release, BBC iPlayer video of episode - only valid for 7 days from initial broadcast). It was a very well put together exposé of the darker side of dog breeding, dog showing, and the health down-side that can occur when dogs are bred thoughtlessly, callously, and with their health and well-being somewhere down the priorities list after the breeder's showing success and financial considerations. It's fair to say that there was shouting at the telly going on in my living room on Tuesday evening. It was a good piece of investigative, issue-driven, campaigning broadcasting - I'm sure the breeders and the Kennel Club won't think it even-handed, but the science and reporting was on the whole sound, and well understood and explained. And the things it covered were not much of a surprise if you're in the veterinary world.
- Extreme breed characteristics which compromise the health and welfare of 'healthy', 'normal' animals of a given breed. Things like the extremely flattened noses of the so called 'brachycephalic' breeds - bulldogs, mastiffs, pekinese, pugs, and the like, who commonly have difficulty breathing and staying cool. The short legs of dachshunds and basset hounds, which due to their abnormal anatomy predispose them to orthopaedic disease and crippling arthritis in old age. The desirable 'diamond eyes' of bassets, St Bernards, and certain other giant breeds, which cause the eyelids to fold out or in rubbing the eyelashes against the surface of the eye causing pain and predisposing to infection. Excess of skin and abnormal skin folds on the bodies, legs, and heads of shar-pei, bassets, bulldogs, mastiffs, etc, which predispose these dogs to painful skin infections where the skin is folded back on itself forming pockets. The malformed spines of pugs and other 'screw-tailed' breeds which can cause extreme pain and paralysis. I see one or more of these conditions in my consulting room every day. Sadly this list is a very very short sample of the breeds with health issues of this kind. Even more distressingly, all of these characteristics will perversely gain rather than lose these dogs marks in the show ring.
- Genetic diseases in certain breeds. These are distinct from those above in not being desirable characteristics as such, rather illnesses and conditions which have hitched a lift in the breed's genetics. Examples include syringomyelia (a painful neurological condition) and endocardiosis (a debilitating degenerative heart abnormality) in cavalier king charles spaniels, hip and elbow dysplasia in labrador retrievers which cause lameness and arthritis at a young age, progressive retinal atrophy (a genetic form of blindness) in setters, allergic diseases in west highland white terriers. Again, the full list is much much longer than this.
- Finally, line breeding. This is the frankly distasteful habit among some pedigree dog breeders of breeding close relatives back to one another to keep the line 'clean' and preserve and enhance 'desirable' characteristics. Breeding litter-siblings to one another, or mothers to sons, half-siblings to one another, grandfather-to-granddaughter, are all regarded as acceptable and even desirable by a minority of pedigree dog breeders. The consequence of this is a greatly enhanced risk of seeing (particularly autosomal recessive) genetic disorders in the offspring, compromised immunity, and a great reduction in the genetic diversity of the breed.
Quick facts:
- Poison(s): ethanol (drinking alcohol), isopropyl alcohol (rubbing alcohol), methanol (methylated spirits)
- Species affected: Dogs and cats, more common in dogs.
- Toxic dose: Varies depending on substance ingested and strength of the preparation. Published LD50 (mean lethal dose, usually derived from studies in rodents) for ethanol is ~10g per kilo of body weight. Serious toxic effects can be expected well below this dose. Doses above half a standard unit (or 4g) per kilo of body weight of ethanol are very likely to have severe or even life threatening consequences. LD50 of methanol and isopropyl alcohol are around half that of ethanol. Lower doses (particularly of isopropyl alcohol and methanol) are also likely to cause serious problems
- Symptoms: Initially coordination problems, excitement progressing to depression, loss of consciousness, progressing to cardiac and / or respiratory arrest potentially resulting in death. If inhaled, can cause severe breathing difficulties. Where skin contact occurs, irritation is possible. Serious damage to the eyes can occur from splashes of concentrated alcohols. Methanol also causes liver damage and blindness.
- Action: Seek veterinary advice as soon as possible if your pet is showing any signs of alcohol poisoning or if you believe they may have ingested or come into contact with any noxious substance. Small amounts of weak drinking alcohol (eg the dregs in a beer can, or a small amount of spilled wine) are unlikely to cause a problem and emergency treatment is probably unnecessary, though you should monitor your pet closely for any symptoms and seek advice and treatment if appropriate.
- Treatment: Will depend on the substance swallowed / inhaled, dose, and severity of symptoms, but may include gastric lavage (stomach pumping), intubation to protect your pet's airway, and drug treatment to control symptoms.
Alcohol poisoning is commonly the effect of accidental ingestion of alcoholic drinks by pets. Dogs are generally more prone to eating and drinking things they shouldn't than cats are. Sadly, we also see cases of people intentionally feeding animals alcoholic beverages. While small amounts of alcohol are unlikely to be dangerous, please never give dogs or cats even small amounts of alcohol. No, Auntie Mabel's Chihuahua does *not* want or need a tot of brandy at Christmas! And despite the fact a lot of dogs seem to like the taste of beer, please don't buy them a pint when you get your round in at the pub!
The relative difference in body weight between pets and humans, and differences in metabolism of alcohol, can make even small doses potentially hazardous. Also consider that the experience of being 'drunk', though some humans might find it pleasant and it may be entertaining to watch, must be very frightening for a pet who doesn't know what is going on!
Don't forget the risks of dogs or cats ingesting significant quantities of alcohol in liqueur chocolates (we'll get on to the hazards of chocolate - and theobromine, which it contains - further down the alphabet), booze-soaked Christmas cake or Christmas pudding (which also contain raisins and currants which are toxic in their own right) or 'cleaning up' human vomit at boozy teenagers' parties!
Next time - B is for Barbiturates.
Those of you in the UK can't have failed to notice that we've had Foot and Mouth Disease back in the last month. I was alerted to this fact while trying to enjoy a BBQ at a friend's on a Friday evening on call by the arrival of a text message from a colleague. It's one of those bits of news you just don't want to hear, even now that I'm not a mixed practice vet any more.
Anyway, it's a testament to the speed and thoroughness of the response, this time, that things seem to be under control, and we got (yet another, very keen they've been) fax today from Animal Health letting us know that movement restrictions are now being essentially removed and that we can soon export meat to the EU again. So, good work all around.
The outbreak seems to have been halted with only two premises finally confirmed infected with FMDV strain 01/BFS67, a strain of foot and mouth disease which was responsible for the 1967 UK outbreak but which has not been seen circulating in livestock or wildlife anywhere in the world for several years, living out a peaceful retirement as a reference strain in bottles in a number of research laboratories, and with a sideline in vaccine production.
Except.
[And the rest of this piece is pure speculation, and comes with a *humungous* caveat, which is that I have no real idea what the procedure for confirming FMDV is, other than that samples are taken on suspicion and a day or two later a press release comes out from DEFRA saying 'confirmed' or not. The difficulty with FMDV is that several other disease of cattle, sheep and pigs, such as Mucosal Disease, and Vesicular Stomatitis, mimic the clinical signs of FMDV very closely, so that suspect cases actually come up more often than people would expect. If the procedure is a good robust one with multiple samples sent to multiple labs for cross-checking, then the following isn't really at all likely. But I just have a slight worry that what happens is that the samples taken are sent off to one VI (veterinary investigation) lab somewhere, possibly even Pirbright, where one technician or scientist, or small group of technicians, whose job it is to process suspect FMDV samples, get on and do their jobs. In which case...]
There are two possibilities here, and I think the second deserves at least a passing glance. The first and apparently accepted story is that, somehow, despite the biosecurity precautions at the Pirbright Institute for Animal Health, and at the vaccine plant operated by Merial on the same premises, some of virus strain 01/BFS67 was allowed to escape, and somehow came into contact with cattle and caused the outbreak.
But isn't it just possible that, if suspect samples are tested in one place, by one group, perhaps even with the same batches of reagents, that the two 'confirmed' results are in fact the result of contamination of the samples with a reference strain inside the laboratory? Just a *little* possible? After all, modern analytic processes like PCR can be exquisitely, painfully sensitive. And contamination in labs with reference material has certainly been known to produce false positives in the past.
Anyway, I'm sure the clever people who are paid to think about these things have considered this, and ruled it out. But it occurred to me in an idle moment and brought me up short, so I thought I'd share it with you all. Not so much a conspiracy theory as an incompetence theory, I suppose. And as my Gran would have reminded me, you should never attribute to malice what can be adequately explained by carelessness or stupidity.
The 'Veterinary Times' is not one of the august journals of our profession. It's the veterinary rag, really. Advertisement-funded and full of articles of dubious merit, and rants one one subject or another. Still, I read it, because it lands on my desk once a week and it's something to do to pass the time while drinking a mug of coffee and waiting for afternoon surgery to start.
I thought I'd share with you a glorious typo in last week's VT. Apparently an organisation called 'Worldwide Experience' is organising the 'Vets Go Wild' project, an opportunity for those final year veterinary students who can afford it, essentially, to go on a 16 day Safari in South Africa and call it EMS (Extra Mural Study). According to the article:
"Veterinary experts will provide students with a mix of practical and theological learning in conservation-based veterinary medicine." [emphasis mine]
Made my day, that.
Last week, this blog was paid a visit by the erstwhile Josh himself (well, this is the Internet, so you can never be sure, but it seems plausible) thanking me for mentioning his book, and inviting me to read what other vets have had to say about it. He has so far failed to take me up on my offer to read his book if he sends me a review copy, which is sad. But not wanting to be unfair on him or his literary endeavours, I went off and read his reviews. Very depressing reading they make, too.
I'm not going to argue against the assertion that many people in this job are somewhere on the spectrum from unhappy to frankly suicidal, that as a profession we suffer from higher than average rates of alcohol and other substance abuse, and that many vets frankly feel that they were sold a lie, that their work is simply not as satisfying as they were promised when they chose it, that their customers are often ungrateful for their work and resentful of their bills, their patients mostly want to bite or claw them, they spend a lot of their time dealing with pus and blood and shit, and that having got this far, they feel unable to back out, admit that it's not for them, and find something else to do with their lives. Hell, I've had times like that.
The issue of depression and suicide in the profession is one that has been gone over many times by many different people. It seems to me, thinking back over the people who were with me in my years at vet school, that we probably chose people for veterinary training who may not be that suited to the reality of the job after graduation. In the UK, at least, selection for extremely tightly contested places is essentially on academic attainment, plus an interview in many but not all cases. My classmates were, for the main part, very hard-working, driven, obsessive / perfectionist / idealist personalities, with a smattering here and there of brilliant types who appeared never to have to do any work (though, like many things, I suspect this appearance was often deceptive). There really isn't any scope in the selection mechanism to select for people who cope, make do, are practical and enjoy solving gnarly problems without an ideal solution.
Because it doesn't take long to realise that the job isn't about finding 'the answer' or 'the right solution' or deploying 'the gold standard treatment' most of the time. The way I see things, it's about trying to tread the difficult line between the animal's best interests, the owner's desires (reasonable or otherwise), the financial constraints, and your professional responsibilities, while trying to avoid stepping too many of the generously scattered ethical and legal landmines. And as for the actual bread and butter of the job - it's not intellectual, it's practical and it's about interpersonal skills. It's about coming up with an often alarmingly Heath Robinson Plan B when the Plan A you were taught at vet school fails in some exciting way. It's about sensing and responding to owners unspoken, and often unconscious agendas, issues and twitches and somehow producing the best result you can under the circumstances, one that the owner is comfortable with, one that minimally compromises the animal (because, yes, that's often what you're left aiming for), and which meanwhile produces an income for the practice sufficient to keep your boss of your back. And I love it, for all of that. That's the challenge. And I can see why a perfectionist, obsessive, idealistic type would find it completely impossible.
Against a background of all of that, we need to add in the fact that recent graduates are now carrying a mountain of student debt, one which will only get bigger as the 'top-up fees' university generation graduates, and which recent graduate salaries are simply not sufficient to service while providing a reasonable quality of life, not an unreasonable expectation after five or sometimes more years studying on a student income, and galling when you glance sideways and see newly graduated doctors earning upwards of 35k.
As an aside, I'd love to know how the *attempted* suicide statistics for our profession stack up with other occupations. I rather suspect that the ratio of successful to attempted suicides is rather higher for us than for accountants, say. After all, I have the all the necessary means to a relatively painless and pretty much guaranteed-effective death in the boot of my car right now, if I wanted it. I know of vets who have used it.
Are things similar in the US and other places? I would love to know my readers' thoughts. And Josh, I'd love it if you'd send me that review copy...
Some of you will have recognised this blog's namesake as one of the lesser-known James Herriot novels. I think in common with many of my collegues, the Herriot books were a formative influence - though of course they tell you on no account to mention this on your UCAS form! Doing a spot of Wikipdeia browsing this afternoon, I found a quote by Alf White (the man behind the Herriot nom de plume) which fairly sums up the way the industry has changed in the last 50 or so years since the Herriot books were based.
"Years ago, farmers were uneducated and eccentric and said funny things, and we ourselves were comparatively uneducated. We had no antibiotics, few drugs. A lot of time was spent pouring things down cows' throats. The whole thing added up to a lot of laughs. There's more science now, but not so many laughs."
The quote is attributed to a piece in Time Magazine in 1992 by Jonathan Margolis titled "But It Did Happen to a Vet", a horrible title at the best of times and I haven't followed up the attribution so this being Wikipedia I can't vouch for it (a whole other argument, mind, I think Wikipedia is *wonderful*). Rings true, though.
An aside - the Wikipedia piece on Herriot reminds me that there's a new book out which is causing some annoyance in the veterinary press, mostly from people who (like me) haven't bothered to read it. Well, it seems likely to be a pile of dross, and we're busy people. I certainly don't recommend you buy it, though I'm in no position to comment in detail. It's called "Pet Hates: The Shocking Truth about Pets and Vets" by someone calling themselves 'Josh Artmeier'. Nice anagram to hide behind, 'Josh'. Mind you, I'm one to talk...
I doubt anyone will really have noticed, but it's been a month and a half since I had anything to say for myself here. On the off-chance that anyone reading here cares what I've been up to (or, indeed, that anyone is reading here at all!) it's all change in Beth's world. Very shortly I will be starting a new job, and moving away from mixed practice into small animal work. Mainly dogs, cats, and rabbits, in other words, plus a few other pet-type-things, exotic animals and so on. If it seems strange that I may be closing the door on over half my training this early in my career, my reasons are quite straightforward really.
The mixed practice work I have been doing until now has been heavily small-animal biased, mostly as a consequence of being the most junior person in the practice and getting last-pick of the work. The up-shot of this is more or less that despite doing mostly dog and cat work during the day, I still found myself on call being sent to colics, and dealing with lambings and so forth out of hours. This really isn't a very good way to go about things, though a successful lambing is one of the great joys of veterinary work, and something I think I'll probably miss.
The other aspect of wanting to make the move into small animal work is the question of the sheer volume of knowledge, not just that we have to have to graduate, but of constantly shifting new information, new techniques and new drugs with which we have to be familiar. Mixed practice veterinary work is always going to be a compromise between depth and bredth of knowledge and competence. For my own peace of mind I prefer to strive to be the best possible small animal veterinary surgeon I can be, rather than struggle to stay afloat spreading what meagre professional development time I have across every possible veterinary species.
Finally, a thought about mixed practice itself. I suspect that in most parts of the UK mixed practice is not the future of the veterinary profession. Already a great many mixed practices are either scaling down or giving their farm work up altogether. The economics of farming in this country, and by extension of farm animal veterinary work, are not what you'd call favourable and in many cases, particularly where you have a reasonable density of livestock farms in the area, the most effective solution is specialist farm-animal only veterinary practices focusing heavily on health planning and preventative health care, significantly a consultancy role, and driving large distances to their clients rather than locally-based mixed practices providing essentially a fire-fighting service. Meanwhile, the pressures of being a mixed practice in terms of staffing and the necessity of providing veterinary call-outs to farms at short notice throughout the working day (and night!) can detract from providing the best possible small animal provision, not to mention that in many cases the small animal work is expected to cross-subsidise frequently loss-making farm work.
Anyway, enough of all that. If you've read this far I'd like to reward you with a picture of some new-born kittens we delivered recently by caesarian section. Very cute they were, too, and at suture removal mother and all three kittens were doing well.
The contents of my handbag (well, shoulderbag-thingy) as unloaded this evening:
One copy of the Veterinary Record, thumbed, dated February 24, 2007.
One box of Mr Kipling Lemon Slices (Twin packed for lunchboxes!) 2 for £2.
One paperback novel, Jasper Fforde 'The Well of Lost Plots' (v good, incidentally).
One pharmacy bag containing miscellaneous cold-management chemicals (Paracetamol, generic, 500mg x16, 'Non drowsy Sudafed decongestant tablets' (pseudoephedrine hydrochloride) 60mg x12, Ibuprofen, generic, 200mg x12. All dog-eared with tablets missing).
One folding umbrella, black.
One Cadbury's Cream Egg.
One till receipt from the Co-op.
One piece of torn A4 paper with a client's address scribbled on it.
My mobile phone charger.
One jar of Carte Noire instant coffee, opened.
My life is so glamorous and exciting.
Client: "Yes, it's about my dog, he's got chronic diarrhoea."
Me: "Oh, right. How long has this been going on for?"
Client: "Well, he was fine this morning."
Me: *scratches head*
So, today, let's talk about words, and what they mean. Because words mean different things to different people. In my time at vet school, I learnt lots of new words. Long words like 'erythematous' which I'd only ever use talking to another vet (it means 'abnormal redness of the skin' incidentally). I also learnt that words we all use in day to day life have specific meanings in a medical context. These meanings can be a narrowed-down form of what they're used to mean in day to day life. But sometimes the standard usage has morphed to mean something almost opposite to the technical use.
'Chronic' then. To my client, it means 'bad'. To me, it means 'of long duration'.
'Acute' probably also means 'bad' to my client. To me, it means 'of sudden (and probably recent) onset'.
So, in techincal use, chronic and acute are more or less opposites of each other. And my client's dog, in fact, has acute diarrhoea.
'Acute' is not the same as 'severe'. 'Severe' *does* mean 'bad'. The opposite of 'severe' is 'mild'. So, despite what some people thought at the time (mentionning no English-graduate journalist-types who really should have known better), SARS (Severe Acute Respiratory Syndrome) was a perfectly sensible, meaningful, and non-tautological name for the condition. Despite the fact that in common usage 'severe' and 'acute' are used almost interchangeably.
Acute things can be either mild, or severe. So can chronic things, though it's rarer that something is both severe and chronic, because if it's severe enough it will kill the patient before it gets the chance to be a chronic condition. My client's dog had severe, acute diarrhoea.
I hope that clears things up a little!
Two people have refused to let me see their budgies in the last couple of days. The first, because they thought it was too cold to take a budgie outdoors (almost reasonable, though I suggested various ways in which it could be done, to no avail). The second, because "If I take it outside to get here it might catch bird 'flu". *Sigh*
In amongst all this, the practice support staff seem to have got the idea that 'Beth is the person to talk to about budgies'. I don't want to be a budgie vet! How do I make this stop?
Recent Comments
-
Vet In Harness said:
You're most welcome, Josh. (Cor, this blog has a much higher profile than I thought!)If you wanted to send me... read more
on James Herriot (well, it had to happen one day!) -
Josh said:
Please at least read the comments of vets who have read Pet Hates: http://www.hometown.aol.com/veterinfo/vetfeed.html read more
on James Herriot (well, it had to happen one day!) -
Josh said:
[this is good]Thanks for mentioning my book. read more
on James Herriot (well, it had to happen one day!) -
crazyscot said:
Interesting, smells like yet another reality blog in print (cf Frank Chalk, Tom Reynolds). Except, this one doesn't seem to... read more
on James Herriot (well, it had to happen one day!)
on 'Pedigree Dogs Exposed' - the BBC TV programme that has got all my clients talking.