That's a question I'm asked a lot when
people find out what madness I've embarked on. Many seem to think it's seven
years. It's not usually that long to get qualified as a general practitioner
type of vet. Changing career has meant I've had to do A-levels first though
so it's taken me a while to get this far - finally applying this year!
Not a vet yet!
The beginning of becoming a vet in the
UK you apply to study veterinary medicine at one of the seven vet schools in the
UK:
All applications
are done through UCAS, whether
you're a school-leaver, graduate or other mature student. A big difference
between applying to vet school (or to Oxford/Cambridge or for medicine) and other
for other degrees is the closing date. This is mid-October of the year before
proposed entry (and the Feb after for everything else). You can also only use 4 of the 5 choices available on the UCAS form - so you have
to decide which 3 of the schools not to apply to. The competition for places is extreme, and the entry requirements as a result are very high. I didn't realise this when I decided this was my calling in life! There
are no concessions for mature students - everyone has to meet the entry requirements
and all are considered on an equal basis. Offers can typically be AAA or higher
at A level (+ an additional B at AS/A level for some of the schools). Biology,
chemistry and maths/another academic subject are required, plus excellent GCSEs
including the sciences.
There are also
minimum requirements for practical work experience with vets and on farms/other
animal-based work places which varies for each school. Liverpool currently
demands the highest minimum, at 10 weeks.
Some vet schools
also use BMAT (the BioMedical Admissions Test) results as an extra
filter. The personal statement part of the UCAS form is also considered when
the vet schools are deciding who to call for interview.
Interviewing
can go from November right through to March, which is a lot of time to wait, wondering...
The lucky people who are offered a place
after interview embark on a five year veterinary science/medicine degree (or six
years at Cambridge). This is the basic D100 vet med course that equips you
with the skills and knowledge to practice as a vet. There is also a D101 course
which takes 6 years with an intercalated degree (so you come out with two degrees,
which is the standard approach at Cambridge), plus various foundation courses now
offered by most of the schools which lead into the D100 course. Once you've survived vet school, passed your finals, and completed the required 38 weeks of extra mural studies (EMS) you qualify! The massive EMS requirement spread over the 5 years mean slaving away on farms or seeing practice at vets when other uni students get holidays! You are then
eligible to register with the
Royal College of Veterinary Surgeons
(RCVS), which allows you to practice in the UK as
a vet. This also means you get more letters to stick after your name and degree:
the hallowed
MRCVS!
Holders of foreign veterinary degrees which are not ratified by the RCVS must
sit standardised exams in order to register as an MRCVS and be able to practice
in the UK.
The vet degree qualifies you for general
practice - you know about companion animals, farm animals, horses, and a bit about
exotics, and can work in a first-opinion practice. If you want to go on to
specialise in a particular area then that can mean a year or more as an intern,
followed by two to three more years doing a residency, all on minimal wages and
seemingly working/on call for every hour of every day for the duration!
Anyway, back to the beginning - I've
decided which vet schools I'm applying to (finally!) and have started off my UCAS
application. Exciting times! Watch this space to find out which ones
I've chosen and why.
Phew! Back from a brilliant week snowboarding in Zell am See in Austria, in the most fantastic snow ever! The week before that I was lucky enough to spend at Rossdale's Equine Hospital and Diagnostic Centre in Newmarket, shadowing some of the partners, associates, interns, and nurses. I feel privileged to have been able to spend a week shadowing these superstars of the equine vet world. I met many inspirational people, dozens of quality equines, and witnessed the highest standards of veterinary hospital care. The thoughtfully designed purpose-built facilities with state-of-the-art equipment matched the impressively slick teamwork in evidence there. It's easy to see why everyone in the horse world knows of Rossdales.
They plunged me right in there into theatre on day one to see colic surgery up close, where I was patiently told that no, that thing wasn't a stomach, it was a caecum - by the surgeon Timothy R.C. Greet BVMS, MVM, CertEO, DESTS, DipECVS, FRCVS, who I later realised wrote large chunks of several text books I have. Oh dear! I was still allowed back for more throughout the week so I guess that can't have been the stupidest question I could have asked. :)
What lovely people - as well as putting up with me peering over their shoulders for 5 days they packed me off home with a parting gift of the book 'Guardians of the Horse', edited and contributed to by several of the people I met during the week.
I hope I can go back there some day with some training behind me that will mean I can be more useful to them, to try & repay the favour they've done me!
In the meantime I have a long list of topics to write about, so watch out for some of those coming soon. I'm going to make an effort to keep posts shorter and more to the point than previous blatherings!
I stayed at a lovely B&B in Newmarket a stone's throw from Tattersalls, called Byerley House - recommended!
It's incredible the amount I can forget about something. And not just with my mind. My body seems pretty good at forgetting stuff too. At the moment it's forgotten how to ride a horse effectively. It's not like riding a bike! It's a struggle trying to stay balanced and relaxed enough to stay deep in the saddle to give accurate aids - especially while my mind is trying to remember the difference between the aids for leg yield and shoulder-in! My arse muscles hurt now as well as my brain!
Admittedly it's been a long while since I did any proper schooling, having been a fairly sporadic rider since moving to London. I've never stopped missing being around horses but a few outings to local riding schools left me quite discouraged from riding regularly in group lessons - they can be mind-numbingly dull and the standard seems to not be very advanced - so I kind of gave up on the idea of riding much while living in London. The odd riding weekend and hack out here and there was fun along the way and kept me mindful of how out of condition my legs & backside are, and fence-judging at a few hunter trials and one day events also helped keep total withdrawal symptoms at bay (or perhaps made them worse - not sure which).
Anyway after years of unhorsey distractions taking up my time I decided a while ago that I couldn't stay away any longer so I've started riding again, taking some individual instruction at Aldersbrook Riding School where I've been riding Kasir, a 16.3hh grey ex-eventer who knows how to make me work hard! Everyone there is very friendly and its a nice contrast to some of the dour faces at some places I've ridden at!
On Friday Kas seemed to be concentrating on making me use my legs, threatening to go into a coma if I didn't put heaps of effort in, whereas today he was leaning on the bit and really taking it out on my arms and poor fingers. I think that means my legs are working better today! My instructor today, Steve, was excellent, nagging me into successfully getting Kasir into more of an outline, getting him to soften up and not lean on the bit, and we ended up with some nice walk-canter transitions and fairly collected canter in the end. Need to work on canter-walk-canter though, sloppy, and my lateral work was fairly meh! Fairly embarrassing, but not as frustrating as last week's attempt.
I'm picking up on different bad habits with each lesson. Last week was hands too low and close together, and today I found myself leading him with the outside rein to stay out on the track instead of more inside leg - and using my seat too much in canter, to compensate for my weak legs. I got got some pretty awful shapes going on the right rein in particular (I heard "like riding a plank" from Steve at one point, oops). Anyway it felt like we'd made some real progress today and that's given me hope that I can become a decent rider again - albeit with lots of work! I had been a bit worried that I might not be able to get back to the standard I used to be able to ride at, especially after being in such pain after my first lesson about a week and a half ago! Maybe one day I really will find myself galloping my own home-bred around the cross country course at Badminton (hah!) but last weekend I think I actually had full-on groin strain, ouch!
I've heard several people mention feeling nervous after starting riding again, compared with when they were younger and bounced better. I'm glad I've not had that problem even when a horse decides he sees something terrifying and legs it. Phew! I put that down to having to ride bareback a lot in my yoof - first on nice comfy Blaze (13.2 hands high, round, with a liking for jumping out of his field, tanking it with no warning, and biting people on the arse) and then on his bigger, narrower successors. Learning to stay on board while galloping over ditches and barrels with no saddle help develop stickiness! Thanks Gerry! :) Nope, my problems are all rusty muscles, and hazy memory (must re-learn where the letter markers in the school are because at the moment the only one's I'm sure about are A, C and X!).
Ok, so how is this related to work experience? Well it's not, directly. But I do have an exciting equine placement arranged for next month. Once my final A2 chemistry exam is over I'm heading for Newmarket to spend a week at the renowned Rossdale's Equine Hospital and Diagnostic Centre. I'm over the moon about this - and a little nervous!
I need to seriously brush up on my horse knowledge before I get there so I don't look like a totally clueless numpty. My 20-year-old copy of good old Capt. Horace Hayes' Veterinary Notes for Horse Owners was once pretty much completely contained within my brain, but very little of it has stuck through that much time. I'm now really glad I brought all my old horse books over from Ireland - they've all got dusted off recently as I try to find all that knowledge I stuffed into my head as a horse-mad teenager, while I should have been stuffing in maths, english lit., and the life of Peig (ugh). I put a lot less effort into maths in school and had to pretty much re-learn everything from scratch when doing AS maths earlier this year, and got promising grades so far. Biology I always liked and did fairly well in at school so I remembered some of it when doing my biology A level, which helped absorb the new stuff, and got an A* in the end. So I remain hopeful that I'll be able to dredge up stable management from the depths of my brain yet. Of course, like biology, the world of horsies has moved on - nowadays there's a bewildering variety of bits available, you can get modular saddles, and teaching methods have changed a bit, but the core principles remain the same. So there's a lot for me to catch up on.
The plan is to get my seat and hands back into some sort of decent state so I can arrange a horse share early next year, or even get one of my own if the testing market stays in the good shape it seems to be in, which will mean contracting should do much more than paying the bills. Horses can be expensive, but I reckon kids are more so even though they eat less! Good job I always preferred hairy 4-legged youngsters to hairless 2-legs then.
The other resource that horses need is plenty of time, so that's another factor that'll inform the decision to buy or share - I may still have some maths exams to finish in January, depending on how many I get through in June. An A in all three A2 maths exams this June is probably not realistic if I'm going to be working full time as well as studying, considering that I haven't looked at a maths book since June. And that A has got to be my top priority. I've got more work experience lined up too, so that's also got to fit somewhere!
I'll be lambing in Scotland for a fortnight in March & April, and I've requested a couple of weeks at an Arabian stud in August, so watch this space about that one... I'm also planning a week at an equine first referral vet, and another at a farm animal vets. I'm still waiting on confirmation of a week at another independent small animal vets here in London too, so I think it's time to give them a nudge and remind them about that. Before all of that though I've got the role of Dogs Service Organiser at Crisis at Christmas. We start setting up on Thursday, so look out for more about that in the coming week if I get permission from their media team to say a bit about it.
It feels like things are really moving along now with meeting the requirements for my vet school application - the UCAS application deadline for D100 is looming! October 2012: I finally get to submit my plea for acceptance by one of the vet schools. Then in November there's ANOTHER exam - the BMAT which the RVC requires in addition to A levels to help them filter applicants. More about the whole admissions process for the seven different vet schools in another post because I could really go on about that - it can be long-winded! (I know I can be long-winded too, so that makes for a very long and windy post).
Speaking of which, it's time I got off the internet. I'm dog-sitting today and there's a certain hairy little Sheltie here looking at me that could do with a run, and then I have some chemistry revision calling me!
Edit: Here's a short video of Robert Whitaker clearing 6'9" bareback at Olympia at the weekend:
I've been busy finishing my A2 biology coursework and up to my ears in revision too so I haven't taken the time to blog anything recently, but fret thee not, I'll get on to it soon! Among other things, you'll be getting the lowdown on what's likely to be wrong with a hyperactive skinny old cat, what those jabs are that your moggy/doggy gets once a year, the canine obesity 'epidemic' and the importance of proper nutrition (why Rover shouldn't eat half your chocolates just because you feel guilty for eating them in front of him!)
In the meantime you might like to have a read of some coursework I've written about wriggly red worms and a predatory fungus that eats them (or maybe not, if it's teatime).
Could a predatory fungus be the solution to anthemlintic resistance in small redworms in horses?
A big issue for veterinary medicine is the growing resistance to antiparasitic drugs in parasites of livestock. In the horse industry specifically resistance of small redworms to currently available classes of anthelmintic drugs is of great concern [1].
Over the last four decades there has been a change in the helminth considered to be the most important in horses. Widespread use of the highly effective anthelmintics that became available in the late 1960s [2] has resulted in Strongylus vulgaris (2-5cm large redworms [3]) no longer being the main parasite of concern. The Cyathostominae group (cyathostomins / small strongyles, <1.5cm small redworms [3]) are now the most common pathogenic endoparasite in the domestic horse. Resistance has been detected in this group of nematodes worldwide.
Anthelmintic resistance is a problem because horses treated with currently available worming preparations can still harbour harmfully high worm burdens. This can result in severe pathological consequences, such as chronic weight loss, diarrhoea, and death [4], with potentially high financial as well as emotional costs to owners.
The variety of branded worming products on the market is misleading. There are actually only three chemical classes of wormers available for use against Cyathostominae in horses, shown in table 1. This maps some of the branded products on the market to the class of drug to which they belong [5] [6] [7].
Table 1: classes of anthelmintic currently in use against cyathostominae in horses in the UK
The widespread, long-term misuse of these anthelmintics has placed a large selection pressure on the Cyathostominae populations [2]. Some worms, through random mutation, will have alleles that give them anthelmintic resistance. This reproductive advantage will allow the resistant worms to survive worming treatments and reproduce, passing on their advantageous alleles to their offspring. This results in an increase in allele frequency of these advantageous alleles in the gene pool of the treated population. If the selection pressure continues, the proportion of resistant individuals in the population increases over time – meaning that worming treatments become less and less effective.
The summary data below for UK yards is taken from a large European study [8] done in 2008 to evaluate effectiveness of wormers currently in use. The data show that Fenbendazole, in the oldest class of wormer, had the least reduction in eggs in faeces after treatment, with the majority of results falling below a 90% reduction. This indicates resistance in the cyathostomin population to this class of wormer at these yards. (In some yards this wormer was not tested, accounting for the blank results). The data show more success for the next-oldest class, the nicotinic agonist Pyrantel pamoate, but a less than 90% efficacy here in several yards indicates resistant populations at some yards and suspected resistance in yards with reductions of between 90 and 100%. The newer macrocyclic lactones have the greatest efficacy, but some resistance is suspected in one yard, and indicated in two yards. Only Moxidectin, the newest drug, showed 100% effectiveness in this survey.
This data illustrates the development of resistance over time – the oldest drugs are now the least effective, since the worms have had that selection pressure exerted for longer, and more time to adapt. The same pattern is evident in Italy, Germany, USA and other countries [1][8][12]. It is only a matter of time before the worm populations adapt further to become resistant to the macrocyclic lactones too. New classes of drugs are currently being researched [10][11] but there are no accurate estimates yet for when they could be market-ready. The eventual introduction of new drugs will in any case merely postpone the inevitable resistance of the parasites to anthelmintics [2].
There are potential solutions other than the development of new anthelmintic drugs. Research is ongoing into vaccinations against endoparasites, although with little success to date [11]. Development and maintenance of refugia through more judicious use of anthelmintics is a recognised way to preserve efficacy of existing drugs for a time. Refugia can be described as “the maintenance of worm populations that have not been exposed to a particular drug and hence still contain a large proportion of worms that are not resistant” [13]. A third approach, in my opinion more promising if widely adopted, is the use of a predatory fungus with nematocidal properties, currently undergoing long-term laboratory and field research in horses and other livestock[12][13] [14] [15][16][24].
An understanding of the lifecycle of the cyathostomins has allowed scientists to target the parasites at the infective stage of development using a biological method of control: a fungus that can trap and kill nematodes on pasture. This is a diversion from the typical strategy of attacking parasites inside the host.
Figure 1: Lifecycle of cyathostomins
Cyathostominae is a family of about 50 species of nematode worms, of which about 10 are commonly found in horses [3]. The horse becomes infected by ingesting larvae, L3 infective in Figure 1, that have hatched from eggs in the horse faeces. On pasture these larvae travel up grass stalks and are eaten by the host. They mature to adult stage in the mucosa and lumen of the intestine,. Alternatively they can encyst in the intestine walls for up to two years (L3/L4) after which they emerge en-masse with potential pathological consequences. The adult stage lays eggs (L5) which are then dropped onto pasture in the faeces.
The lifecycle can be interrupted at the infective L3 stage using the predatory fungus, Duddingtonia flagrans. This fungus has been found naturally occurring in horse faeces [17] where it can attack and kill the free-living larval stages of nematodes, reducing the number of infective larvae on the pasture [18]. The chlamydospores (thick-walled, resistant spores) of the fungus are ingested by the host animal along with normal feed. They have no effect on the animal, and are passed out unharmed in the faeces. Once outside they develop into ‘nematode-trapping fungal nets’ [18] in which the worm larvae become ensnared, killed and digested by the fungus. This approach has been shown to greatly reduce the numbers of cyathostomin eggs found in subsequent faecal egg counts (FECs) of livestock fed the fungus compared with controls [15]. Trials using horses [12], cattle [15], and small ruminants [16] as hosts have had similarly positive results: reducing the number of larvae ingested by the animals grazing the pasture leads to a reduction in the worm burden in the animals, quantified by the reduction in faecal egg counts after treatment.
One advantage of this approach is that it is a highly effective method of reducing faecal egg counts when compared with the efficacy of current drug treatments. Another advantage is being able to use a natural substance as a worm treatment instead of exposing horses and handlers to chemicals. Horses are sometimes farmed for human consumption, and this treatment is likely to be approved for use in organic production units. The fungus is also effective against other parasitic nematodes in other livestock [15][20], so the investment in research and development will yield rewards across different sectors of the farming industry.
Research is ongoing into the potential environmental and ecological impact of increasing the abundance of D. Flagrans in pasture habitats, with results indicating “no detectable negative environmental impacts of D. flagrans use in a typical improved pasture” [19]. The dung beetle and the earthworm are both important factors in the normal break-down of manure on pasture. Effective levels of D. flagrans in the animal faeces have been shown to have no detrimental effect on dung beetle populations [20]. The fungus remains contained within the area of the droppings, not spreading onto surrounding soil. Earthworm populations in the surrounding soil have also been studied and no harmful effects determined [19].
Figure 2: trapping mechanisms of nematophagal fungi
A potential disadvantage of the nematocidal fungus approach is that widening use could, like the chemotherapeutic approach, invoke adaptation and eventual resistance. The worms could respond to this new selection pressure and evolve a means of evading ensnarement in the fungal traps. Figure 2 shows the adhesive knobs and constrictive rings made from looped hyphae on the mycelium of the fungus that trap the nematodes [21]. Movement of a worm triggers swelling of the cells in the constricting ring causing it to close around the worm. Alleles for a changed external body structure could allow the worms to avoid adhesion to the adhesive knobs. Mutations allowing the worms to move more quickly away from constrictive rings could allow escape and survival and an increase in the advantageous allele frequency in the population.
At present the most significant disadvantage of this approach is that the treatment is still in the research phase and is not yet commercially viable. As yet it is not possible for horse owners to implement a treatment program using D. flagrans, and it is likely to be some years before commercial products based on current research reach the market.
The other solution to be discussed here, of maintaining refugia, requires re-training for both equine vets and owners in order to bring about a shift in behaviour. The following traits of a traditional worming program have favoured the development of resistance:
Interval dosing programs where all horses are wormed regardless of worm burden to the same schedule, e.g. every 6-8 weeks
Too rapid rotation of the class of anthelmintic drug used
Under dosing due to underestimation of horses’ weights
No veterinary involvement in worming program design – anthelmintics are freely available without prescription
The BEVA (British Equine Veterinary Association) are now calling for changes to be made in how anthelmintics are administered in order to maintain their efficacy for as long as possible [22]. BEVA guidelines instruct veterinarians to ensure owners use the vets’ expertise to devise worming programs that promote refugia through targeting specific drugs against accurately diagnosed parasites, regularly testing for resistance, treating only clinically unhealthy horses, using appropriate dosages, and implementing an appropriate grassland management program.
A major advantage of this approach to solving the problem of resistance is that the horse industry can continue using existing treatments for some time. Maintaining a large unresistant proportion of the cyathostomin population will ensure that the classes of wormer available today will remain effective for longer than if resistance is allowed to grow unchecked.
An advantage for owners is lower expenditure on wormers, from treating only those horses with high enough worm burdens to be potentially hazardous to their health or performance. However, a disadvantage is the added cost of regular FEC testing. Currently costs vary from around £7-£13 per test, recommended quarterly. If tests prove that horses need treatment each time then the cost of testing is not countered by lower worming costs. Owners may opt to continue their previous regular worming instead to minimise potential costs.
There are also potentially higher financial costs to yards due to more complex and labour-intensive grazing management practices. The removal of droppings from all grazing is recommended at least weekly, a practice not yet common in all yards. This is an essential part of the strategy for maintaining refugia.
There are parallels between the development of anthelmintic resistance in parasites to the resistance in bacterial to antibiotics, which has lead to the evolution of multi-drug-resistant ‘superbugs’ such as MRSA due to overuse of antibiotics in humans [23]. The growing public awareness of the problem of antibiotic resistance will hopefully hasten acceptance of the idea of anthelmintic resistance, and the adoption of new worming practices across the horse industry.
An approach to fighting anthelmintic resistance where success depends on changing people’s habits and long-held beliefs about worming makes this a risky approach, in my opinion. I think that restricting anthelmintic availability to prescribed use only, as antibiotics largely are in humans, would help to enforce BEVA’s guidelines and preserve the efficacy of the currently available drugs for longer. I believe that without this control the change in behaviour in the horse industry is likely to be too slow and resistance will continue to grow. The consequence could be a lack of reliably effective treatment for cyathostomins in as soon as a few decades if resistance grows at the rate it has done since the introduction of the benzimidazoles. My preference therefore is for the introduction of treatments based on naturally nematocidal fungi for cyathostomin control in horses as soon as possible. Developing this method of treatment alongside the current behavioural changes will ensure that there is a sustainable and successful treatment available whether the chemotherapeutic approach fails or not.
References 1 Anthelmintic resistance in nematodes of horsesAuthor: Ray M. KaplanPublication: Veterinary Research, 10/2002, Vol. 33, no. 5,Page 491-507Publisher: INRA, EDP Sciences, 2 http://www.sheepandgoat.com/articles/anthelminticswork.htmlAccessed: 12 March 2011 14:37 PM 3 Pathology and parasitology for veterinary technicians, Volume 1Author: Leland ShapiroChapter: Endoparasites of Large Animals, Page 183Publisher: Cengage Learning, Inc 4 Recent developments in research into the Cyathostominae and Anoplocephala perfoliataAuthors: Jacqueline B. Matthews, Jane E. Hodgkinson, Samantha M.J. Dowdall and Christopher J. ProudmanPublication: Veterinary Research, volume 35 number 4, 2004, pages 371-381 5 http://www.surreycc.gov.uk/sccwebsite/sccwspages.nsf/LookupWebPagesByTITLE_RTF/Worming+advice?opendocument Accessed: 11 March 2011, 11:42 PM 6 Leaflet “Confused About Worming?”Publisher: The Ashbrook Equine Hospital, Knutsford, WA16 9JG 7 http://www.aber.ac.uk/~mpgwww/Edu/AntiDrug/DrugTxt.html Accessed: 13 March 2011 17:39 PM 8, 9 Anthelmintic resistance in cyathostomin populations from horse yards in Italy, United Kingdom and Germany Authors: Donato Traversa, Georg von Samson Himmelstjerna, Janina Demeler, et al.Piermarino Milillo, Sandra Schurmann, Helen Barnes, Domenico Otranto, Stefania Perrucci, Antonio di Regalbono, Paola Beraldo, Albert Boeckh, Rami CobbPublication: Parasites & Vectors, vol. 2, 2009, Supplement 2 10 Leaflet: Guidance on the Use of AnthelminticsPublisher: British Veterinary Association leaflet 11 http://www.aber.ac.uk/~mpgwww/Edu/Vaccine/VaccTxt.htmlAccessed: 13 March 2011 17:42 PM 12 Biological control of cyathostomin (Nematoda: Cyathostominae) with nematophagous fungus Monacrosporium thaumasium in tropical southeastern Brazil.Authors: Tavela Ade O, Araújo JV, Braga FR, Silva AR, Carvalho RO, Araujo JM, Ferreira SR, Carvalho GR.Publicaton: Veterinary Parasitology08/10/2010 13 Veterinary Clinic articlePublication: Horse and Hound magazine, 17th March 2011, Page 19 14 Predatory activity of the nematophagous fungus Duddingtonia flagrans on horse cyathostomin infective larvae.Authors: Braga FR, Araújo JV, Silva AR, Carvalho RO, Araujo JM, Ferreira SR, Benjamin LA.Publication: Tropical Animal Health and Production, Vol 42, No. 6, 08/2010 15 Duddingtonia flagrans: biological control of cattle nematodes in the field (Duddingtonia flagrans: controle biológico de nematodeos de bovinos a campo)Authors: Marta Bañolas Jobim; Janio Morais Santurio; Mario Luiz De La RuePublication: Ciência Rural, versão impressa vol.38 no.8, 11/2008 16 Top Dressing of Feed with Desiccated Chlamydospores of Duddingtonia flagrans for Biological Control of the Pre-Parasitic Stages of Ovine Haemonchus contortusAuthors: Sanyal P.K.1; Mukhopadhyaya P.N.Publication: Veterinary Research Communications, Volume 27, Number 5, 07/2003, pages 381-390 17 Biological control of Helminths Author: M. LarsenPublication: International Journal for Parasitology, Volume 29, Issue 1, 01/1999, Pages 139-146, 18 http://www.equinescienceupdate.co.uk/worm4.htmA ccessed: 12/03/2011 23:09 19 Deployment of Duddingtonia flagrans in an improved pasture system: dispersal, persistence, and effects on free-living soil nematodes and microarthropods Authors: M. R. Knox, P. F. Josh and L. J. AndersonPublication: Biological ControlVolume 24, Issue 2, 02/06/2002, Pages 176-182 20 Lack of effect of the nematophagous fungus Duddingtonia flagranson the development of the dung beetle, Aphodius constansAuthors: C. Paraud, J.-P. Lumaret, C. ChartierPublication: Small Ruminant Research 70 (2007) page 276–27904/04/2006 21 21st Century Guidebook to Fungi Author: David Moore, Geoffrey D. Robson and Anthony P. J. Trinci, http://sbli.ls.manchester.ac.uk/fungi/21st_Century_Guidebook_to_Fungi/Ch15_06.htm Accessed: 19/03/2011 16:27 22 http://www.bva.co.uk/newsroom/1698.aspxAccessed: 12 March 2011 2:28 PM 23 http://www.nhs.uk/news/2007/january08/pages/antibioticresistancemeasures.aspx Accessed: 19/03/2011, 6:27 PM 24 Sustainable Worm Control Strategies for Sheep 3rd Edition. A Technical Manual for Veterinary Surgeons and Advisors, Authors: Dr. K. A. Abbott, Prof. M. Taylor, L. A. Stubbings04/2009, Pages 5, 24 25 Prevalence of anthelmintic resistant cyathostomes on horse farmsRay M. Kaplan, DVM, PhD Thomas R. Klei, PhD Eugene T. Lyons, PhD Guy Lester, DVM, PhD Charles H. Courtney, DVM, PhD Dennis D. French, DVM Sharon C. Tolliver, MS Anand N. Vidyashankar, PhD Ying Zhao, MS Publication: Journal of the American Veterinary Medical Association, 15/09/2004, Vol. 225, No. 6, Pages 903-910
I wasn't going to post this today, but now I've written it I will - bit of a downer for just post number 2! I had to write about this at some stage. It's an inevitable part of the job, but I really didn't realise it happened so frequently and that I would be confronting it so soon into seeing practice. One of the reasons it's so important to do a lot of work experience before applying to vet school. Press the Back button if you don't want to read some sad stuff - and it's all a bit dramatic/sentimental, and "me me me!" too, how I dealt with/felt about stuff. I've had the opportunity to get a better idea if I could go into a profession where I would have to regularly put animals to sleep.
Day 1, second consult (i.e. 10 mins after the doors open!), a mum and her daughters bring in their aged and much-loved cat to confirm their suspicions that she's reached the end of the road after going losing the use of her back legs over the weekend. They said their tearful goodbyes and left her to be euthanised by the vet team. I didn't expect to witness this sort of thing so soon.
I was present during the procedure and it was the first time I had actually seen an animal being put to sleep. I had been curious to know how I was going to react, which is a bit morbid, I suppose. I thought I would cope prety well with it, because although I'm an animal lover and have compassion for them, I'm a realist and not, I think, overly sentimental. I was fairly right, this time.
I had in the past found Dinky, one of our pomeranians, dead of heart failure in his basket one evening when I was a teenager. He was only four. I was devastated, in howls of tears every day for a long time. My dad tried to help by suggesting we get him stuffed so he could be with us always. I was never quite sure if he was serious or not. My pom Mitzy lived to a ripe old age (and boy was she ripe by then!) and was taken to be put to sleep by my mum when she got too doddery to have a decent quality of life. I think I would have made sure to be there if I had been in the city, but was living away at the time - and I think I was secretly a bit relieved to not have seen her go. I should have been grown up enough by then to face death, I feel. Years before I had chickened out of being there while one of my ten hamsters (good old Crunchy Nutter!) was put to sleep. Even though he had chewed himself an extra hole so had a prolapsed intestine and was obviously in pain I was too cowardly to stay in the room while he was put out of his suffering - my boyfriend stayed while I paced the car park. Thinking about Crunchy now doesn't upset me, but I still to this day get a bit teary when I think about old Mitz. I have also been known to tear up at some of the overly dramatic parts of Emergency Vets and other programs of that ilk. I blame the music (and worry that maybe I don't have the emotional strength it takes to be a vet).
On to more recent times - back to day 1: a few more consults go by, vaccinations, post-op checks, all good stuff, then a visibly upset couple came in with a very poorly looking cat. She was very old, very dehydrated, off food and not drinking. The owners didn't have much hope for her but had blood tests done to try to find out what the problem was, and the results came back showing creatinine levels up in the 600s, when the upper range is somewhere in the mid-high 200s. Creatinine is a metabolic waste product from normal muscle breakdown and from the diet. Usually it gets excreted in urine, being removed from the blood by the kidneys. Abnormally high levels in the blood are a sign of kidney disease, and at such high levels as shown by this test, at quite a progressed stage - renal failure. Once the kidneys cease to function they can't be repaired. So another case where the kindest option was to put her to sleep. Tact warrants not having work experience people hanging about during such a sensitive time for the owners so I made myself scarce, but the sight of one of the owners in the waiting room coming to terms with her loss had me feeling incredibly inadequate, realising how little I know about coping with such a situation. Going to hide in the kennels was the easiest option (shame).
That wasn't the end of the sad stuff for the day, unfortunately. Later on a 'stray' cat was dumped at the practice, and after some skillful sleuthing by a vet nurse the perpetrator was tracked down and admitted he had been feeding the stray but was now moving, and didn't want to take it with him. This is a whole other big area which I'm going to go into in another post - who is to take responsibility for the welfare of strays or unwanted animals. Anyway this cat was in a terrible state, badly matted, very old, advanced teeth decay right up through the gums, lethargic and sshowing signs of cat flu. There was no hope of her ever being rehomed, the local cat charities were full, and the RSPCA won't take cases like this. The 'owner' gave consent for her to be euthanised. This one I was actively involved with, being shown how to restrain a cat for treatment, how to raise a vein, and then held her while the overdose of anaesthetic was administered and she went to sleep. It happens very quickly, within a couple of seconds. The drug shuts down the cerebral cortex causing rapid loss of consiousness, and then the overdose depresses the deeper area of the brain, the medulla, which controls respiratory and cardiac systems. So they go off to sleep, and then the body shuts down. Afterwards the vet has to confirm that death has occurred by verifying that there is no longer a heart beat. Even a more or less ownerless stray, with no-one to pay the bill, was treated to a respectful death in the end, which was very nice to see. Well, not nice, but you know what I mean. She was in such a sorry state it was... not easy, but less difficult to deal with than the gorgeous British Blue cat from the morning. Still not a pleasant end to the day though. Sigh...
Day 2 was a different kettle of fish (or dogs and cats? No-one's turned up with a goldfish yet). I'll write about it later though, because I want to keep this post more or less about one topic. Everything stayed alive, yay!!!
Day three, a half day at the practice, was a rather hectic morning. Lots of large dogs to be put on diets and owners chagrined for making them into fatties with premature hip problems, and several cat wormers expertly administered through snapping, pointy-teethed jaws by the vet. A few cysts, wound re-visits, annual check-ups and then for the last consult of the day in trots, albeit slowly and unevenly, a little terrier. She's very advanced in years, and in a bad way. A close relative of her owner has brought her in to be put to sleep. Oh no, another one already! A thought hit me - "uhoh, this one's a dog. I wonder if this will be harder to deal with." The vet took her away to prep her by inserting a catheter in a foreleg to make the procedure more straight forward, reducing potential distress for both dog and carer. As he brought her back in I headed for the door to leave them alone, but was told I could stay, so I ended up observing from the back of the room. This did turn out to be much harder than the cats on day one.
I was glad to be in the background with no need to speak because the lump in my throat would have got in the way. I got busy telling myself the dog was going to be better off, having been labouring for breath, difficulty walking, advanced dental decay, large growths, and probably more less-obvious ailments. That helped suppress a few sobs, but only until I was on my own after wrapping her up and taking her remains out to the freezer where she would stay until collected to go to the crematorium or home with her owners. A few sniffles escaped then for sure, and there were definite signs of leakage from the eye area...
Strange that the cats on the first day didn't effect me so badly. I remember thinking how very sad it was that they were so ill and not having any decent quality of life any more, and I was quite able to hold it together then, with maybe a small lump in the throat. Maybe it was first day culture shock in a new enviroment that meant I was affected less than I was by this little terrier. The cats had all looked miserable and disinterested in life, whereas the dog was still looking about, looking me in the eye from the examination table. I had to avert my eyes and studied the drugs cabinets on the other side of the room. I was wondering afterwards if it's because I'm definitely a dog person, and not a cat person that this was hard to stay composed for?! But most likely it was having a distraught carer there during the procedure that made it so excruciatingly difficult to stay dry-eyed and calm-faced, but I think as a vet that's going to be a necessary skill, for the clients' sake - and my own too at the end of the day. I think it's easier to remain more detached in the presence of the vet and nurses and their professional manner. I'll have to find out how the vets and nurses cope with it - what they think during the procedure, how to stay composed while telling the clients, and whether it gets much easier to be around...
That's a situation I'll have to develop a coping strategy so I can maintain (at least a facade of) composure during. Learning to manage the whole process from breaking bad news right through to seeing them out the door in a bereaved state afterwards is going to be one of the toughest things to master. I hope I never get to a stage where I'm desensitized to seeing an animal die, or lose empathy for the owners. I think that would mean becoming an unpleasantly cold-hearted creature. I want to go into large animal practice when I qualify, which will mean dealing more with farmers than pet-owners, so I anticipate much more matter-of-fact discussions about culling, and more commercial viability-driven decisions. That should be easier on the old emotions - although if I'm lucky enough to end up doing equine then we're back to heartbreak territory again!
Telling management their multi-million pound project going to make the ship date pales into insignificance.
Yes, today I did sit down and have another think about whether I could handle a life of regularly putting animals to sleep, and am still sure I can. The good stuff is enough to make it worthwhile. Next post will be all about the good stuff, I promise!!!
I'm not really one for blogging the details of my life out onto the big wide world but I'm about to make an exception. While I work on fulfilling the requirements I need to satisfy to be able to get into vet school I'm going to keep a record of my experiences here. I'll be writing about anything from my job shadowing at vet practices that I find interesting or worth sharing or want to preserve for later, as well as my experiences on farms and other animal establishments. Having all this stuff available here will make sharing it with friends and family easier too - if any of them actually want all the gory details! And who knows, maybe some other aspiring vet students will find some useful info here too.
The seven UK vet schools (and Dublin) all have different requirements for work experience for veterinary medicine/surgery degree applications but the general rule is that if you fulfill Liverpool Vet School's requirements then you've got what you need to apply to any of the other six. So the absolute minimum consists of 4 weeks at at least 2 different vet practices, plus 6 weeks at other animal establishments such as farms, kennels and stables.
Living in central London for the last thirteen years has meant that although I spent a good chunk of my earlier years on or looking after horses, I was fairly lacking in recent equine and large animal experience. That's something I've been working on fixing since deciding to swap my life of air-conditioned software development for one filled with weather, mud, guts, poo, and vomit. Watch this space: I'll be adding a post or two to here about my work with cows so far at some stage, plus whatever else I'll be getting up to that's non-human and non-computer related.
So why start this today, when I really should really be finishing off some calculus revision with the May exams looming?!! Well I'm about to start my first bout of work experience with a companion animal vet so I thought I'd get the ball rolling... Also my brain seems to have become full to capacity for the day, so it was time to take a break. The last thing we want is me overflowing and nasty maths spillage! I want all that stuff to stay INSIDE my head. I'll be needing that later...
Tomorrow will be the start of my first stint at a real live vets, whoohoo! I'm excited and a bit nervous at the same time, although both of the veterinary nurses I've met so far have both been lovely. There's one other RVN plus one trainee and the vet that I have yet to meet. I met one of the nurses briefly last weekend when I called in to show my face and to have a guided tour of the surgery. The senior RVN, who I originally met back in December when we were both Service Volunteers on the Dogs Service at the Crisis at Christmas rough sleepers' shelter kindly offered me some work experience, which is how I've been lucky enough to be able to spend some time at this practice.
Silly to feel nervous I suppose, but I'm a bit concerned about asking stupid questions, getting under people's feet, breaking the little kittens, making small children cry and getting funny looks from the clients for being probably the most ancient work experience 'girl' ever... My aims are to be as unobtrusive as I can while absorbing as much information as humanly possible, and hopefully to contribute something useful during my time there that will mean the staff won't regret having me invading their space for a whole fortnight!
I think I have a pretty good idea what to expect, from talking to vet students and other wannabes along the way. I reckon I'll be getting a good dose of cleaning up fur and poo and vomit from creatures of all shapes and sizes, as well as fulfilling the role of tea girl. All part of the program - you need to be multi-talented to be a good vet, and you never get too qualified/senior/important to wipe furry bottoms and clean up sick! There are a few other things I would like to take away from this fortnight at the vets, in addition to becoming more expert at wiping and mopping:
learning how to work with nervous, wriggling animals during one of their most dreaded activities - a trip to the v. e. t.!
seeing what the most common ailments, treatments and procedures are, what can be handled by a local vet and what needs to be referred
getting a better understanding of the day to day running of a vet practice from a business point of view
and seeing how vets and vet nurses deal with the variety of clients that come through the door
The latter is an aspect of the job I anticipate being one of the more challenging - the people side of things - I'm sure there will be plenty more about that in the coming weeks.
