Tag Archives: health

Live Freshr – reigniting a passion for food

Food, as far as I am concerned, is one of life’s true pleasures and I personally find the act of cooking and consuming interesting and varied fare to be a very invigorating and inspiring process. I have always been of the opinion that if you want to have balance in your wider life and continue to feel fit and healthy, both physically and mentally, then a carefully considered and, above all, interesting diet is a must. Although I generally feel that I ate well at university I did make a conscious deal with myself when I started working full time that given I was now earning I could therefore afford to buy good ingredients and learn to prepare food of a much higher quality than perhaps I was used to during my student days. I soon rediscovered how preparing simple yet interesting meals does not demand a professional kitchen set-up and similarly does not enslave you to the stove for hours on end. In fact, some of the best dishes are really quick and easy to knock up.
“Food is one of life’s great pleasures.”
Recently I had lapsed back into the classic trap of many young, busy professionals by feeling that I simply didn’t have the time to devote to coming up with new and interesting recipes and so I found myself living on the same few simple meal ideas that I was super comfortable preparing and that took very little time to do so. Although these meals were nutritious, balanced and tasty, the lack of variety that had established itself in my diet did see me start to eat out more in order to re-introduce some of the variety that I obviously subconsciously craved, an expensive and not necessarily healthy option. A friend then told me about her experiences of using a new service in Dubai that one signed up to online, choosing between one of four options – meat eater, vegetarian, paleo, and ‘premium,’ which basically just describes itself as being an ‘organic’ option, for what that is truly worth – and that then delivered, once per week, the ingredients to prepare five meals. Hearing my friend describe the tantalising variety of incredibly tasty dishes that she had already been preparing – a different one each day – peaked my interest and literally had me salivating like Pavlov’s pooch. A quick survey of the simple yet elegant website (www.livefreshr.com) convinced me that the idea sounded like a winner and I duly took advantage of the referral code the same friend forwarded to me, and eagerly awaited my first week’s delivery.
The order process was simple and with only four options to choose from it actually took a lot of the anxiety of ‘choosing what to eat’ out of the equation. At less than 200 AED (£40 / $55) per week for the equivalent of five meals per week I considered the price to be fair, being aware as I was of hardly ever spending less than that per trip to the store and returning home with what seemed to be far less in the way of food. I guess I am not alone in also finding trudging to the supermarket, especially several times per week, to be incredibly tedious and I know that I fall into the trap of opportunity buying whilst in store – not exactly the most cost-efficient approach to grocery shopping. The fact that I was able to specify that I was a single person and so would be cooking per day for just one person, with the ingredients for each recipe arriving in pre-portioned quantities, seemed like a revelation. So simple but yet so brilliant! It is almost impossible to buy base ingredients in the store for a recipe to satisfy the needs for just a single meal for one person, meaning invariably that one either overeats, wastes food (the classic “lets watch veggies rot in the fridge” game that I am sure I am not the only one who has been a regular participant in), or ends up eating the same meal for several days. The promise of a different recipe each day, prepared with fresh ingredients reinvigorated my interest in food, something that I believe is important for wider mental well-being.
Perfect for those singletons among us who also want to cook & eat great food.
The fact that I am able to specify a delivery day and time-window, with the food duly being delivered within the requested time, is another win for the service, and the presentation is excellent. The fresh, refrigerated, ingredients come in an insulated box, complete with ice packs to keep them fresh during transit whilst the dry ingredients and small per-meal ‘ingredient’ tick-lists come in a branded cardboard box, meaning that it can be easily recycled. A simple yet impactful presentation and way less intrusive on my overall day than having to trudge to the grocery store after work.
I have been using the service now for a week and just taken delivery of my second week’s set of ingredients and have to say that the first week has been flawless, so much so that I did feel compelled to produce a simple review video, not an act that I am quick to spend time performing in usual cases. With each meal’s ingredients clearly labelled, getting everything out and in front of me before starting to cook just appealed immediately to the organised process-fan in me that likes the order that it represented. The recipes themselves are found on the website, and can also be viewed as PDFs, and are clear, simple to follow and take, on average, about 45 minutes to prepare, long enough to know that you are, in fact, preparing good food from scratch, whilst not tipping over into tedium that can come with spending more than an hour in the kitchen – after all, who these days really has the time to do that?! I find the entire process of cooking to be quite meditative and enjoy getting lost in podcasts, audiobooks or music whilst I cook. It is, actually, this aspect of cooking that I particularly enjoy as it is a great opportunity to mentally relax before sitting down to enjoy some really decent food and the feeling of immense satisfaction that comes with knowing you are responsible for it turning out great. I can also envisage the service being a great way to get friends and couples cooking together, an activity that I know can be thoroughly enjoyable and a real bonding experience.
“Cooking is actually quite meditative.”
The variety is one of the main perks I have enjoyed with the service. So far I have enjoyed recipes as varied as fresh salmon with citrus risotto, chilli-ginger chicken and pumpkin and gorgonzola cannelloni, to name but a few, with each day being a new culinary adventure. Once again I actually look forward to my main meal of the day and feel the general sense of inspiration that comes with a varied diet, a sense that I feel extends into other parts of my day.
Live Freshr Food Delivery
Live Freshr Dishes
If you fancy trying the service out for yourself, then feel free to take advantage of the following referral link – money off for you and money off for me, so everyone’s a winner!

LiveFreshr.com Review from Chris Queen on Vimeo.

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

Scared of Ticks?!

ticks
Small but serious

I had a cracker this week after apparently failing to remove every single tick off a dog that was presented to me during consultations. In spite of safely removing those that were found during the fifteen minute appointment on a very busy weekend consulting block, and both demonstrating safe removal and disposal whilst also clinically examining said dog and spending time imploring the owners to effectively treat their pets against ticks, including examining the environment to try and identify the likely source of the acute infestation, prescribing safe and efficacious measures and discussing the potential health implications of ticks for both their pets and them as humans, it was apparently all insufficient due to the fact that they had ended up having to remove further ticks at home.

I won’t go into why the complaint was just silly as it is basically a waste of good electrons but it is worth picking up on one of the daft comments made as part of their groundless gripe: “it almost seemed as though the vet was scared of ticks.” Brilliant!

On that point, however, they are correct. I am scared of ticks. Terrified. As should everyone. They are serious little parasites who can and do kill as a result of some of the horrendous diseases that they carry, and I am not only referring to pets here.

“I am scared of ticks. Terrified. As should everyone.”

The big concern with ticks here in the UAE is the risk of ehrlichia, and it is a disease that we sadly diagnose and treat – not always successfully – all too often. It is also a potentially serious zoonosis, meaning that we can contract it if bitten by an infected tick. This is why we preach about effective and regular tick control over and over again, sounding like broken tick-themed records. It is a serious business that sadly too many people do not fully comprehend. So yes, I am scared of ticks. I approach them with caution, removing them with care and the respect that a dangerous killer attracts, and it is exactly why it may well seem as though I am being ‘over-cautious’ in the consult room and why I implore owners to treat their pets AND to take home the means by which to safely remove and kill any further ticks that almost certainly will be found by the owner at home.

“The battle against ticks does not begin and end with the vet.”

At the end of the day all I can reasonably do as a clinical veterinarian is to do my best to deal, in the time reasonably allotted, with the immediate issue (ie the ticks that were found and removed) and both educate and equip the owners to do the correct thing by their pets. The battle against ticks does not begin and end with the vet; it is an ongoing battle that is best fought in a preventative manner at home and taken as seriously as the “terrified” vet seems to take it. The long-term health of both you and your pet may well depend on it.

For more detailed information on ehrlichia in dogs, click here.

Further information on ehrlichia in humans can be found here.

Dubai – Blood, SMS & Stores

Blood tube, samplingStabbed on my first day. By a medic, granted!

I know I should have slept on the flight, especially given that it was an overnighter and would have really helped stave off jet lag, but then they have so many awesome films on demand. How can I sleep through that?! As a self-confessed movie addict the whole point of a flight for me – other than the obvious, doh – is to catch up on some serious marathon film consumption. I am not sure that my choices were particularly worthy of celebration but hey ho, they were darn entertaining so who cares. (in case you’re looking for a couple of movies to waste some time then Maverick Riders and Pitch Perfect were both adequately entertaining – epic surf and a decent music mashup! What’s not to love?!)

Anyway, major digression – I blame the mild jet lag as I write this – so back to the main narrative. At last I have arrived in Dubai. After all of the preparation, recent delays and the near miss at the airport, it was awesome to finally touch down, pick up my nice new employment visa and march on out of the airport to kick off the adventure. Chandy, who works for the clinic I am now employed by, collected me – a true sight for sore eyes – and I know that pretty much every taxi driver in the area let out a big collective sigh of relief as I promptly loaded up the car with the mother of all bike boxes – honestly, that thing is HUGE!

Now I am not going to bore you with descriptions of the weather so lets just assume that it was hot and sunny, which would be a good default assumption to make. The first port of call was to complete the obligatory health screen, which all new workers have to do. This involved a surprisingly quick blood sample – given that this was the first sample I have ever had taken, I will admit that I was somewhat nervous about the whole process as majorly wussy as that sounds. The truth is that I am more than happy blood sampling patients but the thought of having a needle plunged into my own vein had always freaked me out. The fact that I barely noticed the sample being taken has reshaped my views and I really wish I had grown a pair whilst back at home and donated blood. The mind truly is a powerful machine!

So, blood sample done it was off to the radiography department next for a quick chest X-ray, again all achieved in record fast time. Sweet! Health check, um, check. Next on the list was my first taste of a supermarket in the city to stock up on the basic essentials of life, principally an Emirati SIM card. You know you’re definately a child of the digital age when the first things you concern yourself with upon arriving someplace is a) whether you can get online and b) how to get cell reception. Dubai is like most other cities in the world in as much as getting a PAYG SIM is soooooo simple. 40 AED and a 50 AED credit top up later, I was the proud new owner of my very own Emirati cell number. Woo hoo! How to start feeling at home.

One of the things that its probably going to take a couple of weeks to get used to is the fact that over here, Sunday is a normal working day as the weekend takes in Friday and Saturday inclusive. As such, many of the people I immediately sent text messages to were at work – a reminder that Sunday is the new Monday 🙂 Not that it applies to me quite yet, as I am currently sat writing this in shorts, T-shirt and flip-flops – in sharp contrast to the thermals I was having to wear all of last week back home in Norfolk! Winter Sun: loving it already 😉

Travel Tip:

If you are looking to make the move over to Dubai then its a great idea to bring several photocopies of your passport, as to get things like a cell number requires you to provide ID, a copy of which they keep. Copies of any visas would also be a smart idea, for the exact same reasons.

Elephant Hills – Vet School experience

Jess Quinlan is currently studying veterinary science at Nottingham University and has also contributed, along with her dad, to previous editions of my book, Vet School. Jess recently spent some time out in Thailand working with elephants at the Elephant Hills centre, and here she offers her insight into this amazing experience.

 

elephant spraying water“We had been planning to undertake our 4 weeks of optional Animal Husbandry work experience at Elephant Hills, Thailand so a bit of a break from the norm. We had been really excited for ages about going but were also really worried. Our second year exams had been incredibly tough and even though we had worked as hard as we possibly could; we were still worried about the possibility of having re-sits in August.

9th July came and our results were due out at 10am. We were both terrified, not just for our own results but also for each other. I logged onto the university portal and although I couldn’t quite believe it at first, I had passed! Within two minutes I found out that Grace had also passed and that was it, we were going to Thailand!

We had only given ourselves two days to pack and get ready but before we knew it, we were on the plane and on our way into the middle of the jungle! When we arrived in Phuket, the transfer van picked us up and after five hours of travelling through extensive jungle, we had finally arrived!

Our first impression was stunned. We looked out over the restaurant to be faced with a vast expanse of trees and mountains, it was absolutely gorgeous! They gave us the day to settle in so we went to our tent and used the pool. In the evening, we were able to join the tourists. We watched the children from the local schools who showed us their traditional Thai dancing; followed by a cooking demonstration and dinner. Traditional Thai food for all (with a few chips for the kids)!

The next day we started the real work. We had to be up by 6…incredibly early even for an ex-lamber but the ten minute truck journey allowed us a chance to wake up a little! We arrived into the elephant camp a little stunned and with no idea what we were supposed to be doing. We soon discovered that in addition to this, nobody could speak English and so unsure as to what to do with ourselves, we picked up a broom from the corner and went to help some of the mahouts clean the area around their elephants, their condo.

After a few days, we had managed to develop a routine and also learn lots of words in Karen, the local language spoken by the mahouts and used only by members of the Karen hill tribe. We would help to clean the elephants’ condos in the morning and then we would walk the baby elephant through the jungle. This is probably one of the best things I have ever done in my life and definitely what I looked forward to every day. When we got back to the camp, we would chop up and prepare fruit for the tourists to feed to the elephants in the afternoon. Every two or three days, we would measure baby Haha in order for the managers of Elephant Hills to keep an eye on her weight progress. This was another favoured activity because this baby elephant loved to play! As soon as we got into the pen with her, she would chase us around and try to knock us over. When the tape measure was out she would grab it with her trunk, step on it or just take it off us all together. We had to measure her feet, heart girth, flank girth, elbow height and overall height. These measurements would be placed into a computer programme to give us an estimation of her weight, very important for tracking the health of a baby elephant. In the afternoon we would help the tourists who would come to the camp to feed and wash the elephants.

On our last day they also took us to the Elephant Hospital which is the only one that is present in the south of Thailand. It was there that we realised just how well looked after our elephants were. It was also really interesting to see some of the operations they were doing such as wound cleaning, as well as the elephant version of a cattle crush…it is huge!

We spent four weeks with the elephants and their mahouts and I can honestly say it is one of the best things I’ve ever done. We became really close with all of them and as we left, the head of the mahouts told us we’d been like their little sisters in their big jungle family.

After we had finished at Elephant Hills, we spent three weeks travelling around Thailand. It was amazing and I’m so glad I was able to travel and have fun whilst incorporating work from the Vet School at the same time. It is one of the reasons that I wanted to become a vet; to see and be able to get so close to so many amazing creatures and I would definitely recommend it to anybody who wanted to do something a little different for their Animal Husbandry EMS.”

 

For more information, please follow this link showing the newsletter the managers of Elephant Hills created about our visit.

http://www.elephant-hills.com/news.php

Animal Health Care, Big Apple Style

Animal Medical Center, New YorkIs it possible to mix business and pleasure? Well, yes, I believe it is and I think I managed it during my recent trip to New York. One of the days I spent out there saw me take a break from the usual tourist efforts and instead saw me head east, to 510 East and 62nd Street, in order to visit the Animal Medical Center, one of New York’s most revered veterinary establishments and a world-renowned teaching hospital.

Arranging the visit couldn’t have been easier, with the power of Twitter as a medium for more than just pointless digital static being proven as I managed to make initial contact via the social networking tool. A simple follow-up email later and a tour of the center for the friday of my visit was booked. Simple.

Set within viewing distance of the Queensboro Bridge and the Rockefeller Island Tram, a cable-car connecting Manhattan to Roosevelt Island a short skip across the East River, the building itself doesn’t quite do justice to the state of the art work conducted inside. Still, early twentieth century architecture was what it was and the important thing is that the center has been devoted to advanced treatment, research, education and exemplary veterinary healthcare since 1910, over 100 years, and has grown impressively in that time. Covering eight entire floors of their current building, the main action happens on the second, where clients are registered, patients triaged, including 24/7 emergency provision, and many of the center’s services are provided. The Animal Medical Center has everything, from it’s own on-site pharmacy, to a dedicated emergency ward, state-of-the-art imaging equipment, with everything from echocardiography to digital radiography, to MRI and CT, and beyond. The surgical facilities alone would make any surgeon worth their salt weep with delight and feel convinced that Christmas had come early. All in all, a very impressive set-up and it is little wonder that the Animal Medical Center is the first place vets from around the world think of when planning a trip to NYC.

Animal Medical Center, New YorkEducation is one of the core focuses of the Animal Medical Center and each year they take on a number of veterinary undergraduates and graduates for externships (short placements, normally during university vacations), internships and residencies. The competition is fierce, and the fact that New York is one of the toughest states in which to become registered to work as a vet, comes as little surprise. I had the chance to meet briefly with a German undergraduate who was a week into an externship before returning to complete her studies in Germany. She was incredibly complimentary and enthusiastic about the center and cited the high standard of teaching as being a major draw, something that was exemplified by the evidence I saw of the daily seminars and tutorials that take place.

“So, how do I actually go about working in the states?” Good question. The answer is that the process is neither simple, quick or, by any means, cheap, with the total cost likely to be in the region of $10,000, assuming you pass all of the stages first time. There will be another dedicated post on this subject but in the meantime, this AVS page gives a pretty good overview of the process.

Talking of working overseas, if any students find themselves at the Animal Medical Center and have any inclination to apply to study veterinary in the UK, they now have the advantage of their very own copy of Vet School: My Foot In The Door, which I gifted to the center during my visit.

The Overcharging Vets Myth

I was a little disappointed recently to read a certain celebrity vet’s blog post about ‘overcharging vets.’ Despite a couple of sentences that attempted to act as somewhat of a balancer by ‘hoping that their view is coloured by bad personal experience’ and acknowledging that not all vets overcharge, I couldn’t help but feel that the comments were misguided, unhelpful and may simply act to further add to the list of grievances, both reasonable and unreasonable, that some may wish to level at the veterinary profession, whom the vast majority of the general public still imagine rake it in and live the lives of monied privilege, whilst the opposite is usually the case.

Although it is undoubtedly true that some vets may be tempted to propose additional tests and treatments that may ultimately, in hindsight, prove to be somewhat superfluous, I firmly believe that the motives for 99.9% of vets to make recommendations and suggest preventatives, procedures and other treatments are clinical, sound and ethical, with little or no concern for their own material gain. Granted that with the introduction by some veterinary employers of incentive schemes and bonuses linked to things like turnover, some individuals may feel the pressure to over-emphasise certain options in the pursuit of a boost to their salaries. However, if the vet in question is paid appropriately for their skills and expertise then I don’t see how the potential promise of a few extra quid in the monthly pay packet can really lead to their clinical morals becoming corrupted. If they’re the kind of person who is overly motivated by money then they probably wont spend a lengthy career in veterinary anyway and will probably work out that there are significantly easier, and possibly less stressful, ways of making themselves rich than trying to fleece the pet owning public. Personally I don’t view financial incentive schemes as being a particularly great idea in veterinary as I fear that they do introduce the risk of conflicts of interest developing, even if those conflicts never actually manifest themselves. Most organisations that employ turnover based bonus schemes use them as a means by which to justify keeping base salaries towards the lower end of the scale, especially as vets on lower salaries can “earn more of a bonus as a result if they exceed their monthly turnover targets,” due to the difference between the target monthly turnover figure, usually based on the current salary and the actual monthly turnover figure achieved, which can ultimately vary with the cases that walk in the door that month. I had a debate about exactly this when trying to negotiate a perfectly reasonable salary increase with my first employer a year after graduating and starting work as a vet. I ultimately left as a result of their refusal to appropriately value my training, skills and experience, preferring to espouse the apparent merits and “additional earning power” of the bonus scheme. Myself and my colleagues at that practice, and others that I have since worked at, did not make clinical recommendations because option A was going to make us an extra £15 compared to option B, but instead used our training and judgement as vets to discuss the various options with the owner and ultimately make recommendations, with the owner ultimately making the decision having felt satisfied that they were getting value for money.

The example given by the author of a friend whose dog was taken to the vets suffering from “mild intermittent digestive upsets for a while” and subsequently received a bill for £1700, which was then derided for being unjustifiable and clearly motivated by profit seemed to me to be one-sided, emotive and jumped to a number of conclusions, which was unfair to air publically without offering the vet in question the opportunity to justify the charges. There was no mention of the dog’s previous treatments or the nature of the digestive upsets that had been the problem. Nor did it make clear whether the owner had been involved in any discussion about the investigation options, including potential costs, and thus whether in spite of the final amount being quite a lot and the ultimate diagnosis – note that a diagnosis was reached – being fairly benign (hindsight is a wonderful thing), the owner knowingly consented to the range of investigations carried out and their cost. If not then yes, there is a problem, but that problem is one of proper client communication and customer care, not of profiteering. £1700 is not a lot of money for such an exhaustive, all encompassing investigation into a problem that by the sounds of it had been grumbling on for a good while. The alternative, of course, could have been to conduct the various tests over a longer period of time, but then that may have involved having to administer multiple anaesthetics (additional cost and risk to the patient), and may have simply served to prolong the period that the animal was suffering from the problem and the course of supportive therapy, such as prescription diets, that may have been used in the interim. The result? That the final bill would have potentially been significantly greater than £1700 and that the vet is accused of dragging the entire process out in order to maximise profit. Damned if you do and damned if you don’t.

People talk a lot more with each other than they ever used to and one result of this is that if there is something that people don’t like, whether it be poor service or excessive charging, then it is not long before everyone is made aware and if the issue is not addressed then the individual or organisation runs the risk of being adversely affected, especially if the messages are consistently poor. Vets that overcharge – and it is easy to ascertain whether this is the case by comparison with other vets, offering a similar service – will find that word gets out and they will either have to bring their prices and practices in line with their professional peers or risk not remaining in business for very long. As such, I simply don’t believe that overcharging is a real problem in veterinary medicine. In fact, I think that pet owners get a very good deal considering that they have access to exceptional standards of private medicine, often with the convenience, clinical and cost advantages of same-day diagnoses and treatments, especially when you compare that humans pay many times more for similar tests and procedures privately themselves.

I will be very interested to hear the kind of stories that are submitted to the author and predict that he will undoubtedly receive an electronic sackful of complaints and countless accounts of “profiteering” within the veterinary profession. However, what I suspect won’t be accompanying those stories are clear, detailed explanations for why various treatments, tests and procedures were advised, what the animals’ previous histories were, or whether the options were clearly discussed, explained and ultimately consented to, including knowledge of potential costs. Incidentally, you don’t see many vets driving Aston Martins, living in mansions or sending their kids to Eton, so I do wonder where all of these scurulous profiteers are hiding out?

Big cats, Big surprises

lion, leopard, tigerThe standout feature of this week’s Safari Vet School – other than ITV’s incredible ability to massively over-dramatise everything –  was the lion dart, transport and release experience. As in previous posts most of the fun adventures that the students get up to manage to trigger some memory I have that I am able to draw parallels from with the safari experience. After all, in spite of being born in South Africa there are not too many Lions roaming the streets of Hampshire for me to get my clinical teeth into. Plenty of unpredictable, oft grumpy and sharp moggies though.

The students had to administer sedation to the two lions in question, in order to safely transport them across the reserve, and had to remain vigilant during the process due to the risk of the lions waking up. It highlighted the inherent unpredictability of sedation in general and how not all of our patients take note of the dose charts. We had a feline patient in yesterday who it was suspected may have had a foreign body impaction (ie may have had something stuck in his guts) as he had not been to the toilet and had been seen for vomiting previously. In order to fully assess him, including taking an xray of his abdomen, we opted to admit him for sedation and to start him on a drip in order to rehydrate him. In the end we needed to sedate him before we were able to place an i/v line as he was a bit of a flighty chap. The sedation worked a treat and within a few minutes our bouncy feline customer was a pliable bundle of fluff. This proved two points for me: 1. it is often preferable, both in terms of reducing stress on the patient and for making sure you, as the vet, are able to do the best job possible in the least amount of time, to sedate animals that are making life a little tricky when it comes to examining them; and 2. the response to sedation is such an inherently unpredictable game – another cat of the same weight may not have been touched by the dose we gave whilst the cat yesterday responded perfectly. Having top-up drugs, reversal agents, and additional medications and supportive treatments, such as oxygen, on hand is therefore essential, so that you are able to respond in real time to what is actually happening with your patient, rather than relying on what is ‘supposed’ to happen, as it rarely goes the way it should. The other thing to remember is that even though our patient wasn’t a 300kg lion, it could still have caused a decent amount of damage to either myself or one of my colleagues, especially during the recovery phase when animals are often very disorientated and confused. Anyone who has been on the sharp ends of a cat will certainly know what I mean. In terms of what was wrong with the cat, it turned out he was massively constipated and so a decent period of rehydration and an enema later and he was right as rain, including being significantly lighter than before! Ah, the glamour.

As a footnote, I just wanted to commend Fitz on her rather spectacular feat of acrobatics in diving out of the way of the zebra’s flailing hoof, which would have made quite a dent in her head if it had hit. Vets do seem to have to develop the reactions of a wired cat as, again, the unpredictability of our patients means that danger can literally fly at you from any direction at any time. Another feature of vets, and indeed nurses, seems to be our ability to contort ourselves into the oddest of positions and maintain said postures for lengthy periods of time in the course of administering to our patients. It sometimes feels like being a vet instantly puts you in contention for the title of World Twister Champion. Maybe compulsory yoga classes should form a part of the vetty curriculum?!

 

Oxford Entrepreneurs Shine Yet Again

Idea Idol 2012I love entrepreneurism and there is one society that really seems to embody all that is exciting and fun about seeking new ideas and opportunities, and that is the Oxford Entrepreneurs. Each year they hold their famous TATA Idea Idol competition for new business ideas and each year the entries simply get better and better and better. This year was no exception.

The format is basically the following:

  • Stage 1: Hopeful future business tycoons submit a short description of their business idea for initial consideration by the board.
  • Stage 2: Those fortunate enough to be selected are taken through to the semi-final, of which there were 40 this year, whittled down from over 200 initial entries. I am proud to say that the apps (Mucky Pup & Purrfect Paws) were among the semi-finalists this year, something I am personally hugely proud of. Following an afternoon training session on writing a great Executive Summary (1-2 page summary of the business plan), we had one week to complete and submit our summary.
  • Stage 3: Just six business ideas make it through to the final, with the lucky six receiving further training in pitching their business ideas before the big night of the final itself.
  • The Final: Each team, or rather one individual from the team, has just 2 minutes to present their business idea to the packed lecture theatre in the Said Business School (Oxford) and then 5 minutes of grilling by seasoned business experts and entrepreneurs who make up the judging panel. This year’s judges were Melody Hossaini (CEO of InspirEngage International and The Apprentice fame), Gary Frank (CEO of The Fabulous Bakin’ Boys), Will Chadwick (VP of Tata Interactive Systems), and Leo Johnson (Co-founder of Sustainable Finance Ltd).

The pitches were amazing and the business ideas presented exceptional. The six companies vying for the grand prize were, in no particular order:

  1. Rehabox – a personalised service to manage prescribed movement rehabilitation exercises for many conditions, including back pain, osteoporosis, injuries and following strokes.
  2. Oxford NanoSystems – a novel re-design of heat exchange systems found in boilers.
  3. BaNaPads – a social enterprise, initially focused in Uganda, providing locally manufactured female sanitary pads made from banana pseudo stems, an abundant organic waste, and a significantly more cost-effective material for pad manufacture.
  4. InVision – software that recognises hidden emotions by detecting facial micro-expressions with video technology.
  5. Medopad – a mobile health start-up providing hospital doctors with secure real-time access to patient data, images and lab results via iPads.
  6. FoetoH – provides home-based monitoring for babies before birth.

FoetoH winn Tata Idea Idol 2012The ultimate winner was judged to be FoetoH and the team, led by Dr Michelle Fernandes, won the grand prize of £10,000.

 

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.