http://www.avru.org/?q=vetpet/vetpet_vetsnakesign.html
Saturday, January 3, 2015
Friday, January 2, 2015
New Grads on call.
New Graduates.
Practices employing new graduates need to be aware that most of them need mentoring to help close the gap between Vet School and private practice. This enables them to become valuable team members in a shorter time and start their careers with confidence, rather than disillussionment.
Practice owners who have never employed new vets, are often not well prepared to help them bridge the gap. Going on leave the moment your new grad arrives is certainly not on, no matter how long you have been a solo practitioner!
The following issues have been raised by vets employing new veterinary graduates worldwide:
Poor client communication: New vets try too hard to explain to clients what is wrong with their animal, taking too much time, including too much technical detail and using big words. They also spend more time talking to the animal than to the client.
Money: New Graduates often are reluctant or embarrassed about asking for money. This often manifests as apoligizing for having to charge the set fee.
Variation in clinical skills and confidence: Some new graduates are brave and excited by new challenges and learning opportunities. Others are intimidated and insecure.
Time: New graduates tend to be slow, taking too much time to perform consultations and procedures, and are slow at surgery.
Many Vet School clinics are not driven by the same need to be financially viable as are private clinics, so often do not prepare graduates adequately for the time and money pressure of private practice. New graduates who have worked in clinics as technicians or vet's assistants, have a better idea.
In a time of oversupply of vets,graduates often feel that they have to take the first job they can find. However, it is important to find the right employer for your first job. Solo practitioners who have worked hard in their own practice for many years, are probably not the best choice. They will often have high expectations and little time to train a new grad. They are probably also desperate to go on leave.
It is however imperative to familiarise the new vet with the practice and its protocols first and make sure they have the skills and the confidence tocope without being overwhelmed.
I am doing a locum in a rural Australian town at the moment. It is a great practice with nice boss, staff and clients. However, three days into the locum, on my 2 nd night on call, I actually got called out for the first time.
The clients and I arrived at the door simultaneously. The dog was still standing, but was showing definite signs of shock with an ice cold muzzle and very pale mucous membranes. I had been told that the heavy security gate needed to be lifted to unlock the deadbolt, but had no idea just how hard that would be. Too much or too little and it just would not open. It took me 10 to 15 embarrassing minutes just to get in!
Clinical examination gave no clues as to the cause, but the main order of business was to get a drip up. The nurses had told me earlier that they would leave a drip setup ready to go. If I have to place an IV catheter without a trained assistant to hold the vein up, I use a wide elastic band clamped with an artery clamp to raise the vein. After a search with owners watching, I could find a forceps, but no elastic. I managed to raise a vein and place a catheter. I moved the 44 kg dog to the cage next to the drip setup with the owners'help - only to find that the drip was a fancy complicated double system that had to be used with an IV pump and I had no idea how it all worked. After quite a struggle, I finally got the drip going. The owners left just as the system started beeping. More trouble shooting followed. Just as the drip was flowing again, a second emergency arrived. This time I needed to sedate a little dog with acute earache (suspected to be due to a grass seed) to try to determine the cause. It turned out to be acute middle ear infection. However, before sedating the dog, I wanted to find the Hartman;s crocodile forceps used to remove small objects from tiny ear canals. Again a major search was required!!
While waiting for the sedaton to take effect, I started to do an estimate. The wife went to an ATM to draw cash to pay as per practice policy after hours. When the procedure was completed, I could simply not get back into the dog's record, try as I might. I needed to complete the invoice and would be unable to receipt the money. Meanwhile the IV pump was beeping again in the treatment room. My stress levels through the roof and my level of embarrasment pretty high, I asked the owner to return to pay once the offic was open again after the public holiday.
Back at the IV pump, I realized the catheter had slipped and fluid had run in subcutaneously. Now alone, I had to replace the drip while sitting on my knees, pushing the dog who was trying to get out of the cage, back with my shoulder, while holding the vein up with one hand and guiding the catheter with the other. Then I had to tape the catheter on securely. That done, the pump settled into a rhythm. As I still wanted to monitor the dog, whose condition meanwhile was quite stable, I sat down in front of the computer, only to find that I now could not get back into the computer program at all!
The whole episode made me realise again how very hard it can be to be the new vet. If, on top of all these frustrations, resulting from a lack of familiarity with a practice, one is a new grad and unsure of one's abilities, the stress must be unbearable. Unfortunately many colleagues are so desperate for some relief, that they will happily throw a new graduate into the deep end without a thorough introduction and familiarisation with the practice and it's systems. A new vet should never be expected to be on call alone!
Practices employing new graduates need to be aware that most of them need mentoring to help close the gap between Vet School and private practice. This enables them to become valuable team members in a shorter time and start their careers with confidence, rather than disillussionment.
Practice owners who have never employed new vets, are often not well prepared to help them bridge the gap. Going on leave the moment your new grad arrives is certainly not on, no matter how long you have been a solo practitioner!
The following issues have been raised by vets employing new veterinary graduates worldwide:
Poor client communication: New vets try too hard to explain to clients what is wrong with their animal, taking too much time, including too much technical detail and using big words. They also spend more time talking to the animal than to the client.
Money: New Graduates often are reluctant or embarrassed about asking for money. This often manifests as apoligizing for having to charge the set fee.
Variation in clinical skills and confidence: Some new graduates are brave and excited by new challenges and learning opportunities. Others are intimidated and insecure.
Time: New graduates tend to be slow, taking too much time to perform consultations and procedures, and are slow at surgery.
Many Vet School clinics are not driven by the same need to be financially viable as are private clinics, so often do not prepare graduates adequately for the time and money pressure of private practice. New graduates who have worked in clinics as technicians or vet's assistants, have a better idea.
In a time of oversupply of vets,graduates often feel that they have to take the first job they can find. However, it is important to find the right employer for your first job. Solo practitioners who have worked hard in their own practice for many years, are probably not the best choice. They will often have high expectations and little time to train a new grad. They are probably also desperate to go on leave.
It is however imperative to familiarise the new vet with the practice and its protocols first and make sure they have the skills and the confidence tocope without being overwhelmed.
I am doing a locum in a rural Australian town at the moment. It is a great practice with nice boss, staff and clients. However, three days into the locum, on my 2 nd night on call, I actually got called out for the first time.
The clients and I arrived at the door simultaneously. The dog was still standing, but was showing definite signs of shock with an ice cold muzzle and very pale mucous membranes. I had been told that the heavy security gate needed to be lifted to unlock the deadbolt, but had no idea just how hard that would be. Too much or too little and it just would not open. It took me 10 to 15 embarrassing minutes just to get in!
Clinical examination gave no clues as to the cause, but the main order of business was to get a drip up. The nurses had told me earlier that they would leave a drip setup ready to go. If I have to place an IV catheter without a trained assistant to hold the vein up, I use a wide elastic band clamped with an artery clamp to raise the vein. After a search with owners watching, I could find a forceps, but no elastic. I managed to raise a vein and place a catheter. I moved the 44 kg dog to the cage next to the drip setup with the owners'help - only to find that the drip was a fancy complicated double system that had to be used with an IV pump and I had no idea how it all worked. After quite a struggle, I finally got the drip going. The owners left just as the system started beeping. More trouble shooting followed. Just as the drip was flowing again, a second emergency arrived. This time I needed to sedate a little dog with acute earache (suspected to be due to a grass seed) to try to determine the cause. It turned out to be acute middle ear infection. However, before sedating the dog, I wanted to find the Hartman;s crocodile forceps used to remove small objects from tiny ear canals. Again a major search was required!!
While waiting for the sedaton to take effect, I started to do an estimate. The wife went to an ATM to draw cash to pay as per practice policy after hours. When the procedure was completed, I could simply not get back into the dog's record, try as I might. I needed to complete the invoice and would be unable to receipt the money. Meanwhile the IV pump was beeping again in the treatment room. My stress levels through the roof and my level of embarrasment pretty high, I asked the owner to return to pay once the offic was open again after the public holiday.
Back at the IV pump, I realized the catheter had slipped and fluid had run in subcutaneously. Now alone, I had to replace the drip while sitting on my knees, pushing the dog who was trying to get out of the cage, back with my shoulder, while holding the vein up with one hand and guiding the catheter with the other. Then I had to tape the catheter on securely. That done, the pump settled into a rhythm. As I still wanted to monitor the dog, whose condition meanwhile was quite stable, I sat down in front of the computer, only to find that I now could not get back into the computer program at all!
The whole episode made me realise again how very hard it can be to be the new vet. If, on top of all these frustrations, resulting from a lack of familiarity with a practice, one is a new grad and unsure of one's abilities, the stress must be unbearable. Unfortunately many colleagues are so desperate for some relief, that they will happily throw a new graduate into the deep end without a thorough introduction and familiarisation with the practice and it's systems. A new vet should never be expected to be on call alone!
Sunday, October 26, 2014
Nieu-Bethesda
Just back from spending a week in beautiful Nieu-Bethesda in the Karoo where I attended an art workshop with Cathy Milner.
Compassberg, is a mountain peak of the Sneeuberge range in South Africa. It is located 55 km due north of Graaff-Reinet in the Eastern Cape Province. At 2504 metres, it is the highest peak in South Africa outside the Stormberg-Drakensberg massif.
Tuesday, October 14, 2014
Friday, October 10, 2014
Friday, September 19, 2014
Prostatitis in dogs
Male dogs may suffer from an inflammatory condition of the prostate gland. The proximity of the gland to the microflora of the distal urethra plays a role in this. Under normal circumstances, bacteria are prevented from reaching the prostate by these mechanisms:
1. Urine flow during urination
2, Pressure in the urethra
3. Urethral mucosal characteristics
4, Secretion of prostatic fluid and its antibacterial properties
5. The prostate may produce IgA in response to bacterial infection.
Infection is most commonly due to bacteria and may be caused by the same organisms as those which cause urinary tract infection. Anaerobes may be involved in abscess formation. Fungal infections are rare. E. coli is the most common bacterial pathogen involved. Benign prostatic hyperplasia occurs more often than infection of the prostate. Infection is usually a problem in intact male dogs.
Infections may be acute or chronic, with chronic infections the more common. 14% of intact male adult dogs have prostatic cysts as seen in hyperplasia. Up to 42% of cysts are infected with the same organism as seen in urine.
Pathogenesis is suspected to be as follows: Secondary migration of bacteria takes place up the urethra. It may also spread via blood, semen, urine and rectal flora. The bladder, prostate and urethra are close together and are often infected simultaneously. Prostatic fluid may reflux into the bladder and urine can enter prostatic ducts during micturition. Conditions which may cause an increase of bacterial numbers in the prostatic urethra, predispose to infection. This may include urolithiasis, neoplasia, trauma, stricture or lower urinary tract infection.
Acute bacterial prostatitis and abscess formation may cause septicaemia and severe clinical disease. Causative bacteria are not always isolated. Chronic prostatitis may develop insidiously, or may result from acute infection. Bacteria are not always isolated, A chemical inflammatory response resulting from urine reflux into the prostatic gland may be the reason for negative cultures in the presence of inflammatory prostatitis. Chronic infection and cyst infection may cause abscess formation. Rupture of abscesses cause peritonitis.
Diagnostic tests required are urinalysis and C&S. In cats or neutered male dogs treatment should continue for 10 days. Intact male dogs should be treated for 21 days. If infection persists, investigate kidney, bladder, prostate or other underlying prediposing conditions, as well as antimicrobial resistance.
The only antimicrobials used for genital tract infections which have good penetration to the prostate is enrofloxacin, marbofloxacin and tetracycline. E,coli has shown resistance to tetracycline.
Other antibiotics which may be considered for prostatitis are trimethoprim, fluoroquinolone,erythromycin and clindamycin.
Reference:
Blondeau JM. Steps to Antimicrobial Therapy, North America Compendiums Inc,2009, 109-113
1. Urine flow during urination
2, Pressure in the urethra
3. Urethral mucosal characteristics
4, Secretion of prostatic fluid and its antibacterial properties
5. The prostate may produce IgA in response to bacterial infection.
Infection is most commonly due to bacteria and may be caused by the same organisms as those which cause urinary tract infection. Anaerobes may be involved in abscess formation. Fungal infections are rare. E. coli is the most common bacterial pathogen involved. Benign prostatic hyperplasia occurs more often than infection of the prostate. Infection is usually a problem in intact male dogs.
Infections may be acute or chronic, with chronic infections the more common. 14% of intact male adult dogs have prostatic cysts as seen in hyperplasia. Up to 42% of cysts are infected with the same organism as seen in urine.
Pathogenesis is suspected to be as follows: Secondary migration of bacteria takes place up the urethra. It may also spread via blood, semen, urine and rectal flora. The bladder, prostate and urethra are close together and are often infected simultaneously. Prostatic fluid may reflux into the bladder and urine can enter prostatic ducts during micturition. Conditions which may cause an increase of bacterial numbers in the prostatic urethra, predispose to infection. This may include urolithiasis, neoplasia, trauma, stricture or lower urinary tract infection.
Acute bacterial prostatitis and abscess formation may cause septicaemia and severe clinical disease. Causative bacteria are not always isolated. Chronic prostatitis may develop insidiously, or may result from acute infection. Bacteria are not always isolated, A chemical inflammatory response resulting from urine reflux into the prostatic gland may be the reason for negative cultures in the presence of inflammatory prostatitis. Chronic infection and cyst infection may cause abscess formation. Rupture of abscesses cause peritonitis.
Diagnostic tests required are urinalysis and C&S. In cats or neutered male dogs treatment should continue for 10 days. Intact male dogs should be treated for 21 days. If infection persists, investigate kidney, bladder, prostate or other underlying prediposing conditions, as well as antimicrobial resistance.
The only antimicrobials used for genital tract infections which have good penetration to the prostate is enrofloxacin, marbofloxacin and tetracycline. E,coli has shown resistance to tetracycline.
Other antibiotics which may be considered for prostatitis are trimethoprim, fluoroquinolone,erythromycin and clindamycin.
Reference:
Blondeau JM. Steps to Antimicrobial Therapy, North America Compendiums Inc,2009, 109-113
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