Tag Archives: Emergency

Night Shifts – All Bad?

The list of probable detriments to one’s health of working nights makes for rather grim reading, from an increased risk of cancer, diabetes, heart disease and even accelerated ageing of the brain. I was vaguely aware of the research that supported the claims that working night shifts was ultimately bad for us back in the UK when I used to do a lot of overnight veterinary shifts for Vets Now, the out-of-hours provider, and always downplayed the message by telling myself that “I am only doing it occasionally.” The fact that I now find myself coming to the end of a 7-day run of 12-hour night shifts, again, in a veterinary capacity, has inspired me to revisit the subject.
The advantages of working nights – and there are some for sure – are compelling, in my current case the main one being that in exchange for working 7 days in a row (or nights if I am going to be accurate) I get 7 days off. For anyone who is used to working in a normal capacity that equates to having some decent annual leave every two weeks, which kind of rocks! I for one know that I can make really great use of that kind of continuous ‘free time,’ engaging in fun activities when the rest of the world is slaving away at the office and working on my own projects on a schedule of my choosing. Bliss indeed.
The main advantages of night shifts, specifically in the veterinary sector, are the following:
  • Drip on hospital cage
    From in-patients to emergencies & OOH consults, there is usually a steady stream of cases & decisions to be made during night shifts.

    Autonomy & independence – the camaraderie of working with other vets during the day is great and it is always good to have others to bounce ideas off. However, long-term the danger is that always being able to “check things” with a colleague can lead to a slow erosion of the ability and confidence to truly think and act independently. With night shifts, where it is usually only ever a single vet in charge, there are no others to check in with. Assessments need to be made and decisions executed based on what I believe to be best practice. If I don’t know something then of course I can, and do, check in with trusted sources of information but ultimately I am the one who has to decide and act on a variety of unique cases and clinical situations. Although it can be scary at times, such as my first night on that saw me presented with an aged Boxer dog that seizured pretty much continuously all night, the confidence that gradually comes from relying on your own ability to process information, apply knowledge and skill and ultimately make decisions and take actions that have real outcomes is empowering. For this reason alone I think that doing some night work is very valuable for all clinicians.

 

  • Variety – we see and hear it all during the graveyard shifts, that’s for sure! From the full-on emergency requiring all hands-to-the-deck, to the varied hospital cases that seem to swing from one state to another almost by the hour, consults for ultimately simple complaints to downright bizarre calls, we do get variety in our lives. Often the main challenges presented during the night are the human ones, with the most unusual calls coming in, such as one we had at 2am from a lady concerned about whether her sister’s dog was in pain after having been neutered a couple of days ago. My nurse spoke for a short while with said lady before offering an appointment at which point she informed her that the dog was actually in Scotland! (nb: we are in Dubai!) Another classic night-time call is often from an owner who has been sitting on a pet health issue for the last week only to decide that now, in the wee small hours of the morning, is the time to seek advice and assistance and to then act surprised when the cost of being seen is pointed out to be higher than during the day. Just plain odd. Again, from a training in how to deal with people and communicate standpoint, night shifts are an invaluable learning environment. Either that or fertile anecdote-mining terrain for the next book!

 

  • Vet working at computerFree time – some nights are literally spent working for the entire time, such as the aforementioned fitting dog scenario, whereas a lot of the time things do tend to quieten down after midnight meaning that there is an opportunity to catch up with paperwork, do some CPD or even just indulge in some more light-hearted pastimes such as reading. As someone who is generally busy working on all sorts of personal projects, having the time to sit down during the night is one of the main draws of working these shifts. Of course there is always the risk that a call will come in or something will change with an in-patient, requiring you to switch attention, but generally it seems that there is time available.

 

  • The filtering effect of the higher consult prices – it costs more to be seen out-of-hours, the reason being that our costs of providing a service overnight are higher than during the normal working day. The advantage of this fact is that it can, and does, serve as a very effective filter for those genuine emergencies versus those cases where the pet can either wait to be seen when the clinic is running with a full team and the real time wasters. It never ceases to amaze me how what is initially dialled in as a “real emergency” that simply “must be seen NOW” quickly becomes “oh, its okay – I’ll see how we go overnight and then see the vet in the morning,” once the cost of the overnight consult fee is made clear.

 

  • Leaving as everyone else arrives – despite being tired and very much looking forward to hitting the sack, there is a satisfaction that accompanies being able to head out the door, past everyone else in the world who is heading in the opposite direction to start their working day. One might call it a sense of smugness.

 

  • Time off – we touched upon this primary perk above, with the main point being that the reward for working a full week of long night shifts is an entire week completely off work. Brilliant!
The price? Well, there is the small matter of the week of night shifts to get through. No pleasure without pain, eh?! So what exactly is the “pain” of night work anyway?
Dark corridor
It can feel odd being up when the rest of the world sleeps

Our bodies and brains just aren’t used to functioning optimally during the entire night and regardless of the amount of sleep one tries to get during the day it never feels as though it is enough, meaning that, for me anyway, I have spent the last week feeling somewhat jet-lagged. The worst periods are the hours during which I am actually writing this now: 2am – 4am, the real ‘dead of night,’ when every fibre of my being is screaming at me to close my eyes and just switch off. The evidence shows that the body and brain changes state during these hours, meaning that even the food we eat during the night is processed differently to if it was consumed during daylight hours. Increased long-term risk of developing conditions such as heart disease, diabetes and obesity are recognised sequelae. Although there are plenty of articles and sources of advice on how to “adapt” to night shifts, the truth is that you never really “adapt,” especially if you then adjust back to a normal routine. One of our nurses who works nights has actually converted to a pretty much permanent state of nocturnal being, continuing to stay up all night and sleep during the day even on her off weeks, so maybe she has managed to adapt over time but that is not something most of us would be happy to do.

The disruption to the normal rhythm of my life is the main thing I have noticed during the last week, with it proving difficult to really continue exercising normally. By the time I get home in the morning, all I really want to do is get some breakfast and get to bed. Even if I did decide to exercise in the morning, driving to the gym would be dangerous in my sleep-deprived state and although I could choose to perhaps go for a run outside, I feel that I am simply in danger of giving my body very mixed signals by elevating my heart rate whilst it is getting lighter to then expect it to settle into a state of sleep a short while later. As such, by the time I have managed a few hours of interrupted sleep, there is little real drive or time to exercise before grabbing some food and preparing to head back in for the next shift. One thing I am very much looking forward to with a return to normal daytime living is a normal exercise routine!
Socially, night shifts can be isolating with the fact that you sleep whilst others are awake and vice versa making it difficult to maintain a healthy social life during the actual night shift period. Of course there are your night-time colleagues to chat and hang out with but given that nights are usually staffed by a significantly smaller team – such as one vet, one nurse, one receptionist and one animal care assistant – and the fact that it is usually the same people who simply rotate, the truth is that you end up spending a lot of time with the same people. I am not saying that is necessarily a bad thing – after all, I work with awesome people – but given the rather carousel nature of night shifts, social interactions can start to feel very limited in scope. Again, there is the silver lining of the following week off but getting to see friends properly only every second week can, I can see, get testing for all parties.
Okay, so we’ve established some of the pros and cons of working nights. What about the actual logistics? How do you actually prepare for, manage and then readjust from working nights? All I can offer is personal experience and the tips that I have picked up from doing some independent research, but generally I find the following works:

PREPARING FOR NIGHT WORK:
  • Try to get a little sleep directly before the first night on duty, even if it’s only a couple of hours of rest, preferably in the dark. You’ll still feel tired during the shift, especially during the very early hours, but psychologically I find it better than trying to go straight from being a ‘day-walker’ into being a creature of the night.

 

  • Prepare some healthy, wholesome food to take in to work, preferably something you can heat up and have as a ‘proper meal.’ The temptation with night work is to snack, especially on the kind of crap that you wouldn’t normally indulge in often. Snacking on junk combined with the stresses of already being awake all night will gradually have a detrimental effect on your health. Eating decent food is one thing that you can control and giving your stressed body and brain the right kind of fuel will make the process so much less damaging in the long run.

 

  • Take something to do during those ‘quieter’ periods. I always go into nights expecting to be busy all night, with any ‘free time’ ultimately being seen as a bonus. I find this approach much easier to cope with psychologically than going in expecting to have free time only to get all pissed off when I find that 1am emergency rocking up. Whether you take in some reading, a movie or some project work to do, having something on hand to focus on during the occasional lulls will help keep you awake and stave off the attack of the drowsies!

 

  • Get in early so that you’re not rushing and feeling flustered before you start, especially if you then end up heading into a busy night. I personally like to arrive about 30 minutes before my shift, change into my work clothes actually at work and maybe even kick back for ten minutes before heading upstairs to find out what fun-and-games await me.
DURING THE NIGHT SHIFT:
  • Expect to feel tired at some point, even as you get further into the week. I have not had a single night over the past seven days where I have not felt the strong desire to curl up and sleep at about 2am. There isn’t really any way around it unless you choose to make use of stimulants such as caffeine, although I don’t recommend it as a) you simply end up elevating your heart rate, stressing your body at a time when every bit of it’s programming is telling it to be relaxed; and b) unless you process caffeine super rapidly you’ll likely screw yourself over for when it comes time to get your head down at the end of your shift. I do have a small coffee before heading in for my shift, as that would normally be part of my ‘breakfast’ routine, but otherwise I avoid caffeine for the rest of the 24 hour period.

 

  • Try and get some rest, even if it does just mean a 15 minute lie down. The restorative properties of simply remaining still and allowing the brain to rest, even for short periods, is established. It’s unlikely you’ll get to actually sleep so I wouldn’t bank on it and besides, any more than a 30 minute nap usually results in feelings of sluggishness and confusion when you come back around, so the apparent advantages don’t really seem to materialise.
AFTER THE SHIFT & BEFORE THE NEXT ONE:
  • Get a healthy breakfast, avoiding caffeine, and go through whatever morning routine suits you. I personally need about two hours to fully unwind from the shift, getting into bed by about 10am.

 

  • Assess whether you’re safe to drive. Extreme fatigue has been proven to have the same effect on driving ability, hazard awareness and reaction speeds as drinking, so if you do feel super tired in the morning then do yourself a favour and get a taxi home. Crashing your car on the way back home would be a really shitty way to end a shift.

 

  • GET SOME SLEEP! The bulk of the day should be given over to sleep, not to “getting things done,” as will be the temptation. Creating the right conditions for a decent sleep can help, from making the room as dark as possible or even wearing a mask, to turning the temperature of your room down a little. Even then, it is likely that you will not sleep as soundly, or for as long, as you would normally during the night but that is to be expected. I have aimed for at least 6 hours a day (10am to 4pm) and found that I have been waking naturally just before 4pm anyway. The first day of sleeping and then waking in the evening was odd and it took me a moment to remember what time of the day it was, which was a surreal, almost dream-like experience.

 

  • Turn off distractions such as phones. You’re much more likely to be disturbed by various notifications, messages and emails pinging continuously as they hit your phone during the day, especially given that you’ll likely be sleeping less heavily than normal, so turning off any such notifications is wise. Obviously the one notification you will want to ensure you hear is your alarm call and it is for this reason that I personally choose not to use ear plugs.
RE-JOINING THE DAY-CROWD:
The end of the loooooooong week of nights is finally over! Hurrah! Life can return to normal as you transition back to your usual routine.
  • Get a good breakfast, as with any day.

 

  • There are two techniques I discovered during my research that can aid in transitioning back to a normal day-centric routine:
    • Sleep for a few hours (e.g. 10am to 2pm) and then get an early night later in the evening, with a normal return to daytime routine the following day. This is the tactic I intend to employ.
    • Sleep through for 36 hours and write off the first day in order to start the following day on normal routine day mode.

 

  • Expect to feel a bit out of sorts for a couple of days. Much as jet lag can leave you feeling a bit weird for a day or two after returning from a long-haul trip, coming off nights can feel the same. Not to worry though: it’s normal.

 

  • Plan some awesome stuff to do during your time off and enjoy – you’ve earned it!
And for anyone who has actually done nights already….. you’ll know this scenario :p
Handover, dog, hospital
References:
Are Night Shifts Killing Me? – http://www.bbc.com/news/magazine-33638905

Emergency!

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.

Take a moment and breeeeaaathe…

Don't panic buttonErm, really?

Although I am enjoying the Safari Vet School series, and it always cool to see vets getting airtime – especially prime time – I do feel compelled to pull ITV up on a couple of, what may seem trivial, points. The first is in response to the opening lines, “Amakhala Game Reserve is home to one of the most demanding vet schools in the world.” The course the students are on is NOT a “vet school,” and the show should really be careful with how it uses the term. The second point is in response to the statement, “the course forms part of the vital work-experience the students need to qualify as vets.” It is more accurate to say that the course CAN form part of students’ EMS, but that students don’t have to do it in order to qualify, which is the impression the show does give. The fact is that most vet students simply would not be able to participate in the course, which in spite of the fantastic conservation work that is done and the incredible role the course plays in promoting conservation, does cost a lot of money to take part in. Most vet students will and do complete all of their EMS prior to graduation in the UK. Pedantic points perhaps but worth just clarifying I think.

One other thing…

It has been interesting to see the contrast between the two sets of students, although I must say that it does feel like we’re simply seeing the same show repeated, as they are doing effectively the same things as the previous group we followed: giraffe capture; mass capture of a herd using the funnel system etc. As such, I do wonder whether the show could have actually been a few episodes shorter than it has been(?). Controversial view perhaps. I also wanted to offer a note to any students reading this who feel that they wouldn’t be able to get the same experience from their more ‘pedestrian’ UK based work experience: you can and will. The excitement of herding sheep, or a herd of cows in Wales can easily match that of herding wild safari herbivores, with the same level of danger and adrenaline being provided. If you have ever been faced with a cow that has spotted a gap and you’re the only one standing between them breaking free and staying put then you’ll understand. Although it is amazing to have the chance to get that level of excitement and animal contact in a more exotic location and setting, the fact is that you will be able to experience similar levels of adrenaline and satisfaction right here.

Stress: a vet’s permanent companion

The main theme seemed to be ‘the stress of being in charge,’ with the pressures of leading a team in a high pressure situation where time is of the essence and lives are at risk being explored. The students were involved in the tense activity of capturing Giraffe which, as we saw in a previous episode, carries a high level of risk to the animal, especially if the vet does not administer the sedative antidote in time. Any vet who has been in the situation where a genuine emergency (eg a dog that has been rushed in after being hit by a car) has occurred will know the surge of stress and excitement that accompanies such a situation. It is all too easy to lose your head in such scenarios as you are expected to think fast and act rapidly. The added pressure of being in charge of directing a team adds to the pressure cooker of emotions that can result. I have been in many situations where I could feel myself starting to freeze like a rabbit in headlamps and hear my thoughts go from a steady, ordered, organised set of signals to a random fuzz of static. The key, however, is to realise that you can, and should, take a moment – and that’s all you really need – to gather yourself as it is only once you are in control of your own thoughts that you can take control of the emergency and keep everyone else focused and effective. As a vet, even a newly qualified one, you possess all of the skills and knowledge to apply basic first-level emergency care to a patient. These basics don’t really change regardless of the emergency and are obvious when you think about it:

1. Is there any bleeding and if yes, is it both possible and safe to halt, or at the least reduce it, immediately? For example, if there is a large wound to the neck and significant bleeding from the area, rapid application of a pressure dressing would be appropriate. After all, a patient who has bled out is not really going to be bothered that you haven’t detected and dealt with it’s fractured leg straight away. Because it will be dead.

Rapid access to a vein, and starting on fluids to support the animal’s circulatory system is another thing that, if you think about it, makes immediate sense. The rate and other factors can easily be adjusted once the animal is more comfortable and stable, but at least you will have intravenous (i/v) access and thus be in more control.

2. Is the animal in pain? Probably yes. Would giving decent pain relief straight away be a good idea? Again, probably yes. The likelihood is that the animal that is wildly thrashing about in a frantic panic, thus making the entire scene ten times more dramatic than it could be, suddenly becomes calmer and thus easier to more fully assess. I, for one, would want my doctor to get some decent analgesia into me long before he starts messing around with my busted leg! In fact, if they didn’t then I would probably bite them, so we can’t really blame our patients for doing the same.

3. Is the animal having trouble breathing? Can you give it oxygen safely? Yes? Well do it! Either put the animal in an oxygen cage (these can even be ‘mocked up’ with the use of a kennel, or carrier, and roll of cling-film) or apply a mask to deliver oxygen enriched air to the patient. Is the animal unconscious? If so then getting control over it’s airway by placing an endotracheal tube would be the thing to do. Again, once you have control of the basics then you can pause, reassess and adjust the plan accordingly.

So, the key point really that I am trying to make is that it is all too easy to get caught up in the stress and excitement of an emergency situation and forget that you do actually know what to do, at the very least, to stabilise your patient. Oh, and one thing to remember at this point: in spite of all your best efforts and pulling out a textbook Super Vet act, some patients will die on you. Fact. Although every one is a shock and hurts, it is a fact of being a vet and something we have to accept and be able to move on from.

Death Is Coming

Red Hartebeest
Red Hartebeest

Elephant Adventures

The latest episode of Safari Vet School saw a new group of vet students arrive at the reserve, with most being more experienced than their predecessors yet just as keen to get stuck in to the fun. This week’s episode seemed to have much more of an edge to it, with the word ‘danger’ very much being the one that kept cropping up. Whether it was the ‘danger’ posed by getting too close to a protective female elephant and her calves, or the ‘danger’ posed to the Hartebeest that was very close to succumbing to the effects of hyperthermia, the new students had a lot to really keep their adrenaline levels at maximum.

The elephant experience reminded me of a story my late grandfather used to tell us, in which he came face to face with a rogue bull elephant whilst living in Kenya right out in the bush. The elephant in question had apparently been terrorising local people and it was suspected that it had something very wrong with it. My grandad was charged by it and had the terrifying and upsetting decision to make of having to kill it, in order to safeguard his own life and those of his family. As a result, we had it drilled into us from a very early age of the unpredictabilty and ‘danger’ posed by animals, even those we consider to be cute and generally harmless.

Overheating & Death as an unhappy fact of the job

The incident with the Hartebeest was a close one and it was clear that the group very nearly lost the animal to over-heating. This really drove home the fact that in spite of our best efforts, animals are ultimately complex biological systems with all of the inherent unpredictability that you’d perhaps expect but which can serve up real curve-balls on occasion. This is an important lesson to learn early on in a veterinary career as there are guaranteed to be a number of such situations throughout any vet’s working life. I had one such case on the weekend. We had a middle-aged Rottweiler transferred to us from it’s vet for ongoing fluid therapy and treatment for vomiting, weight loss and bloody diarrhoea (not the nicest of combinations). The dog was also very yellow and clearly had significant liver issues. Owners have a great way of really piling on the pressure and the owner’s parting words were that her dog “could not die.” As I say, no pressure. Further blood tests and an ultrasound scan later made it clear that the dog had serious liver problems and as such the prognosis was guarded to poor. She did, however, start to look better and more responsive after a few hours of fluid therapy, and as such we felt that we may have made a difference. Now this is where as a vet you have to be very careful as animals like this have a particularly nasty habit of perking up just before a major crisis, and that’s exactly what happened. The dog suddenly went downhill, turned pale and basically started dying in front of our eyes. Unfortunately, in spite of our very best efforts, the damage was too great and she was put to sleep. This really drove home the fact that cases can take an unexpected turn, sometimes for the better, sometimes for the worse, and that as vets one of our most important tasks is to sensibly manage owner expectations. It would have been easy at admit to reassure the owner by telling her that her dog was “going to be OK,” but that would have been misleading and caused even greater anguish to her compared to being realistic and cautious by advising a guarded prognosis. Although the dog’s owner was understandably very upset, she had been given a chance to come to terms with the fact that her pet was very ill and may well die rather than languising under false, or misguided, thoughts that everything was going to be OK. So, the thing I would say to the Safari Vet School students is that in spite of their best efforts, that particular Hartebeest on that particular day had obviously ‘decided’ that it was going to test the boundaries between life and death. Sometimes stuff just happens and you have to be prepared to accept the fallout, learn any lessons and then move on.

Pet Blood Bank – Great to get involved

Chris the Nerdy Vet with Joseph, a proud pet blood donor
Me with a happy blood donor, Joseph the dog

I had the pleasure on Sunday of being involved in an official capacity with the Pet Blood Bank, a fantastic UK charity that collects blood from volunteer dogs, with the blood then being processed into packed red cells and plasma, which is then made available to vets around the country for use in emergency situations and for major surgeries.

The organisation was fantastic with the session overseen and administered by a fantastic team from the Pet Blood Bank HQ based in Loughborough. The whole day was relaxed – for donor dogs, owners, and even vets! My role, as an official vet, was to health check the donors, including taking pre-screening blood samples, and to decide whether, in my professional opinion, the dogs could indeed go through to donate. Every dog I saw was an absolute picture of health, and so well behaved, that the entire day just seemed to whiz by in a happy, healthy blur of activity. The criteria for dogs to donate is quite strict, and rightly so, with dogs having to meet the following criteria:

  • be aged between one and eight years old
  • weigh more than 25kg
  • have a good temperament
  • never have travelled abroad
  • be up to date on all vaccinations, and not have been vaccinated within the last two weeks
  • be fit and healthy
  • not be on any medication, other than routine flea and worm control

Before the dogs can donate they have a blood sample taken, and their packed cell volume (PCV), which is the percentage of the blood that is made up of red blood cells, and total protein (TP) are measured. If they are both within certain healthy limits then they can be cleared for donation. Every dog I saw passed with flying colours! Each dog then donates 1 unit of blood, which is equivalent to about 450ml of blood, and the actual donation stage only takes about 5-10 minutes. The great thing is that every dog then gets to tuck into some tasty food – the equivalent, I guess, of our ‘tea and biscuit’ – after their session and gets a goody bag, complete with toy, to say a huge thank you for their donation.

The great thing is that the blood that is donated goes to help vets save lives in real practice – something that as an emergency vet myself, I have been involved in first hand. Donor blood truly does save lives! The wonderful thing was that the day saw experienced, repeat donors turn up as well as dogs and owners for whom this was their very first experience, and everyone had a good time doing something worthwhile.

If you would like to find out more about the work of the Pet Blood Bank, including how to get involve yourself, then click here to visit the Pet Blood Bank website.

Aortic thrombo-Embolism in cats – a tragic condition

I had the tragic task of dealing with a case of aortic thrombo-embolism in the emergency clinic at the weekend, in a beautiful cat who had been presented by her owner after suddenly going off her back-legs.

This condition, which results in a blood clot forming and blocking the major blood vessels to the legs – most usually at the point where the body’s main artery, the aorta, branches to supply the hindlimbs – results in cat suddenly losing the use of their back legs, with the legs often feeling cold to the touch and with the absence of any normal sensation. This was confirmed when I performed a test to see whether there was any blood flow to the back legs by making a small needle impression in the pads (which normally results in a small spot of blood, as you would get if you pricked your finger with a needle) and by cutting the nail back past the quick, which is the equivalent of the very tip of our fingers and usually results in bleeding. The absence of any blood after both these tests confirmed the diagnosis and as a result the decision was made to put the cat to sleep.

There can be many reasons for such a clot to form in cats, with the most common reason being an underlying heart condition which if left undiagnosed and untreated can result in abnormal blood flow and potentially a clot forming, with some devastating and sudden effects. It is therefore important to ensure that you take your cat to the vet for regular check-ups, which will include the vet listening to their heart. Sometimes, however, as in the case yesterday, there is no apparent reason and it it just makes the situation that much more tragic.

Click here to read some more information about emergency situations with cats.

Caesarian Companion

Over the Christmas period I found myself performing a caesarian section on a Pug, with the result being four healthy young pups. Thankfully the anaesthetic was stable and we had more than one nurse who was able to step in and help to receive and revive the puppies as I delivered them. It did, however, get me thinking about those situations where you might find yourself with just you, the surgeon, and one nurse – a common situation in out-of-hours (OOH) emergency work. What would happen if the anaesthetic was unstable or there were simply more puppies than the nurse could manage on their own?

Rough sketch for 'Caesarian Companion'

The idea for the Caesarian Companion thus came to mind. The principle is that the surgeon can drop the newly delivered puppy/ kitten into one of the flexible ‘slings’ (flexible and clear to allow easy breathing, be comfortable and enable close visual monitoring), which can be detached, replaced and even come in different sizes, depending on the expected size of the delivered babies. The slings could be suspended within a frame that is gently vibrating to encourage tactile stimulation of the new pup/ kittens, with their heads poking out of the end into a chamber delivering the optimal amount of oxygen. The chamber would be heated to keep the puppies warm and made out of a clear, easily cleaned material to maximise hygiene. The idea behind carefully suspending and ‘agitating’ the newborns is to help any fluid that may be present on their chests to drain and to gently stimulate the newborns to start breathing on their own. Once suitably awake and when the nurse, or other staff member, is free then the newborns could be removed and transferred to a standard heated incubator, with the Caesarian Companion potentially doubling as one, with the newborns being placed on a heated, padded mat inside.

NB: This is simply an idea & the design is certainly not complete. Please feel free to comment/ suggest changes/ improvements.