Animal Care

WATCH AND WAIT

Mark Newton-Clarke MAVetMB PhD MRCVS, Newton Clarke Veterinary Surgeon

The problem with autumn starting in August is by the time we get to October, we’re already a bit tired of dewy mornings and cold nights which are becoming longer and longer. The slugs and snails have been having all night festivals for months now, reminding us to keep treating our dogs with anti-lungworm medicines. Not all worm treatments are effective against these beasties so make sure you are using the right products; just ask us if you are not sure. I make no excuses for mentioning the subject yet again as I want to record another lungworm-clear year, making a run of five. Before we recommended monthly worming with milbemycin-containing products, up to ten dogs a year were presenting with the symptoms of the lungworm parasite, with each host potentially at risk of losing life.

Last month I introduced Liv, the spaniel puppy who became suddenly and inexplicably in pain. My colleagues and I were delighted to see Liv improve with pain killers, but remained unconvinced about the cause. This was going to be a case of ‘time will tell’, a strategy that has its limitations, but with Liv improving, a justifiable approach. Personally, I was expecting Liv

Ermolaev Alexander/Shutterstock

to relapse after an initial improvement as a shortacting steroid wore off. Had this been so, further tests and treatment would have been essential as the diagnosis would have been much more complicated. In the event, I was wrong and Liv seemed to return to normal as quickly as she deteriorated, making for very happy owners (and vets!).

Liv’s case highlights the issue of when to watch and wait and when to intervene with further tests. Such interventions carry with them a degree of stress for the patient, potentially some risk and certainly cost for the owners. These considerations need to be balanced against the benefit that more clinical information can give, especially when treatment options are considered. I very rarely recommend diagnostic tests unless the information gained has a practical consequence on treatment planning. This is of particular importance if the treatment under consideration is lengthy, unpleasant or carries the risk of side-effects.

In Liv’s case, we were considering a diagnosis of sterile meningitis/arthritis, an auto-immune condition which requires months of immune-suppressive treatment. Certainly not ideal for a young puppy. Also not ideal is the way the diagnosis is confirmed, with cerebrospinal (CSF) and synovial (joint) fluid needed and neither being particularly accessible. If any of you have had a lumbar puncture, I am sure you know what I mean. Although I have performed this procedure on many horses (a long time ago) with only a sedative and a set of stocks as restraint, most dogs need a general anaesthetic (GA). Modern anaesthetic drugs and monitoring equipment mean the risk of a problem under GA is tiny but is still there. Also, the need to interpret CSF almost immediately presents logistical challenges, otherwise results can be misleading. So that’s why we elected to watch and wait and keep little Liv under close scrutiny. In this case, that was all that was required as true to form, Liv literally bounced back and has been fine since.

I touched on the risk that a GA represents for a dog or a cat but the actual risk of a patient dying during a GA is actually difficult to quantify as different studies give different numbers. Possibly the most relevant estimate of risk in our clinics comes from my personal experience, giving a figure of around 1 in 2000, which includes all patient categories. By that I mean anaesthetics given to young, healthy animals for elective procedures (mostly neutering) as well as older animals with some health issues (often dental work) but also critically ill patients that need emergency surgery. Clearly, risk is not evenly distributed.

So, how do we minimise risk for any patient undergoing anaesthesia? It’s a mixture of forewarned is forearmed and real-time monitoring. With so many owners understandably worried about their pets having a GA, it might be worth looking at this in more detail next month. Hopefully, I can make the subject interesting enough so you won’t all go to sleep...

FROM CHEF TO VET

MY UNUSUAL CAREER PATH Paul Doran MA, VetMB, MRCVS, Friars Moor Livestock Health

Several of my colleagues suggested it would be interesting if I wrote about how I became a vet, having started my working life as a chef. When I tell people that I used to be a chef, they are usually surprised and say it’s quite a dramatic career change that I’ve undertaken. I tend to shrug at this and say that as a farm animal vet, I still consider myself to work in food production – I’ve just chosen to focus on a different part of the process. I decided on a career change when my wife was pregnant with my son. I was 23 at the time and the thought of being a father encouraged me to rethink my life. There were a number of reasons for my decision but the main one was that my hours in the kitchen were very long and left me little time for a life outside of work. Whilst, perhaps remarkably, my marriage had survived several years of me working as a chef, I just couldn’t envisage my work being compatible with starting a family. I didn’t want to be a perpetually absent father as well as husband. I gave a lot of thought to what other work I might pursue and veterinary medicine seemed to be the ‘best fit’ for me.

I had grown up in a rural area, was interested in animals, food, farming and science and whilst I had never put it to good use by that point in my life, I knew that I was quite academically able. When I looked into what becoming a vet would actually involve, I initially dismissed the idea. I didn’t have the right entry requirements for university and places on veterinary degrees were highly sought-after and embarking on a five-or six-year degree course when I had a young child to think about didn’t seem very sensible. I did consider several other career possibilities. In the short term, I left the kitchen behind and took a job for a local farm supplies company. The job suited me quite well. It paid a similar amount to my salary as a chef but allowed me to go home at 5pm every day which was a very welcome lifestyle change. The work was a mixture of shop work, warehouse work and forklift driving. I enjoyed the social aspect of being in the shop and got on well with the customers, most of whom were farmers, but after a very short time I got incredibly bored.

In the absence of a better plan (or at least any plan for which I had equal enthusiasm), I decided to pursue veterinary medicine after all. I had adequate GCSEs to apply to vet school but I certainly did not have the required A-levels and work experience. Having researched night school courses in the area (there weren’t any suitable ones), I realised that the

Trevor Clark/Shutterstock

only way forward would be to teach myself A-levels. This didn’t seem too difficult as the exam boards published their syllabuses online and there was always a recommended textbook that covered all the core knowledge expected. In terms of sitting exams, a number of private schools were willing to enter external candidates for a fee but they were less willing to accommodate the coursework element required of most science A-levels. In the end, I was able to get help from a friend who taught biology at a local sixth form. She arranged for me to be able to complete my coursework in their science prep room. Without her help and that of her colleagues, I would have been quite stuck. In the end, I was able to complete Biology, Chemistry and Physics A-levels in my spare time, over the course of 3 years.

Because I was so bored by the lack of intellectual challenge in my day job, I found it very rewarding to spend my evenings and weekends studying. The work experience aspect was another big bridge to cross. All the universities expected applicants to have some experience of veterinary practice but some were far more demanding, expecting a wealth of experience in various animal husbandry roles. My day-job turned out to be a bit of a godsend. Employees generally took turns to staff the shop on a Saturday and would accrue a day off in lieu for each Saturday worked. Naturally I volunteered to work all the Saturdays I could get. Thus, combined with my holiday entitlement, I accrued enough time off work to facilitate both taking my exams and undertaking plenty of work experience. I also soon learned that because the shop opened late and shut early on a Saturday, every time I worked on a Saturday, I was able to milk on a local dairy farm, owned by friends of mine, both before and after work. This made for a long but very fulfilling day.

During this time, it became more and more clear to me that I really wanted to work with farmers and farm animals. I wasn’t disinterested in other areas of veterinary medicine, but this was clearly my passion. I applied to vet school in 2010 and accepted an offer from the University of Cambridge. Although, the Cambridge course was longer than most (6 years instead of 5), it offered several advantages for me. It seemed like a nice, safe town to raise a child in and the university offered a generous level of financial support to mature students with a family. The first couple of years of vet school were the most difficult, not just academically but emotionally, for all of us, as we had uprooted ourselves from everything and everyone we knew. Over the following years, things got easier and we managed to adjust better to our circumstances. My studies became more manageable and I came to enjoy being a student parent. I think that I was able to enjoy seeing my son grow up better than I would have been able to if I’d been in full time work.

I graduated in 2017 and have worked at Friars Moor ever since. I found the practice to have a very friendly, supportive culture that appealed to me right away and they went to a lot of trouble to help me ‘find my feet’ as a new graduate. It’s also quite a diverse workplace which may have helped my unusual work history seem a little less odd than it might’ve done otherwise. They have really helped me develop as a vet and encouraged me to pursue my specific clinical interests. Although it necessitated a lot of work and determination to change career in the way that I did, it required a lot from the people around me as well. Most of all, my wife Juno was incredibly supportive. She encouraged me and believed in me, even when I didn’t believe in myself and she helped me so much in so many ways. But I still love to get in the kitchen and cook and enjoy it very much as a hobby.