Today served up one of those true examples of something not quite being as simple as one might initially have expected, this time in the form of a tricky case of hide and seek. Clinical hide and seek that is.
The afternoon saw a stray cat presented with a history of a swollen paw, with the concern being that it was broken. The fact that the cat was weight bearing and had a discharging wound on the front of the paw did make me doubt whether we were dealing with a fracture or, as I suspected, simply a bad case of infection on account of a cat fight. Anyway, the cat was duly tested for FeLV and FIV, both unfortunately common among the stray cat population, and was thankfully found to be negative for both. Examination of the paw under anaesthetic (it was too painful to examine thoroughly conscious) resulted in pus being expressed – so clearly an abscess was present – but there was something about the level of swelling that didn’t quite fit with a simple cat bite abscess. As such, x-
rays were taken after all and the cause of the swelling and discharging tract soon identified: a small radio-opaque foreign body present in the paw, sitting, based on the views taken, right in between the metacarpal bones, the equivalent in humans being the bones in the main body of the hand. The object was suspected to be a tooth and was, according to the images, in line with the open puncture wound on the paw.
Consent was received from the owners to take the cat to surgery in order to remove the mystery item; a simple procedure that I would be able to complete within thirty minutes before my afternoon consults. Or so I thought. As is often the case in all walks of life, from professional veterinary practice to business, and life in general, the initial simple imagined scenario – ie, I open the wound a little, find said object quickly and heroically remove it from the paw thus effecting a rapid resolution of the cat’s problems – ended up being anything but. Do you think we could find the mystery object? No. No we could not! For what felt like ages I found myself frustratingly exploring the area, having to extend my initial incisions to open the region up more and all the while wondering why on earth I was not able to locate the offending article. Further radiography, this time making use of needles and the mobile dental x-ray unit in order to more accurately ascertain the precise coordinates of the object, which was very clearly visible on the films, eventually led me to see what ended up being the tiniest of pieces of tooth lodged firmly between the two middle metacarpal bones and virtually imperceptible to the naked eye. With the tip of what was clearly a cat canine tooth finally extracated from our patient’s paw, I was able to finally close the area, dress it and let the owner know the result.
My team of nurses were, as ever, superb and the entire operation ended up being a lot more challenging that any of us had initially imagined it would be. Thankfully the fact that the surgery took longer than anticipated was not a major issue as my colleague was able to handle consults whilst I rooted around delicately but purposefully in search of a biological needle in a fleshy haystack.
The main lessons that I took away from the experience include the fact that apparently simple situations can sometimes become more complicated or time consuming than first imagined and being prepared to cope with and adapt to changing circumstances is vital. Everyone on my team remained calm and acted in a really smooth and professional manner during the entire process and it ended up being a great example of effective teamwork. Remaining calm in a stressful situation is so vital as you need to be able to think clearly and make decisions, actions which are difficult if stress is at high levels. Trusting the evidence gathered is also important as in this case I knew that there had to be something to be found, due to the unequivocal radiographic evidence, meaning that persistence was simpler to adopt than if doubt had been allowed to creep into the scenario.
All in all, a testing afternoon but ultimately a triumph of appropriate clinical process, access to decent, reliable diagnostic equipment, trust in one’s own ‘gut instinct, and the superb dynamics of a great team. A great result all round, with a more comfortable and happy patient as a result.
With another Windsor Triathlon under the belt today saw me pack up and leave the relative calm of Maidenhead for the altogether zippier pace of London itself, complete with obligatory traffic queues on route to my ultimate destination of Battersea.
My good friend Martin had kindly offered to host me in his apartment overlooking the currently-in-the-process-of-having-a-major-facelift Battersea Power Station, a breathtakingly striking architectural icon, with London to be my base for the next two days of my UK trip. The first challenge of the day, aside from driving there, which was slow but otherwise straightforward enough, was to find somewhere to park! London may have it’s charms but readily available parking options do not feature among them. After confirming that there was absolutely no street parking available in the immediate area, a series of exasperated text message exchanges between Martin and myself finally hit upon the option of parking at nearby Battersea Park, where I had the option of staying for up to four hours (at an exorbitant rate I hasten to add), giving me the chance to hop on a train to Victoria, meet Martin at his offices (Google), grab some food, take a tour and then head back to Battersea, keys in hand, to thus allow me to retrieve the car park access fob and thus be able to relax safe in the knowledge my car and worldly possessions were securely stowed away.
All the above went nicely to plan in the end and the fact that London is actually geographically relatively tiny became very apparent as my initial concerns about not making our agreed-upon midday meeting quickly evaporated as it transpired that Victoria was literally one stop along the train line. Simples!
Google – Willy Wonka’s Chocolate Factory for the Digital Generation
I had the distinctly geeky pleasure of getting a tour around the Googleplex in California back in 2012 and so I had already witnessed with my own eyes the sheer joyful awesomeness that a Google ‘office’ embodies. It was with a similar sense of giddy toddler-esque enthusiasm that I jumped at the chance to tour the London offices (or should I say, more accurately, one of them) where Martin works. We met at the lobby of the fairly standard London office block opposite Victoria, where Google rents space, and headed up to grab some lunch at one of the several eateries found within the Google-sphere. From the minute I walked in it was clear that these were no ordinary offices, with a funky, coloured reception area leading through to one of the cafes, where we grabbed our respective lunches, me going for the healthy option of a delicious turkey escalope and roasted vegetables, and joined the assorted throng of young Googlers all doing the same. Sitting there in my jeans, red Vans, matching red Swatch and Superman T-shirt I instantly felt right at home among fellow nerds, the vast majority of whom would quite easily have been able to totally out-nerd me. I had found my people! Seriously, one of the things that is almost instantly apparent at Google is the relative youthfulness of the employees, with only a couple of guys that I saw clearly being over the age of forty.
With lunch eaten it was time for the tour itself. It would be very easy to get lost in Google given the apparently random layout that seems to have been applied but on reflection this is actually a misleading mis-truth, as it was simply the fact that there is no uniformity to the spaces, as the futuristic corridors open seamlessly onto serene coffee enclaves at one turn whilst guiding Googlers into engineer areas, where the real digital magic takes place on the other. Our first stop was such a coffee area, complete with free snacks, a heady array of fresh coffee options and a naturally lit seating area complete with fake grass that made one feel as though we’d happened upon a San Francisco version of Narnia. Fresh latte and yoghurt covered raisins in hand it was into the recording studio/ music room for a bit of impromptu drum and guitar action before checking out the games room, makers workshop, massage studio, more cafes and even a 1920′s style auditorium where tech presentations are given in some style. Oh, and then there was the informal meeting ‘room’ that is basically the back of a London bus. In the offices! Love it.
Dogs & Cats & Familiar Faces
Google fix had it was back to Battersea to get myself settled before an impromptu, spur of the moment decision to pop in and visit the Battersea Dog and Cats Home, literally a stone’s throw down the road from where I am staying. After asking if it would be possible to get a tour ‘behind the scenes’ on account of being a fellow veterinarian, I was guided by 2007 London graduate Phil, whom I am almost certain I had met before, maybe back in the midst of our university days, hearing about the day-to-day work of the home and the impressive plans afoot for a major renovation and expansion, the evidence of which was already on show, as well as being heard. The Battersea Power Station project is literally set to transform the immediate area and it seems that the dog and cat home is to join in with this major facelift, which will see, in addition to new kenneling, a shiny new vet clinic. This comes after the addition of an impressively designed and very modern cat section, complete with central spiral staircase and glass kennels, with extensive environmental enrichment to keep the resident felines as happy and stress free as possible during their (hopefully) short stays before rehoming. Such is the small world in which us vets move within that it wasn’t long before I met a fellow Bristol graduate in the form of Claire Turner, who later informed me that I literally missed out on the excitement of an evacuation of the site due to a bomb scare! (Apparently there had been an unexploded WWII bomb found over by the power station, which would explain the presence of the police as I walked past en route back from the home. Exciting stuff indeed!)
So, there you have it. In the space of a few hours two very different examples of good work being done here in the capital, and an incredibly interesting start to my short stay in London.
I have had a few people ask me about the exam that one has to sit in order to become registered as a veterinarian here in Dubai. As such I thought it would be a good idea to write a short piece on exactly that subject and hopefully answer many of the recurring questions that crop up.
NOTE/ DISCLAIMER: The following was correct, as far as I was aware, at the time that I experienced the exam process. Like much here in Dubai, processes are subject to change, often abrupt, and so no guarantees can be made on current accuracy or validity of the following. As ever, you are encouraged to do your own independent research and discuss your specific requirements with your employer (current or prospective) or to clarify matters directly with the relevant Ministry.
To become registered officially as a veterinarian here in Dubai, which permits you to work in a solo capacity in a clinic, the Ministry requires vets to apply for and sit the official exam. Eligibility for this is determined on the basis of having completed and satisfied all of the registration/ licensing requirements, such as demonstrating evidence of 5 years veterinary post-graduate work experience (for non UAE nationals).
The exams seem to run about once per month. There is little point, however, of applying to sit it until you are confident that you have all of the licensing requirements ticked off.
I sat mine at the Ministry that deals with veterinary licensing, which happened to be the Ministry of Environment and Water.
What does it involve?
It was about an hour in length, although it was easily possible to complete it in less time. There were essentially three sections:
1. Short questions on the relevant laws and bylaws, pertaining to the practice of veterinary in the UAE.
2. Short questions of a clinical nature, especially focusing on diseases of a zoonotic and notifiable nature. There were also some basic questions on subjects such as the TPR (temperature, pulse and respiration rates) for species such as dogs, cats, camels and cattle.
3. Long questions, of no more than a single side of A4. There were two of these in my exam, asking me to outline the signs, epidemiology, treatment and cause of certain notifiable diseases, such as TB. Having a basic overview of the various notifiables, as listed in the Ministry guidelines, is essential for passing this exam.
How hard is it?
Honestly? Not very. Assuming, of course, that you have actually bothered to do some revision and go in with the relevant knowledge, even if at a superficial level. Personally, I was not convinced that my answers were anything other than average at best when I left the exam, but I passed, so feel confident that unless you do no work in advance or have a complete meltdown in the exam, you’ll pass.
How quickly did you get your results?
I found out whether I had passed within two weeks, so very quickly.
Did you get anything after passing? A certificate?
Um, no. Just a feeling of relief that it was over and, once I had passed, that I was able to practice as a vet.
I have included a downloadable PDF here of the revision notes that I compiled and used to prepare for my exam. Again, I make no guarantees regarding this content and provide it merely as a learning aid. You are ultimately responsible for your own learning and preparation so if you don’t pass then don’t blame me 🙂
You can access it here: Dubai Ministry Vet Exam Notes
This week has made me realise something that I had long suspected: being a vet is very much like being a start-up entrepreneur, or certainly an employee of one. This idea crystallized in my mind after watching the fascinating and very motivating documentary “The Startup Kids,” which takes a look at a number of tech start-ups and their founders, a subject that I have always been utterly fascinated by.
What characteristics or features of working as a vet do I consider to be in parallel to being involved in a start-up? I reckon the following merit mention….
- Multiple Simultaneous Roles – I have oft advised potential new vets that a career as a veterinarian is not simply a matter of wearing the “fixer of sick and maintainer of healthy animals” hat. The truth is that most days involve us having to swap our various hats more often than a lady at Ladies Day at Royal Ascot. In any given day we could act as doctor, negotiator, team-leader, social worker, financial planner, debt collector, psychologist, gymnast, electrician/ mechanic, inventor, problem-solver extraordinaire, confidante, sprinter, weight-lifter, endurance athlete, receptionist, diplomat, surgeon, clairvoyant, magician and, at times we are also expected to be both super heroes and miracle workers! Only the other day I found myself spending a good hour taking on the unexpected role of financial problem solver, empathetic negotiator and fiscal planner whilst carefully navigating the options for a possible payment plan structure for a client who clearly could not afford the required treatment for their pet but didn’t wish to consider euthanasia of said injured animal. I am no financial planner but found myself having to assume the role, liasing between various members of the clinic team and the client in the process. Fixing the animals, it seems, tends to be the easiest bit of being a vet.
- Small Dynamic Team Players – Most vets work in relatively small clinics as members of small, focused teams, with de-lineated roles such as vets, nurses and reception team. Working so closely with so few people in what is often a high pressure and rapidly changing environment is very akin to that seen in most start-ups and whilst highly stressful at times can lead to superb examples of team-work and extraordinary results. I think back to the example I had when a rabbit we were anaesthetising suddenly went into cardiac arrest (ie died!) and as a direct result of superb teamwork involving skilled, focused and motivated professionals we were able to resurrect said bunny!
- Cope with Caos & Rapid Growth – Think that your vet spends their day floating along from one kitten consult to the next puppy on a cloud of serene tranquility? Think again. In many busy clinics the hectic schedule kicks off the second you arrive (usually early) to the minute you finally exit the building (usually late), with the spectre of the unexpected always lurking around the corner and with every phone call. This level of (organised?) chaos is amplified if you happen to be in a rapidly growing clinic, with new clients and their new and newer animals rolling in. Embrace the chaos! We do.
- Work to Tough Deadlines & Multi-task like a Juggler – Can you spay a cat quicker than it takes to spell cat? No? Well you’ll quickly learn. Especially when you cop a look at the ops list for the day as it spills off the board and starts streaming down the wall. But no worries as you can just keep going as there are no consults in the afternoo….. oh, wait… yes, there are. Vets work to deadlines all day long and swap out roles as mentioned above like a juggler on a Red Bull infusion.
- Lunch? What lunch?! – One really cool feature of most tech start-ups that I frequently read about is that many place real value on taking breaks, especially lunch, to catch their collective breath and hang out with colleagues, with many of their best ideas often coming out of this time. I make no secret of the fact that I value my lunch highly and can become a tad grumpy if and when I am denied it. The most productive people I know are those who are actively encouraged to tune out and re-fuel, even if it’s not for very long. Ironman races see athletes encouraged to re-fuel – in fact, not refueling would quickly lead to poor performance and probably failure. So I don’t see why it should be any different in our industry which has unfortunately seemed to collectively hold on to this “lunch/ breaks are optional” mentality. Start-ups know that rested, fueled team members usually perform awesomely and I am convinced that vets, nurses and the rest of the team are no different. When it does happen then I have seen how awesome team spirit and performance can be.
- Super Flexible – Part of the excitement of being involved in a start-up is that it’s never always possible to predict exactly what is going to happen. Vet clinics are the same, as previously mentioned, with a new emergency or challenge literally a phone call or walk-in away. We have all been in situations where our manageable consult or surgical list has suddenly been thrown into disarray by an unexpected event and the ability to be super-adaptable and flexible to a dynamic work environment is key to being a successful vet, as it is to being a start-up team member.
I daresay that there are many other examples and feel free to add any you can think of. In the meantime I am off to grab some lunch.
We have recently had an all too familiar scenario occur at the clinic wherein a puppy was presented to us in a very ill state, having been purchased from the usual suspect sources, and was subsequently diagnosed as having parvovirus.
For anyone who knows a bit about parvovirus you’ll be aware that the prognosis is shockingly poor, although if you can initiate treatment quickly and aggressively then it is possible to save the occasional puppy, as we have indeed done. However, we always paint a very grave picture for owners and advise them, quite rightly, that the prognosis is very guarded to poor and that they may well end up spending up to 10,000 AED (about $2600) with no guarantee of even having a live dog at the end of it. We then routinely ask for a decent deposit, especially seeing as much of the costs are borne in those initial days, with aggressive fluid therapy, blood screening, gastrointestinal support, tube feeding and antibiotic therapy. If clients do not feel they can commit at this initial stage then it is sensitively suggested that perhaps euthanasia would be best, as tackling parvovirus needs to be an all-in or tap-out early affair. Most of our clients fully understand the seriousness of the situation and appreciate the financial implications of heading down the treatment path.
It is always devastating when we lose a parvo puppy, as we unfortunately did recently, but the pain is compounded by frustration and anger when some clients turn round and decide that in spite of the carefully explained warnings and explanations of potential costs and outcomes at the very start, and indeed through daily updates, that simply because we lost the battle and their pet succumbed to this terrible disease that this fact suddenly releases them from the obligation to actually pay their outstanding account. The response we had in the recent case was “Why should we have to pay if our dog died?” Erm…. how about because we don’t operate a personal injury lawyers type system of ‘No Win No Fee,’ or I guess in this case ‘No Pet No Pay!’
Losing an animal is gutting enough for any vet and their team but it is an extra slap in the face when people then insult us by refusing to honour their end of the bargain: we will do everything in our power to try and treat and save your pet, and in exchange you pay the fair rates for providing such care. The costs have already been incurred, in the form of vet and nurse time and expertise provided, costly medicines and supportive care administered, and facilities made use of. We have to pay for all of these things and, like any business in the world, pass on those costs to our customers, in our case pet owning clients. Refusing to pay for something you knowingly agreed to even if the outcome was not what everyone hoped for is simply poor form and just has the effect of reinforcing the misguided view of some that all vets care about is money, as it simply means we have to be even more careful and proactive in asking clients for larger deposits before initiating treatment. As ever, it is the actions of a few that adversely affects the experiences of the many.
As a vet who routinely rides the emotional rollercoaster that our professional lives involve, to work hard and then have that work thrown back in our faces leaves a very bitter taste in the mouth, all on top of the deep disappointment that we are all already feeling at having lost out to a horrible, yet preventable, disease.
The past two weeks have seen the launch of our 24-hour service, meaning that the clinic is now open round the clock, with a vet available any time of the day or night, much as we are used to having in the UK.
With two new vets enlisted to take it in turns being on overnight on alternate weeks, backed up by a night nurse and our existing night animal care staff, the service officially kicked off at the start of the month and has so far proven to be popular. There have, inevitably, been some adjustments to the way the rest of us regular day staff operate, such as some new shifts and a few later than expected or usual finishes, but we’re all optimistic that once the initial adjustment period is complete it will actually make our lives less hectic and stressful.
One of the changes has been that naturally we need to do a handover with the night vet going into the day shift, and so one of the vets is assigned to the hospital for the week. This basically means that they come in for an earlier start at 7am, which gives them an hour to effect a detailed handover with the night team, before being in charge of checking, planning, updating and generally doing what is required by the various in-patients. Given that our wards are usually pretty well populated, this can result in quite an intense shift, with the hospital vet then consulting from about half ten until their finish time at 4pm. The early finish clearly makes for a nice end to the day, although that does assume that they get to actually walk out at four, which so far I don’t think has really happened.
The other vets come in as usual for an 8am start and crack on as before with admitting surgeries and seeing consults, or getting on with the various procedures booked in for the day. Trying to get our full compliment of two hours of lunch (sounds like a lot but bear in mind we are in from 8am to 7pm) is still a challenge, although when it happens it really does help to set us up for the afternoon/ evening consulting period, which is usually pretty busy. One change that certainly seems to have occurred is that the couple of hours leading up to 7pm have become a lot busier, with more of what we can refer to as the genuinely ‘sick’ animals booking in. As such the final couple of hours have been, on the whole, very busy. With the consults being booked up to, and even beyond 8pm, it does mean that when 7pm, and hence our scheduled home time, comes round it is usually the case that we either have results pending for a case we have seen in the afternoon, or there are simply more clients waiting to be seen than would be fair to leave the late vet to deal with solo – after all, we’re all nice people and we’re not the kind of individuals who can knowingly walk out leaving both clients and our colleagues delayed and inconvenienced. That has meant several late finishes which, again, I am sure will even out as the new system becomes established and when we get some new vets on the team.
Last night was a particularly intense affair, with both an in-patient requiring a blood transfusion at the end of the day – never a quick process – and a ‘sick, off-colour’ dog coming in which turned out to have some seriously nasty business going on internally and so required surgery that evening, including, again, a blood transfusion. As such we all stayed on until gone 10pm, well into the night shift, although sustenance was provided by a much welcomed, and oh so chocolatey cake, that one of my colleague’s clients had dropped off earlier.
The cases in question, for those of you with an interest in such gory details, were a cat with a severe immune mediated haemolytic anaemia, most likely secondary to tick-borne disease and not helped at all by being FeLV positive. A lovely little young cat, she was presented the evening before with, again, a history of just not being herself and was found to be very pale. Her bloods revealed the true extent of her predicament, as she was sadly diagnosed with FeLV (Feline Leukaemia Virus) and had both a severe anaemia, with a red blood cell percentage very much on the borderline of needing an immediate transfusion, and a raging high white cell count. Aggressive treatment was started but the response was not enough to prevent needing a blood transfusion last night.
The second case was that of a geriatric dog who, as with the cat, was presented with a history of just being quieter than normal. Again, pale and lethargic, bloods revealed a low red cell count and concerns about possible internal bleeding were confirmed by ultrasound, as we found her abdomen to be full of blood due to a ruptured splenic mass. As such, the options were starkly binary: euthanase or operate to try and save her. Her owners opted to try and save her so after bringing in a blood donor we took her to surgery and removed her spleen, complete with nasty, ruptured splenic mass which was the cause of her abdomen being full of blood. The surgery went well and at the time of writing the patient was recovering well, although is certainly not yet out of danger.
So there we have it…. the next chapter in the vetty adventures here in Dubai, complete with a new 24-7 element. Things should continue to be very interesting and, I daresay, remain intense.
If your pet does need to be seen overnight, then Al Safa Veterinary Clinic, on Al Wasl Road, Dubai, is now open 24 hours, 7 days a week, and can be contacted on +971 (0) 4 348 3799.
Moments of intense stress often bring out the best in both individuals and teams. Last week served up an extreme test of the level of calm yet effective teamwork that can really work wonders in veterinary.
This story starts with a rabbit – let’s call him Mr Bunny. A rather elderly bunny but a healthy rabbit all the same. Well, apart from the large, unsightly, ulcerated and all round nasty mass attached to his lip, hence his being in the clinic with the intention to surgically remove said mass. Everything pre-op went according to plan and with an intra-venous catheter safely placed in Mr B we proceeded to give the standard anaesthetic combination of drugs, ready to continue monitoring his anaesthetic during the surgery and until he was back safely hopping around and munching on his hay again.
As I am sure most of us are acutely aware, real life sometimes follows a different script to the one planned and Mr B had plans of his own. Basically his heart stopped. Literally.
As soon as he had been given his medication my nurse, who had been listening to his heart from the word go, identified that there was a problem. The potential at this stage for mass hysteria and panic was there, especially considering that the owner (an employee of the clinic) actually happened to be in the same room, albeit talking with someone else and not actually involved in the procedure taking place. Full credit to my team as we very swiftly and decisively put a rapid resuscitation plan into full swing.
The reversal agent was immediately given, oxygen was adminstered, rapid fluid therapy was instigated, adrenaline was injected and cardiac compressions started. This continued for several minutes, although those minutes often feel like hours in such highly charged situations. Rabbits, as anyone with experience of either owning or treating them will be able to attest, aren’t great at dealing with stress at the best of times and always seem to be plotting cunning schemes by which to expire early. As such, the chances of a successful resuscitation effort seemed at best remote and at worst dismal. It was with a sense of surprise and relief then that during the cardiac compressions I felt Mr Bunny’s little heart kick in and take over the rather vital task of pumping. From there on it was a slow but steady path back from the light and into the world of the living again.
Mr Bunny did make a full recovery and actually returned this week for another attempt at removing the large mass on his face. This time, thankfully, things went much more smoothly and Mr B bounced through his operation safely.
This episode did highlight the benefits of a well trained, calm yet decisive team, coupled with a sensible approach to preparation and the importance of monitoring to pick up on issues very early on. The response of the entire team was exemplary and Mr Bunny is still with us as a direct result.