The presentation above is a recorded version of the same one delivered at the 2018 VR Voice ‘VR in Healthcare Symposium’ held at Harvard Medical School, Boston, USA.
Please follow the link below to access a PDF version of the full paper from the above presentation, including the results of the survey conducted on the experiences and awareness of VR and AR within the veterinary profession.
Click link below to access paper
What a great day checking out the VR/AR Association startup zone at #IOTX in Dubai. Great ideas, great products, great people, such as Shujat Mirza (VR/AR Association Dubai Chapter President) & Clyde DeSouza (VR Filmmaker) – Spherical Image – RICOH THETA
AWE (Augmented World Expo)
- Seeing how much bigger the event has become, even over the last three years. One could really get a sense of VR and AR starting to be embraced by the mainstream and the energy during the event certainly felt like it had been etched up a notch from the previous year.
- Getting to speak. I was one of several speakers who took to the stage on the Life track and thoroughly enjoyed being able to deliver my vision of where I see VR in Veterinary currently standing and where I see it going in the future. I believe I am correct when I say that I might have been the first veterinary surgeon to speak at the event so representing the veterinary profession in such an exciting and rapidly advancing industry was truly an honour.
- Checking out Lllama Zoo’s HoloLens dissection experience. Charles and Kevin from the company had made the journey down from Canada and both my friend, Deborah, and I were privileged enough to be given a live demo of their augmented reality canine dissection tool, using the Microsoft HoloLens. With each of us wearing a headset, we were both able to see a high resolution holographic image of a set of lungs and heart floating in midair and move around it viewing it from different angles, remove layers and learn about the specific anatomy of this part of the body. The image quality was superb and I was not aware of there being any flicker or issues with the hologram staying fixed in position. A very compelling demonstration and a real glimpse at the future of anatomy teaching in vet and medical schools.
VR in Healthcare Symposium (VR Voice)
Mixed Reality & Virtual Reality
In 2016 I was fortunate enough to be at one of the conference parties where someone happened to have two Microsoft HoloLens headsets and was demonstrating them to the small crowd of curious nerds that had gathered around him. Well, I was one of those nerds and before long had the pleasure of donning one of the sets and so was introduced to the wonders of true mixed reality.
Much like a small welding mask, in both look and feel, the HoloLens is essentially a set of transparent screens that sit in one’s field of view by means of the headstraps that keep the device in place. Whilst not especially comfortable and certainly not something anyone is going to ever be in a rush to wear out in public on account of looking, frankly, ridiculous, the experience that it delivered was compelling. With the use of a simple gesture, specifically an upward ‘throwing’ movement, a menu popped into view suspended perfectly in mid-air and crystal clear as if it were right there in the real world in plain sight of everyone around me. Of course it wasn’t and the only person able to see this hologram was me. Selecting from the menu was as simple as reaching out and ‘touching’ the desired option and within seconds a holographic representation of the Earth was spinning languidly before me. I could ‘pick up’, ‘move’ and otherwise manipulate the item in front of me as though it were a physical object, and if I did move it, for example off to the right, out of my field of view, that is precisely where it remained and where I found it again when I turned back round. The human body application was similarly cool, as I was able to explore the various layers of anatomy through interaction with a highly rendered hologram. Whilst comical for onlookers not wearing a HoloLens, as I appeared to apparently be pawing away at thin air like someone suffering a particularly lucid acid hallucination, the thrill of what I was actually seeing and engaging with myself allowed me to ignore my daft appearance.
What are the medical education applications for such mixed reality technology? Whilst holographic visual representations of anatomy are, at first, a magical phenomemon to experience and a pretty cool party piece, it is the fact that mixed reality sees realistic holograms merged, or so it appears to the user, onto the real world, in contrast to virtual reality, which replaces the real world experience with an entirely digital one, that lends itself to unique educational applications. Anatomy instruction by being able to accurately overlay and track in real-time deeper layers onto a real-world physical specimen, enabling students to understand the wider context in which various anatomical structures sit is a far more compelling and useful application of MR than a simple floating graphic. Similarly, surgical training involving holographic overlays onto a real-world, physical object or combined with haptic technology to elicit tactile feedback, offers the potential to deliver programmable, repeatable, easily accessible practical training with minimal expense and zero waste on account of there being no need to have physical biological specimens.
Imagine: a fully-functional and resourced dissection and surgical training lab right there in your clinic or home and all at the press of a digital button. Imagine how confident you would become at that new, nerve-wracking surgical procedure if you had the ability to practice again and again and again, physically making the required cuts and placing the necessary implant, being able to make the inevitable mistakes that come with learning anything new but at zero risk to your patient. Being able to step up to the surgical plate for real and carry out that same procedure that you have rehearsed and developed refined muscle memory for, feeling the confidence that a board-certified specialist with years of experience has, and all without having had to put a single animal at risk – that’s powerful. That’s true action-based education at it’s most compelling and it is a future that both VR and MR promises.
I predict that the wide adoption of graphically rich, immersive and realistic digital CPD programmes, through both VR and MR, will result in a renewed engagement of professionals with CPD training and ultimately lead to more confident, skilled, professionally satisfied and happier clinicians. I, for one, know that were I able to complete practical CPD by simply donning a headset and loading up a Vive or HoloLens experience from the comfort and convenience of my clinic or home, all whilst still being able to interact in real-time with colleagues both physically present and remote, my CPD record would be bursting at the seams. That has to be a great thing for the profession, our clients and society in general.
You’ve done it! Five, or even six, years of lectures, practicals, placements, projects, rotations, deadlines, exams, and, of course, a whole lotta fun and here you now find yourself. Graduating, finally, as a fully qualified vet. Hoorah! It is most certainly the end of a MASSIVE chapter in your life and the start of, some would argue, an even BIGGER one. Now I don’t profess to be the font of all wisdom or to be able to bestow upon you the ultimate guide to be awesome as a new vet – to claim to be so would be both horrendously arrogant and plain wrong – but what I can offer to do is pass on a few tips that I have learnt – often the hard way – along the path from newbie vet to older, more grizzled vet with less hair than I started with.
- Take some time off after graduation/ finishing vet school – I remember loads of people in my year rushing out and starting work the very minute they got their paws on that degree certificate only to hear many of them state later that they wish they had taken more time off post-graduation to just enjoy, well, being free. Free from the stresses of studying, revising, being examined and assessed all of the time, free even from competing with one another, which admit it or not is exactly what we do throughout university – it’s in our ‘high achiever’ DNA. Save for taking a sabbatical between jobs, which many vets do after a few years, often to travel the world before ‘finally settling down’, this is one of THE best opportunities to just kick back, relax and take some stock of what it is you have actually achieved over the past half a decade. Granted it is getting more competitive in the veterinary job market and, true, loans do need to be paid off but we have not yet got to the tragic state where ALL the best jobs will have been snapped up immediately and student loans only actually start getting paid back once you are earning over a certain amount (other loans, such as professional development loans, may, it is fair to say, come with different repayment terms but generally speaking there isn’t as much of a pressing imperative for you to rush out and jump into the frays of work that you might imagine). So simply ENJOY!
- Be selective about your first job – this kind of follows on from tip number 1 but is something that too many new grads forget, or just don’t even consider. Jumping into the very first job that is offered to you may well get you practicing, and thus earning, faster BUT it is a really smart long term career move to ensure that you accept an offer from the very best job that you can attract. This doesn’t simply mean the highest paid. No. What it means is picking a practice, a team, a culture in which you will be more likely to thrive as a new grad and grow and develop into the top veterinary surgeon that you surely have the potential to be. Regardless of what you might feel, or believe, immediately post-graduation you are not the fully formed product. Nay! You are, or certainly should be, ‘day one competent.’ There is a reason that you are expected to complete the PDP (Professional Development Phase) after graduation and that is because there are still loads of things you will NOT be anywhere close to fully competent at doing. And thats ok. It’s normal. It’s expected. So, with this in mind I am sure we can agree that accepting a position to run a solo branch clinic as a fresh-faced newbie with little to no support or meaningful guidance from the older, more experienced vets, does not necessarily lead to a smooth learning curve towards year one competency. What it almost certainly does guarantee is the mother of all baptisms of fire and if you are the kind of person who feels that they learn best by jumping into the ring and just start swinging, or find the whole ‘Sink or Swim’ philosophy appealing then a sole-charge position may be the one you do want. My first job, whilst being part of a larger clinic and technically not 100% solo, did see me mostly based out in one of the group’s satellite clinics, where we had a more limited set of diagnostics tools, a piss-poor surgical set-up and probably THE worst X-ray machine and processor ever that made me actually hate any case that required an X-ray to be taken (that’s a lot of the standard caseload!). Whilst I coped, relying on what I did know, what I could pick up along the way from books, online and colleagues, I know now that I would have developed into a far more competent, well-rounded, omni-skilled vet – and, if truth be told, enjoy my job more – had I spent my really formative years working in a truly multi-vet environment, with high clinical standards, equipment and staff to meet them. Well run practices that think long-term recognise the true value in developing their new grads properly and invest time and resources into them. They will often reap the rewards down the line when that same new grad starts, as second nature, to work cases up properly, fully utilising a range of skills and knowledge to maximum effect for their clients, patients and the clinic. So it might take a little while to find this kind of practice but trust me, it is worth the wait. The alternative, which a lot of people opt for, whether they actually realise it at the time or not, is to take one of the first jobs offered, struggle for the first year and then quit, moving to another clinic, often a little more jaded about being a vet. And that is just sad. The other reason to really be selective is to ensure that you also choose somewhere where you’re going to enjoy living. Having a good salary doesn’t make up for living somewhere crap!
- Sign up to SPVS to get the annual veterinary salary survey, and READ IT – make sure you actually enter the veterinary job market knowing your market worth and start your professional life on the best footing you can. For many of us the very idea of negotiating our salary, including ‘perks’ or extras such as the level of CPD allowance, is more terrifying than a 3am GDV (only marginally, mind) and most new grads will simply not attempt it, instead just accepting what is offered. It is rare that you will take a salary cut as your career progresses, unless you change to a part-time position or change direction entirely thus dropping down several rungs on the old career ladder, so why not do yourself a favour and try and start a little higher up the greasy pole? Knowing what the market generally says you are worth paying via salary surveys is a good starting point in any job hunt. Whilst we’re on this topic it wouldn’t be the worst idea in the world to maybe use some of that post-graduation downtime to read some good books on subjects that might not seem immediately relevant but that will actually pay dividends many times over. Books on topics such as negotiation, sales and basic psychology are not only interesting reads in their own right but will equip you with some highly valuable soft skills that can be applied to job hunting and can make your transition into a working professional smoother and more productive.
- Be Confident of Your Worth – this naturally follows from the previous point but relates more to knowing why we charge what we do for our services and having the faith in your, and your profession’s, worth to avoid apologising to clients for it. It is a fact that you will be made to feel time and time again that you are a member of a “money-grabbing” profession who simply cares about profit over animal welfare. This charge, often spat at you when you are feeling at your lowest ebb, will come from clients who may well be frustrated, for whatever reason, legitimate or otherwise, but who have zero real appreciation for what it costs to provide top-class medical care and the fact that YOU are ridiculously highly trained and DESERVE to be paid reasonably for your skills, knowledge and service. I am as guilty as anyone of starting out in this game withering under these kinds of baseless attacks and finding myself nervously, awkwardly apologising for our prices being “expensive,” before feeling under pressure to cut costs, discount and generally acquiesce to unfair pressure. I have since developed a much tougher skin and fully appreciate both my worth and the worth of the profession, and of the wonderful service we provide. Business fact: without profit there is zero incentive to keep a business running, and veterinary clinics are no different. Having a building, medicines, surgical facilities, a skilled and dedicated team that is on hand round the clock to ensure animals, and their owners, have access to superb healthcare, does not happen by magic. Someone has to pay for it. If you believe that you should practice simply for the love of it then that is all well and good – go and work for a charity – but if you value the investment that you have made in your own training and the value of the service we provide then do NOT be bullied into apologising for what you do and what you charge to provide the service that you do. Of course some people will find the Gold Standard of care prohibitively expensive and may not have the luxury of insurance, or any other variation on the theme of not being able to meet the costs involved. We are, as a profession, sensitive to this fact and that is why as a professional you should be prepared to discuss all of the available options, including referral to charities, looking at less pricey (but often less effective) treatment options or, in the event of ‘treat or the animal suffers’ cases, offering euthanasia. As hard as it will be to remember this fact, it is NOT your fault or responsibility if the owner in question does not want to entertain any of the other options offered and still insists on the Gold Standard but without wanting to pay. You are not a money-grabber. You are not a bad person. You are not disinterested in animals. Quite the contrary – every one of us could have gone off and earned multiples of what we do in different industries and probably with less stress. You simply have confidence in your own worth and that of your profession. It is worth noting at this point that the vast majority of the clients you meet will appreciate and value the good work you do. That cannot and should not be understated.
- Be nice to nurses – well, you should be nice to everyone, obviously, but especially nurses as they very much hold the power to make your life as a vet, and especially a new grad, either awesomely awesome or miserable. They will know loads of super useful things way beyond the academics of being a vet, such as how to actually, safely hold a cat for you to examine, blood sample or the like without sustaining injury, and will be able to let you in on those little tips and tricks that are specific to the clinic in which you actually work and that can help to smooth the flow of the work-day. Aside from just being a decent person, polite, respectful and all that obvious stuff, you might find that mucking in and making the odd round of teas or actually cleaning out that shitty kennel that you happen to be the first person to see, rather than walk past and pretend you didn’t, will go a long way to ingratiating you as a genuine member of the team. In fact, just remembering the old adage “behave as you would want others to behave towards you” is a simple way of putting it.
- Develop interests/ a social life OUTSIDE of work – one of the biggest culture shocks to most new vets is the fact that we all go from being part of a pretty sizeable family, getting to see your mates every day, to often finding that you live miles away from both them and your family. Throw in the inevitable stresses that accompany starting work and the fact that you are now professionally responsible for what you do, plus lengthy working days and it is easy to see how one can quietly slip into a bit of a social rut or depressing cycle of ‘work-home-bed-work.’ Ensuring that you have an interest, hobby or social outlet outside of the clinic and that can serve as a healthy outlet for the stress et al of a vet’s working life will keep you sane, balanced and happy. Vets have an alarmingly high rate of depression, alcoholism (often started at vet school if my observations are any guide) and suicide, with the fact that the job can be quite isolating and lonely on a lot of occasions. Coupled with the sudden change in circumstance from being part of a big, social group of like-minded people to being out there in the world on your own can contribute to a deleterious cycle. Whether it be sport, or music, or art, or a whole host of other activities and interests, please do either continue to pursue them or develop one as soon as possible after moving to your new home.
- Treat yourself when you get your first salary payment – there is no sweeter feeling than being able to buy yourself something that you’ve always really wanted and that you can now afford. A big TV? A new car, perhaps? Or a holiday? Whatever it is that you will truly enjoy splurging on now that you can afford to enjoy doing so when you get your first payslip. It’s wonderful and screams out “I have arrived!” Savour the feeling of spending power and throw caution to the wind before you have to become all grown up by moving onto more responsible attitudes to your money.
- Save & Start a Pension – yes, yes, I know. I have actually typed those words and have instantly turned myself into a granddad in your eyes! Well, if thats the price I have to pay for offering really good advice then so be it. And it is awesome advice. Probably some of the best advice you will ever get. As much as you will not want to think about it the inescapable truth is that you will age and you will eventually want to do such things as retire, or maybe buy a house, or get married. You know, the kind of things that old people do but that you will end up doing too before you’ve had time to realise it. I am sure that you want to have a great standard of living when you finally stop working – I know I do – and that the likelihood of there even being such a thing as a state pension by the time we get there is pretty much zero. As such, you NEED to make provisions for your latter years and the truth is that the earlier you start the sooner you can begin to take advantage of one of the most powerful forces there is: COMPOUNDING. I won’t go into an in-depth definition of what compounding is here – you can Google it – but suffice to say that it is awesome and can be the difference between you eating baked beans everyday as a pensioner or living the good life. The key with compounding is time and so the earlier you start saving, and especially contributing to a pension scheme, then the more you will benefit from it. Establishing good habits – and we all know that saving IS a good habit – early can quickly lead to them becoming just that: habits. As in something we do without really giving it much thought. As in automatic. If you’re anything like me then without making a conscious, early decision to put aside a certain, fixed percentage of my salary automatically and regularly, I would probably just feel it burning a hole in my pocket and be the proud owner of even more Apple products than I already am! The fact that a set amount just disappears out of my account as soon as it lands in there and goes towards something with long-term benefit to me, means that I essentially do not even miss it because it was as if it was never really mine anyway. As such, my monthly budget is based on what I keep and it is amazing how I have adapted to this smaller amount quite happily. Having money saved regularly also means that should you wish to make a larger, discretionary spend, such as an awesome holiday, or maybe even need some ready cash in an emergency, it is already there courtesy of your good, early habits. That is incredibly liberating. So, start a regular savings plan as soon as you start earning and as much as it will feel like it is something that someone of your age has no place doing book an appointment to speak with a pensions advisor. (NB: I really, really wish we could change the word and use something other than ‘pension.’ It just has certain automatic connotations that I strongly believe serves to put young people off the very idea).
There are doubtless many more bits of advice that will see you sail smoothly from the life of an aspiring student to that of hard-working professional so feel free to suggest your own below. In the meantime, enjoy your success and good luck with whatever is next in this insane journey we call life.
“Virtual Reality was made for education.” I have no idea who first said that – can I claim it? – but I am sure it has been uttered countless times since and I assure you that it will be said countless times in the future. From feeling as though virtual reality (VR) was nothing more than a sci-fi promise of things to come yet never quite delivered to the current situation in which VR feels as if it is undergoing a true renaissance.
With the arrival of devices, such as the Vive, Oculus Rift and Samsung GearVR, that are finally capable of delivering truly-immersive, high resolution and, most importantly, non-nausea-inducing experiences that captivate both young and old alike, VR has arrived and the exciting truth is that we are simply getting started!
There are already creative, innovative and fast-moving teams working on sating the appetite for immersive content, with gaming naturally leading the charge, and 360-degree video experiences also offering many their introduction to the world of VR. This, however, is not where VR ends and it continues to excite me to see the educational promise that this technology offers and that pioneers in the field are indeed delivering on. Unimersiv, one such team, refer to the idea that whilst 10% of knowledge that is read and 20% of that heard is retained two weeks later, a staggering 90% of what is experienced, or physically acted out, is recalled. If that is indeed the case then VR, with its power to immerse users in any environment that can be digitally rendered, offers a hugely powerful educational tool. The fact that the big players in the tech arena, such as Google, are now taking VR seriously speaks volumes for how impactful it is predicted to be, and that I believe it will be.
Potential medical, especially educational, applications abound, with veterinary no exception. Whilst my interests in the technology are NOT limited to veterinary, it is an area that I have direct experience of working in and so where perhaps I am most effectively able to postulate on the future applications of a technology that IS, I strongly believe, going to shake things up for all of us. In terms of medical and science education, for example, work such as Labster’s simulated world-class laboratories, where students can learn cutting-edge science in a realistic environment and with access to digital versions of professional equipment. It may be digital and simulated but that does not diminish the educational power that such experiences delivers. I can see Labster’s technology inspiring a new generation of scientists to develop a fascination for the subject and ultimately help solve many of the world’s most pressing problems, such as the issue of antimicrobial resistance and the drive to develop new drugs.
So what about the potential uses for VR within veterinary? Well, perhaps some of the following….
- Dissection – Anatomical training without the need for donor animals/ biological specimens. More efficient, with multiple ‘reuse’ of specimens in a digital environment, leading to revision of key concepts and better learning outcomes, translating into better trained, more confident practitioners.
- Physiology – take immersive ‘journeys’ through biological systems, such as the circulatory system, learning about how these systems work, both in health and disease. Simulation of the effects of drugs, parasites, disease processes can be achieved, with significant learning outcomes compared to traditional learning modalities.
- Pharmacology – model the effects of drugs on various biological systems and see these effects up close in an immersive, truly memorable manner, thus deeply enhancing the educational experience.
- Surgical training – simulate surgical procedures thus enabling ‘walk-throughs’ of procedures in advance of actually physically starting. With advances in haptic technologies, tactile feedback can further augment the experience, providing rich, immersive, powerful learning environments. Surgeons, both qualified and training, could learn in a solo capacity or with team members in the digital environment – great for refreshing essential skills and scenario role-playing with essential team members. For example, emergency situation modelling to train team members to carry out their individual roles automatically, efficiently and effectively.
- Client education – at home and in-clinic demonstrations of important healthcare messages, helping drive healthcare messages home and driving clinic sales, revenue and profitability, and leading to more favorable healthcare outcomes and client satisfaction.
- Communications training – many of the issues faced in medical practice stem from breakdowns or difficulties in communication with clients or between colleagues. Communications training is now an integral part of both medical and veterinary training and should be extended to all members of a clinic’s team, from receptionists to nurses and veterinary surgeons. With the immersive power of VR and the ability to create truly empathetic experiences, it offers the perfect tool for communications training.
- Pre Vet School education/ Careers counseling – think you know what it means to go into veterinary practice? Can’t arrange a farm placement but still believe you have what it takes to pursue a veterinary career? Imagine being able to experience a range of VR simulations that guide you through a host of realistic scenarios faced by veterinary professionals, enabling you to make informed career decisions based on ‘real’ experience. It has been demonstrated that those who experience high-quality VR feel genuine empathy for those situations into which they digitally stepped. The power of this for making informed choices about future plans and for challenging preconceived notions about what it means to be or do something is compelling.
- Commercial demonstrations/ trade show experiences – custom-made VR experiences for showcasing new products and services to prospective customers, creating truly memorable and impactful campaigns. I for one look forward to VR becoming a mainstream component of company presentations at trade shows.
These are simply a snapshot of some of the potential applications for VR with most easily being applied in other, non-veterinary contexts. I look forward to continuing to grow my knowledge and expertise in this exciting area and welcome anyone who shares the same sense of wonder and optimism at the possibilities to get in touch.
Originally published in VN Times (Vet Nursing Times) – VN Times Technology Column – Smart Phones, Smart Practice
Smart Phones, Smart Practice
If someone had told us ten years ago that we would, one day, all keep a small supercomputer in our pockets, they may have been dismissed as some crazy, science fiction obsessed oddbod. How smug do we imagine them feeling today as that is pretty much what has happened, with a very high number of us all owning either iPhones or other such all-singing, all-dancing smartphones.
They have become so much more than just a simple means of making calls or sending text messages, with the ability to do virtually anything that we could imagine wanting to do with a small electronic device. They are information providers, email and chat platforms, games consoles, cameras, even tickets for everything from concerts to flights! Do they have a place in the veterinary clinic though? I personally think the answer to that is yes, they do, and I can see them becoming ever more useful to both vets and nurses.
One obvious use of smartphones in the clinic is as a portable, easily accessed source of information, from the Veterinary Formulary for rapid medication checks, to a video tutorial on placing a feeding tube, or lining up a dental radiograph for the best view. Being able to access information at our patient’s sides is only ever going to improve the quality of our service to them.
With the invention of apps, which will likely be heralded as one of the 21st Century’s Great Innovations, we now have some great clinically relevant tools at our finger-tips, for everything from calculating dose rates of medications and drip rates, such as the VetPDA Calcs app on iPhone, to more specialised apps and portable gadgetry like the AliveCor, which is an awesome instant ECG monitor that runs via the iPhone and a funky case, which houses the skin contacts and works wirelessly. All very cool technology and, even better for us in practice, all portable.
So where will the future take us? What will we be using our smartphones for in the clinic of tomorrow? It is likely that every one of us will use a portable device at work, through which we will have access to our patients’ notes, be able to easily design treatment plans, monitor everything from heart rate and rhythm to temperature, and even take payments from clients for in clinic purchases. The future is bright; the future is mobile.
Okay, I admit it…. part of the reason that I have been “off the grid”, in a blog writing capacity at least, is that I have been having fun. Lots of fun. In fact so much fun that you’ll probably want to hate me for it. But I’m cool with that. Seriously though, I just realised that it’s been over a month since my last post and I honestly had no idea such is the pace with which my time here in the UAE is hurtling past.
Much has happened since my last installment, from some interesting clinical cases and happenings at work through to some awesome social, sporting and, well, just fun endeavours.
In terms of the clinical, the main changes since my last post appear to be (in no particular order):
Down a Vet
The loss of one of our vets meaning that there have been some changes to the weekends that I now get to enjoy. Unfortunately one of our more recent vets just wasn’t getting on well and was, as far as I could tell, also quite unhappy. It was pretty darn clear even from the moment I started that there was a major mismatch between her style of consulting and flexibility to new ideas and ability to cope with the challenges of this particularly busy clinic with exceptionally high standards. It was telling that she seemed to spend rather a lot of time being corrected or otherwise having meetings with the bosses in the office, on a number of occasions preventing me from getting my stuff and getting home! In the end it was no surprise to discover that she was asked to part way with the clinic, a decision which was clearly inevitable. As I mentioned, it did mean that instead of my usual Friday to Saturday weekends, I was switched to working Saturdays and so generally get my weekends on Thursday and Friday, or occasionally Wednesday and Friday.
As mentioned above, I am now working regularly on Saturdays with the change in staffing, meaning that my working week technically starts on a weekend. This was initially at the main hospital all day, which tends to be crazily busy all day, although since we opened our branch in Mirdif, a part of town out near the airport, on Saturday mornings, I start there and then head back over to the hospital in the afternoon. Most Saturdays I arrive to find the clinic as busy as it often is on weekends, with people waiting to be seen and my colleagues all dealing with additional in-patients. There seems to be this annoying feature of veterinary life that dictates that there is never just a happy medium to anyones’ day. It’s either full on, crazy mental, oh-my-God-I-haven’t-even-got-time-to-think-let-alone-eat-or-go-to-the-toilet, with consults booked solid, walk-ins galore and extras just pitching up expecting to be seen (and doing so because we’re just nice like that), or nothing at all with plenty of time to thumb-twiddle, although there is obviously always plenty that can be done to fill the time. Busy is good: I would rather have stuff to do, especially as the day does progress much more smoothly and at pace than if you’re simply thumb twiddling. What I don’t like, however, is the frantic nature of those insane days, when everyone is just rushing around not quite sure if it’s all going to go to shit at any moment. What I have found some weeks is that by the end of the working week there is the danger that people start to get a little snippy with one another, meaning that there is sometimes some definite tension in the air, something that I find very uncomfortable. I like the people I work with – they’re great and I think we have a great team. I don’t like to see them stressed to the point where peoples’ tempers or nerves are getting stretched, which is what I have felt happening some weeks. The notion that it’s “just part of the job” is also something I don’t subscribe to, in much the same way as I view the concepts of “lunch is a luxury in veterinary” and “animal bites are part of being a vet or nurse” as the big crocks of shite that these viewpoints clearly are. It should always be possible to organise things in such a manner that people are busy and able, if necessary to work at 100% capacity when called upon to do so, but not to expect that level of intensity all of the time. The irony, of course, is that we will then get days where there are virtually no appointments – one of the twisted facts of life in veterinary!
Passed With Flying Colours
After a month of waiting, and a few days of hasty revision using my geekily created “Dubai Exam PDF”, I was once again back at the municipality to sit my exam for real this time. It was just little old me this time and I was led up to an office where I sat as if working for the ministry and completed my exam, with “colleagues” around me at their desks discussing various matters in Arabic. The exam itself was a fairly straightforward affair, following the formula that seemed to be firmly established by past papers: three questions on matters related to ministry rules and regulations, such as the duties and responsibilities of a vet and what is supposed to happen in the event a sole vet is absent from the clinic for more than 60 days; then some short clinical questions, including being asked for TPR ranges (temperature, pulse and respiration) for cows and camels – yes, there was a camel question! Most of the clinical questions are geared towards notifiable diseases and public health, so there were ones on everything from leptospirosis to rabies. The last part of the exam was three longer “essay” style questions on, if my memory serves me well, tuberculosis, distemper, and strangles (I think). I didn’t come out of that exam feeling like I’d nailed it and was actually rather apprehensive about what the pass mark might have been. However, this apprehension was misplaced as I discovered a couple of weeks later that I had in fact passed and so am now fully registered.
So, what does being “registered” actually mean? Well, it simply means that I am legally permitted to work in a solo capacity as a vet, such as I now do at our Mirdif branch, and not a great deal more. I have been led to believe that there are many vets operating in Dubai that are not fully registered and it seems they are still able to go about their business. Monique and Malcolm, however, choose to do things properly, which as grating as I am sure it must be to know others are blatantly flouting the rules, is the correct approach to take and one for which I applaud them.
Its been busy so that must mean some interesting cases, right? Exactly. There have been some great cases to deal with, as well as some just comical or downright bizarre experiences within the clinic, such as the situation I found myself in last week when a rather attractive client came in with her dog, very professionally and elegantly dressed, and then promptly farted in front of me. Not once, however, but twice! My initial reaction was to think it was the dog but it was quite clearly not and so I did the gentlemanly thing by simply ignoring what had just happened, even when it occurred twice! The bizarre thing was that she didn’t even seem fazed by it and I suspect just considered it a perfectly normal and reasonable thing to do in front of the vet. Bizarre indeed.
We see a lot of skin cases in Dubai, with ringworm top of the list when it comes to dermatological issues. Having never seen a case of ringworm in practice in the UK, with my only experience of it being getting it myself as a young vet student working on a dairy farm (I thought it was just a really nasty rash from rolling out the straw each day – it wasn’t), I now provisionally diagnose and start treatment for it on an almost daily basis. In fact I use the UV Wood’s Lamp so frequently that it occasionally feels like I’m running a tanning salon 🙂
Ear mites are another dermatological scourge oft seen and it seems the ones here tend to be bruisers compared to their whimpy European cousins, as you can easily see the little rascals scampering around down the lugholes of lots of the pets we get in.
When it comes to parasites, ticks are the big problem here whereas we see very few, if any, fleas. In fact I think I may have seen a single flea here since arriving, which is in complete contrast to my experience of working as a vet in the UK for the past five years. As I say, ticks are the big issue here, and unfortunately it’s a fact that they carry some pretty nasty diseases, especially ehrlichia, which I have diagnosed several times. I had a dog presented to me at the end of last week which had been missing from home for several days. When it returned it was found to be absolutely infested with ticks. Our nurses alone removed over 30 from the poor dog! Although the dog wasn’t displaying any overt clinical signs of ehrlichia, we routinely test where appropriate and so a blood test was run, rather unsurprisingly proving positive. Ideally in such cases a full blood count (CBC) would be run to assess the nature and extent of any haematological abnormalities but the owners were not keen to spend the money and so after checking a PCV (normal, thankfully), the dog was started on a 30 day course of doxycycline at 10mg/kg once daily and started on Frontline, to kill any remaining ticks and provide protection against potential further bites. Instructions were given to the owners to a) bring their other dog in for a check and testing – he also proved positive and so treatment was started – and to thoroughly spray the house against ticks, as ehrlichia is a known zoonosis, and a potentially very nasty one at that. Definitely not something that any person wants to end up contracting.
On the theme of ticks, we see a large number of “yellow” cats here, with Bartonella felis, from ticks bites, being the usual culprit. There was one case in particular that came in one day with a history of just being very quiet, flat and “just not right.” Upon examination it was clear that the cat would probably have glowed in the dark, such was the vividness and intensity of the yellow discolouration that it was showing. As with ehrlichia cases, a full blood count is performed, in addition to biochemistry, and the cat was found to have a severe anaemia, as a result of immune-mediated haemolytic anaemia, and so aggressive treatment was started, with doxycycline and steroids at immunosuppressive doses so as to halt the ongoing destruction red cells that the cat’s own immune system was undertaking. After several days in hospital the cat did make a good recovery and the last time I saw it for a check-up, it was a much more normal colour and a tad more feisty – always an encouraging sign!
Fun and Socials…
I always thought I had a lot going on in my life when in the UK but since moving over here it seems that the options for ways in which to spend any spare time you get are numerous, and at times it is difficult to know which options to choose and which to pass by. Since my last post I have been up to the following shenanigans:
Kitesurfing. After taking a few lessons, more as a refresher following the course I undertook in Wales last August, I took the plunge and invested in my own kite, and other gear, so that I am able to get out and put my new skills to use whenever it is windy and I am free. The past few weeks have been somewhat devoid of wind – good for a skydiver – and so I have only really been able to make it out onto the water properly twice. The first outing was fun but rather expectedly frustrating at times, as I spent the time getting used to the kite and board, never really getting up properly or in control, and crashing the kite on more than one occasion, at one point rather alarmingly near a group of sun bathers – quite why they choose to sit on a beach where there are loads of very large kites flying around is beyond me, but there you go, they exist and so it is generally regarded as polite to avoid thwacking them on the head with a large kite if at all possible. Friday, however, was completely different and in spite of the beach being packed, I had a blast, getting straight up on the board and actually kitesurfing for real for the very first time! The feeling of being in the water and then with a simple movement of the kite and a powerful pull from the wind, finding yourself skipping across the waves is indescribably awesome and it is instantly easy to see why people get hooked on the sport. You feel as though you’re actually flying across the surface of the water, which is an amazing feeling indeed. Although I had to ‘bail’ from the board a few times, I found it very simple to control my kite and steer back to my board, and didn’t crash the kite once during my session, which constitutes a major achievement in my opinion. I actually cannot wait until the next windy day when I am off and already find myself doing the kitesurfer thing of constantly assessing whether the wind is strong enough, even whilst walking across the street to get lunch and back. I am addicted it seems but as far as vices go, playing with kites seems a harmless one.
Skydiving. My other passion which, rather ironically, also relies heavily upon the wind, or preferably on very little wind being present, is jumping from perfectly good aeroplanes in the name of sport. Since arriving here in Dubai I have taken advantage of the fact that one of the best dropzones in the world is on my doorstep by jumping at Skydive Dubai several times. Unfortunately I have not yet reached 500 jumps and so am unable to jump at the jewel in the skydiving crown, The Palm, which is really the ultimate aim owing to it’s absolutely stunning location and views. I have, instead, been doing my jumps out at SD2, the desert dropzone, located on the main road between Dubai and Al Ain, and past both the Sevens rugby stadium and the main camel racing track. Getting out there is so easy given how good the roads are here, meaning I can, in theory, leave my villa in the Springs and be in a plane within the hour. As it’s generally hot and sunny all of the time, it is very rare that we get weather delays, although it does get really hot by about mid-morning, meaning that being packed into a small plane for the climb up to jump altitude can be a bit uncomfortable. Its so worth it though as that door opens and you get to leap out into the vast UAE sky.
I am currently working towards my USPA B-license, having logged over 50 jumps. Part of the requirements is to complete a canopy course, which basically teaches you how to fly (and land) your parachute better (in other words, more safely). The first day was sadly too windy and was cancelled but day two was on and so I spent the day learning the theory of more effective canopy flight, including such principles as stalling (not for the faint-hearted, as it basically involves pushing your parachute to the point where it collapses) and finding the flare “sweet spot,” before going up and out to put into practice what we were learning. As it is just the part of the skydive under canopy that we were concerned with there was no need to go to full altitude, meaning that those of us on the course were the first out of the plane at 5000 feet and literally pulled our chutes a few seconds after exiting the plane – Hop & Pop. Although jumping at 12,000 feet is exhilarating enough, the fact is that 5,000 feels so much closer to terra firma (because it is) meaning that the thought of impacting it seems to be much more prominent in the mind. My first exit wasn’t the most stable and it would be easy to just get into a panic and deploy before being in a stable freefall position, all of which increases the chances of there being a deployment issue and ultimately having to cut away. As such, it is vitally important to remain calm, remember the training, breathe and relax – the key to skydiving. After correcting my body position on exit, the next four jumps went very well and I finished the day with a series of pretty good landings, meaning that I have been able to ‘graduate’, as it were, onto a slightly smaller canopy. In practice, what that means is that I fly under canopy much faster, all increasing the importance of having good control so as to lead to a safe and stable landing, which is the number one priority with this sport.
My parents came over to visit. I have had my first set of visitors as my parents headed over for a week in April, arriving on the day of the World Cup horse races, which we attended. Although I had to leave them to entertain themselves for most of the week, owing to the need to work, the three days we did manage to spend together were action packed and a great deal of fun. There is something about having guests that ensures you remember to do all the touristy stuff that as a resident you’d probably not actually ever get round to doing normally. For example, we headed up the Burj Khalifa – a Dubai must – and had breakfast at the Burj al Arab – again, another must see and do in my opinion. One of the highlights of their trip was a desert ride, although it was not without it’s helping of initial drama, more of which I shall delve into.
So, all in all its been a busy few weeks since I last posted and although I have only actually been here for about nine weeks I do feel as if its been significantly longer, which can never be a bad sign. The next significant challenge, however, is going to be the summer, which I have been led to believe by many, many people is brutal. I guess I shall be catching up on a lot more DVDs then 🙂