tag:blogger.com,1999:blog-6604725464113190752024-03-13T10:12:27.622-07:00WelcomeBEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.comBlogger32125tag:blogger.com,1999:blog-660472546411319075.post-7357562484369899322018-10-09T06:28:00.002-07:002018-10-09T06:28:55.602-07:00Helen Dagg's experience of a BEVA Trust day<div class="MsoNormal" style="text-align: justify;">
As a two year graduated mixed practitioner, my opportunities for equine castrates can be few and far between, so when I saw the advert on the BEVA website I jumped on the opportunity to be a part of a BEVA Trust Castration Clinic. This did however mean that I had to step/leap out of my comfort zone. I was worried that the other members of the team would be more confident than myself and that my limited experience would be a hindrance to the team rather than a help. So it was a rather anxious drive to Ardingly in West Sussex on a very bleak Wednesday morning.<br />
<br />
Our base camp was the South of England Showground which was ideal as we had a lot of undercover work space, a luxury that cannot always be provided on these days. We were expecting 65 horses/ponies for passporting, microchipping, worming and 35 of these were booked for castration. These were performed in individual scaffolding pens and each vet was provided with an assistant. After a group meeting and a vets huddle my concerns about the day diminished. I felt like a valuable member of the team right from the off and it was clear that we would be supported all day. All that was left to do was don some overalls and get on with the job in hand. Before long I was grabbing my equipment with gusto and getting stuck in.<br />
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The day was ran with military precision – I have never seen more clip boards in one location. The support staff had the arduous task of organising vets and owners alike, which at points looked as difficult as herding cats. A huge help was the ability of the trained volunteers to complete the passports silhouettes, a job that I was very grateful to bypass, particularly when the majority of the ponies on our day were skewbald or piebald. The support team were incredible throughout the day and these clinics could not run without them.<br />
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I’m not sure how it happened. Perhaps it is my vertically challenged physique (5’4) – but I managed to lead the charge on castrating the Shetlands. Throughout the day I was struck by how engaged the owners were by the advice that we were all giving on after care following the castrations, worming and dental care.<br />
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After just one day of castrations my confidence was rejuvenated. I have taken my experiences of the day back with me into practice, happy to perform castrations when required. The work of the BEVA Trust continues and I would urge anyone who is passionate about equine welfare to get involved. On a personal level I set out to feel more confident in castrating – Mission Accomplished. Volunteer for a BEVA Trust Day – you will not regret it!<br />
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BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com18tag:blogger.com,1999:blog-660472546411319075.post-48070977235843031102018-08-07T02:00:00.001-07:002018-08-07T02:00:09.377-07:00Rossdales joins the campaign against equine obesity <br />
<span style="color: black; font-size: 12.0pt;"><b>Words by Lucy Grieve</b></span><br />
<span style="color: black; font-size: 12.0pt;"><br /></span>
<span style="color: black; font-size: 12.0pt;">Rossdales held their first
'Weight Wise' clinic on 16th June 2018 at the Diagnostic Centre in Exning,
Newmarket. Horse owners were invited to book an appointment where their horse
was weighed on an electronic weighbridge, nutrition and body condition
scoring was discussed with Georgina Gatehouse from Spillers, and
weight-tape and veterinary advice was discussed with the
ambulatory vets, Mark Grant, Lucy Grieve and Paul Martynski. <o:p></o:p></span><br />
<br />
<span style="color: black; font-size: 12.0pt;">Owners received goody-bags
containing a weight record chart, baseballs caps, the NEWC grazing muzzle
advice leaflet, weight-tapes from Virbac and forage hand scales donated by
Horse Requisites of Newmarket. <o:p></o:p></span><br />
<br />
<span style="color: black; font-size: 12.0pt;">There was a super uptake of the
clinic and owner feedback was extremely encouraging. The opportunity for some
dedicated one-to-one advice on all things regarding weight, nutrition and
management, was welcomed. Similarly, getting an accurate starting weight
and learning how to body condition score and use a weight tape, meant that
owners had a clearly defined start point and end goal, with the confidence to
know what they were aiming for and how they could achieve it. <o:p></o:p></span><br />
<br />
<span style="color: black; font-size: 12.0pt;">The practice was inundated with
owners who couldn't make the date and so there are plans to run a second clinic
towards the end of autumn. It appears that there are plenty of owners
who are determined to achieve a healthy weight for their horses, they just need
the information and the support to do so. <o:p></o:p></span><br />
<br />BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com29tag:blogger.com,1999:blog-660472546411319075.post-26704511467306810822018-08-07T01:36:00.002-07:002018-08-07T01:36:28.307-07:00Tackling Equine Obesity In The UK – What can we learn from small animals and humans? <div class="MsoNormal">
<span lang="EN-US"><b>Words by Nicky Jarvis</b></span></div>
<div class="MsoNormal">
<span lang="EN-US"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US">Government statistics show that nearly 62%
of people in the UK are overweight with 27% considered to be clinically obese
(body mass index of 30 or higher) compared to just 15% in 1993. With rising obesity
levels questions have been raised over how to tackle patient issues and how best
to achieve effective weight loss. Studies also show that between 29-39% of dogs
and 19-29% of cats are thought to be overweight and many small animal practices
have invested time in weight management clinics. But how much success do our
human and small animal counterparts have and what lessons can we take forward
to the equine world?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">In companion animal practice only a few
studies exist on the success of weight loss programmes and many are focused on
short-term results rather than return of the animal to optimal weight. In one
study, which included client education, only 53% of the dogs enrolled completed
a six month weight loss programme. Owner related issues such as lack of
compliance and illness were cited as reasons for not completing the course and
interestingly the more obese animals were most likely to be lost to follow up.
One factor for lack of compliance may be that diets aim to achieve a safe
weight loss of 1% bodyweight per week and for the first 6 to 7 weeks this is meaningful
to the owner. However, without regularly reducing the feed ration further, weight
loss quickly falls to 0.3% BW per week. Whilst still a significant percentage
for a cat or a dog, this can prove frustratingly slow to the owner.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Like humans, cats and dogs also show the
‘rebound effect’ when it comes to weight loss. One study showed 48% of dogs and
46% of cats began to gain weight at the end of a weight loss programme. So is
finding ways to support and motivate horse owners long-term just as important
as that initial short term success?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Weight gain is often insidious and in small
animals many risk factors have been identified. Breeds such as the Labrador,
Pug and Golden Retriever have a higher prevalence of obesity thought to be
linked to early life rapid weight gain seen in the growing phase of these
breeds. Certainly in humans, rapid weight gain in growing children has now been
linked to an increased likelihood of obesity in adulthood. The existence of a
‘thrifty gene’ is often discussed and debated in native ponies and cobs. And
with recent studies demonstrating specific genetic markers in horses which result
in elevated insulin levels, increased obesity and laminitis could we soon be
soon be able to identify ‘at risk’ horses before they become obese?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">And what becomes of those animals that
never even enroll on a weight management programme. Two small animal studies
from 2008 and 2014 suggested that vets discussed the weight and body condition
of overweight dogs in less than 2% of consultations. So do some of us struggle
to raise the subject of an overweight horse?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Guidelines for human doctors recommend regular
screening of patient weights and active encouragement to join commercial weight
loss programmes that have been found to be far more effective than ‘going it
alone’. In fact a doctor can now refer a patient to Slimming World and similar
organisations on the NHS. However doctors find that lack of time and knowledge,
fear of causing offence and a belief that intervention would be ineffective hold
them back from raising the subject with patients during routine consultations. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">A study led by Professor Paul Aveyard and
published in the Lancet looked at the efficacy of a scripted ‘brief’ opportunistic
intervention by GP’s in terms of encouraging patients to lose weight without
the advice being deemed ‘inappropriate’. Patients attending a routine
consultation were invited by the practice receptionists to weigh themselves on
arrival at the surgery and then at the end of the consultation the GP was asked
to spend just 30 seconds advising those patients deemed to be overweight:<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">GP: “While you’re here I just wanted to
talk about your weight. You know the best way to lose weight is to go to
(Slimming World or Rosemary Conley) and that’s available free on the NHS.” <o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Patient: “Oh?”<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">GP: “Yes and I can refer you now if you are
willing to give it a try?”<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">Patient: “Yes, OK.”<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US">GP: “Ok, what you need to do is to take
this envelope to reception…….. And I’d like to see you again in 4 weeks time
please if that is OK?”<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">The study found that 77% of patients
offered the service agreed to take part and over 40% went on to successfully
attend the weight management programme. This success was also replicated in
Hugh Fearnley-Whittingstall’s experiment featured in BBC One’s ‘Britain’s Fat
Fight’ where a group of Bristol based GP’s were trained in the brief
intervention technique. And 4 out of 5 patients reported they found the
conversation both helpful and appropriate.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">So perhaps this is something we can learn
from the human world. If one of our biggest struggles is getting horse owners
to recognise that their horse is overweight and motivate them to address the
problem perhaps we need to start with that opportunistic conversation, our own
‘brief’ intervention at the end of a routine consultation. And as most weight
gain is insidious perhaps by automatically producing a weight tape or body
condition chart at every vaccination or dental check we can show owners with
how much their horse has gained (or lost) in a few months rather than waiting
until the situation harder to manage. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<span lang="EN-US" style="font-family: "Cambria",serif; font-size: 12.0pt; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-latin;">There
are no studies out there to tell us how successful weight management programmes
are in the equine world and that’s why I will be asking equine practices, who
currently run weight clinics, what advice and tips they can give us on how to
encourage and support horse owners to achieve the right weight for their horse.
I will be sharing what I find over the coming weeks on <a href="https://www.beva.org.uk/Home/New/Resources/For-Vets-Practices/Clinical-Practice-Guidance/Obesity-in-horses" target="_blank">the obesity resource webpage</a></span>BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com17tag:blogger.com,1999:blog-660472546411319075.post-77234748495661641182018-08-07T01:31:00.003-07:002018-08-07T01:31:51.143-07:00Libby Smith's experience of setting up an equine weight clinic<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-size: 12pt;">I'm
thrilled to be asked by <span style="background: #FFEE94;">BEVA</span> to
write a blog on Westover's recently launched Equine Weight and Condition Club. RVN's
within equine practice are such an under-utilised resource in
comparison to their small-animal counterparts, introducing the idea of
nurse-lead clinics to make use of the wealth of knowledge RVN's have is the
perfect opportunity to create greater challenge within practice, whilst
tackling one of the biggest health issues our profession faces.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-size: 12pt;">Although
we aim not to dissuade those with thin horses being interested in our service
(following medical workup), this clinic is primarily aimed at dealing with the
rising number of overweight and obese horses we see within practice. I can't
stress enough how much easier it is to launch a service like this with a
"whole-practice" approach. Within first-opinion practice, the
ambulatory vets are those in most contact with clients, and therefore it's
critical the nursing team can rely on those vets to upsell this service at any
and every call they attend with an overweight horse. The flip-side of this is
those that do embrace nurse-lead weight consults see their own workload
reduced, as they can refer clients to nurses to discuss all things
weight-related, freeing themselves up to do more challenging work. I'm sure
many vets can relate to the difficulty of being stuck at a consult way beyond
the scope of time left for a vaccine discussing variables like diet. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-size: 12pt;">That's
not to paint a picture that we are fortunate to gain every upsell the vets send
our way - sadly as many will already realise, the issues surrounding obesity do
not gain the sort of recognition or concern from clients that we would like,
and therefore we don't get the volume of consults booked in that we would ideally
like to see. By ensuring weight remains a high profile issue and not being
deterred from discussing it we hope in time to secure a wider audience.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-size: 12pt;">The
most effective consults are held at the horses' location as opposed to the
practice, as it removes subjectivity about grass quality and grazing
management, and is particularly important if you have a predominantly
leisure-horse caseload who may not all have transport. We aim to have an
objective assessment of the horses’ condition and weight, as well as an open
discussion about factors that may limit compliance to a diet and exercise plan:
these plans must be bespoke in order to be successful, so if a client can only
ride once a week due to work commitments or a horse is recovering from injury
we need to take this into account. We weigh their current diet to the gram,
usually creating great amusement amongst owners who prefer a “handful” method!
We also discuss our starting point in terms of exercise and management. Much
like the subjectivity over grass quality, you may have to be quite probing -
I'm still amazed at how many feel a 20 minute walk around the block constitutes
a physical challenge!<o:p></o:p></span></div>
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<span style="font-size: 12pt;"><br /></span></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-size: 12pt;">This
consult is predominantly fact finding, so unless emergency measures need to be
put into place we usually return to create a written plan incorporating diet,
exercise and management changes to be sent to the client within 24 hours. This
bides us time to consider all the variables at play in order to create the most
effective plan possible.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-size: 12pt;">Maintaining
regular contact with our client's is also pivotal to our vision of the Westover
weight programme. There is significant evidence in human medicine that those
enrolled in group meetings see greater weight loss than those trying alone, so
mimicking this feels like the obvious step. We are trying to create a forum
group, giving clients the opportunity to discuss their difficulties with others
going through the same. Although this is challenging whilst numbers are low,
once you get a handful starting at the same time this soon adds additional
value to the programme for minimal staff input. This forum is interspersed with
regular information-based emails from myself as an RVN tackling weight related
subjects –research articles on grass intake whilst grazing and how to use a
grazing muzzle effectively as examples. This is a great way to engage with your
client’s more, as well as upselling more services like nurse-lead clipping
clinics or EMS blood sampling. This is all an additional revenue stream nurses
can provide that is new to the practice.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-size: 12pt;">The
main struggle we face is retaining re-sees in cases receiving other ongoing
veterinary intervention, or in cases that have improved to now be at
a non-critical state. This relates to both the vets and clients
perception of what a weight consult offers. If a horse has a vaccine and the
vet puts a weigh band around the horse, this is enough for some clients, but I
hope in time to alter this mindset and show that we could offer them so much
more in terms of advice and support. Similarly, much like Weight Watchers
offers it's gold membership to those who reach their target weight as a
nod to the idea weight loss is a lifestyle, and not a one-off diet, I hope that
by continually banging the drum that it's important to frequently re-assess our
horses' health status and condition, client's will see the benefit of a re-examination
even when their horse has dramatically improved to help formulate the most
appropriate plan moving forward.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<span style="font-family: Calibri, sans-serif; font-size: 12pt; line-height: 107%;">Understandably, starting anything new like this is a daunting task, and
I'm well aware that this was made easier for me in a supportive, open-minded
practice. My advice to anyone else interested in starting something similar in
their own practice is to try and make your enthusiasm rub off on at least one
other member of the clinical team, so you have one other person to upsell the
service and to bounce ideas with when you meet a challenging patient. For the
nurses out there that may be asked if they’d like to take part in something
like this, grab the opportunity for autonomy with both hands and you’ll never
look back!</span>BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com3tag:blogger.com,1999:blog-660472546411319075.post-73700548232133908502018-06-14T07:15:00.000-07:002018-06-14T07:15:40.562-07:00How I ended up on route 66<div class="separator" style="clear: both; text-align: center;">
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<br />
Dear BEVA enthusiasts,<br />
<br />
Our BEVA executive assistant Fiona who completed the 66 mile challenge has asked me to write you a blog about how I intended doing the 30 mile cycle on the 3rd of June but accidentally ended up cycling the 66 mile challenge which I playfully call Route 66’. Being Irish necessitates an innate talent for taking “the mick” out of oneself so I gladly accepted the opportunity to write my ‘Route 66’ blunderful revelations.<br />
<br />
I will begin by explaining what my mid breeding season BEVA sportive preparation actually consisted of. While the rest of the Donnington Grove team committed themselves to regular weekend cycles, I only managed one cycle that was 24 miles long wearing an ugly horse-riding helmet “borrowed” from the practice. After only 24 miles of cycling, one of my regular stud farms found my new gait concerning and gave me some bicycle shorts. This in itself was enough to put me off further training. I spent the next few weeks preceding the challenge avoiding Bruce who would have sacked me if he found out that I had no intention of cycling 91 miles.<br />
<br />
On Saturday following stud rounds I set off to Yorkshire. I bought a helmet in Halfords that morning purely to blend in with the other cyclists. It was an easy journey following the two other Donnington Grove vehicles and listening to their terrible attempts at road trip singing via whatsapp. Approaching Birmingham it dawned on me that I had left my gift bicycle shorts and any form of comfortable underwear at home in Newbury. But this wouldn’t matter since I was only doing 30 miles - right? I met the rest of the team in a restaurant that evening and was surprised to see them looking rather apprehensive. This was because Bruce had taken them for a drive around the 91 mile course and consequently driven them ... around the bend. It seemed like the only thing keeping a smile on the faces of at least the men on the team was the prospect of meandering their way across two hills they affectionately christened “the bosoms of Yorkshire.”<br />
<br />
Let me tell you about the Donnington Grove team. Georgio is a cool, collected Italian surgeon who had put in plenty of training. Emma, a Kiwi housevet who has cycled thousands of miles around South Island was calm and confident. Surgeon Alastair hails from Yorkshire, can lift three times his own body weight, and looked similarly confident. Naomi, the most experienced housevet is a keen cyclist so the impending pain didn’t seem to faze her. Marc, one of DG’s talented ambulatory vets was an enigma to me. I had not seen him on a bicycle but he definitely had all the gels and electrolytes to complete 91 miles. Abbie, also a Donnington Grove housevet was petrified but remarkably determined. Bruce, our team leader and motivator, who needs no introduction to BEVA members, had very worryingly run out of words. Then of course there is yours truly, smug at the prospect of cycling a mere 30 miles and enjoying coffee and cake along the way.<br />
<br />
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<br />
And they were off! Half an hour later I was at the start line. I got the general lecture and guidelines about the course from the gentleman at the start line. I stopped listening after “follow the green signs”. How hard could it be for an Irish to follow some green signs right?<br />
<br />
I set off with a banana and half a bottle of water. I’d be back soon. With my head down, I cycled with determination. I skipped Hovingham’s most amazing coffee shop (already obliviously off course) in order to quickly pedal round to the finish line, drive to the Donnington 91 milers and offer them moral support and Volvo draft. As I kept cycling with blinkered focus, it started to dawn on me that I had been cycling for some time now and that there seemed to be more hills than I had anticipated. Upon acquisition of internet signal, google maps confirmed that I was 45 km away from the finish line by the shortest route and I had been cycling for almost 3 hours! I called my most patient friend Shelley who pulled up the routes on her computer and confirmed that since I had passed through Kirkbymoorside (35 miles from the start) I was in fact on the 66 mile challenge. Shelley is still wondering how I navigated my way through vet school, let alone this thing called life. <br />
<br />
I sat in the grass and pulled out my banana and half a bottle of water and considered my options ... of which there were none. I had to finish the 66 mile challenge. I was lucky to be discovered in said position by Gem who is a small animal vet at Calder vets in York and her husband Steve. They offered me all the moral support, patience, and water to get me through a despondent middle third of Route 66. Antique tractors offering a draft for 5 miles around Malton were also welcomed. Team Donnington’s geographically challenged member finished 66 miles strong in 6 hours 12 minutes, a time that somewhat softened the stupidity of ending up so far off course. I was just happy that I made it in time to cheer on the Donnington Grove 91 milers on their arrival back.<br />
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One person on the Donnington team deserves a very special mention. This is the story of a girl who does not love cycling, got attacked by road bollards and had a nasty fall in the first stretch of the 91 mile challenge, but still refused to abandon the challenge. She continued to complete more than 91 miles over Yorkshire highs and lows. Abbie finished with a damaged ankle and a giant smile on her face. She also completed a day of work the following Monday. She is the newest qualified veterinary surgeon at Donnington Grove and exemplifies all the mental fortitude and positive attitude that’s needed to tackle the inevitable bumps in the road to success. After 91+ miles I think this photo says it all.<br />
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So what did I learn on completion of this surprise challenge? <br />
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Prior preparation prevents poor performance ... make time for all those P’s.<br />
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Sometimes life will throw you off course and the lesson is to embrace and “ride on” because you might meet some fantastic people on the new route and end up in a better place.<br />
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Abbie exemplified riding the hard road, your attitude defines your altitude.<br />
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And finally;<br />
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Victoria’s Secret is great for certain activities ... and cycling is not one of those activities.<br />
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See you all at the next BEVA challenge!<br />
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BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com1tag:blogger.com,1999:blog-660472546411319075.post-84316633909970797082018-05-16T04:43:00.003-07:002018-05-16T04:43:25.859-07:00Victoria Gregory : Being an Equine RVNI started working at Rossdales Equine Hospital in 2003 and qualified as an Equine Veterinary Nurse in 2007. In 2010 I took a sabbatical to work at Scone Equine Hospital, Australia, during their foaling season. I enjoy teaching so in 2015 I decided to move to a university hospital so that I could continue to be an equine nurse but teach as well. I spent some time at the Royal Veterinary College in Hertfordshire before moving to Scotland to work at Weipers Centre Equine Hospital at the University of Glasgow.<br />
When I’m not at work I enjoy spending time exploring the Scottish countryside with my Springer Spaniel, Jonty.<br />
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I grew up with horses and all I wanted to do was work with horses. After leaving school I attended Moulton Agricultural College where I completed a BSc (Hons) in Equine and Estate Studies. It was during my time there that I saw a job advertised for an equine veterinary nurse and decided that that was the career for me. When leaving college I sent my CV to several equine practices enquiring about trainee nursing positions. During the summer I took a temporary position at an equine rehabilitation centre to enhance my CV.<br />
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I was lucky enough to get a job as a trainee nurse at Rossdales Equine Hospital, which was already an established training practice. After a year of working as a theatre assistant I was enrolled on the Equine Nursing course which was then an NVQ level 2 & 3. I went to college one day a week for two years and completed a portfolio at work to show that my clinical skills were up to standard. I had to sit multiple choice question exams at the end of year 1 and 2 as well as practical exams at the end of year 2.<br />
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The role as an equine veterinary nurse can vary greatly between practices, some giving nurses more responsibility than others. No day is ever the same, you can set a basic daily routine but this can be disrupted by emergencies and patient compliance! The basic daily routine where I work is:<br />
8.30 – start. The students have started the morning checks and treatments, nurses assist with this when necessary. If there is a surgery booked in, the nurse guides the students through catheter placement, administering any medications and removing the horse’s shoes.<br />
9.00 – Rounds, each patient is presented by the student in charge of that case.<br />
9.30 – the first surgery is anaesthetised. Any inpatient procedures are started, such as x-rays, re-exams and bandage changes<br />
10.00 – the first outpatient appointments start – the university is close to the city so owners often get stuck in traffic if asked to arrive earlier than this.<br />
Inpatient care and outpatient appointments continue throughout the day until the work is completed. The nurses are on a rolling rota, spending a week with the medicine team, a week with the orthopaedic team and a week on the late shift, helping out wherever. As well as helping with the patients the nurses work as a team to ensure that stock orders are placed, rooms are fully stocked and cleaned, bins are emptied, equipment is in full working order, necessary equipment is clean and sterile for procedures, medications are ready for dispensing with patients that are going home, the bills are up to date for when the owners enquire and the list goes on! Being a teaching hospital the nurses are also responsible for teaching and assessing students for their Direct Observation of Procedural Skills. These include tasks such as x-raying, shoe removal, IV catheter placement and bandaging.<br />
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I would describe my job as rewarding. There is nothing better than seeing horses going home, after a stay in hospital, with their owners so happy to have them home again. In the university it is also rewarding to see the student’s progression in the time that they spend with us. The vast majority are not horsey but they are always keen to learn and be involved. It is extremely tough at times when there is nothing more that you can do to help a patient but at least it is possible to end their suffering and know that they had the best possible care until the end. The thing I love most about my job is the horses!</div>
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I was extremely proud when I qualified as an equine veterinary nurse; I had worked really hard to get there. My proudest achievement though, is probably being asked to make a DVD for Lantra to promote equine veterinary nursing as a career choice.</div>
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For the future I would like to carry on advancing my equine nursing knowledge in order to care for the patients as best as I can. I would also like to continue to be involved in teaching veterinary nursing students and veterinary students. </div>
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BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com1tag:blogger.com,1999:blog-660472546411319075.post-11466745855931337462018-05-10T05:01:00.005-07:002018-05-16T08:24:56.786-07:00Marie Rippingale : Being an REVNMy name is Marie Rippingale. I have worked in equine veterinary practice since 2003. I qualified as a Registered Equine Veterinary Nurse (REVN) in 2007. I obtained my Advanced Diploma in Equine Veterinary Nursing (DipAVN Equine) in 2013. I work as a senior equine nurse at Scarsdale Vets, and as a lecturer in equine veterinary nursing at Bottle Green Training. I live with my other half who is a small animal vet, and a small 15 year old ginger and white cat called Dougal, who constantly declares that he is hungry, regardless of how much he is fed! I also own a 20 year old Irish Sports Horse called Chaplin. We mainly compete in British Eventing (BE) 80 competitions, and Novice dressage. Chaplin specialises in running away on the cross country course, and spooking at random things in dressage arenas! I also enjoy scuba diving and snowboarding (badly!).<br />
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I completed a BSc (Hons) in Equine Sports Science in 2005, and as part of this course, I took a year out to work as an equine nursing assistant at Scarsdale Vets. I enjoyed this year out so much that I went back to work at Scarsdale as soon as I graduated from university. I have always loved horses, and cannot think of any better job than caring for them, and treating them, when they are unwell.<br />
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I took the vocational route of training. This involved me working at Scarsdale four days per week, and attending college one day per week. The course lasted two years, and was assessed with exams, a practical portfolio and practical exams (OSCEs). It was a lot of work, and was really challenging both academically and practically. Working full time and training at the same time was hard, but it was totally worth it in the end.<br />
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The structure of my day depends on what area I am working on that week (the nurses all rotate around areas spending 1 week on each). The areas we rotate around are:<br />
Pharmacy (8am-4.30pm): This involves helping with Artificial insemination (AI) mares first thing in the morning. After that we unpack the drugs order, put it away insuring correct stock rotation and update all of the stock records. The rest of the day is usually spent helping out in the hospital or with the inpatients. You will often go out and assist with ambulatory procedures when on this area e.g. radiographs, ultrasound scans and endoscopes. In the afternoon we construct a new drugs order, and an order for the hospital. Due to the reduced contact with inpatients on this area, this nurse is usually nominated to look after the isolation cases when they are admitted.<br />
Hospital (8.30am-5.00pm): This involves helping out with procedures in the hospital e.g. lameness work ups, gastroscopes, radiographs, ultrasound scans, shockwave treatment, general anaesthesia and assisting in theatre. There are usually two nurses on this area and they work together with the hospital vet for that day to get everything done, and make sure it all runs smoothly.<br />
Inpatient care (8.30am-5.00pm): On this shift you check and TPR all of the inpatients and give them their medication. You will consult the case vet for each patient, and obtain a plan for that patient for the rest of the day. We compile and fill out nursing care plans for the critical patients we get at the practice, and fill these in when we are on this area. We also groom the horses and pick their feet out. This is good for their general health and well-being, as well as supplying them with some much needed TLC – happy horses heal faster! When working on this area, you will also prepare the horses for general anaesthesia, including intravenous (IV) catheter placement, clipping, mouth washing and giving pre-anaesthetic medications.<br />
Although it says here that we should finish at 5pm, we all know that horses do not just get sick during working hours, so if a patient needs care after this time, one of us will often stay behind to help. We also work on a weekend on call rota.<br />
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I find my job challenging, fascinating, exciting and rewarding. I really love seeing our longstanding patients, either for a re-examination, or when they come in for a vaccination. It is so nice to see them looking well in themselves and enjoying life. You build up a rapport with the client too which is really nice. I also really love it when inpatients start to improve and look better.</div>
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My proudest achievement as an equine veterinary nurse was volunteering for the BEVA Trust to go out to the Gambia in West Africa to work at The Gambia Horse and Donkey Trust (GHDT). I have taken two trips so far, one in 2015, and one in December 2017. These trips were challenging and fascinating all at the same time. I was delighted to find that I could actually help out there, but I learned an enormous amount in return. I have an limitless amount of respect for the staff at GHDT for the amazing job they do out there. I am very proud to have met and worked with them.<br />
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My ambitions for the future are to continue to develop my skills and knowledge, and pass these on through teaching. I will also continue to raise awareness of equine nursing within the veterinary industry, and with the public also. I would like to see better recognition for veterinary nursing as a profession overall. </div>
BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com1tag:blogger.com,1999:blog-660472546411319075.post-38310122222200280202018-05-02T04:22:00.002-07:002018-05-02T08:20:43.451-07:00George Hunt : Being an Equine RVNMy name is George Hunt and I work at Pool House Equine Clinic in Staffordshire. I qualified as a small animal RVN in 1998 and then as an Equine RVN IN 2014. When I am not at work I am busy looking after my two young children. I also ride regularly and am keen on equine behaviour.<br />
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During my training as a small animal nurse I worked in a busy mixed practice and was one of the few nurses who were happy to go out on large animal calls!! It was during this time that I developed an interest in equine nursing.<br />
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I decided very early on in school that I wanted to become a veterinary nurse and have never wanted to do anything else!! I have now been nursing for over 25years and still love my job.<br />
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A typical day for us starts with doing inpatient rounds along with the interns and surgeons. At this point we discuss daily treatment plans, case progression and discharge recommendations. This will be followed by preparing any patients for surgical procedures both standing and general anaesthesia. We also run in house laboratory tests, assist with gastroscopy, as well as ensure all equipment and instruments are maintained and of course last but not least lots of cleaning up. We have a 24hour emergency service so theatre is always left set up ready for colic surgery as this is our most common surgical emergency. During the summer months we often have sick foals in need of nursing too!<br />
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No two days are the same which means we have to be flexible and always prepared for the next case as horses are very good at getting themselves into mischief!! It can be stressful but also very rewarding!<br />
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The part I love most about my job is when emergency or critical patients recover and go home! This the most rewarding feeling knowing we have made a difference!<br />
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My proudest achievement has been obtaining my equine nursing top up qualification after not studying for a very long time and having two small children to take care of!!<br />
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The number of equine nurses is currently small compared to their small animal counterparts and so my ambition for the future would be to continue to support the growth of the equine nursing profession through training of new nurses and promoting our skills. As equine nurses our skills make a positive difference to the care of horses. TLC has been proven to improve welfare and outcome of hospitalised patients.<br />
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I am also keen on promoting more sympathetic and positive training in the horse to allow for better welfare through behavioural knowledge. This is so important not only for the welfare of the horses but also the safety of staff when dealing with difficult patients.<br />
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BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com0tag:blogger.com,1999:blog-660472546411319075.post-46841772132778457572018-02-28T04:30:00.005-08:002018-02-28T04:55:34.084-08:00Vicki Nicholls talks about a day judging at the Petplan Veterinary AwardsWow. What a day. Fresh from the Petplan Veterinary Awards Judging with a warm glow about the profession. Days like today make me even more thankful that I am a vet and able to celebrate this remarkable profession that we are part of.<br />
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The experience was stratospherically at odds with my pre-conceived expectations however. I stupidly assumed this was another Presidential meeting to be squeezed into my hectic calendar with the usual challenges of childcare scheduling, made all the more difficult by the unfortunate clash with half term. One child and a dog happily left with grandparents 200 miles away and the other child safely ensconced in childcare (plus trusty trainers in my bag to dash from the train) and I was ready to “do my duty”.<br />
It was certainly worth it.<br />
I'll admit I was slightly perplexed by the judging system but having dutifully read and ranked each of the nominations in my category I felt as prepared as possible. Now I'm a prescriptive kind of person -I like tasks with recipe- like instructions. But you have to break some eggs to make an omelette (a delicious one at lunch thanks Petplan!) right? This is veterinary judging like no other…more “X Factor Judges Houses” than “Strictly Come Dancing”. There are no set criteria, no prescriptive guidelines, no previous examples and no benchmarks to follow. This was about finding something in the nomination that really stood out. Not that difficult I hear you mutter. BUT, and this is a very big BUT...clients appreciate gestures and words that we take as completely normal in this amazing profession and nominate their vets/practices/VNs accordingly. Knowing a pets name and greeting them with a smile and warm welcome may seem a normal part of your working day but Little things really DO count. One small gesture to us can really make a different to an owner...and a thoughtful nomination for the Petplan Veterinary Awards. The net result? Over 22,000 nominations this year to sift through and pick winners for each category. I suddenly realised that kindness and compassion is often taken for granted, but what a lovely way to recognise it. I'm already planning my nominations for next year and wishing I had thought to recognise colleagues in previous years.<br />
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I digress, so armed with my list of short-listed nominations (again I was amazed that Petplan employs an independent company to sort each nomination into category and short list so they have no input into the judging) I sat down with my two co-judges to discuss our group. No specific assessment criteria plus a panel of scientifically minded people equals a bit of head scratching where to start but we were soon underway with enthusiasm and due diligence. Thankfully we had been well briefed to judge only on the nomination statements and each judging panel was comprised of at least one Veterinary association President and a past winner of that category which helped enormously. Relief soon flowed around the table when we realised that something about our category winners had obviously struck a chord as our choices were unanimous. Again we took a vow of secrecy and were strictly reminded not to divulge our choices to even the Petplan organisers.<br />
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Being a vet gives me a great sense of community - I am part of one big and very special family. I am constantly astounded by the kindness, generosity, care, compassion and support within the veterinary population. Whatever your role within the veterinary team, there is no one defining criteria nor job description that recapitulates “what you do”. Every day is different and although the challenges are widespread, today reminded me of how extraordinary the individuals are within our profession. The generosity of spirit, the camaraderie and support, and the inspirational stories within the nomination packs exemplifies the very best of the veterinary profession. Today I was prouder than ever to be part of it. There seems to be a tide of apathy in the profession, a disgruntlement with the changing face of the "James Herriott" era. But the core of the profession hasn't changed and the foundations are built on kindness and compassion. Do something amazing for your profession and nominate someone for next year.<br />
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And the winner of my category is....you shall have to wait until April 5th 2018 like the rest of us!<br />
<br />BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com1tag:blogger.com,1999:blog-660472546411319075.post-15268816145969713142018-01-05T08:33:00.000-08:002018-01-05T08:33:18.128-08:00Vicki Nicholls on her day volunteering at a BEVA Trust Education and Welfare Castration ClinicI will admit, like most things in life, it’s easy to be skeptical about an experience before you have actually tried it. Don’t get me wrong, as BEVA senior vice president I have always supported the work done by the BEVA Trust but it wasn’t until I took part in a BHS Castration clinic that I realized what an amazing project this is.<br />
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So to give you some background, I have a pathological hatred of castrations. A bad experience early on in my career has literally scarred me for life. Of course I have done countless castrations since but my recent move to the University of Liverpool Veterinary Postgraduate Unit has left me a little “match unfit” in terms of practical skills wielding a scalpel. Notwithstanding that I volunteered on the premise of “doing dentistry”; I haven’t really be doing a lot of that either recently thanks to the demands juggling BEVA commitments with the rest of my life. A frantic text flurry to a colleague the night before did little to reassure me that “it was just like riding a bike” …not least because I’m not very good at that either.<br />
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Therefore, It was with some degree of trepidation that I arrived at the Bakewell Livestock Auctioneers last week. Having hastily scrabbled together a reasonably looking professional kit to meet both the demands of the weather (including some borrowed waterproofs thanks Hannah) and any potential challenges posed by the day, I felt as ready as a new graduate on the first day of practice.<br />
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But I need not have worried. The entire Veterinary Team was brilliant in both camaraderie and support. The support team incredible, efficient and friendly and even the naughtiest patient restrained with the skill of an experienced RVN. The BHS and equine welfare charities actively recruit participants to the clinic; relief quickly replaced skepticism when well-known local offenders turned up for the first time. The owners were incredibly grateful and took the educational opportunities on board with relish. And making a difference to one horse’s mouth made it all worthwhile…whether the owner calls the BEVA member we recommended remains to be seen but at least the pony can eat comfortably now and the indiscriminate breeding of the “rescued” herd has been halted by widespread emasculation.<br />
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No one struggled, help was freely offered and there was a real sense of comradeship. We were all in it together for the welfare of the horse. The University of Liverpool veterinary students (and people like me needing a refresher) had the opportunity to see (and do) more castrations than ever possible in practice whilst making a difference, whatever tip of the iceberg may be. The local practices were hugely supportive and the entire day run under the professional yet sympathetic organization of Gemma Stanford of the BHS who later told me<br />
“It did feel like ‘Challenge Anneka’ at times as we all raced to beat the rain to passport, chip and worm 37 ponies and castrate 15 of them”…including a few too small to castrate standing.<br />
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We have now had 710 horses attend the BHS/BEVA Trust clinics and 328 of those horses have been castrated – all through the support of BEVA members giving up their time and expertise. That’s pretty Incredible! That one-day reignited my passion for the veterinary profession and the kindness that is within it. I urge you to support the BEVA Trust like so many have already done and be proud of our equine veterinary profession.<br />
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BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com10tag:blogger.com,1999:blog-660472546411319075.post-35817531214191507962017-08-02T03:50:00.002-07:002017-08-02T03:50:18.120-07:00Joining a directorship and having a life?!?!?!I am currently 33 and just about to buy into an established equine practice. I have been a salaried director for 2 years having joined the practice just over two and a half years ago with the intention of joining the directorship. I have worked in 100% equine practice for most of my career (bar a short stint in mixed practice as a new graduate) and have always looked for the next challenge!! Prior to joining my current practice I worked for four and a half years in a fantastic practice as an equine vet, but felt I had to leave as there were no directorship opportunities and it wasn’t particularly near my family. I was reluctant to settle into life long term as an assistant, and 3 hours from my family home. I have always been one of those annoying people who relishes the most difficult option in life. I remember being told by numerous careers advisors that I should pick a different degree course to apply for as ‘nobody gets into vet school’ (which was true of the college I did my A Levels at), but all this did was spur me on to prove them all wrong.<br />
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Having achieved a certificate in Equine Orthopaedics and Advanced Practitioner Status in my previous practice I was then looking for the next challenge. I decided to look for a job nearer my family and with more opportunity for progression. I only applied for one job, met my now business partner and decided there and then that this was the right place for me. The practice needed some modernisation, but I got on well with my now partner, we had a very similar outlook on things and she complemented my orthopaedic bias by being an Advanced Practitioner in Equine Medicine and an experienced stud vet.<br />
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Rather naively I thought moving to a new practice with a few more letters after my name would cement me into the practice team quickly and gain me a name with the clients. This didn’t happen – I still spend time doing vaccinations, being rejected by clients for being new, getting complaints because I didn’t do things in the same way ‘xxxx’ used to. <br />
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Joining the directorship has been a HUGE challenge – possibly more than I was looking for. At times I have gone home and cried after yet another staff member has moaned about lack of communication in the practice, or handed in their notice when we are already short staffed. The clients have been critical at times too, some of the long established clients have complained about my bedside manner and disliked the new practices adopted (not least that we now insist they pay their bills…). I have come to the realization that you have to expect everything to be slightly falling apart all of the time – there is always someone complaining, someone leaving, someone off sick, some difficult case that has been pushed in your direction. I am getting better at leaving it at work and trying to relax in my own time, but it is much harder once the buck stops with you. I now get to fret about the practice finances, staff members, cars, equipment, H+S, practice standards inspection, accountants and a whole load of other stuff that never even crossed my mind when I was just a vet.<br />
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On the whole though I am enjoying it, I am now in a position where I can make decisions – hopefully to the benefit of our team and the business. I am enjoying learning new skills (last week I learnt how to do the till rec after someone in accounts decided the best time to retire at short notice was when someone else in accounts was on holiday) and find the prospect of growing the business exciting. I take great pride in every letter of thanks, every favourable Facebook post and tweet, every client who tells me how much they like one of our vets or nurses. I am slowly winning round some of our long standing clients, but I think it will take time. Being a director does not fast track you to the top of their ‘favourite vet’ list – you have to clock up years of service like everyone else. <br />
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In terms of work life balance I am finding it hard. I am writing this on a Tuesday evening several months after I was asked to write it because of lack of time. I have been on CPD courses learning about putting all your tasks into categories and spending time doing the important but not urgent things – I fail at this mostly and spend lots of time doing urgent unimportant things!! I am constantly worried about neglecting my friends and family by working too hard, so try to cram lots into my weekends off. I have managed to maintain some rules from my life as an assistant – I still switch off my work phone when I’m not on call (though my colleagues have my private number my clients don’t), I vowed to take every single day of my holiday allowance every year and my allocated TOIL and so far, I have. I try to exercise a few evenings a week and spend time with my other half. I get up earlier so that I can ride my horse before work – meaning I can start the day with something enjoyable and not immediately be greeted with problems (this plan back fires if the horse throws me off which has happened a few times….). Overall I think becoming a director has been the right choice for me, but it is a lot of work and stress which I don’t think you can appreciate until you make the jump. My advice would be to find a practice where you get on well with the other directors – they will be your partners – the rest of the team are important but your fellow directors are the people who need to have your back. I would probably suggest working in a practice a bit longer than I did before taking the plunge, it has been hard to gain the clients trust and loyalty at the same time as the staff, if I had more years of service under my belt I wouldn’t necessarily of had to do both at the same time.<br />
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BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com0tag:blogger.com,1999:blog-660472546411319075.post-60176792311561017902017-06-13T03:45:00.000-07:002017-06-13T03:45:15.869-07:00Bullying with some positivesBe nice…sounds simple doesn’t it? But why does it seem so difficult to find a job in academia where people are simply pleasant to each other? Having experienced several years of upset within my own workplace, I have started to question, is being nice enough?<br />
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I’ve worked in academia and in private practice both in the UK and abroad. Is there more bullying and negative behaviour in academia? I don’t know, but what I can say, is that based on my experiences, it certainly feels so.<br />
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One would hope that academia would be full of like-minded professionals, keen to advance the boundaries of veterinary medicine. Unfortunately, the reality can be one of an environment tarnished by interpersonal disagreement, professional rivalry and immense stress and loneliness. Behaviour that would not be tolerated in private practice seems rife in the university setting.<br />
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I have witnessed bullying, some of which was extreme, go unreported, or worse still, be ignored by heads of department and by human resource staff. Have I been guilty of turning a blind eye to such negative behaviour? Unfortunately, I have. I’ve fallen into the “Be nice Paradox” and smiled, gritted my teeth and walked away, trying to be the grey man, to blend into the background, to avoid being the next victim and to stay out of trouble. Do I regret this? Every day. Never more so than when I look at my children and I feel like a hypocrite telling them to always stand up to bullies….something I have failed to do. <br />
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It is easy to start out as idealistic, but it only takes a couple of failed attempts of seeking help for people to simply stop trying and to ignore the problem. I once tried to discuss an issue with a head of department to be told that if I took the matter further he would “make life very difficult” for me. Is it any wonder that we have problems when we have with attitudes like this from leaders? As vets, we seem used to just getting on with things and never want to trouble others with our problems for fear of looking weak. Surely, when a problem becomes bad enough that it is reported, it should be taken seriously?<br />
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In a profession diseased with high rate of depression, burn out and suicide, we really need to be mindful and to watch out for our colleagues. I am so tired of seeing friends and colleagues either burn out and become disillusioned with the profession after years of bullying or those who perpetuate the problem and become the bully that they once despised.<br />
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In my experience, the people who tend to survive in such a toxic environment are those who take a back seat from the office politics and get on with their job as an individual as much as possible. Certainly, this can improve quality of life for the individual, but is this really the way we should be working? Shouldn’t we be tapping into the potential of teamwork to give the best quality of care to our patients, while pushing the boundaries of research and clinical expertise?<br />
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Is it as bad as it sounds? It can be, but as with any job in our field, there are some wonderful colleagues out there. Certainly, I have had the privilege of working with some outstanding members of the profession and some of my closest, most treasured of friendships have been made at work. Indeed, it is often easier to socialise with colleagues as they are the very people who never mind when dinner reservations are delayed or cancelled because of a blocked cat or a GDV and they are the people who will truly understand when you need to offload the stresses of a difficult surgery or euthanasia. To be so bold as to paraphrase Dickens, it can be the worst of times, but it can also be the best of times. We are after all a profession of caring people who just want to please people and improve quality of life of animals.<br />
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Perhaps we need to stop trying to simply be nice and instead try to be brave, to promote a zero tolerance approach to bullying, to stand up to bullies and to lead by example.<br />
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BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com0tag:blogger.com,1999:blog-660472546411319075.post-6138453844950713992017-06-01T08:38:00.001-07:002017-06-01T08:40:30.325-07:00Bullying and survival in academia: is the female-female divide bigger than the male-female divide?<div class="MsoNormal">
For those vets working in academia, the priorities between
teaching, research and running clinics have always been hard to balance. Universities
tend to swing between putting research first when the Research Excellence
Framework (or, Research Assessment Exercise, as it used to be known), is on the
horizon; and then swing in the opposite direction when the Teaching Excellence Framework
(formerly, Teaching Quality Exercise), becomes the focus. Despite teaching
bringing in the far greater income, “research”, however, remains the measure of
a University’s excellence; and despite what most mission statements say,
research lies at the heart of the ‘measured’ success/prowess of a university
and drives HEFCE funding allocations.<o:p></o:p></div>
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So how does a vet, employed as an academic, fulfil
obligations to perform research to the highest standard, attracting
multi-million pound grants on a regular basis, yet simultaneously maintain a
clinical commitment, usually with an out-of-hours on-call requirement, and all
this with a heavy teaching load? There is no simple answer, as most of us
aren’t Superman or Wonder woman. And for some, their mere survival in academia
is fraught with jealousies, back-stabbing and plagiarism. If there’s one thing
for certain, you need eyes in the back of your head and a very very thick skin
to survive and thrive in academia. There is no room for sensitivities; and not
much for high morals or a conscience! Those that climb the academic ladder tend
to assure their position by trampling on those around them, usually after using
them as leverage. And once at the top, most will then withdraw the ladder,
effectively stopping others joining them. The Hubris syndrome is common indeed
and bullying, from the top-down, is rife, despite most institutions having
‘policies’ to supposedly guard against such behaviour.<o:p></o:p></div>
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Although the press is full of woe regarding the male-female
divide in terms of wages, most universities don’t do so badly on that front,
especially those applying for Athena Swan recognition – but there’s still room
for improvement as there are still fewer women in the highest positions than
men. However, the most noticeable battles, and usually of the bullying type,
appear to be between women, especially between those at the top and those
aspiring for promotion. It seems such a shame that after fighting for equality
in the work place with their male colleagues, women seem to be fighting most
amongst themselves. Perhaps now is the time that they should take heed of this,
examine themselves in the mirror, and stop the bullying?<o:p></o:p></div>
BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com1tag:blogger.com,1999:blog-660472546411319075.post-74699441248876235042017-04-20T01:59:00.001-07:002017-04-20T04:52:23.408-07:00Suicide<div style="text-align: center;">
Nobody heard him, the dead man,</div>
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But still he lay moaning:</div>
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I was much further out than you thought</div>
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And not waving but drowning.</div>
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Poor chap, he always loved larking</div>
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And now he’s dead</div>
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It must have been too cold for him his heart gave way,</div>
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They said.</div>
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Oh, no no no, it was too cold always</div>
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(Still the dead one lay moaning)</div>
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I was much too far out all my life</div>
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And not waving but drowning.</div>
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Stevie Smith</div>
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I attended funeral about 3 months ago. A family member who killed themselves.<br />
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The dogs, frantic through the night, found him first, then his son. Just imagine.<br />
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We stood in the rain, a community of working people, heads bowed, in suits too big or too small, around a fresh grave with hot tears.<br />
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He wasn't a strange man, or a desperate man. Just a man lost in day to day banality and finally lost in his mind.<br />
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And I was angry. Not with him, with him I felt nothing but an aching pity I couldn't have reached out to him at that unGodly desolate hour and given him peace, but with the people who said "I'm not surprised."<br />
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"I'm not surprised!?" Because you saw the mental and physical deterioration that resulted in such a violent and tragic end when you could have stepped in?<br />
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"I'm not surprised" because of the situation or the work, his position or the circumstances he found himself in?<br />
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"I'm not surprised" because it's considered normal for a hard working man in a stressful and lonely position to take his own life and allow his family to find his bloody remains mixed with a muddy yard?<br />
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I'm still angry.<br />
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Then I received news a couple of days ago about a vet I taught. Dr K God bless you. He ended his life.<br />
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Also alone, in some dark place he could only find one way of escaping.<br />
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I recall him as a jolly person, always willing to participate. I don't know what happened, only that he was found alone. He was buried this morning surrounded by a huge number of people.<br />
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A few weeks ago I lectured at SEVA and was lucky enough to be invited to the evening dinner where I sat with several final year students. One lady I spoke with carried the nervousness I could only ascribe to social anxiety and the excema on her forearms and tic of trying to conceal her scratching belied something I feared may become more ugly with the exposure a young graduate is faced with from day one and which only grows with increasing responsibility.<br />
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I spoke with her for little more than 45 minutes but slept fitfully that night wondering what my duty as a fellow colleague should be, or whether my observations were aberrant and even offensive?<br />
I've always been astounded by the trail of tragedy that follows veterinary medicine in its literal wake. Depression, alcoholism, family break ups, injury and suicide. It is so common place that it is met with the "I'm not surprised" dismissive and idiotic "the show must go on."<br />
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If anyone is reading this and is in that place. The place where your thoughts are not your own, where the next day envelopes you in fear, where the need to escape may trickle in ideas of death. We know that it hurts, that you are not alone and that at last help is there. In Vetlife, in MindMatters, in the Samaritans, in AA, in a call to a colleague or a friend, on a knock on the door of a neighbor. I only ask and beg that you never allow anyone to utter the words "I'm not surprised."<br />
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<div class="MsoPlainText">
If you need to talk to someone, Vetlife Helpline is
avaialble 24 hours a day. Call: 0303 040 2551 or email via the website: <a href="http://www.vetlife.org.uk/">http://www.vetlife.org.uk</a><o:p></o:p></div>
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Ben SturgeonBEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com10tag:blogger.com,1999:blog-660472546411319075.post-15151323553901153662017-04-03T00:10:00.005-07:002017-04-03T00:10:57.115-07:00A reply to BoozeI am really surprised at how few responses there are to this blog. Yes, it is about alcohol, but it is also about the need we equine vets have for support and compassion from both within and outside the profession.<br />
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Thank you to the author of the blog for sharing your story, which is painful to read, and no doubt worse to be part of. I’m sure that you are a good equine vet – and certainly good enough - because you obviously care very much about your patients, clients and professional standing.<br />
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What is it that is missing from the veterinary profession that makes this is such a common story? I know others who did not manage to extricate themselves from the downward spiral and ultimately paid with their lives. Depression, loneliness, isolation and then liver failure. Sadly, far from being supported, they were actually ridiculed and left to struggle alone.<br />
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Most of us want to be the best we can be and strive to achieve this. Unfortunately in too many practices there seems to be an element of competition rather than collaboration between individual vets. I was lucky enough to realise that there were times when I needed to bounce ideas off a colleague or receive specialist advice so we developed a network of friends who had expertise in different areas and we could phone for advice at any time. So often all it takes is a 2-minute phone call in a moment of uncertainty to allow one to proceed with confidence. Caring and sharing with a few moments of one’s time . . .<br />
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Things don’t always go perfectly and our work is never over as there is always the next difficult case. Thankfully the profession is recognising the importance of looking after mental health with its increasing programme of ‘mindfulness’. But awareness and empathy have to come from within practices. Could it be that with the corporate ‘takeover’ vets will have time to look after each other? Perhaps the remaining independent practices will consider this a priority. Thirty four years in equine practice has been a privilege and at the age of 60 I am not planning to retire. If I had my time again I would not change my career path but it would have been nice to have more support at times along the way.<br />
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Sue DevereuxBEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com2tag:blogger.com,1999:blog-660472546411319075.post-57042570571726876642017-03-10T05:56:00.000-08:002017-03-10T05:56:12.348-08:00Is work killing you and your patients?Irrespective of disease presentation and progression the ability of a clinician to make an accurate diagnosis and implement appropriate treatment is paramount in outcomes and prognosis. Most veterinary work requires out of hours work or shift patterns and the equine veterinary surgeon is arguably most likely to experience and undertake a multiplicity.<br />
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Our photo-periodic health or circadian rhythms are entrained by the paired suprachiasmatic nuclei (SCN) of the anterior hypothalamus which regulate a host of diverse physiologic processes from sleep, behavioural activity and appetite, through to hormone and steroid production and function, hepatic activity and renal excretion. Interference of these rhythms are associated with many pathological conditions; simple disturbances of sleep or in sleep quality results in excessive daytime sleepiness is referred to as “chrono-fatigue” or “Shift Maladaptation Syndrome,” however, increasingly more significant conditions such as cancer, metabolic syndrome, cardiovascular disease, diabetes, depression, arthritis and asthma have been recognised. The effect of shift or night work has been demonstrated for example, to effect gene expression at the level of the SCN and influences release of various hormones, protein products and cytokines. To take mental illness as an example; chronic stress as experienced by emergency or regular night work has been shown to reduce Brain Derived Neurotrophic Factor (BDNF), which provides feedback from the periphery to the SCN, and a link between chronic stress and BDNF levels with anxiety and depression in people has been demonstrated . Whilst the incidence of cancer among veterinary surgeons in general is unknown, the incidence of depression and mental disorders is above national averages.<br />
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Furthermore and importantly, to improve the clinical prognosis of any patient, the ability of the clinician, especially those where work is out-with normal hours, and almost by definition of a stressful nature, to maintain objective and rational cognitive decisions is vital in allowing correct diagnosis, implementation of appropriate therapy and avoidance of medical error. Unsurprisingly, cognitive function is most efficient when well rested. Whilst fatigue can occur independently of sleep deprivation, for example during high stress periods; it often arises due to the nature of equine veterinary work and can lead to error. Diagnostic error can be categorized into 3 major groupings: no-fault, systemic and cognitive. No fault errors occur when disease is silent or atypical, systemic errors are attributed to system failures but it is in the human-factors and individual characteristics influencing cognitive and affective behaviour and decision making that is most influenced by day/night influence or chronobiology. Under conditions of stress, including fatigue, the manner in which a clinician differentiates and implements diagnostic or therapeutic protocols depends and is determined by a variety of factors and it is the summation of these factors which leads, hopefully, to one or a limited number of cognitive dispositions to respond (CDRs) and a diagnostic and therapeutic protocol (Figure 1).<br />
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<img alt="Image" class="WACImage SCX124218775" 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<span class="TextRun SCX14569474" lang="EN-US" style="font-family: "times new roman" , serif; font-size: 12pt; line-height: 19px; margin: 0px; padding: 0px;" xml:lang="EN-US">Figure 1</span><span class="TextRun SCX14569474" lang="EN-US" style="font-family: "times new roman" , serif; font-size: 12pt; line-height: 19px; margin: 0px; padding: 0px;" xml:lang="EN-US">:</span><span class="TextRun SCX14569474" lang="EN-US" style="font-family: "times new roman" , serif; font-size: 12pt; font-weight: bold; line-height: 19px; margin: 0px; padding: 0px;" xml:lang="EN-US"> </span><span class="TextRun SCX14569474" lang="EN-US" style="font-family: "times new roman" , serif; font-size: 12pt; line-height: 19px; margin: 0px; padding: 0px;" xml:lang="EN-US">CDR determining factors and actions.</span><span class="TextRun SCX14569474" lang="EN-US" style="font-family: "times new roman" , serif; font-size: 12pt; line-height: 19px; margin: 0px; padding: 0px;" xml:lang="EN-US"><span class="NormalTextRun SCX14569474" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: inherit; margin: 0px; padding: 0px; user-select: text;"> From </span><span class="SpellingError SCX14569474" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: inherit; background-image: url("data:image/gif; background-position: left bottom; background-repeat: repeat-x; border-bottom: 1px solid transparent; margin: 0px; padding: 0px; user-select: text;">Henriksen</span><span class="NormalTextRun SCX14569474" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: inherit; margin: 0px; padding: 0px; user-select: text;"> </span></span><span class="TextRun SCX14569474" lang="EN-US" style="font-family: "times new roman" , serif; font-size: 12pt; font-style: italic; line-height: 19px; margin: 0px; padding: 0px;" xml:lang="EN-US">et al</span><span class="TextRun SCX14569474" lang="EN-US" style="font-family: "times new roman" , serif; font-size: 12pt; line-height: 19px; margin: 0px; padding: 0px;" xml:lang="EN-US"> (2005). Advances in Patient Safety: From Research to Implementation</span><span class="EOP SCX14569474" style="font-family: "times new roman" , serif; font-size: 12pt; line-height: 19px; margin: 0px; padding: 0px;"> </span></div>
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<span class="EOP SCX14569474" style="font-family: "times new roman" , serif; font-size: 12pt; line-height: 19px; margin: 0px; padding: 0px;"><br /></span></div>
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<div class="Paragraph SCX47621466" paraeid="{fded279b-0de1-433e-b66c-f6a6934b9b1a}{251}" paraid="1687280613" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span style="font-family: inherit;"><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">As highlighted there are a number of determinants of CDR</span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">s but they largely fall into 3 </span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">groupings: ambient conditions, past experience and </span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">impact of affective state, and </span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">arguably all three can be influenced by chronobiology. For example; temperature, activity level, motivation and other variables that may a</span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">ffect clinical performance are </span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">influenced by diurnal phase in many individual</span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">s</span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB"><span class="NormalTextRun SCX47621466" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: inherit; margin: 0px; padding: 0px; user-select: text;">. Premenopausal women may be subject to </span><span class="SpellingError SCX47621466" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: inherit; background-image: url("data:image/gif; background-position: left bottom; background-repeat: repeat-x; border-bottom: 1px solid transparent; margin: 0px; padding: 0px; user-select: text;">infradian</span><span class="NormalTextRun SCX47621466" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: inherit; margin: 0px; padding: 0px; user-select: text;"> mood v</span></span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">ariations</span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">, circannual influences such as winter</span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB"> darkness can exert a negative </span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">influence on affective state, and the ci</span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB"><span class="NormalTextRun SCX47621466" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: inherit; margin: 0px; padding: 0px; user-select: text;">rcadian </span><span class="SpellingError SCX47621466" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: inherit; background-image: url("data:image/gif; background-position: left bottom; background-repeat: repeat-x; border-bottom: 1px solid transparent; margin: 0px; padding: 0px; user-select: text;">dys</span><span class="NormalTextRun SCX47621466" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: inherit; margin: 0px; padding: 0px; user-select: text;">-synchronicity that </span></span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">results from shift work, common in equine veterinary medicine, can pr</span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">edispose to </span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">depressive-like symptoms. These vario</span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">us influences are collectively </span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">referred to as </span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; font-style: italic; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">affective dispositions to respond</span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB"> (ADRs) an</span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">d compromise cognitive control </span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">and therefore the efficacy of c</span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">linical decision making (Table 1</span><span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB">):</span><span class="EOP SCX47621466" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;"> </span></span></div>
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<div class="Paragraph SCX47621466" paraeid="{fded279b-0de1-433e-b66c-f6a6934b9b1a}{254}" paraid="1722647767" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX47621466" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB"><span style="font-family: inherit;">Table 1: Potential Chronobiological Influences on Affective Dispositions to Respond</span></span></div>
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<span style="font-family: inherit;"><span class="TextRun SCX14569474" lang="EN-GB" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; color: windowtext; line-height: 20px; margin: 0px; padding: 0px; user-select: text;" xml:lang="EN-GB"><span class="NormalTextRun SCX14569474" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: inherit; margin: 0px; padding: 0px; user-select: text;"></span></span><span class="EOP SCX14569474" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; color: windowtext; line-height: 20px; margin: 0px; padding: 0px; user-select: text;"> </span><span style="background-color: transparent;">1. Specific affective biases in decision making </span></span></div>
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<span style="font-family: inherit;">2. Endogenous affective disorders within the clinician </span></div>
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<span style="font-family: inherit;">• Depressive disorders </span></div>
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<span style="font-family: inherit;">• Anxiety disorders </span></div>
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<span style="font-family: inherit;">• Manic disorders </span></div>
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<span style="font-family: inherit;">3. Emotional dysregulation in clinicians </span></div>
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<span style="font-family: inherit;">• Unconscious defences, avoidance, anxiety </span></div>
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<span style="font-family: inherit;">• Emotional involvement or detachment </span></div>
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Adapted from Henriksen et al (2005). Advances in Patient Safety: From Research to Implementation. </div>
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Long hours of work, sleep deprivation, stress and accumulated sleep debt are common in the equine veterinary workplace. Generally, the longer people stay awake, the sleepier they become and their cognitive and psychomotor performance is impaired reaching its nadir between 3-4 am when cognitive performance is the equivalent of being intoxicated. This brings in to sharp focus veterinary actions to perform intricate surgery, or make life-influencing decisions, during those hours or, perhaps suggesting that postponement to daylight hours is preferential. </div>
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There has long been an association between sleep deprivation and medical error, and was found to have the greatest impact on diagnostic error with interns making substantially more serious errors when they worked frequent shifts of 24 hours or more than when working shorter shifts. This was supported in later studies which also identified additional effects including a higher predisposition to road traffic accidents, a highly relevant finding for the ambulatory vet. </div>
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Interestingly people are recognized as demonstrating different chronotypes, with their sleep-wake cycle to the light-dark cycle differing between individuals. This is generally expressed as “larks” for early chronotypes and as “owls” for late ones and can be quantified perhaps suggesting the possibility of selecting people more suited to certain shifted roles. </div>
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Whilst a number of chemical aids have been used to alleviate fatigue and psychophysiological performance their effects were limited and more work needs to be directed at management with preventative strategies and protocols implemented to reduce the potential for diagnostic error addressing both CDRs and ADRs. These may include heightened metacognition, simulation training and development of cognitive forcing strategies but could just as well be asking for a few more hours in bed. </div>
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Ben Sturgeon</div>
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BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com2tag:blogger.com,1999:blog-660472546411319075.post-76003142395835220022017-03-08T05:47:00.000-08:002017-03-08T05:47:13.146-08:00How do you know you exist?The short answer is you don’t. But is very clear that each of us tends to have a robust experience and sense that “I exist.” In the latest Veterinary Record (180(7):165) a study is presented examining the potential benefits of exercise in stress relief. You can almost certainly predict the results and whilst I in no way belittle a novel approach, I believe it goes far deeper than a simple biological saturation with endorphins.<br />
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I was asked, in an interview, several years ago, why did I think vets, including myself, undertook extreme sports during their down time? I answered it was because of their type A personality but knew that answered nothing other than incorrectly associating cause and causality.<br />
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Interestingly there is a neuropsychological condition called Cotard’s syndrome, where people are convinced they do not exist. It has been shown that in such people, brain scans demonstrate that activity in the area of the brain associated with internal awareness is low. Down even to levels seen in people who are minimally conscious and so creating a perception of non-existence.<br />
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In the deeply claustrophobic world of depression, a plight suffered by many and seemingly increasing numbers of vets, there is often a feeling of non-existence. A living state of existence without value, existence without recognition, existence without self.<br />
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I know that going for a run, no matter how endorphin inducing, does little to remove this core feeling, and it is in my view crass to suggest to a sufferer to “go for a run.” Extrapolating from Cotard’s however suggests that by creating a vivid perception of our body and its various states, our brain also generates the feeling of existence of self, a vital sense of worth that may aid in a simple but vital step toward improvement.<br />
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But is not just perception of our bodies, it could be perception of spaces, of environments, of countryside, of people, music, art, food, science, dance….. Anything that reawakens the mind and person to their existence as a vital and necessary human being. Whilst the need for recreation and escapism will always exist, whilst exercise is a valid aspect of therapy, don’t forget or ignore that the variety of life may be all you need to remember and remind you that you do truly exist.<br />
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Ben SturgeonBEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com0tag:blogger.com,1999:blog-660472546411319075.post-6565364439637933392017-02-23T06:32:00.000-08:002017-02-23T06:32:28.560-08:00The problem with Women…I think I’ve finally figured it out. Why women are always late. Or at least why I’m almost always late or rushing not to be late. It all comes down to the difference between men and women, and how their brains are wired up. This startling revelation (to me at least) has taken me two children, three dogs, one husband and at least twenty years of multi-tasking (albeit badly) to work out.<br />
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Take for example one of my super busy, successful parent friends from school. We were all rushing around last week trying to shepherd unruly 5 year olds into their swim class (which involves somehow getting the most awkward plastic bright green swim hats onto them without causing tears) when she realised she didn’t have to rush off as usual to pick one of her three boys up as her husband was (unexpectedly) home early. She paused for all of 60 seconds before rapidly re-calculating what she could do with the unforeseen “spare” 20 minutes in her day. She worked out that she could either fill the car with fuel or pop into the supermarket on her way home, thus saving a job for the following day and freeing up more time…to fill again. Maybe we need to learn to use “spare” time to catch a breath instead?<br />
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Another friend (male this time and a successful business man) agrees that we approach things differently. He is forever telling me to “cut the waffle” – apparently I could say everything I need to in an email in half of the words. So what I perceive as a blunt or impersonal message seems to be viewed as assertive and to the point by the men who receive it. I will admit that this has made me re-think how I approach my emails. Don’t get me wrong, I still write long, chatty messages to my girl friends but my BEVA emails are thankfully getting shorter and more succinct. And I’m trying not to read into the tone of text and emails…it is so much better to pick up the phone than second guess a written (often in haste) message.<br />
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The same friend also pointed out another reason for my ever-increasing workload. I’m too impatient. If his wife asks him to do a job, she expects it done in five minutes. If he procrastinates, she gets on and does it herself. How many times have we muttered to ourselves “I would be quicker doing it myself” and then borne a slow burning grudge of resentment? Men are the cleverer (or lazier?) species here…they have worked out if they take 15 minutes to procrastinate then their female partners will probably do it for them by minute 10. I guess this is a little like chess…and I need to learn to delegate and be more patient.<br />
<br />
And finally I’m easily distracted. Performance coach Andy McCann presented a really thought-provoking plenary lecture at the VMPA/SPVS congress recently. According to a University of Pennsylvania study, male and female brains are wired differently: male brains are wired front to back with few connections bridging the two hemispheres. Women’s have pathways criss-crossed between left and right. So whilst men are better at learning and performing a single task, women are equipped for multi-tasking. But I’m sure it’s only multi-tasking when you are actually performing each task efficiently. I may think I’m multi-tasking listening to a podcast whilst typing an email and eating lunch but I’m sure I’m not doing any efficiently. Perhaps I need to think more like a man and focus on one job at a time. And then I might actually listen to what my husband and dad say?!<br />
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I came across this lovely story when researching time management and effective multi-tasking<br />
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<b>“Rocks, Pebbles and Sand – The important things in life”…</b><br />
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A philosophy professor stood before his class with some items on the table in front of him. When the class began, wordlessly he picked up a very large and empty mayonnaise jar and proceeded to fill it with rocks, about 2 inches in diameter.<br />
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He then asked the students if the jar was full. They agreed that it was.<br />
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So the professor then picked up a box of pebbles and poured them into the jar. He shook the jar lightly. The pebbles, of course, rolled into the open areas between the rocks.<br />
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He then asked the students again if the jar was full. They agreed it was.<br />
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The professor picked up a box of sand and poured it into the jar. Of course, the sand filled up everything else.<br />
<br />
He then asked once more if the jar was full. The students responded with a unanimous “Yes.”<br />
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“Now,” said the professor, “I want you to recognize that this jar represents your life. The rocks are the important things – your family, your partner, your health, and your children – things that if everything else was lost and only they remained, your life would still be full.<br />
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The pebbles are the other things that matter – like your job, your house, your car.<br />
The sand is everything else. The small stuff.”<br />
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“If you put the sand into the jar first,” he continued “there is no room for the pebbles or the rocks. The same goes for your life.<br />
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So if we multi-task and fill every minute trying to get “stuff done” we may miss the important things in life. As my Dad keeps reminding me “Never get so busy making a living that you forget to make a life”….or the rather priceless “you must find time to sit on you’re a*^e and contemplate”.<br />
<br />
Vicki Nicholls<br />
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BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com6tag:blogger.com,1999:blog-660472546411319075.post-13474879913021648942017-02-06T07:01:00.000-08:002017-03-09T06:16:29.671-08:00Booze<div class="OutlineElement Ltr SCX112408569" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-family: "Segoe UI", Tahoma, Verdana, sans-serif; font-size: 8px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;">
<div class="Paragraph SCX112408569" paraeid="{27735eb0-ebbb-4a35-ba6b-68255a642ace}{140}" paraid="1798576193" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">I’ll let you decide and by the end perhaps we’ll disagree? I’m not an alcoholic, m</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">aybe that’s the first sign I am. </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> I’m not because I know full well the how and the why it happened and I know what to do to stop.</span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="Paragraph SCX112408569" paraeid="{27735eb0-ebbb-4a35-ba6b-68255a642ace}{159}" paraid="652611746" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">There are many vets who accept that complaints, legal accusations and professional questions are just part of the job. They accept it as part of the 9 to 5 an</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">d move on. I’m not one of them.</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> I wish I was, but each questioning accusation or each occasional loss of a client I take personally. So much so I question every action I made in the lead up to that moment. </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">An introspection</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">, a self-examination, a dissection of my personality. </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> It always results in the same conclusion</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">, “I could have done better.” But you know what? It</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> actually</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> doesn’t end there. “I could have done better, I could have been more thorough, I could have been more professional, </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">I</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> could have been a better person.” It is this spiral</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">, </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">the snakes and ladders lifestyle of an equine </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">vet</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">that</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> gives us a profession of ozone rich high and calamitous methane lows. </span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="Paragraph SCX112408569" paraeid="{27735eb0-ebbb-4a35-ba6b-68255a642ace}{164}" paraid="1710743766" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">We are trained to review and evaluate, it is a clinical skill, but it often leaves us feeling that we don’t know enough, didn’t do enough, or now</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> and most fundamentally</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">, do not matter enough.</span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="Paragraph SCX112408569" paraeid="{27735eb0-ebbb-4a35-ba6b-68255a642ace}{174}" paraid="1010223466" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">The spiral can continue, “</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">is</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> my professionalism sufficient, am I on</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">e of the misguided who should leave</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> the profession to ultimately respect </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; font-style: italic; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">primum</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; font-style: italic; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> non noncore</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">, is it right I leave my family in a potentially parlous situation based upon my wit or lack of, to survive in this velvet glove world of cloak and dagger?”</span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="Paragraph SCX112408569" paraeid="{27735eb0-ebbb-4a35-ba6b-68255a642ace}{179}" paraid="460369271" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">Booze usually starts as a quiet tipple. The </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">end of the night wind</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> down. But for me, when staring into the abyss that is my inner reflection, conscience and consideration of my soul and core, booze becomes a way of shutting out that clarion call of a brain screaming at you – “you’re not bloody good enough!”</span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">I first recognised this at university. </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">4</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 8.5pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"><span class="NormalTextRun SCX112408569" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: inherit; margin: 0px; padding: 0px; user-select: text; vertical-align: super;">th</span></span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> year and exams at the end of every subject or every 4-6 weeks.</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> Each and every one counted towards finals and </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">the </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">questions we sat in the exam were the very same we had been taught only the previous day.</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> This may be the norm now but at the time we were the first year to try this, the guinea pigs and no one knew how it would go.</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> At the end of the first term one friend was in hospital due to stress</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">, another on anti-depressant</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">s</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">. I and most other students hit the bars. </span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="Paragraph SCX112408569" paraeid="{27735eb0-ebbb-4a35-ba6b-68255a642ace}{212}" paraid="411239077" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">Second term was more of the same only this time the end of night collapse into bed and finding of anxious sleep was eased by Vodk</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">a. </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">A</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> bottle or two a week,</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> a method of escape by any means.</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> Luckily within a couple </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">of months I realised the</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">un</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">healthy </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">spiral </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">and made the active decision</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> not to loose sleep over exams, not to base my health on success or failure. I decided that if I failed, I failed</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">, s</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">o</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> be it. Better that attitude than succumb to further booze or follow my colleague into hospital. Luckily, thankfully or perhaps deservedly I passed and my attitude continued to final year exams with the same results.</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> In fact excelling and achieving University recognition.</span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="OutlineElement Ltr SCX112408569" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-family: "Segoe UI", Tahoma, Verdana, sans-serif; font-size: 8px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;">
<div class="Paragraph SCX112408569" paraeid="{27735eb0-ebbb-4a35-ba6b-68255a642ace}{216}" paraid="269543605" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">Time passes and we each gain experience and responsibility. Sometimes both are thrust upon us without a desire to receive but it is part of “the job.” Booze hit me again 10 years later due to an RCVS investigation. Forgive me for not supplying details suffice to say I was not fraudulent, not lying, </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">not unethical, merely naïve. It was ultimately thrown out but the process led to the soul searching each of us does in that situation.</span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="OutlineElement Ltr SCX112408569" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-family: "Segoe UI", Tahoma, Verdana, sans-serif; font-size: 8px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;">
<div class="Paragraph SCX112408569" paraeid="{27735eb0-ebbb-4a35-ba6b-68255a642ace}{223}" paraid="321427859" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">I remember the letter and I physically shook for 5 days. Whilst the physical manifestation went, the emotional burden that availed me lasts to this day and during the 18 months it took to resolve I regularly found solace in the bottle. </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">Wh</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">iskey this time.</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> A</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">t it’s worst, half a bottle a night.</span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="Paragraph SCX112408569" paraeid="{27735eb0-ebbb-4a35-ba6b-68255a642ace}{228}" paraid="1915316225" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">I wasn’t an alcoholic, I didn’t wait for opening time or dive into it the moment I went home but used it only to </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"><span class="SpellingError SCX112408569" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: inherit; background-image: url("data:image/gif; background-position: left bottom; background-repeat: repeat-x; border-bottom: 1px solid transparent; margin: 0px; padding: 0px; user-select: text;">bestill</span></span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> a mind that shouted even though my personality became mute.</span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="OutlineElement Ltr SCX112408569" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-family: "Segoe UI", Tahoma, Verdana, sans-serif; font-size: 8px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;">
<div class="Paragraph SCX112408569" paraeid="{27735eb0-ebbb-4a35-ba6b-68255a642ace}{233}" paraid="135917209" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">I was lost </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">in a morass of mental doubt </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">at this point and couldn’t see the dangers. Out of hours were worst because of the quiet when all you have for company is your mind.</span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="OutlineElement Ltr SCX112408569" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-family: "Segoe UI", Tahoma, Verdana, sans-serif; font-size: 8px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;">
<div class="Paragraph SCX112408569" paraeid="{27735eb0-ebbb-4a35-ba6b-68255a642ace}{243}" paraid="299298511" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">Ultimately and with a slow return to self I recognised the behaviour. </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">Perhaps this is the moral or the kicker or where we’ll agree to disagree but </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">I didn’t and still do not consider the behaviour wrong, I needed something to alleviate the mental pain and it did. This is not wrong but a normal human behaviour to seek respite from a stressor. Some may drink, some </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">take </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">drugs, </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">some</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> seek physical contact, some self flagellate through physical pain. All are simply human reactions.</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> </span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="OutlineElement Ltr SCX112408569" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-family: "Segoe UI", Tahoma, Verdana, sans-serif; font-size: 8px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;">
<div class="Paragraph SCX112408569" paraeid="{128557d9-1bfb-4a30-80a5-30114da66cdd}{1}" paraid="2077377795" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">What, of course, we should do is seek help in a non-damaging way. </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">Through spouse or partner support, through counselling, through</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">friends and professional aid.</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> But at that p</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">oint, when your brain is ablaze and your inner voice is in conflict, </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">you don’t think straight, you don’t rationalise,</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> you look for respite,</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">I</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> reached for the bottle.</span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="OutlineElement Ltr SCX112408569" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-family: "Segoe UI", Tahoma, Verdana, sans-serif; font-size: 8px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;">
<div class="Paragraph SCX112408569" paraeid="{128557d9-1bfb-4a30-80a5-30114da66cdd}{6}" paraid="1229964144" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">Ultimately I sought counselling to allow me to understand and hence control my </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">emotions and </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">actions. Even when the case was dismissed I continued to question even more if I wanted to remain as a vet in a profession which would or could expose me to such torment apparently without empathy or personal consideration.</span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="OutlineElement Ltr SCX112408569" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: white; clear: both; cursor: text; direction: ltr; font-family: "Segoe UI", Tahoma, Verdana, sans-serif; font-size: 8px; margin: 0px; overflow: visible; padding: 0px; position: relative; user-select: text;">
<div class="Paragraph SCX112408569" paraeid="{128557d9-1bfb-4a30-80a5-30114da66cdd}{15}" paraid="1074041580" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">That is why I carry it today, waiting perhaps for the next circumstance or s</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">hift in luck for the pendulum and sword of</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> Damocles to sway back again. I hope this time I’ll be better equipped to avoid the pitfalls. Perhaps I will, perhaps I won’t. Sadly I know I won’t</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">, it is partly my nature,</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> but I will </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">k</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">now it is damaging and the phase will be short.</span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span></div>
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<div class="Paragraph SCX112408569" paraeid="{128557d9-1bfb-4a30-80a5-30114da66cdd}{24}" paraid="1203295640" style="-webkit-tap-highlight-color: transparent; -webkit-user-drag: none; background-color: transparent; color: windowtext; padding: 0px; user-select: text; vertical-align: baseline; word-wrap: break-word;">
<span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">There by the Grace of God go I and we should all be mindful of the situation of others, do out best to recognise, and do our </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">best to empathise. Sympathy,</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> understanding</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> and support</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> </span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB">is</span><span class="TextRun SCX112408569" lang="EN-GB" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;" xml:lang="EN-GB"> all anyone would ask for and it is in the power of all of us to provide it.</span><span class="EOP SCX112408569" style="font-family: "calibri" , sans-serif; font-size: 11pt; line-height: 20px; margin: 0px; padding: 0px;"> </span><br />
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<span style="font-family: Verdana, sans-serif; font-size: 10pt;">If you have been affected by this story or want to talk
confidentially about this or a similar subject then contact Vetlife here <a href="https://www.vetlife.org.uk/">https://www.vetlife.org.uk/</a><o:p></o:p></span></div>
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BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com5tag:blogger.com,1999:blog-660472546411319075.post-48849524814363475482016-12-22T03:44:00.000-08:002016-12-22T03:44:27.732-08:00What is the ethos of BEVA's MumsVet?<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Calibri",sans-serif; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Yesterday I
had a frank conversation with a veterinary colleague and (male) friend about
MumsVet. It was a really thought-provoking and interesting chat as always and I
was reminded to be mindful that there are always two sides of every argument.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Calibri",sans-serif; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">MumsVet was
a concept developed by four female equine vets (our brilliant male committee
member joined us later on…) to tackle the headaches and challenges posed by our
jobs as equine veterinary surgeons. Despite a huge amount of advice on
government websites and the like on safe working in pregnancy the equine field
poses its own unique challenges that have historically relied on anecdotal
advice from a “phone a friend” network.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Calibri",sans-serif; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">MumsVet was launched
to provide a support network and one-stop shop for advice and resources for
Mums and Dads…and the colleagues that invariably end up stepping in to help
support them. But what about employers? How does a pregnant assistant affect an
equine veterinary business? Has anyone stopped to consider the effect of
multiple maternity leave (s) on the on call rota of a small equine practice? My
friend has had his fair share of assistants on maternity leave so knows the
score in terms of ensuring his assistants are supported through pregnancy and
maternity leave but realistically how does this affect his practice? We are all
acutely aware of the fickle nature of equine clients and their “preferred vet”
and the long process of ensuring a new member of the team is accepted by all of
the equine clients, but what happens when two members of our team simultaneously
announce they are pregnant? Suddenly the remaining vets (and often the long
standing and already over worked assistants and partners?) have to shoulder the
responsibility of calls because the client “won’t have anyone else”. Is this a
problem of our own making? <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Calibri",sans-serif; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "MS Gothic"; mso-fareast-theme-font: major-fareast; mso-hansi-theme-font: major-latin;">Additionally,
what happens when a prospective partner in your practice suddenly announces
that she’s pregnant? Where does that leave you in terms of staff/budget/client
complaint/workload responsibility for the next 9 (if you are lucky) months? How
many potential partners do equine vet practices lose to motherhood? There are
clearly some notable exceptions (and none other than our remarkable BumpVet
blogger and her amazingly supportive practice) but what happens to private
practice owners if the female vets all get pregnant and decide to work part
time. Is this a feasible option or is corporate equine practice the only
answer? Who is fighting the (male?) senior partner corner? <o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: "Calibri",sans-serif; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">The answer
is BEVA MumsVet. Scratch beneath the slightly misleading name (we liked it and Family
Vet just didn’t have the same ring to it) and look at all of the inspiring real
life stories, podcasts and resources. Part time working CAN work in practice
and if employers embrace the concept of flexible working then they will
hopefully be rewarded by experienced, hard working parents who are happy in
their jobs and willing to give 100% effort albeit not full time in a
traditional 8-6 role. There are plenty of people </span><span lang="EN-US" style="font-family: "Calibri",sans-serif; font-size: 11.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Times; mso-hansi-theme-font: major-latin;">who
have the experience and WANT to stay in the profession but is it possible to
combine equine practice with family life?
A debate at BEVA congress 2015 which asked, "does equine practice
need to change to be compatible with family life" showed 92% of the
delegates voting in favor of the motion. This was reiterated by the 2016 BEVA
congress session about alternative careers where Anna Hammond discussed the
benefits of part time working... But how can we help employers?!<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<span lang="EN-US" style="font-family: "Calibri",sans-serif; font-size: 11.0pt; mso-ansi-language: EN-US; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: major-bidi; mso-fareast-font-family: "MS Gothic"; mso-fareast-language: EN-US; mso-fareast-theme-font: major-fareast; mso-hansi-theme-font: major-latin;">MumsVet
was created both to support employees (mums AND dads) but also employers and we
must not lose sight of that. Employers (and specifically small businesses) have
a tough time with logistics when considering maternity leave/pregnancy health
and safety issues/employing the right vet too. We aren't talking about the
multi-national businesses here like Apple and Google; pregnancy/maternity OR
paternity leave and the ramifications of covering the subsequent work load with
our demanding equine clientele are a really difficult task. We must absolutely
support our pregnant equine vets (and those on maternity and paternity leave)
but spare a thought for the employers as well. If we want to continue the
"family feel" of independent equine practices rather than the
cooperate feel of "VetsRus" small animal comparisons then we
absolutely need to work together. Part time vets have benefits for employers
too (a full share of the OOH rota means everyone does less on-call for
instance) so we need to look at opportunities rather than threats of flexible
working. BEVA is mindful of supporting ALL of our members as feminization of
our profession increases. We are currently working on a "BEVA
family-friendly practice" toolkit to support employers and employees and
would welcome member comments on this blog or to mumsvet@beva.org.uk </span>BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com2tag:blogger.com,1999:blog-660472546411319075.post-41392186461366303302016-12-09T08:11:00.002-08:002016-12-09T08:11:28.767-08:00Maslow’s Hierarchy Part 2 – Your RoleThis may be a philosophical view point but in essence I can only describe my personal view on trying to scale the pyramid. As suggested each of us will have a different emphasis and this will depend on stage of life, life experience, and any on any ascertained goals or desires. Whilst this may not be exclusively relevant to veterinary life I hope my view could be translated, bits poached or indeed rejected as fanciful by anyone.<br />
<br />
<br />
In describing Maslow’s hierarchy I fairly firmly placed the emphasis on how the job or your employers can empower or provide an environment for personal and professional growth. In an altruistic environment this would be ideal but as we know and have experiences of, vet practices are not necessarily geared towards the actual vet. Richard Branson coined perhaps an idealistic view of his companies by saying “you need to train someone so well that they could leave, but look after them better so that they won’t.” If only. But if this isn’t the case, what should you do to keep striving?<br />
<br />
There is a book by Rhonda Byrne called “The Secret” which highlights the Law of Attraction. This suggests that we all have the ability to acquire whatever it is that we want as long as we go about it the right way. I’m always extremely dubious of psychobabble but increasingly have the view that my actions, in combination with the right preparation, understanding and conditions means that reaching a defined goal can be achieved or at least pulled a little bit closer. I’ll give you another quote, this time from Henry Ford, “whether you think you can or you can’t, you’re right.”<br />
<br />
<br />
In any practice, as a team member, you have a big contribution to make. You could define it specifically – conditions to understand, clients and colleagues to communicate with, drugs to order etc. But it is far simpler than that. A true team member will be someone whose behavior feeds positive energy. A strong belief in your ability to get “the job” done will allow you to be assertive, decisive, patient, reflective and supportive.<br />
<br />
Your thinking will be empowered and you will find yourself in a position to move forward. Let me give you an example to mull over. In 1954 Roger Bannister broke the 4 minute mile. Medics claimed that running at such speed would make a persons’ heart explode. When Bannister broke the record in1954, thirty seven did it in 1955, and over two hundred in 1956. Belief was all it took.<br />
<br />
Again, I hear you shout, what has this to do with the practicality of veterinary life? The answer is in “challenge.” The challenge to attain a better salary, to attain a directorship, to attain a certificate…… That challenge to you should be the challenge to everyone around you. A mutually beneficial relationship of worthy colleagues, substantial people, and recognized characters who gain from their investment in a positive, motivated you and you from them. You work openly toward your defined goal with honesty and positivity, and your associates aid you in that pathway reaping the benefits you bring.<br />
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<br />
It is true that such relationships can be hard to find, or be easy to lose and that any relationship is dynamic and the nature of give and take can change. Ultimately your input into the role and the output you receive may run its course. This is not failure, but simply a natural conclusion and it is, nor should be, a reflection on either party so long as effort and respect was maintained. Things will not always go to plan but these “things” are often outside of our control and influence. Losing sleep over them will simply make you tired.<br />
<br />
<br />
The essence of the amble is this: allow yourself to be successful. Set a goal that is worthwhile to you, a goal that will stretch you while still being attainable, and that by reaching that goal you’ll be recognized as a more valuable person by your colleagues and more importantly by you. Relax the “have to” achieve thought process and change it to “allow yourself” to achieve.<br />
<br />
Ben SturgeonBEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com0tag:blogger.com,1999:blog-660472546411319075.post-88468624283232944552016-12-06T06:29:00.001-08:002016-12-06T06:29:10.351-08:00What is a good job? Fulfilling your hierarchy (Part One)It is not uncommon to be asked “why did you become a vet?” And with a certain exasperated sigh and life flashing before the eyes thousand mile stare, your answer will be stock: “I care about animals.” When perhaps really what you actually meant was “all those years ago, I did care about animals, science and medicine excited me, knowledge excited me, I thought the money would be good, vets drove a good car, and…….. there was a certain level of kudos.”<br />
<br />
But when asked 10 to 20 years later, you realise it was all smoke and mirrors. You still do care about animals. But do they care about you? Do they **$!<br />
<br />
Almost every survey on the veterinary profession returns depressing figures of poor job satisfaction, and with it the unedifying relationship with mental health. In any other profession, this would and should not just set alarms bells ringing but call in the fire brigade.<br />
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<br />
In 1943 an American psychologist Abraham Maslow presented the theory that human actions are directed toward goal attainment (“A Theory of Human Motivation”). This is a theory of psychological health predicated on fulfilling innate human needs in priority, starting from mere physiological subsistence, to belonging to a social circle, eventually in pursuing your talent and culminating in self-actualization.<br />
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<br />
Maslow’s Hierarchy of Needs has often been represented in a hierarchical pyramid with five levels. The base levels are considered physiological needs, while the top levels are considered growth needs. Vitally, any lower level needs must be satisfied before higher-order needs can occur, and if the deficiency needs aren't satisfied, the person will feel the deficit, with potential clinical results, and this will stifle his or her development.<br />
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* Physiological – air, food, water, sex, sleep.<br />
* Safety – security of environment, employment, resources, health, property.<br />
* Belongingness – love, friendship, intimacy, family.<br />
* Esteem – confidence, self-esteem, achievement, respect.<br />
* Self-actualization – morality, creativity, problem solving.<br />
<br />
When Maslow's hierarchy is applied to work situations, it implies that managers/partners/directors have the responsibility, firstly, to ensure the deficiency needs are met. This means, in broad terms, a safe environment and proper wages. Secondly, it implies creating a proper climate in which vets can develop their full potential. Failure to do so often results in frustration, poor performance, low job satisfaction, and increased withdrawal from the organization and even within the individual. Achieving it would mean the reverse; a motivated, engaged and happy vet and the practice would be regarded as a more considerate, supportive and interested organisation.<br />
<br />
Importantly good leaders/managers need to have this level of understanding if they are to be in a position to motivate. And to be a good leader and manager you need to recognise that people are different and at different stages in their development or hierarchy. Some people come to work to earn money (existence needs) but have no desire either to get on with others (belongingness needs), or earn promotion (growth needs). Others work to meet people and have a personal challenge and sense of achievement (belongingness needs). Others work to gain experience to get promotion (growth needs). For others, it may be a combination of these. How you go about influencing or motivating these needs is up to you and depends upon the person. For example, existence needs may mean simply paying someone enough, belongingness needs may be improved communication, recognition and praise; and growth needs may be training, encouraging creativity, involvement in practice decisions, new challenges etc.<br />
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<br />
So to return to the title – “what is a good job?” A good job is one which satisfies your needs. Your needs at the time and your potential needs as you develop.<br />
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Ben SturgeonBEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com0tag:blogger.com,1999:blog-660472546411319075.post-86289595329119701352016-11-30T02:26:00.003-08:002016-11-30T02:26:37.741-08:00The Five Freedoms: Useful Facts? Or Just Words?I have a new word for you, “hyper-normalisation”, well maybe not that new (Alexei Yurchak 2006, Everything was Forever, Until it was No More: The Last Soviet Generation) but describes a failing system, a system everyone knows is failing, but as no one can imagine any alternative, the “pretence” of normality is maintained. Over time, this delusion becomes a self-fulfilling prophecy and the “fakeness” is accepted as real.<br />
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In 1965, the UK government commissioned an investigation, led by Prof Roger Brambell, into the welfare of intensively farmed animals, partly in response to concerns raised in another book, this time by Ruth Harrison (Animal Machines 1964). The outcome of the report were the five freedoms:<br />
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Freedom from thirst, hunger and malnutrition<br />
– By ready access to a diet to maintain full health and vigour<br />
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Freedom from thermal and physical discomfort<br />
– By providing a suitable environment including shelter and a comfortable resting area<br />
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Freedom from pain, injury and disease<br />
– By prevention or rapid diagnosis and treatment<br />
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Freedom from fear and distress<br />
– By providing sufficient space, proper facilities and the company of the animal’s own kind<br />
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Freedom to express normal behaviour<br />
– By ensuring conditions which avoid mental suffering<br />
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These five freedoms have been adopted world wide and also form the basis of two key pieces of animal welfare legislation in the UK, The Protection of Animals Act 1911 which states “to cause unnecessary suffering by doing, or omitting to do any act and” The Animal Welfare Act 2006 which goes further by introducing a “duty of care” not only to avoid conditions, that may lead to suffering, but also to promote positive welfare.<br />
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The sharp among you will note that five freedoms are, in fact eleven and importantly are all outcome measures. The freedoms are not legal precedents either but only represent an ideal or a kind of check list to assess the quality of a husbandry system, realistically the definition “freedom from” should perhaps be interpreted as “free as possible from.” Furthermore the five freedoms cannot really capture the current knowledge of biological processes or predisposing situations which may affect welfare, especially in horses.<br />
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A simple example of this would be in the failure of the freedoms to address the potential for long-term problems. Fulfilling freedom from hunger or freedom from thermal and physical discomfort or freedom from pain, injury and disease highlights the shortfall possibilities of a stabled horse. In such circumstances horses will experience periods of effective starvation (usually overnight) as well as generally receive concentrate high energy feed and by nature of their confinement, be exposed to potentially harmful air spaces. Furthermore, a comparison between feral and stabled horses shows feral horses spend 60% of their time eating, 10% lying, 20% standing and 10% in other activities, whilst stabled horses eat 15%, lie 15%, and stand 65%. This is a clear change in normal behaviour as well as potentially predisposing to long term health issues such gastric ulceration, abdominal pain, various stereotypies, and inflammatory airway conditions although it could be argued that such horses receive a high level of “stable management”.<br />
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The implication is that any true “outcome-based” guidelines on welfare advice should include or consider chronic indices of a failure to cope with physical and emotional challenge.<br />
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This latter point is perhaps highlighted in the fifth freedom: Freedom to express normal behaviour. This is perhaps the most interesting or controversial because this is the only “to” freedom, the others all being “from”. The freedom “to” must bring into question what “is” normal behaviour? Freedom to roam, freedom to compromise the welfare of another horse, complete sexual freedom? Arguably a horse demonstrating behaviours relating to pain such as napping, ducking, refusing to jump, failing to yield are all “normal behaviours” yet they are in response to noxious stimuli to which a horse would unlikely present itself voluntarily. This approach however, leads to sophistry, is best avoided but has led to the evolution of the five freedoms to the Five Domains categorizing nutrition, environment, health, behaviour and mental state. The main change with the Five Domains is the acceptance that animals can express rewarding behaviour or positive experiences as well as negative ones hence determining its overall welfare status, and is the basis for the emerging science<br />
of “equitation”. It highlights for example whip use where a horse is “just being corrected” or “encouraged” and questions whether the benefit outweighs the cost? Importantly it makes us consider the things we do on the mental state of horses under our care.<br />
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Let me finish with another new word, in fact according to the news the most used word (thanks to Brexit and Trump) this year, and again from another book (Ralph Keyes 2004, Post Truth). Post-truth refers to the rebuttal of factual evidence with reliance on emotional disconnection from those facts. We as vets see the evidence of a failure to consider or uphold the timeless principles enshrined by the five freedoms; gastric ulceration, inflammatory airway disease, stereoptypies, stress fractures, tendon failures, displacement activities, laminitis to name a few. Acting as the bastions of welfare; physical and mental, is in our remit and as scientists and medics we should not ignore the information at our disposal, what is happening in front of us, nor what is factually emerging.<br />
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Ben Sturgeon<br />
BEVA Ethics and Welfare Committee MemberBEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com3tag:blogger.com,1999:blog-660472546411319075.post-41435902992241006122016-05-25T06:32:00.001-07:002016-05-25T06:32:27.009-07:00The Coming Storm? Horse Genetics and You<div style="background-color: white; color: #666666; font-family: Helvetica, Arial, 'sans serif'; font-size: 12px; margin-bottom: 10px; outline: none; padding: 0px;">
The date is significant – 6<sup style="margin: 0px; outline: none; padding: 0px;">th</sup> of May 2016, this may be the date that horse racing changed, the date equine sports medicine changed, the date that we all changed a little. What happened? The announcement by Hugo Palmer of his decision to withdraw 2000 Guineas winner Galileo Gold from the Epsom Derby was informed by the results of a genetic test.</div>
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Of course the marketing people for the test were pretty happy –</div>
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<em style="margin: 0px; outline: none; padding: 0px;">“It is not the first time that a key decision to race a horse in the Derby has been made based on a combination of traditional methods and our genetic tools.”</em><em style="margin: 0px; outline: none; padding: 0px;"><br style="margin: 0px; outline: none; padding: 0px;" /><br style="margin: 0px; outline: none; padding: 0px;" />“Hugo has a clear understanding of how to combine the scientific information with his deep knowledge and understanding of the horse to ensure it is given the optimal opportunity to perform at its best.”<br style="margin: 0px; outline: none; padding: 0px;" /><br style="margin: 0px; outline: none; padding: 0px;" />“We firmly believe that equine genetics will enhance the Thoroughbred breed by allowing owners and trainers to understand more about how to get the absolute best out of each individual horse for both racing and breeding.” </em></div>
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Whichever way you look at it, such tests are here to stay.</div>
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The modern Thoroughbred can be traced back some 300 years to the arrival, in England, of 3 stallions in the 17<sup style="margin: 0px; outline: none; padding: 0px;">th</sup> and 18<sup style="margin: 0px; outline: none; padding: 0px;">th</sup> centuries, providing the paternal genetic basis for the entire breed. The natural athleticism has been selected for, and enhanced by breeders ever since, aided by management, nutritional and environmental influences, producing the modern equine athlete. Whilst calculated environmental influences play a large role (up to 65%) on a horses’ development, a significant proportion then lies in athletic inheritance. It is however, both damning and interesting to note that winning times in the Classic Thoroughbred races, have improved little in over 100 years.</div>
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The successful mapping of the horse genome in 2007 has provided a tool for evidencing apparently desirable traits such as speed and muscle development along with detrimental genes (Webbon 2012).</div>
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<img alt="Equine Genetics Table" height="233" src="http://www.beva.org.uk/_uploads/imgpool/bsblogimage.jpg" style="border: none; margin: 0px; outline: none; padding: 0px;" width="410" /></div>
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The commercial applications are already evident in some breeds and breed societies such as Foal Immunodeficiency Syndrome in Fell and Dale Ponies, in Lavender Foal Syndrome and Combined Immunodeficiency in Arabs and perhaps most significantly, due to potential numbers involved, in Polysaccharide Storage Myopathy in a variety of sports horses. The genetic tool then would have a potential influence upon carrier identification influencing breeding &/or upon the long term environmental impact, husbandry, diet and training schedules that may occur in for example, carriers of PSSM genes. As a result, we can only hope to improve their direct welfare and reduce the potential for severe cases of homozygous matings.</div>
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This is extremely encouraging and the additional use of SNP (Single Nucleotide Polymorphism) has allowed mapping of single base variations between DNA sequences and ultimately identification of sequences within “phylogentically superior” horses that may be used as markers for their “superiority”. Most notably this has identified myostatin (MSTN) as a genetic marker and provides the thrust of commercial interest due to performance implications and was the basis for Galileo Gold’s withdrawal. </div>
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As highlighted, despite years of “trained eyes” looking over horses and selecting the best apparent traits, winning times in the Classic Thoroughbred races, have improved little. Why this is, is hard to say other than be flippant in the skill of the apparent “trained eye”. Of significance is the use of such genetic tests to influence the breeding program. Using the gene test to inform stallion selection (selecting for sprinters with homogeneous MSTN foals known as C:C) for each mare, one breeder decreased his proportion of T:T foals (those best suited to longer distances) produced from 18.0% to 6.8% in 1 year (2011), decreasing it further to 4.3% in 2 years (2012). Notably, of the 30 male foals produced in 2012, none had a T:T genotype. This speed of change is incredibly rapid when compared to simple “eye-ball” or “self-selection” breeding.</div>
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The question is are we promoting natural selection or genetic engineering and what does this mean? How will it impact on horse numbers and their treatment (especially if their “genetic blue print” is not deemed advantageous), on the acceptance of blood screening at sales for example, or in the doomsday scenario on future loss of heterogencity within the Thoroughbred breed especially, leading to more potential cases of “selected” diseases such as laryngeal hemiplegia.</div>
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Irrespective, the opportunity to breed horses with greater muscle mass will appeal with the opinion that if “we” provide the apparent best horse, the rest is up to you. This will influence practical breeding with breeders attempting to optimize progeny to a specific genotype, to breeders with foundation mares and stallions utilising genetic profiles to financial advantage, and importantly to trainers and owners in influencing sales decisions, veterinary pre-purchase examination protocols, as well as then reducing operational costs by introducing tailored exercise programmes for individual horses.</div>
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However, a genetic “result” does not make a phylum. Heritability is variable and highlights that individual differences may be attributable to genetic differences. This provided me with the dismay I felt as I heard Mr Palmers’ decision. The heritability variation makes environmental factors very important and emphasizes that the presence of a specific gene or variant, with its proposed advantages, is specific to a particular population in a specific environment and emphasizes the continuing need for appropriate veterinary advice on training, environmental and disease modification aspects.</div>
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Interestingly, the heritability of complex diseases are or have also been elucidated:</div>
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• Rhabdomyolysis 0.43</div>
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• Laryngeal hemiplegia 0.23 – 0.61</div>
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• Osteochondrosis 0.24 – 0.52</div>
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• Recurrent Airway Obstruction 0.30</div>
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• Behavioural traits 0.23 – 0.28</div>
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• Conformational traits 0.16 – 1.00</div>
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and again these are becoming part of the overall “genetic assessment”, based on a blood sample with increased cost, but should highlight that such conditions <em style="margin: 0px; outline: none; padding: 0px;">do not</em> or <em style="margin: 0px; outline: none; padding: 0px;">are not</em> simply under genetic control and that veterinary advice is still vital.</div>
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It is however, not all crazy geneticists and it is quite rightly a principal goal of the Horse Genome Project to benefit the health and welfare of horses and they have many current projects including:</div>
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– Athletic performance</div>
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– Cervical Stenotic Myelopathy</div>
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– Contracted Foal Syndrome</div>
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– Congenital abnormalities/infertility</div>
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– Fracture and Tendon Injury</div>
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– Laminitis</div>
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– Lavender Foal</div>
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– Osteochondrosis</div>
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– Recurrent Exertional Rhabdomyolysis</div>
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– Stereotypic behaviour</div>
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I certainly feel that whilst this is at least in its relative infancy we need to ensure that we as vets in the field understand or consider our role in this, as advocates for animals, for correct medical procedure and explanation, and as modulators of expectation not only based on the results of a black and white test.</div>
BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com5tag:blogger.com,1999:blog-660472546411319075.post-92180298360827443442016-02-25T04:32:00.000-08:002016-02-25T04:32:40.422-08:00The ethics of sports medicine and treatment or the challenges in balancing the demands of competition with the duty of care to the equine patient<div class="MsoNormal" style="text-indent: 18.0pt;">
Firstly perhaps, a couple of quotes; from the magus of them all
Hippocrates who opined “science is the father of knowledge but opinion breeds
ignorance” and from the esteemed surgeon Sir Wiliam Osler; “it is much more
important to know what sort of patient has a disease than what sort of a
disease the patient has.”<o:p></o:p></div>
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For fear of appearing flippant, the challenges faced by a vet in
balancing competition with patient care lie largely in communication. This does not mean singularly that the vet
dictates to the owner/carer/trainer/jockey but, as in the trial of <i>Mr C
versus Broadmoor</i> which, highlighting autonomy, transformed the face of all
medical advice; defining that the owner/carer/trainer/jockey must both
understand and comprehend any medical information supplied providing “informed”
consent. Unfortunately, vets have
somewhat surrendered this and their Aesculapian authority on the bonfire of
their own vanities, removal of previous professional boundaries, and upkeep of
finances, and have also been pressurised by the equine owning publics’
cessation of understanding of the origins of <i>husbandry</i> (Rollin 2006)
where animals, not only horses, were viewed as greater than that of an object
to provide pleasure or work. Indeed
Immanuel Kant pointed out that one of the fundamental dictates of moral law is
to treat objects of moral concern as ends in themselves, not merely as a
means. This is an extremely valuable and
fundamental point and whilst attitudes are changing, as set in a prescient case
in 1979 in New York, <i>Corso v. Crawford Dog and Cat Hospital</i>, in which
the judge declared that a “pet occupies a place somewhere between a person and
a piece of personal property,” it is in this myriad of competing pressures that
we work, and this sorrowfully is before we even consider the horse. In this capacity we become and largely can
only be advisors to the competitor.
Whilst acute and traumatic injury (often related to repetitive failure)
is comparatively easy to manage and implement treatment, with owners actually
observing clinical improvements, it is here perhaps where we have already
failed. Our primary aim should be in preparatory
and prophylactic medicine requiring greater input at all stages of the equine
athlete’s life. <o:p></o:p></div>
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The financial and time pressures
placed upon however, a competitor or trainer means that such idealism is rarely
met or largely ignored, unless the horse has already achieved at an elite
level; even to the level where husbandry levels are insufficient (promoting
dental disease and lower airway disease for example), and this is conferred to
the treating vet who’s role is to return the animal to pre-injury levels of
competition with expediency. At a recent
course I attended, a highly respected <st1:city w:st="on">Newmarket</st1:city>
“racehorse only” vet quoted “our role is not to get the horse better, it is to
get the horse back on the track.” I’m
sure he would add several caveats but the implication is inclement and
highlighted in <i>Contemporary Issues in Bioethics</i> (Benson and Rollin
2004). Although the aim is to return the
animal “healed” it is very difficult to always provide complete evidence of
true healing due to the lack of sensitivity of several routine techniques such
as ultrasonography of tendon or ligament tissues and radiography of bone, with
emerging techniques such as UTC and higher modality imaging (CT, <st1:stockticker w:st="on">MRI</st1:stockticker> and to a lesser extent scintigraphy) both
providing evidence of true healing and more accurate diagnoses (and hence
therapies). That injuries such as SDFT
tears and SI desmitis have a relatively high recurrence rate presently, and
that medical issues such as <st1:stockticker w:st="on">LAD</st1:stockticker>,
EIPH and various myopathies and neuropathies still remain as an almost accepted
“occupational hazard” of the equine athlete shows just how far we still have to
go.<o:p></o:p></div>
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Despite all this our duty of care
remains paramount and is defined not only in our Hippocratic Oath, in the
Animal Welfare Act 2006 and highlighted, although only with “guidelines” in the
Codes of Professional Conduct. Whilst
the aforementioned pressures of finance (from owner and practice ownership),
societal distortion of a horse’s role, implications of rest and treatment on
short term career results and even on long term career advancement when
involved in team sports, impose parameters in which we work and balance care of
the individual with achieving competitive status; by careful, sensible and
reasonable communication and education of the client, advocacy can be
achieved. The only area of which we
cannot balance is that of long-term health of an aged or ageing athlete. That occupational related disease is expected
does little to affirm its acceptance and again the high incidence of for example,
metacarpo-phalangeal and sacroiliac osteoarthritis, questions whether our goals
are toward short or medium term health stability or to promotion of life long
(i.e. 25-30 years) wellness (Dunn <i>et al</i> 2007).<o:p></o:p></div>
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Practical and specific examples of
such dilemmas include the use of various joint therapies in an obviously
deteriorating joint to allow continuing competition, in the reluctance to
adhere to exercise regime for musculoskeletal exercise programmes to achieve a
“faster” return to racing, in the cost implications of non-use of supposedly
superior therapies such as stem cell treatment for tendon lesions or of medical
treatments for common conditions such as gastric ulceration, in the promotion
or “benign ignorance” shown when presented with unethical treatments such as
pin firing, through to pressure to vaccinate late due to competition
rules. In each situation our role as the
animals advocate in awakening moral awareness is key. <o:p></o:p></div>
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<o:p>Ben Sturgeon</o:p></div>
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<o:p>BEVA Council Member </o:p></div>
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<o:p>BEVA Ethics and Welfare Committee Member</o:p></div>
BEVAhttp://www.blogger.com/profile/09239939369943367704noreply@blogger.com8