Category Archives: Veterinary Medicine

The Passing of Thistle–A Poem by Peter Davison

scotty

This is our first summer without a dog.
Fifteen years of disgraces in the night
(tattered screen doors, overtuned garbage pails,
unexpected puddles on the guestroom bed,
and other misbehaviors) have ended at last.
She had a way of posing in the landscape,
arranging herself against a screen of trees,
upon a lawn or on an outdoor deck
so as to bring out the hero in photographers
who could focus on the challenge of her darkness.
When on the move she carried less distinction:
a scottie, long in the barrel, short of leg,
she trotted country roads like city sidewalks,
so long as a glance behind her could confirm
the support of the authority that gave her hers.
Absent such authority, she panicked:
could be found, after a search, hysterically
galloping somewhere in the wrong direction
if we returned from shopping or the movies
through a region she had not known long enough to own.
On her home turf she brooked no trespassing,
at least by motorcycles, dogs, or horses,
though she’d roll over basely for human intruders.
The children who had grown up while she watched
were patient, watching her as age declined
from sleepiness to blindness, deafness and
incontinence. Before her last collapse
she lived her life entirely through the nose
and sense of touch. And as they watched her sleep
they saw their childhoods disappearing with her
and by so much ceased a little to be children.

I who had shared, in my two-legged way,
in what I could grasp of her doggy memories,
knew we had lived through all the same affections,
felt the same losses, searched through an empty house
for someone who would never be returning,
brooded on sights and voices that had vanished.
Perhaps she had a way of understanding
our loss that she could never share with me,
but now our past belongs to me alone,
now that she’s gone, and no one else remembers
the weekends that we spent in the house together
letting each other in and out of doors.

Copyright © 1989 by Peter Davison. All rights reserved. As published in The Poems of Peter Davison (Knopf, 1995). 

Originally published in The Atlantic Monthly, September 1989. 
 

John Cheever, on the rest of us “doctors”

Didn’t think too much of us, apparently, inasmuch as he might have shared the beliefs of his protagonists. Or maybe he did like us, but we were just too middlebrow. Or maybe he was making fun of his snooty protagonists. In any case, I don’t think that Cheever’s view differs that much from that of the rest of society.

Photograph: Bettmann/Corbis.From newyorker.com

Photograph: Bettmann/Corbis.
From newyorker.com

They were the sort of people who discussed the price of things at cocktails, exchanged market tips during dinner, and after dinner told dirty stories to mixed company. They did not belong to Neddy’s set—they were not even on Lucinda’s Christmas-card list. He went toward their pool with feelings of indifference, charity, and some unease, since it seemed to be getting dark and these were the longest days of the year. The party when he joined it was noisy and large. Grace Biswanger was the kind of hostess who asked the optometrist, the veterinarian, the real-estate dealer, and the dentist.

From The Swimmer, by John Cheever

Veterinary Medicine Once Again Profession with Highest Suicide Rate in UK

High-risk occupations for suicide.
Psychol Med. October 2012;0(0):1-10.
S E Roberts1; B Jaremin; K Lloyd
1College of Medicine, Swansea University, Swansea, UK.

Article Abstract

BACKGROUND: High occupational suicide rates are often linked to easy occupational access to a method of suicide. This study aimed to compare suicide rates across all occupations in Britain, how they have changed over the past 30 years, and how they may vary by occupational socio-economic group.

METHODS: We used national occupational mortality statistics, census-based occupational populations and death inquiry files (for the years 1979-1980, 1982-1983 and 2001-2005). The main outcome measures were suicide rates per 100 000 population, percentage changes over time in suicide rates, standardized mortality ratios (SMRs) and proportional mortality ratios (PMRs).

RESULTS: Several occupations with the highest suicide rates (per 100 000 population) during 1979-1980 and 1982-1983, including veterinarians (ranked first), pharmacists (fourth), dentists (sixth), doctors (tenth) and farmers (thirteenth), have easy occupational access to a method of suicide (pharmaceuticals or guns). By 2001-2005, there had been large significant reductions in suicide rates for each of these occupations, so that none ranked in the top 30 occupations. Occupations with significant increases over time in suicide rates were all manual occupations whereas occupations with suicide rates that decreased were mainly professional or non-manual. Variation in suicide rates that was explained by socio-economic group almost doubled over time from 11.4% in 1979-1980 and 1982-1983 to 20.7% in 2001-2005.

CONCLUSIONS: Socio-economic forces now seem to be a major determinant of high occupational suicide rates in Britain. As the increases in suicide rates among manual occupations occurred during a period of economic prosperity, carefully targeted suicide prevention initiatives could be beneficial.

Euthanize Your Pet Now, and Avoid The Holiday Rush

May 8, 2012 - Source: John Moore/Getty Images North America

May 8, 2012 – Source: John Moore/Getty Images North America

Holidays in the Veterinary ER

Animal emergency clinics are tough places to work. There is a fair amount of suffering and dying that goes on in them. To be sure, the work can be very rewarding–a veterinarian can make a big positive difference in a short period of time at an emergency clinic.

Unfortunately, many times the animal arrives in extremis. The owners have brought in their pet either because it looks like it’s about to die, or they already know that it’s time for their friend to be eased out of this existence and into whatever comes next.

Alas, the worst time of the year in e-clinics seems to be Christmas. Inevitably, it seems, either on Christmas Eve or Christmas Day or Boxing Day, some family brings in a pathetic case that should have been euthanized at Thanksgiving if not at Halloween. However, they wanted to keep it alive, just until Christmas. One colleague recalls his worst Christmas,  euthanizing 10 in a single day.

We understand the motivation. Maybe the kids are coming home and want to see their childhood pet just one last time. Maybe the family wants just one last picture under the tree,  or maybe the idea of the holiday without the pet is too painful in a season where one is supposed to be happy, especially for those people who consider their pet their best friend.

What happens when trying to hold out for Christmas is that instead of the Happy Last Christmas for Fluffy we get the creation of a new annual holiday:  The Day We Had To Put Fluffy To Sleep.

Isn’t Christmas stressful enough already? I hear that it is, but if not, you can always save that euthanasia for near-darkest day of the year, while the Yule logs burn and the wassail flows.

The above picture is from a photoessay on at-home euthanasia. You can find it here at Zimbio.com.

Cry “Havoc!” and let slip…

> 10^3 Words

For the rest of the photo essay from Foreign Policy, click here.

 

From the Amazon: Another reader with a vector-borne disease?

HAVE YOU SEEN THESE CRITTERS?

Mosquito

mosquito

flea

sand fly

ticks

Richard:
Didn’t see an email for you, so hopefully you’ll get this message.  I was down at my lodge in the Peruvian Amazon this past November.  At the time, I got chewed up viciously my chiggers.  But in retrospect, I suspect it may have been more than just chiggers.  Long story short, upon my return to the states, came down with virulent flu-like symptoms including chills which nearly had me in convulsions that hurt my muscles and than an hour later a fever that would drench my blankets.  All the other flu-like suspects as well.  Even though I had been visiting the jungle for nearly 14 years, I had never been this ill before.  Eventually, the symptoms went away and I didn’t give it much more thought.  Fast forward.  In December, noticed a ringing in my ears.  In February, my left arm began to ache and was unable to lift it.  At the same a mysterious rash appeared one night on both the left and ride side of my ribs right beneath my arms.  No itch or pain, but looked like flea bites.  But nowhere else on my body and my wife didn’t have any bites. Seemed odd, but after a few weeks it disappeared.  But then the pain in my left arm migrated into my right arm.  Also, a slight numbness on the left side of my face.  Went to my GP and he told me I had rotator cuff injury and I should see a physical therapist.  Wait, I’m not stupid.  Where in the medical journals do they talk about rotator cuff injuries traveling from one arm to the other?  None-the-less, I’ve since moved onto a neurologist who had had many MRIs performed, blood tests and most recently a spinal tap.  Based upon my research, I’m starting to hypothesize that maybe I got bit by a tick in addition to all those chiggers…but I haven’t been able to find much in online literature that indicates there are ticks in the Amazon jungle, and if so, if they would carry lyme disease or a distant cousin of that?  I’m at my wit’s end and my symptoms are getting worse.  Do you think there’s any merit to my way of thinking?  Thanks, ________

Dear____,

Please tell me that your doctor checked for malaria. Any traveler with a fever who is returning from an area  known to have malaria needs to be tested. Were you tested for any other diseases? Were you on an anti-malarial? If you had been on a quinine derivative for the malaria, that could be the cause of ringing in the ears.

As far as I can tell, Lyme doesn’t really exist in South America.

Mental Health Mittwoch: Is Ketamine Going to Revolutionize the Treatment of Depression?

Ketamine is well-known to veterinarians. It is hard to imagine a veterinary drug cabinet without it. Developed originally in 1962 as a battlefield anesthetic for wounded soldiers, it was quickly adopted by veterinarians for use in their patients, and unlike many anesthetic agents, whose day comes and goes, ketamine has been part of the  basic tool kit for veterinarians for the entire time.

It has also moved beyond it’s original use as a balm for injured soldiers, and is found in all hospitals .  Indications for use  in humans include (from Wikipedia):

  • Pediatric anesthesia (as the sole anesthetic for minor procedures or as an induction agent followed by muscle relaxant and endotracheal intubation)
  • Asthmatics or patients with chronic obstructive airway disease
  • As part of a cream, gel, or liquid for topical application for nerve pain—the most common mixture is 10% ketoprofen, 5% Lidocaine, and 10% ketamine. Other ingredients found useful by pain specialists and their patients as well as the compounding pharmacists who make the topical mixtures include amitriptyline, cyclobenzaprine, clonidine, tramadol, and mepivicaine and other longer-acting local anaesthetics.
  • In emergency medicine in entrapped patients suffering severe trauma
  • Emergency surgery in field conditions in war zones
  • To supplement spinal / epidural anesthesia / analgesia utilizing low doses

THE KETAMINE EXPERIENCE

Using ketamine in a clinic, a new veterinarian learns quickly that at as a sole agent, ketamine is not very good. The animals tend to become rigid during their sedation, their eyes remain open, and they don’t exhibit the floppy type of sedation that we prefer when working with a sedated or anesthetized animal. Furthermore, recoveries from ketamine look rather bizarre and uncomfortable, with the animal swinging his head back and forth as if he’s watching a marathon game of tennis.  Therefore, when used in a veterinary clinic, ketamine is virtually always combined with another drug, generally one that provides relaxation. A historically common ‘cocktail’ is s 50:50 volume mixture of ketamine and valium.

This looks like a cat on ketamine.Note the unrelaxed posture and the open eyes.

Humans, likewise, report hallucinations when using the drug as a sole agent, and physicians will often combine it with other drugs to minimize this effect. The hallucinogenic potential  has made ketamine a popular ‘club’ drug, like MDMA (Ecstasy) or Rohypnol. Until 1999, Ketamine was unscheduled, meaning that it wasn’t a controlled substance. We could use the drug without having to log every single dose used, and without fear of scrutiny from the FDA. Alas, because of ketamine’s growing popularity as a recreational drug, the Feds moved and made ketamine a controlled substance.

.

I’m not quite sure how this was discovered, but ketamine has a rapid and profound effect on depression. Unlike Prozac and the other selective serotonin reuptake inhibitors (SSRIs) which usually take 3-6 weeks to “kick-in”, ketamine takes effect within 24 hours, and often within 2 or 3 hours of administration.

And here is the strange part. Although ketamine’s half-life  is only 3  hours, the anti-depressive effect seems to last at least a week. (A half life is the time it takes for half of the substance to be cleared, so, for example after 4 half-lives [1/2->1/4->1/8->]1/16th of the substance will remain.)

THE FUTURE OF DEPRESSION THERAPY?

So, imagine this. You are in the midst of a depressive episode. Instead of taking a several week regimen of pills, you go to the doctor’s office in the morning, and by lunchtime you are feeling like yourself again.

Fortunately, instead of burying this because of fears of abuse, studies are going forward. The National Institute of Mental Health is conducting clinical trials of the effect of ketamine on major depression and bipolar disorder. The Department of Defense is collaborating with Mt. Sinai School of Medicine on a clinical trial testing ketamine as a rapid treatment for Post-Traumatic Stress Disorder.

There are doctors who are already using ketamine to treat depression. At UCSD, the psych department  offers treatment-resistant depressives intravenous ketamine as a treatment. Because it is not an approved use of ketamine, insurance will not cover it. Ketamine is not an expensive drug. Perhaps in the future depressives will be able to dose themselves with intramuscular shots, much the same as diabetics treat themselves with insulin.

Mental Health Mittwoch: Another reader responds on veterinary suicide

 

From The Book of Bunny Suicides: Little Fluffy Rabbits Who Just Don't Want to Live Any More , by Andy Riley, Plume 2003. Published here without permission but available from The Seminary Co-op Bookstore

From a reader in the UK:

Hi – I too left a lovely job in academia teaching at a vet school in Canada partly due to environmental pressures – we had regular suicides either among postgraduate students or colleagues, the latest a former colleague of mine I’d worked closely with – I’ve been touched by suicide already several – too many! – times, the latest now in our community since we live in the UK….I stumbled across your blog in doing some research on the figures in our profession in the UK, as I would like to get involved in the wider community to raise awareness of this taboo subject…I’ve also since reinvented myself to get away from the terrible work pressures of this profession, having ditched practising as a vet a long time ago when warning bells sounded in my head – I simply realised I wasn’t up to handling the stress. I tip my hat to the many colleagues that do. I’m glad to have read your blog about it.

PS: New post on The Meta-Bug.

On a Personal Note

Why does every depressed person who poses for a picture assume some variation of this pose?

My move from veterinary clinical practice to public health practice wasn’t just a matter of changing a job. Working in clinics, I felt that working there was a danger to my well-being. Not so much my physical well-being, though I did get my share of bites and scratches, and when I was still working with large animals a well-placed kick could have landed me in the hospital. I’m speaking of our mental health, our sanity–our souls, if you will.

We may bring our own problems with us wherever we go, but environment, including career choice, may play a role as well. In other words, I was probably at least partially correct. It turns out that vets are 4 times more likely than the general population to commit suicide, and twice as likely as those in other health professions.

The news came out earlier this year in an article in the Veterinary Record, a British peer-reviewed veterinary journal. The article is titled Veterinary surgeons and suicide: a structured review of possible influences on increased risk. (Veterinarians are called veterinary surgeons in the UK).

Here’s the abstract:

Veterinary surgeons are known to be at a higher risk of suicide compared with the general population. There has been much speculation regarding possible mechanisms underlying the increased suicide risk in the profession, but little empirical research. A computerised search of published literature on the suicide risk and influences on suicide among veterinarians, with comparison to the risk and influences in other occupational groups and in the general population, was used to develop a structured review. Veterinary surgeons have a proportional mortality ratio (PMR) for suicide approximately four times that of the general population and around twice that of other healthcare professions. A complex interaction of possible mechanisms may occur across the course of a veterinary career to increase the risk of suicide. Possible factors include the characteristics of individuals entering the profession, negative effects during undergraduate training, work-related stressors, ready access to and knowledge of means, stigma associated with mental illness, professional and social isolation, and alcohol or drug misuse (mainly prescription drugs to which the profession has ready access). Contextual effects such as attitudes to death and euthanasia, formed through the profession’s routine involvement with euthanasia of companion animals and slaughter of farm animals, and suicide ‘contagion’ due to direct or indirect exposure to suicide of peers within this small profession are other possible influences.

From 1999-2006 “intentional self-harm,” known to the rest of us as suicide, was  the 11th major cause of death in the United States. (It ranks much higher among the young, especially in the 15-24 year age category.) In high-income countries, the 3rd major cause of disease is depression. People struggling to survive in low-income countries, in spite of being at increased risk for other causes of disease, still carry a burden of depressive disorders that cause  them  to rank 7th overall as in causes of illness. However, you look at it, one’s own brain is capable of ruining or taking the life of the organism that supports it. This is not weakness, or a lack of character, any more than cancer is the moral fault of a person’s immune system to fail and recognize a danger created from within.

Laughter always helps