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Saturday, November 28, 2015

A dozen reasons why vets should not try to kill themselves. Dr. Oliver Liyou

A dozen reasons why vets should not try to kill themselves
  - From someone who tried!
Dr Oliver Liyou BVSc (Hons1) MANZCVSc (Eq Dent)
Introduction
Suicide is a delicate topic to discuss at any time, and there appears to be a major problem currently in our profession, leading to the statistics that a veterinarian is four times more likely to commit suicide than the average citizen.
Whether you are a veterinarian, veterinary nurse, work in a veterinary practice or institute, or a member of your family does, I encourage you to read and consider the article below.
I have written it from my both my head and heart, to try to offer some ideas that may help prevent others make the mistakes I have made in my journey called life. I sincerely hope that it is not offensive, upsetting or misleading to anyone who reads it. I am not a qualified mental health professional, but have received a substantial amount of assistance from mental health professionals, and am eternally grateful for the work they do, along with the wonderful support I have received from my family, staff, friends and clients. 
So please read on for my list of 12 reasons why vets should not try to kill themselves:
1)      We are very good at it!!! We are paid in our jobs to euthanase living organisms! From turtles, to horses to lizards and birds, we can put things “to sleep” very well and spend a lot of time in our training and careers focusing on removing pain from lives of our patients!
For the general population, the statistics are that for every successful suicide attempt, there are 20 who don’t succeed. That represents a “success rate” of converting a suicidal thought to a suicide of 4.7 %. I am not sure what the “success rate” for suicide attempts is for veterinarians? Could it be that we are actually no more at risk of attempting suicide than the average citizen, but just far more effective at carrying it out?
2)      Devastation to the family. This one is self-explanatory, but should never be underestimated! No matter what the reason, the feelings of devastation, despair, regret, guilt, sadness, loss, anger, shame etc.  in the family are enormous. No family deserves to go through this!  
If, like me, you do not “succeed”, there is just as much pain in the road to recovery as the pain you were trying to relieve through the action! Painful emotions such as shame, guilt, regret, sorrow and loss are all abundantly common! The road to recovery for you and your family will not be easy!
Should you be affected by depression and suicidal thoughts, it is important to know the potentially harmful and dangerous effects on your mind that certain drugs may have. For example, in my case, the concern of hurting my family had prevented me from acting on suicidal thoughts literally hundreds of time before in my life, since the age of 10 through to 33 years old. But under the effect of SSRI antidepressants for the first time in my life, my mood and thoughts became severely altered, and suddenly the “seemingly logical advantage of suicide was presented to my thought pattern, and I acted on that new and convincing belief”! Alcohol and illicit drugs could also render you more like to act on suicidal thoughts, through removal of inhibitions, so need to be avoided at all costs when depressed!

3)      We should NEVER let our subconscious mind start to apply to ourselves the common veterinary advice that “the animals we euthanase will be out of pain and in a far better off and happier place once we have put them to sleep”. 
One experienced horse vet once said to me, “you know you are in trouble when you start believing the bullshit stories you tell clients at times in trying to simplify a situation!” The reality is that Fifi and Patch are just going into a cold hole in the ground, and not up to fluffy paddocks in the sky where they can play unconditionally with their friends and be eternally happy!
The above paragraph may sound crazy to you, but it is hard for a sane minded person to understand the thought patterns of someone who is about to kill themselves! I for one vividly remembered a clear authoritative voice telling me to “just DO IT and then you will be able to be an angel and be with your wife and boys 24/7 and look after them all the time and forever, and no longer have to work so much and rarely see them! Just DO IT OLIVER!!!!”
4)      The cost to the business you were working in is massive, due to the rapid onset of the tremendous disruption, uncertainty in the clientele etc. It all often results in a major downturn in turnover and thus more financial hardship.
Litigation is now a very real possibility with the responsibility of work places to provide “safe” workplaces, both physically and psychologically!
5)      There is no evidence that things will be better and less painful being dead!  What if you are sent to the burning fires of Hell? What if the kids who beat you up as a kid and all the people you have been unkind to are waiting for you in your next life? What is there is a pack of hungry lions waiting to eat you? Suicidal minds are only assuming that they are going to escape the pain that is hurting them, but there is absolutely no proof – ever!
Almost everything can be improved somehow no matter what the problems are. Usually the problems we are worried about are “First World Problems”, and their magnitude is often being amplified in our depressed and anxious minds. In Australia, even with worst case scenario, we still have food, a roof over our head, and the chance to rebuild our relationships and businesses should they fail.  A wise man once told me, “We were born single and broke, and will be buried single and with empty pockets, so anything in between is a bonus really?”

6)      No one expects you to be perfect, and as a veterinarian, you are likely to be a high achiever - who is known to be at times to be their biggest critics! Be kind to yourself!
There are other more sustainable and proven methods to reduce the pain and anguish and help guide you through the high risk period that WILL pass! e.g. talking to a friend, going for a run (exercise is a powerful therapy and releases endorphins), taking a holiday, seeking counselling, starting CBT course, meditation, phoning the:
a)      AVA Counselling Service 24/7 1800 337 068
b)      Mental Health Line 1800 011 511
c)      Lifeline 13 11 14
d)      Beyond Blue 1300 22 46 36  http://www.beyondblue.org.au/resources
e)      http://www.blackdoginstitute.org.au
f)       Doctors Help Advisory Service in each state of Aust.  NSW 02 9437 6552

7)      Remember that 20 per cent of society suffers from mental health issues, and that pets are a very popular and useful therapy to help them with their health issues. Thus a vet clinic is often a common place for them to take their pets, especially when they are worried about their beloved pet. So when you are being abused by an unreasonable client, consider that it is often not so much about your inadequacies as a vet, as it is their mental health “playing up” on them.
If you are being abused by a client, practice the skill of “Ducking and dodging” their abuse and be pleased that you are intelligent enough to not take it personally.  But you may need to set some boundaries for them after the event, as it is neither pleasant nor acceptable, especially if it recurs!
8)      Even the most solid personal relationships are likely to come under severe strain and possibly fail sooner or later.  As a veterinarian, you have acquired many life skills and attributes that will make you attractive as a long term partner should your current partner decide that having a vet as a partner is no longer for them!  
Should you attempt suicide, with relationship break down as a contributing factor, and survive, then the chances of resurrecting the relationship, or convincing someone else to “take you on” will be far less than had you got help before and thus prevented the suicide attempt.
The past does not equal the future, so long as you take notice to not keep making the same mistakes with your new partner. And remember that you need to work hard at your relationship - just as you do with your career, physical health, business etc., should you want to build a great long term relationship that you can rely on and enjoy.
And always remember if you “get dumped” there are always plenty more fish in the sea! Delays in finding the right partner never means it will not happen! So be patient and focus on being happy, healthy, energetic,  going forward etc., and you will become more attractive to others than you could ever dream of!
Remember that happiness comes from within and relying on a partner for your happiness is doomed to fail!
9)      If you survive the suicide attempt (possibly less likely being a veterinarian):
a.       You may reduce your future employability as a vet or any other jobs should you attempt suicide and survive.  It is not a good thing to have on your “reputation’s CV”!
b.      You will struggle to get a gun licence if you have suicide attempt in your history! Not a big problem, unless you want to start shooting, or buy your kids an air rifle as I did! J
c.        Your income insurance may not pay out for loss of income, as they often have a question in their application form, “Have you ever been stressed, anxious or depressed?”  Even if you are not officially diagnosed with these conditions, if there is ANY evidence of these that comes up in your medical history, they will may pay you when you are not working in recovering from your attempt!
d.      You will struggle to get income insurance in the future. If you do, it will likely have exclusion on mental health issues.
e.      You may struggle to attract employees in the short term, until you get “back on track” etc.
f.        You will likely lose some clients especially if they are personally upset or insulted by your actions.  
g.      Your new lover may be suspicious, warned off, worried or anxious of you until you prove that you are stable and on the mend long term.
h.      You may carry substantial mental and possibly physical scars.
i.        Your family’s scars are likely to be equal to or even greater than yours, whether you survive or not! Like mine, they may have gone through the horrendous period of wondering if you would survive, when you were “peacefully sleeping”, oblivious to the magnitude of the stress of the situation.

10)  We are so, so lucky to live in Australia and not a third world country in turmoil etc.  No matter how stressed or depressed you are, you should never ever forget to remind yourself of this fact! If you think your life is bad, a lot of people living in the graveyard would surely like to swap places!  Never underestimate the power of “stopping to smell the roses” and “stay positive at all costs – no matter what!!! “
11)  There is so much better recognition, acceptance, understanding of mental health nowadays than even 10 years ago. Whether you think you are vulnerable or not, you need to learn about it! If it is not you who becomes affected, it is likely someone close to you will – sometime in your lifetime! No one is immune to the woes of being struck by and devastated by depression, anxiety and suicide!
 I lost a personal veterinary friend, who had been very successful in every aspect of his life, to a point of being so damned busy that he couldn’t juggle all the balls anymore – he had become too popular, and everyone demanded more and more of his time! He had visited me in hospital when I was recovering from my single suicide attempt in 2005. I remember him sitting by my bed, telling me that he had never thought of it, and could never imagine doing such a thing! 2 years later, he was dead, having used the same method I tried!  

So if you find yourself climbing the career ladder so “successfully”, that everyone wants you and only you, remember to set up “safe havens” where you can enjoy some “you time”, have a laugh and  smell the roses. And look after those who matter most to you!


STOP PRESS:  Heads Up was launched in May 2014, with a PwC report revealing that Australian businesses receive an average return on investment of $2.30 for every $1 they spend on effective workplace mental health strategies. www.headsup.org.au
The research looked at the impact the mental health of employees had on their productivity and the number of compensation claims lodged. Absenteeism, reduced worker productivity and claims resulting from employees’ mental health conditions such as depression and anxiety cost Australian employers at least $10.9 billion a year.
The report, along with other research released throughout the campaign focusing on the attitudes of business leaders and employees, provides a compelling case for businesses to get involved and introduce Heads Up strategies into their workplaces. 
The campaign’s centrepiece is the Heads Up website, where business leaders and managers can find out why they could be losing money if they are not investing in employees’ mental health. They can also sign up for practical advice about how to have a more mentally healthy workplace and they can access, free of charge, a range of useful ideas. 
The Heads Up Action Plan allows businesses to create tailor-made mental health plans on the website, based on their priority areas. The unique mental health action plans are accompanied by a suite of free resources. 
There’s also an interactive questionnaire on the site to help workers struggling with depression or anxiety to decide whether they should tell their employer or colleagues about their mental health condition. This is a personal decision for the individual with no wrong or right answer, and it can be helpful to weigh up the pros and cons.

12)  We are so lucky to live in an era where there is a lot less stigma about mental health, thanks largely to the work of the health profession educating the media. Politicians and sports stars “coming out” and admitting they need to take a step back due to mental health issues sure has made it easier to step up and admit to others that you have a problem and are taking steps to address it!
Australia has an increasingly strong support system for Mental Health, with over 2500 psychiatrists and over 25,000 psychologists who you can access help and advice from. 

However I did get some good advice from a very successful veterinarian friend who had a long history battling the “gremlins of depression”. He told me that it will take some time, trial and error to find the right therapist. His theory was that half of the mental health professionals followed the path of mental health to try to sort themselves out, the other half did it to help others! “You need to find a therapist from the latter group! “ he told me!

I saw no less than 4 psychiatrists following my suicide attempt, in two different hospitals, and I really felt uncomfortable with all of them, as if they were not interested or did not believe my words. And then I was recommended one in Brisbane, who I felt “believed” me, and immediately my progress improved.

It is with great relief now that I can have sessions via Skype with this specialist doctor in Brisbane when I am in Grafton. This will be especially beneficial to those affected in rural areas – where a choice of highly qualified and experienced therapists is extremely limited.

 In my case, in rural NSW, the combination of a psychologist (not qualified to prescribe antidepressants ) giving me a piece of paper with “Arapax” written on it, to “take to my GP and get a script”, led to a serious mood disturbance eight days later that I was not warned about, and almost led to me losing my life! All I was warned of was that it may give me stomach upsets!!! L

There is now more education on life balance to protect and insulate us from the stresses of living in the age of ever increasing standards of communications, continuing education, management etc.!  It is great to see organisations such as AVA, EVA, UVG, Deiderik Gelderman etc. all running lectures and seminars on these topics. Ignore them at your peril!
We now know more about avoiding the trap of becoming a seriously good veterinarian, but being “penalised” in some way through becoming too busy and thus overwhelmed. Once a certain level of popularity is gained by a veterinarian, it can easily become a case of “the wider you open your doors, the more clients come in, and the more staff turn to you with their problems etc.!”  So unless you learn to say no, and/or develop and implement systems to successfully manage and mentor your clients and staff, you are doomed to fall from grace in some way, despite your having climbed “the ladder or success!”
Remember that our lives and careers are a journey and not a race! It is a journey that has a path like the flight path of an airplane. Rough winds and external forces may push you off the direct path 95 % of the time, but so long as you don’t panic, and get back on track, you will eventually reach your desired destination – calm, fulfilled and happy!
 Oliver and his 3 amazing boys at a footy game 2014.


Friday, November 13, 2015

Notes on otitis externa

Acute: Cyto: G+ and cocci - Neomycin
Betadine= povidone-iodine 10% - dilute 1 in 10 for 1:50 povidone iodine - intact tympanum, 1 in 20 (1:100) perforated tympanum.
culture: Staph,Strep
Chlorhexidine  2% - dilute 1:40 in water.
Acetic acid (white vinegar 5%) dilute 1:3 in water. Conc of 2 - 5% is irritating.

Cyto: G- bacilli
Culture Proteus sp, E coli
Topical: Neomycin, polymycins, gentamycin.
Acetic acid (white vinegar 5%) dilute 1:3 in water,
Povidone-iodine 1:50 intact tympanum, 1:100 perforated.

Cyto: yeast: Nystatin, thiabendazole, miconazole, clotrimazole

Chronic resistant otitis:
Yeast: topical: clotrimazole, miconazole, silvadene.
Systemic: Ketoconazole 5mg/kg twice daily for 2 to 4 weeks.
Itraconazole 5 to 10mg/kg once daily for 2 to 4 weeks.

Gram neg bacilli:
Pseudomonas sp.
Topical: Gentamycin, polymycin B, colistin or polymycin E.
Polyhydroxine iodine, diluted 1:3 to 1:5 in water and applied twice daily.
Systemic: Ormetoprim-sulfadimethoxine, trimethoprim-sulfonamide, 1st generation cephalosporin.

Pseudomonas sp. cultured.
Topical: Ticarcillen - add 4 grams to 4 oz bottle Oticlens.
Tobramycin
Enrofloxacin(Baytril) diluted 50% in water, 3 to 5 drops twice daily.
Amikacin sulfate undiluted (50mg/ml)
5 to 6 drops twice daily.
Siver sulfadiazine diluted 1:1 in water , 4 to 12 drops twice daily.
TRIS - edetic acid - gentamycin solution

Systemic
Enrofloxacin, marbofloxacin, orbofloxacin, gentamycin

Skin and skin structures:

Synulox, cephalexin, enrofloxacin.

Ears G- bacteria
Pseudomonas - painful, copious light yellow to green exudates, often ulcerated epithelium.
Proteus - light yellow exudates, ulcerated, chronicity.
E.coli - light yellow exudates
Malassezia - dog - light brown to chocolate brown exudate; cat brown.

G+ bacteria
Staph - light brown, pale yellow
Strep (Beta hemolytic) light yellow to light brown.

Otodectes cynotis (ear mite) - dark brown exudates.

Antifungal in ears:
Chlorhexidine
Thiabendazole
Silver sulfadiazine
Clotrimazole
Nystatin
Monosulfiram
Miconazole
Zinc undecylenate

Monday, October 12, 2015

Real Survivor

Left on a tropical island with no food or water sounds like the stuff movies or (more recently) reality TV is made off.

In the seventies, when I was a student at Onderstepoort, I joined Exploratio (University of Pretoria) on a diving trip to Bazaruto. Two post grad students were in charge of the group of about 20. They had organized enough food for a three week stay for those who had booked in advance. At the last minute 4 extra students joined. The food supply was not increased as it was too late. We travelled by car to Vilanculos in Mozambique, My very tall boyfriend and I occupied the back seat of a very small saloon car driven by another student and his girlfriend. About halfway up the length of Mozambique, we stopped at a deserted beach to overnight. We took our sleeping bags quite a distance from the car to sleep on a dune overlooking the ocean. It was delightful until about midnight when a sudden thunderstorm drenched our sleeping bags and us to the bone, necessitating an emergency return to the car and a very cramped and wet night in the car.

Vilanculos was delightful. We had little time to explore as the working fishing boat which was taking us to the island, was almost ready to depart. It was a long trip, as he first headed north in the channel between the islands and the mainland, before swinging widely around the north end of Bazaruto to anchor in a bay on its eastern, ocean facing side. We had to wade through chest high water to the beach, passing our luggage along over our heads.

We camped on the beach, above the high water mark. There were two large tents, but we mostly slept under the stars. During the night one would often be woken up by a scratching sound under your sleeping bag. Upon lifting your bag, it would be a crab trying to dig its way out.

The weather was perfect, the ocean crystal clear. The bay where we disembarked was protected by a reef and the snorkelling, especially for a child of the Karoo, unbelievable. Initially the group got on very well. The fish speared by the serious divers who ventured behind the reef, were tasty and nutritious additions to our stock of cereals, canned and dried foods and bottled water and soft drinks.

One evening one of the group returned to camp to find another resting on his sleeping bag. He became very angry, saying amongst other things that his sleeping bag was like his tooth brush and he shared it with no one.

The following night someone angled for and caught a medium sized shark - about 1.5 meters in length. He hid it in the bushes. During the day, when the owner of the disputed sleeping bag was out diving, he placed it in his sleeping bag, with the guy's toothbrush between the shark's teeth. There was not enough water in the sea to wash that poor sleeping bag!

On the way to the island, the fisherman had told us about a shipwreck a distance from the island. A group of us decided to swim out to it. In spite of my Karoo upbringing, I was a strong swimmer and joined the group. My boyfriend came too, but got into difficulties and decide to swim back to the island just before we passed its northern point. The group tread water and waited for him to reach the beach safely before continuing. We swam for what felt like hours before deciding to turn back without finding the wreck. We were told later that if we had continued just a little further, we would most likely have hit a strong current which would have pulled us out to sea. The foolishness of youth!

After nearly three weeks our food and water supplies were running out. We eagerly awaited the boat which was due to collect us on the 21st day. In those days Bazaruto was not yet a tourist destination and was inhabited by a handful of indigenous Mozambicans  who fished and kept goats on the other side of the island. There was also a radio station manned by two Portuguese soldiers in the hills in the centre of the island.  Dirty water was to be found at a pond fed by a spring in the interior quite a long walk from our camp.
We were getting really bored of fish and of one another.

The boat did not appear even though we scoured the horizon for days! By now all we had was fish and dirty water! I don't know why it did not occur to us to swap a tent for a goat or just some meat! The fish that was speared most often was grouper, which was not particularly tasty and often overcooked. One day someone speared a small yellowtail and cooked it for himself. If this was the TV series, he would surely have been voted off! The water tasted brackish. We were afraid to go far from the camp in case the boat arrived. 7 days after the boat was due to arrive, there was an accident. A girl was speared through her thigh. She and her slightly built boyfriend assisted one another to load the speargun, one pulling on either side. Somehow one let go and the spear penetrated her thigh, luckily missing major blood vessels. She was brought back to camp, half-supported, half hobbling along with the spear sticking out of her thigh on both sides. The closest thing to a medic was a third year veterinary student. He scratched around in the first aid box and found some disinfectant and antihistamine, so that is what she got. At least the latter made her sleepy. Somehow they managed to pull the spear out.

Two guys hiked to the radio station to summon help. We packed up, expecting a boat to arrive soon. It was nearly a full day before a small motorboat arrived. It could only take the injured girl and her boyfriend. The rest of us had to stay a couple more days before the fishing boat that had brought us, arrived. They had beer and bokkems (salty, dried fish) on board. It tasted good!

Sunday, October 11, 2015

What you really need to take with you on the Tankwa Camino.

Camping gear:
Tent - easy to pitch and pack. One you can stand up in is ideal.
Hammer
Shade cloth or groundsheet larger than tent.
Bedding - think comfort and warmth. My blow up mattress sprung a leak
 3 nights before the end. My supposedly
 -5 degrees Celsius sleeping bag was not warm enough. Next time I will take a folding mattress and/or stretcher.
 Comfortable pillow.
Fleece blanket or gown
A 5 liter bucket or folding bucket for wash water, Extra dish or bowl. I used my camping cooking pots for wash and rinse water. A folding bowl for soaking feet.
A torch - head lamp ideal. Extra batteries.
Durable solar cell phone charger - even though there is no reception en route.
Plate and paper plates - simplifies clean-up. A mug. Cutlery.
A flask for hot water (coffee en route) Take your own coffee.
Folding chair.
Small stool to use as footstool.
Brush and dustpan
Gardening gloves for pitching and packing tent away.
Strong longish black plastic box with hinged lid
Day pack with hip belt and camel pack. Splash cover.
Small water bottle.
Moonbag
Entertainment if you are a fast walker: Good book to read
Knitting
Camera with fully charged battery
Strong soft bag for clothing etc. The Pep stores ones are not durable enough, nor are they water or dust proof.
Umbrella (lightweight, small folding - very useful for shade in the day

Clothing - 4 long sleeved shirts
2 T-shirts
Underwear - 5 sets
Socks - 5 pairs
Short stockings
4 prs lightweight long pants. (Zip off legs ideal
rainproof jacket and pants
waterproof gloves.
warm fleece or down jacket
light weight jersey
Warm pyjamas or track suit
Bedsocks
1 set thermal underwear
soap powder to do laundry
laundry bag for dirty clothes
3 rolls toilet paper

Light weight large scarf for sun protection
Safety pins on hat
Buff
Hat
(Beanie)
Sun glasses

Walking shoes. (Trail runners) - 1 to 2 sizes too big.
Inner soles if you are used to walking with them
Spare pair.
Sandals
Soft slippers. (Sheepskin ideal)
Gators - small stones/gravel get into your shoes often.
small towels 2
2 washcloths
soap - dove
shampoo/conditioner - Gills
tooth brush & toothpaste
hairbrush
lip-ice
sun protection - SPF 30 or over
moisturiser

Blisters: disinfectant
antibiotic ointment
sterile sharp blades - 8
Zn oxide plaster
4 rolls 50 mm elastoplast  from your vet. White and stretchy
2 rolls 75 mm elastoplast
Micropore
Bandage to use as pressure bandage in case of injury or snakebite.
Scissors to trim dead skin off blisters and cut elastoplast.
Gauze pads
nail clippers.
Mosquito repellant
Panado
Arcoxia
Somnil
Immodium
Brevispas
Antibiotic?
Antihistamine
Antacid
Iceman or Voltaren gel
vaseline
Magnesium sulphate (soak feet)
duct tape
Wet wipes

Food for breakfast and lunch
eg nuts, dried fruit, moist pre-packed chicken, salads, tinned food, pro-vita, also fresh: strawberries were good for 2 days, small tomatoes about 4 days, peas and beans lasted almost 9 days, as did carrots.
Milk
Milo or Horlicks
Rehydrate
Boxed wine

Decent coffee and plunger (stove not necessary - can usually get hot water at camp kitchen. )

Remember that all the stuff you pack so neatly at home over several days, will soon become disorganized and will treble in volume as you try to pack hastily in your cramped tent! Stay organized!
Your luggage will get hammered en route. The road surface is uneven and there is endless dust.








Tankwa flowers








Senecio sp?


Saturday, October 10, 2015

"The Choice" by Paul Kihn

The Choice

Sing the song of the rain
Joyously beating down,
Sing of the wind keen and clean
And of tramping down some lane.
Sing most poetically
On a rain-swept wintry night
Of the joys of supper and tea
In front of a fireside bright.

Sing too if you can in the sleet
The song of ill-shod feet,
The minor-keyed song and mute
Of the tattered threadbare suit.
Sing the song of a woman who weeps
Over a child that uneasily sleeps
Because it is too cold for dreams.

Yours is the choice.
These are the themes.

Paul Kihn

Thursday, October 8, 2015

Tankwa Camino done and dusted!

Tankwa Camino done and dusted! It was quite a challenge -  being compared by some to Kamp Staaldraad, a notorious bootcamp for the Springboks before the 2003 Rugby World Cup and said to be worse than being in the army. A challenge worthy of any wannabee endurance athlete! 

However, do not be fooled by many of the participants' grey hair and/or lack of a sixpack into thinking that it will be a walk-over! They all have wills of steel - or is it just plain stubbornness?
It is one tough mother of a hike! Ignore those cosy fireside camp scenes on Facebook and in the magazines! The camps (often by the roadside) are generally dusty, cold at night, the ground hard and the creepy crawlies many! As for the toilets - very, very basic, usually backlit by the setting sun and embarrassingly close to the tents - except for the nights one had to cross the R355 gravel road to get to them. Washing is done with only 5 liters of warm water in the late afternoon.
In the daytime a variable number of toilets were set up along the route. I could never work out their spacing. At any rate they were never there when I needed one, which seemed to be very often, as I was making sure that I was staying hydrated - especially after one participant had to withdraw on day two due to anuria (an inability to urinate).  There is also a good chance that you will suffer from diarrhoea a few days into the race as blood is diverted from your digestive system to your muscles. On that note, if after reading this, you still insist on going, take lots of toilet paper along! Leave your sense of shame behind. The Tankwa has kilometers of nothing but small rocks and occasional very low bushes. Squatting amongst the bushes not only offers scant privacy, but also exposes you to tick infestation. You either have to be very fast, or build a shelter out of rocks - but then you risk disturbing a snake or scorpion!

Also look out for rodent (gerbil?) holes in the ground when you sit down to rest. Cover the openings with flat stones so snakes do not crawl out while you are resting quietly. Remember to remove the stones before you leave, just in case the holes are inhabited by gerbils. Remember to leave some of your food to apologize for shutting their door. Examine yourself thoroughly for ticks after sitting down and again in the late afternoon after pitching your tent and washing in your allotted 5 liters of warm water. Remember that when you hide your bum in a bush when "going to the toilet" you are giving ticks direct access. By day three you will be thoroughly bored by the snacks and lightweight packaged foods you brought along and you won't be very hungry anyway. The evening meals at camp are quite tasty and you will make up for not eating during the day. Bedtime is just after supper - giving the large  meal you just ate no time to digest and leading to heartburn. Do not forget the antacids. Also take anti-inflammatory drugs (Dr's prescription) and paracetamol or similar. You will need them. If you take them, you will need to drink even more water to protect your kidneys and liver. (Do not overdose on drugs, tempting as it may be!) Some form of sleeping tablet will also be useful, as aching feet and muscles as well as fluttering tents and snoring participants will keep you awake all night otherwise. You will use meters of elastoplast. Take several rolls and then pack 3 more. The only person I know of who came off blister free, did everything they advise against. She did not walk much beforehand, bought brand new hiking shoes the week before, as well as new socks. She did not wash her socks beforehand. You, however, SHALL get blisters, even if you never had a single one before!

How to prepare? Marathon athletes and speed walkers as well as veterans of many, many long distance hikes suffered from blisters and in general. I averaged about 3 blisters a day, until I covered my  feet entirely in elastoplast by the end of day 3! I still managed to get a couple after that. I am losing a toenail and a second one looks like it may be on the way out! I think the repetive motion on the endless relatively level terrain leads to blister formation. The heat and swollen feet aggravate matters. I stopped every two hours and examined my feet and would find new blisters which had developed since the previous stop.

Weather in the daytime will vary from hot and sunny and dusty, to cold and windy and dusty, to cold and wet and muddy. Nights are very cold. Make sure you have enough warm clothing and bedding. Air mattresses are good until they spring a leak. The last three nights I had to get up every two to three hours to blow up my mattress which had deflated.

The R355 traversing theTankwa is notorious for causing flat tyres. Perhaps that is why most people in their big SUV's try and drive through it as fast as possible, throwing dust and stones at you as they roar past at breakneck speeds. In the afternoons, the cooled air rolling off the high peaks of the Cederberg in the west causes strong winds as it rushes to fill the void created as the hot air rises off the baking Karoo earth. Only after the earth has cooled in the evenings, does the wind  and the dust settle.

You will be bored often. Everyone will always walk faster or slower than you. Unless you have a dedicated companion who will stay by your side no matter what, you will be alone a lot. The road is endless and the scenery often monotonous. On day 4 I woke up tired. My blisters were many and my muscles were sore and stiff and progress was slow. Eventually all the other hikers had passed me and had moved on out of sight. For a while I enjoyed the solitude.Then I realized that I had not seen another human being or a support vehicle for over two and a half hours!

When I finally reached camp, I objected to being left for the predators. For the rest of the walk, the support vehicle would accompany the last walker (usually me) all the way in. This was a mixed blessing as I now felt guilty about needing a rest and found it impossible to use a low bush when nature called.

Why did I complete every step of the way when I had the option to ride with the support vehicle when necessary? There were a several reasons. My grandson sent me a recorded whatsapp message saying "Ouma, I hope you win." I replied that it was not a race but that finishing was winning. For a while this kept me going. Ego and sheer stubbornness played a role, for sure. There was a stage when I thought that teaching the grandchildren that sometimes it is OK to realise that something you started was a really bad idea and that bailing out is a sensible option, is also a valuable lesson. Then I thought of how my finishing would empower my children. Every time a grandchild whines about not wanting to walk somewhere close by, they could say to them: "but your grandmother walked 260 km through blazing sun and freezing rain across the Tankwa at the age of 66!"

The last few days I kept walking through my pain because I wanted to leave no stone unturned or business unfinished, lest I decided to come back again and finish what I had started another time!

Now that it is all over, and bumping my toes against my down duvet at night still hurts, I do feel a great sense of achievement. I made terrific friends. I enjoyed the social evenings and chats along the road. The Tankwa has a certain fascination, magnificent sunsets, lovely flowers and fascinating rocks. I feel fitter than I have done for a long time. The organizers and support team are lovely, real people.
And I really appreciate my bed, my shower, the roof over my head, my good health, and most of all, my grandchildren. May this act of madness be an inspiration to them!

Long live the Tankwa Endurance Camino!
Is this what happens to hikers who do not make it?

Starting point at the giant post box in Calvinia.
At the start  of the R355
Shade! 

Road side toilet
The hikers are still enthusiastic!
Some need their first break


"Murder Most Foul" by Paul Kihn

Years ago my old friend Paul Kihn, gave me his manuscripts shortly before he passed away. He was a great poet. His poems are relevant to the times he lived in.

Murder Most Foul. 20/9/1948

High on Golgota's hill,
Crowned with thorns,
The Prince of Peace
Pierced with nails to a cross,
Was lifted high,
And the heavens were riven,
And darkness fell.

Now,
This other son of peace,
Bernadotte, to whom death came
Dastardly and with shame
Lies dead
In the city of peace.

But unleash no sword
Nor let any banners of battle
Be unfurled.
For the guilt and the blame
Lie heavily on the world.From Wikipedia, the free encyclopedia
Folke Bernadotte
Folke-Bernadotte.jpg
Born2 January 1895
StockholmSweden
Died17 September 1948 (aged 53)
West Jerusalem, de facto Israel
Resting placeNorthern CemeterySolna
TitleCount of Wisborg
Spouse(s)Estelle Romaine Manville
(1928–1948) (his death)
ChildrenGustaf Eduard Bernadotte of Wisborg
Count Folke Bernadotte of Wisborg
Fredrik Oscar Bernadotte of Wisborg
Count Bertil Oscar Bernadotte of Wisborg
Parent(s)Prince Oscar Bernadotte, Count of Wisborg
Ebba Munck af Fulkila
Folke BernadotteCount of Wisborg (SwedishGreve af Wisborg; 2 January 1895 – 17 September 1948) was a Swedish diplomat and nobleman. During World War II he negotiated the release of about 31,000 prisoners from German concentration camps including 450 Danish Jews from the Theresienstadt camp. They were released on 14 April 1945.[1][2][3] In 1945, he received a German surrender offer from Heinrich Himmler, though the offer was ultimately rejected.
After the war, Bernadotte was unanimously chosen to be the United Nations Security Council mediator in theArab–Israeli conflict of 1947–1948. He was assassinated in Jerusalem in 1948 by the militant Zionist group Lehiwhile pursuing his official duties. The decision to assassinate him had been made by Natan Yellin-MorYisrael Eldad, and Yitzhak Shamir, who later became Prime Minister of Israel. Upon his death, Ralph Bunche took up his work at the UN, but was removed from the post around six months after Bernadotte was assassinated, at the critical period of recognition of the fledgling state.





Tuesday, September 1, 2015

Protocol for DKA

This is not my own work. It was written down by a vet at an emergency centre where I did a locum.
I always struggle to get my head around the correct approach to stabilise a newly diagnosed diabetic with (or without) DKA, so will find this most useful. This protocol is used for a symptomatic DKA dog.

Maintain hydration
Keep on top of changes in electrolytes
Aim to get BG between 10 to 15 mmol/L and keep it there

INSULIN admin:
Aim to drop BG approx 3 mmol/L per hour to prevent cerebral oedema.
Insulin type = regular rapid acting insulin - usually 100 IU/ml. NB use correct insulin syringe!
Initial dose = 0.2 IU/kg IM
Then every hour: take BG and inject 0.1 IU/kg IM ongoing until BG is between 10 and 15.

Once this happens - change fluids to
0.45% saline with 5% dextrose
Change IM injections to every 4-6 hours
alter depending on what you need.

Ensure well hydrated at all times
Continue until eating and drinking with no vomiting
Only then change to twice daily dosing with intermediate acting insulin. 

Other option is CRI

Piggy back insulin fluids into the maintenance fluids using a separate infusion pump and allow 50 ml to run through the tube before attaching as insulin binds to plastic.

Dose is 2.2 IU/kg/day or regular insulin for dogs and 1.1 IU/kg/day for cats.

Add to 0.9% saline.
Rate @ 10ml/hr
BG monitoring every 1 - 2 hours.
Need other fluid as well to maintain hydration.

Once BG is between 10 to 15: change main fluid to 0.45% saline with glucose 2.5% and run insulin drip at 7ml/hr,
Once BG drops below 10, drop rate to 5ml/hr.
If BG drops below 5, change to 5% glucose and stop insulin infusion.



Saturday, August 29, 2015

Tankwa Camino

In only 25 days, I start the Tankwa Camino. It is a 256 km hike through the Tankwa Karoo. It takes place over 10 days, starting at Calvinia and ending at Ceres. I fear that I am not nearly fit enough. I "wasted" 10 days of walking time while doing a locum in Ceres recently. I belong to an informal walking group that does a fairly tough hike with lots of hill climbs three times a week. We usually do about 3 to 5 km per walk at a fairly fast pace. I have been walking regularly for several months, but have only done one full day hike. The Camino takes place over mostly flat terrain on a rough gravel road and one does it at one's own pace, so I am hoping that I can do it. The organisers require a letter from a doctor if one is over 65. My doctor issued one. I also had a rabies and tetanus vaccine this week - not for the walk, but because I was bitten by a Pit Bull while doing the locum! It reminded me that I had not had any boosters for a very long time.

I am sure I am cardiovascularly fit enough. What concerns me is whether my joints - especially my knees - will stand up to the long distances day after day. I have stocked up on anti-inflammatories and glucosamine. Now to remember to take the latter regularly!

Tomorrow I am doing a locum in Cape Town, so no hiking. However, from Monday onwards I have to start increasing my daily distances. It is difficult to walk alone because the environment is not safe for a single woman. I walk round and round my neighbourhood, but it does get very boring! I considered joining a gym about 20 km from here, but they insist that I join for a year, and I really do not enjoy working out in a gym, so am not likely to use it once the walk is over. The September issue of Getaway magazine has an article about the walk - written by a young lady who did the walk with minimal preparation. She did however use state of the art everything which will cost a fortune to buy! I trust my old clothes which do not wick, vent or UV protect, will get me through. I did splurge on a Oztrail Eco swift pitch tent. Struggling with fiddly poles on my own after a long day does not appeal. I watched a few videos on folding it up again. That does look a bit tricky, but I am sure once one has the hang of it, it should be easy.

My shoes are well used, though I did buy one pair of light walking shoes a size bigger than normal as advised. Apparently one's feet swell on such a long walk. The other problem many people strugggle with, is blister formation. I will go prepared, but in my younger days when I hiked long distances in the mountians, I rarely had blisters, so I am hoping that this will once again be the case. I am taking a pair of sandals along too, just in case.

One advantage of the regular walking, and not eating any sugar, is that I have lost a few kg. I am hoping to lose a little more before the start of the walk. I am unsure what food and snacks to take with me. The organizers provide supper and some fruit daily, but walkers must provide all other meals and snacks.

I will update this blog post as the time goes on. Hopefully I will be able to report that I completed it successfully.

Sunday, August 2, 2015

Ten-Ten se eerste vlug.

Ten Ten se eerste vlug.
Ongeveer 1998
So bykans twee dekades gelede, toe ek die ouderdom van 40 nader, het ek begin voel my lewe is verby. Daar was ‘n gewaarwording van ongedane sake en onverwesentlike drome en ‘n leeftyd wat sommerso iewers tussen babadoeke en finansiele oorlewing verbygesnel het.
Toe word ek veertig en kom agter dit voel nie veel anders as 35 nie, solank ek net nie te stip in die spieel kyk nie. My lewe was jou waarlik nie verby nie! Daar was egter ‘n besef van dringendheid. As ek van die onverwesentlike drome wou verwesentlik sou ek moes begin werk maak daarvan.
Toe leer ek vlieg! Wat ‘n bevryding! Nie net van die aarde nie. Ook van die ouderdom. Dit laat mens besef hoe relatief alles is as mens ‘n nuwe vaardigheid aanleer en boonop jou eie vrees herhaaldelik moet oorwin. As gevolg  van al die adrenalien het ek glad 3 kg verloor in die eerste paar weke.
Nou kon ek vlieg!  So kom dit eendag dat ek besluit om van Gaborone na Jwaneng te vlieg om ‘n kliniek daar te gaan doen en ook ‘n halfmak siek volstruis op ‘n wildplaas te gaan vang en behandel. Vroeg die oggend ontmoet ek my helper Ten-Ten Ikwathaeng, agterkleinseun van Koning Khama se toordokter, by die praktyk. Hy staan slaggereed – medisyne klaar gepak, pylgeweer vir die volstruis gereed vir in geval,  maar wat onmiddelik opval is sy kleredrag! Sy blink gepoleerde skoene weerkaats die oggendson en sy hempkraag se punte staan wyd soos die das styf om sy nek geknoop is. Hy het tot ‘n baadjie aan en op sy bors pryk vir die eerste keer sedert ek hom ken ‘n ZCC wapen.  Ek wonder nou nog of hy bloot gedink het hy moet goed lyk vir sy eerste vlug en of hy gereed gemaak het om sy maker te ontmoet.
Toe ek by ons terugkeer na ‘n suksesvolle dag van honde dokter en volstruis vang vir hom vra “hoe was die vlug?”, was sy enigste kommentaar “Interessant”.


Saturday, July 25, 2015

Peestersiekte

Tuesday, June 9, 2015

Tuesday, April 14, 2015

Sunday, March 15, 2015

Flying vet in Botswana

Earthbound mortals often ask, almost aggressively, as if such madness must surely be wrong: "Why do you fly?"
They are not appeased by my answer either. "I fly for fun!"
Do they ask golfers why they play golf?
To my credit, whenever I can, I try to combine fun with work.
So it came about a few years ago that I persuaded a friend to accompany me on a working fly-in safari in Botswana. The Cessna 150 I used to fly would never get off the ground with 75 kg of veterinary equipment, 25 kg of personal luggage and 94 kg of dog food. I needed my friend, Leon, to take me in our mutually owned experimental aircraft - a Comp Air 6. He groaned when he saw my luggage. He had more than enough of his own. The fact that we were delayed by various circumstances and only took off at 11.20 am on a very hot day, did not help.
Although the CA6 needed a slightly longer ground run than usual to reach flying speed, she lifted off without a hitch. Climb performance was somewhat impaired by the ambient temperature of 35 degrees Celsius. To be on the safe side we remained near the Gaborone-Francistown road. We reached Francistown later than expected due to a strong headwind, but still had to wait for the day to cool down before departing for Sua at 16h30.

There we were met by Tom and Nicky who whisked us of to the Sua Pan for sundowners at the water side. The pans were full, with water stretching as far as the eye could see. As night fell, the flamingos became noisier and noisier, taking off in droves after dark for their night flight to their nesting grounds to the south. The whooshing of hundreds of wings overhead in the dark was an eerie sound.

Early the next morning Nicky and I transported my gear to to a nearby garage where I was to hold my clinic. Striving to maintain high surgical standards in an open garage can be quite a challenge. However, we managed to perform surgery on 10 animals and vaccinated and treated about 30 others.

The following day we left early for Nata. The CA6 took off eagerly from the narrow tar strip in the cool morning air. The 20 minute flight over the pale blue pan dotted with pink flamingos was beautiful, and was over too soon to my liking. I think Leon felt the same when he saw that Nata's short, bumpy, gravel strip had a strong crosswind blowing across it. In spite of that, his experience and skill ensured a smooth landing in the tricky taildragger.

Nigel of Nata Lodge met us at the strip. His indigenous hound, Katy, who had a protracted stay at our clinic in Gaborone the year before, was not pleased to see me. She had suffered a dilated oesophagus after gulping down a whole fish. She did her best to hide under the furniture when I went to vaccinate her. Luc, the Boerboel, did not move from his favourite sleeping place under the office desk, but growled softly as I crawled in alongside him. (And they say flying is dangerous!) Honky-Tonk, the white Bull terrier, was delighted to see me. Sadly though I had to break the news that his ears were not affected by bad eczema, but he in fact had skin cancer.
 Meanwhile Leon and Nigel had discovered a shared passion for cricket and were watching the South Africa - Pakistan match on a TV set up under the trees. What with cricket and a delicious tea, it got rather late and by the time we returned to the airfield it was almost noon and once again very hot. Flying the heavily loaded plane was quite a challenge and we had to fight for every foot of altitude. We remained above the tar road, rarely climbing to 500 ft above ground level, and regularly being pushed back to 200ft by down draughts.
Keeping a constant lookout for bateleurs and vultures, who were also battling to stay aloft, kept us wide awake. I was amused that I could read the names of roadside bars - of which Botswana has many in the most surprisingly remote locations - as we flew past! We also had a great view of ostriches and zebras brave enough to move in the heat as we flew over the Makgadigadi Game Reserve.

Finally in Maun we had litres of cold drinks at the Duck Inn. It was too hot to fly, so I did some shopping while Leon delivered a computer he had brought along for a friend. By 15h30 it was still hot, but Kasane was a considerable distance away and we wanted to reach it before dark as we would be flying over some very inhospitable terrain where lions roamed.

We headed out directly to Kasane, initially following the Maun-Savuti road. The road, however, meanders all over the place and becomes quite faint in parts. The fact that our GPS chose this moment to start acting up was not very reassuring The paucity of landmarks in Northern Botswana has to be seen to be believed. After flying on the Directional Indicator for some time, the Gcoha hills could be seen in the distance
This was our only landmark while traversing the seemingly endless  Savuti marshes, interspersed with forest and woodland. Although we were now flying at 3000 ft above ground level, we could easily discern a great many animals below - the elephants and giraffe being the easiest to spot.

Not far past the hills we flew over the village of Kachikau. From here onwards, we followed the gravel road to the edge of the swamps south of Linyanti. Then we turned slightly east, following the demarcated line between forest and marshland near the Namibian border. We were met at Kasane's modern airport with its excellent tarmac runway by Tony and Frances.

The next morning it was back to work for me. I got up early to set up my clinic in the garage. Tony's lively German Shepherd, McGinty, was intrigued by all the strange animal smells emanating from my boxes. Karen, who had organised my appointments, arrived at 8am, as did my first surgical case, a Boerboel by the name of Chimanimani, belonging to Dee. Dee lives on the banks of the Chobe river. Her experiences brought home the wildness of Kasane to me. Her male Boerboel bears the scars of a leopard attack. Her cat was swallowed by a python right under her mobile home. Her Labrador was dragged off by a crocodile while she watched helplessly and one of her horses died after being bitten by a cobra. Yet, she is raising her young family here. Africa is not for sissies.

After a long day of surgery and consultations we visited Heidi at Kubu Lodge to vaccinate her dogs, Yago and Tess and her cat Minnie Mouse. Her previous cat was severely injured after a run in with a hippo and had to be put to sleep. After seeing Dee's horses and checking up on Chimanimani, I still had to do pregnancy diagnoses on Karen's dairy cows. This kept us busy until dark. Dave, the manager, warned me not to accidentally touch the electric fence beside the cattle crush. It is there to keep the lions out of  the cows' camp. After we left, Karen reported that two zebras got into the cow camp in spite of the fence and were now grazing with them.

We were airborne out of Kasane by 9am on Thursday. The plane was considerably lighter now and climb performance was noticeably improved. There was a solid bank of dark cloud to the south and south-west of us and pilots from Maun reported heavy downpours. We headed south-east, skirting along the edge of the storm to intercept the road to Nata. We stayed above the tar to Pandamatenga and cut across the vast acreage of cultivated land. Over the Sibuyu Forest Reserve we turned south-west and headed straight for Gweta. We would be crossing over 200km of very sparsely inhabited and inhospitable land. From time to time we spotted small groups of elephants at pans below.

We passed directly overhead Gweta, situated on the Nata-Maun road and found the airstrip  called Xirago, with the help of our GPS. We buzzed the camp nearby as instructed. There were some zebra in the pan directly in front of the camp. By the time we had parked the plane under the shade of a large tree, Rod, the camp manager, arrived at the airstrip in his dark green Landcruiser, with it's distinctive "Uncharted Africa" brass nameplate.

From this moment onwards we experienced SERVICE unlike anything I have ever experienced in my life. "Welcome to the camp. What would you like to drink?" He conjured up a vast selection of ice cold drinks. The 6km drive back to the camp was our introduction to the bird life of the grassland surrounding the pans. I can now distinguish between a LBJ and rufous napped lark or desert cysticola. In fact on my return home I had listed 35 species whose names I could actually remember.

At the camp a long legged blond German beauty was waiting for us. Lunch would be ready when ever we were, what would we like to drink and did we want to shower now or later? After a delicious lunch under a large spreading camel-thorn tree we retired for an afternoon nap. The spacious safari tents were tastefully furnished with Persian carpets on the floors and antique wood and brass furniture and fittings creating a real "old Africa" ambiance.

On our afternoon game drive we were most surprised to discover a heavily laden table with drinks in the middle of nowhere. We started a small campfire and whilst enjoying our sundowners, our very knowledgeable guides explained to us how the pans had evolved. Surrounded by the magic of the full moon shining through the clouds, with the world around us quiet and peaceful, while simultaneously teeming with vivid life, we became deeply aware of the tranquility of nature.

Back in the camp we sat down to an exquisite dinner by the light of paraffin lanterns in the large dining tent with its teak floor. Friday morning Leon and a guide, Joe, went up in the Comp Air to spot the migrating zebra. We were then able to follow them into the Game Reserve on the ground. Never before have I seen such concentrations of zebra - herds of far over a thousand - strung out from horizon to far horizon - the galloping of thousands of hooves drumming across the plains; synchronising with the zebras' high pitched whooping calls.

In the evening another surprise awaited us. Just before sunset we arrived at Chapman's Baobab - said to be the second largest tree of its kind in Southern Africa. The setting sun coloured the huge trunks a surreal orange pink. Perched in the lower fork of the 5000 year old tree, we were told of early explorers who passed this way, bringing a long distant time back to life in a place that had seen very little change over the centuries.

After such a fantastic stay, being pampered like royalty while experiencing the true uncharted Africa, we were really sad to leave the camp. We arrived back in Gaborone just as the sun was setting.

Who says one has to have a reason to fly?