End of life…

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As I walked out of clinic at 1am on Monday morning a family were arriving to say goodbye to their pet having been summoned by phone just 15 minutes before when he started to deteriorate so rapidly that it was obvious he only had minutes to live. They made it in time to say bye thanks to the Vets Now ECC nurse recognising what was happening early and allowing them to be summoned.

Through the weekend we’d helped countless animals who left the clinic to go home with their parents, yet there was a high proportion that was never going be leaving, whether or not their pet parents realised it when they arrived. Unfortunately our pets can never tell us how sick they are, how much pain they are in, and that they want to go on over the rainbow bridge.

This is worse as often it is not just that they are seriously ill (and sometimes even dying painfully), but is also so sudden that their parents may not have had time to come to terms with this and accept it. It is not human nature to give up and sometimes when it comes to the decision to end life it can feel this way even though it is really not.

The weekend was a mix of those that came to ask us to help them send their loved pets on over Rainbow Bridge – the request of one parent that nearly made me cry was that someone would cuddle them as they moved on. Then there were those that hadn’t realised how bad the condition was and how much pain their pet was in that let them go on pain free when realising. There were also those that just refused to give up even though it could be considered to be  the kindest thing for their pets.

Vets are legally entitled to euthanise an animal on welfare grounds if they believe the welfare is compromised and the animal is suffering. However , we realise the importance of the bond parents make with their pet and that doing so will not be easy on the parents – in fact it would be very traumatic for the parents which is something we never want.

Instead we rely on our ability to communicate with pet parents. Sometimes it is very obvious to us how bad an animal is because of our experience and training whilst it may not be to their parents. We release that the animal is never going to be able to leave alive, and whilst we may attempt to make the animal comfortable with very strong pain medications, it is the owner that we need to treat.

Euthanasia is one of the most powerful tools that a vet has – read about how it really works here.

It’s not all about money… how Vets Now try to save you money!

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The emergency vet is always going be more expensive than your normal day vet. It costs money just to open the door and have the team there ready whilst it is not possible for them to guarantee that they will have patients.

Because of this fee just to be seen by a vet there is a big effort to make sure that only pet parents that really need to be seen arrive at the clinic. This starts with the national contact centre where a call handler, supported by a qualified veterinary nurse  will talk to you about your pet on the phone and tell you whether you can wait for your day vet or you need to be seen by an emergency vet.

If, on arriving at the clinic, the client’s pet has improved dramatically, then or course they can change their mind with no charge. If a vet is not available to see an owner and sick or injured pet within a short time of arriving, then as soon as possible a registered veterinary nurse will triage the animal and get any immediate first aid needs started. Veterinary nurses are unable to diagnose or prescribe medication so this may be in conjunction with the veterinary surgeon ‘behind the scenes’ but with the owner’s informed consent.

There are a limited number of consultations that registered veterinary nurses are legally allowed to undertake on their own. These include things such as replacing a slipped or damaged dressing and are charged at a lower fee.

Then something that really surprised me when I arrived was that a manual blood test was used (I’ll write more about this later) instead of using automated machines that were used by the day vet in the same building. This was weird at the start – however in discussion it costs less than half the price of the automatic machines, is faster, and most importantly takes much less blood to do. It took less than 0.2ml for nearly every patient over the weekend which for an emergency patient keeping as much blood as possible in the body is important. Plus it means that certain parts of the blood test (such as amount of Red Blood Cells) can be repeated as needed without being forced to test everything again.

Sometimes a pet may need to come into the hospital for monitoring or to be given IV fluids to help them with dehydration for example. When this happens instead of being charged for the entire night or weekend the hospitalisation is split into 7 hour slots so you only actually get charged for the time your pet is in the hospital.

Off course the treatment varies between patients, however the vet does consider the different options to keep the cost of treatment as low as possible whilst keeping your pet alive. Emergency medicine is about trying to rule out possible life-threatening conditions and it can be necessary to be proactive to achieve this. While this can cost money it could potentially be life-saving and cost less in the long run, both financially and emotionally. Anything Vets Now do will be discussed with you and as I have said options will be discussed wherever possible and at the earliest opportunity. Many of the emergency tests Vets Now use regularly need to be repeated to get the most value from them. Sometimes repeats are built into the hospitalisation and nursing fees so there are no additional charges but allow your pet to have a high standard of monitoring and care.

I personally would recommend getting insurance such as Pet Plan to help you cover the cost of emergencies. Responsible pet ownership is something that Vets Now are very keen to promote, as they understand just how quickly veterinary bills can rise . Costs can quickly rise in the initial part of any emergency, even if the outcome is not good. Being able to find out more information to help the vet get an idea of prognosis, while not having to worry about the fine detail of the financial situation can be a great benefit of pet insurance. Lots of policies exist however and it is important to find one that meets your needs so always read the small print.

The emergency patient…

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Arriving to Vets Now with a quick tour of the practice and introduction to the team I changed and it was time to see my first consult with head vet Rebecca. It was not the bleeding dying dog or cat that I expected but a rabbit with early gastrointestinal stasis that had stopped eating – giving medication against pain and to encourage gut movement we hope that we had caught it early and that the rabbit would be fine.

One of the attractions of emergency and critical care is that you never really know what is going to come through the door. Most patients will go through telephone triage so we may get a little notice to prepare if necessary; however there is always the chance that someone will run a dying pet straight in. If you have time to telephone (or can get someone else to telephone) before you come then it is better because it allows preparation of anything necessary before you arrive. This can be even more important if there are already critical patients as it may be necessary to triage the least critical to a secondary area so we have a table to work on or a connector for oxygen.

The uncertainty of what is next is also one of the challenges of  emergency medicine; you need to be very confident in your ability to deal with whatever comes in. And you have to be able to cope well under pressure  – especially when multiple emergency patients arrive at the same time.

Whilst able to send some patients home, there were unfortunately a few where euthanasia was the best option – either because they were not treatable or because they lacked any quality of life. I’ve written an entire post on euthanasia that will follow in the next couple of days.

The day quickly became one of maggots with what felt like an endless supply of the wriggly white flesh eaters being found on a cat, pigeon and a rabbit. It is amazing how quickly with the summer heat that flies will take advantage of any moist fur to lay their eggs. The eggs tend to hatch rather quickly so within 24 hours there can be a serious problem if not treated so these were emergencies. Fortunately shaving half the cat managed to remove all the maggots and only the top layer of skin was damaged, however the pigeon and rabbit had much more extensive wounds and had to be euthanised on welfare grounds.

For my first day however it was a rather relaxed introduction to emergency practice – I had time to learn how things worked – and to pick the brains of the vets and vet nurses I was working with to get a better understanding of how it worked with Vets Now. It also gave me some time to practice some of the clinical skills such as manual PCV (blood cell counts) that I’d not done for several years.

The Emergency Vet…

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Accidents can and will happen, most often when you are not expecting them, and medicine is not cheap. This is especially so when it happens when your normal vet is not open, as then you are often sent to a specialist emergency vet, which is almost like an A&E department for pets. The vets here are trained to save your pets life; in addition to specialist training they have access to the important equipment and drugs necessary to do this.

Over the next 4 days I have been invited to join Vets Now one of the UK’s leading providers of Emergency Centres for Pets that have been in accidents or are seriously ill. I’m excited to learn a lot of things to help with emergencies, yet I am apprehensive about how intense it will be and how little I know.

I’ve been invited into two different centres in two different cities so I can see a range of different patients and learn from several different vets.

The first centre I am at just for the weekend, expecting to be there from 12 lunchtime until 7pm Saturday evening. Then again all day on Sunday from 8:30am until evening again with night staff taking over to continue to provide the care needed.

The second centre I am on overnights on Monday and Tuesday from around 6pm until the next morning as the normal overnight shift is 15 hours long. This centre also takes patients from the PDSA charity so is expected to be a lot busier.

During this time I’ve been allowed to tweet – so keep an eye on my twitter feed @vetschooldiary for live updates from behind the scenes as it happens.

And off course I will be blogging my experience as well (potentially once I’ve managed to catch up on sleep!).

Over the rainbow bridge…

Euthanasia - Crossing the rainbow bridge

As the vet reaches for the cats leg to give the final injection the cat lies alone on the table. She has had trauma and is not in good way, and her parents cannot stand to see her in this way. I reach out to do nothing more than stroke her as she starts her onward journey over the rainbow bridge.

As the injection goes in I see her laboured breathing stop, she looks calm and relaxed as I stroke her and wish her a safe onward journey. The injection is in and the vet removes the needle before reaching out and stroking her as well briefly before they listen for a heartbeat. I’m sure she’s gone but it is important to check, sometimes it can be difficult to tell with all the noises that occur after death so sometimes can feel like you are listening a long time.

I’m sad this cat I knew only for a short while at what is probably the worst point in her life couldn’t be saved, yet I take comfort in the fact she now gets to run free. We gently remove her IV cannula to go to the clinical waste, clean her, and then wrap her in her blanket to go home with her parents for burial.

She is not the first, and will not be the last; however she did not go alone. Even for those few minutes she took a piece of my heart with her, and she went on her final journey across the rainbow bridge loved and cared for. This is something her parents never saw and something maybe one day they will wonder about, however they should not worry. They have the memories of her running around the house not struggling to breathe unable to lift her head.

I will never judge a parent that cannot be there at the end, it’s one of those choices that is so difficult to make. There is rarely a right answer, and sometimes there is not even any time to even think about it properly. Yet these parents may say their goodbyes when it is time to bury her, I will never know. It is a choice that can only be made by you. Sometimes after trauma we will explain to parents what to expect to see as sometimes injuries look much worse after being shaved and cleaned so that the parent can make a choice.

Personally I believe saying goodbye is important, some vet practices even have rooms just for this so we can give as much time as parents need. Sometimes in a busy practice we do not have enough of these rooms so we make do with what we have. We will explain what will happen to you, and tell you what we are doing. We’ll never try to rush you, we’ll try to keep noise outside to the minimum, and we will all feel your pain.

EDIT
If you have lost a pet and are struggling with the loss then please do call the Blue Cross Pet Bereavement Helpline – 0800 096 6606 (UK Only) – or visit their website for more information at  https://www.bluecross.org.uk/pet-loss. It is a traumatic experience, and there are people that have experienced it themselves who want to listen to you.

The Best Marketing Tips for Veterinary Practices

Just like any business, a veterinary practice lives and dies by the customers it has. If you are not attracting enough clients to your practice, it could be because you aren’t marketing your clinic the right way. With that in mind, read on to discover the best ways to advertise your veterinary practice.

  • Focus on SEO – Search engine optimization is a must for all businesses today, veterinary practices included. Veterinary SEO involves using an array of different techniques to move your website up the search engine rankings. This is imperative in today’s digital age, giving your website plenty of exposure, and ensuring your business is at the top of the results whenever someone looks for a vet clinic in your area. After all, whenever people need to find a business today, they usually turn to the Internet!
  • Profile your team – When setting up your veterinary clinic, you may not have a big team of staff, but this does not matter, you should still create a profile for each member – it does not matter whether you are a team of two or ten. This is because people like to know who is going to be looking after their animals. By highlighting the accomplishments and talents of your individual staff members, people will feel more comfortable about leaving their pets in your hands.
  • Offer a reward for customer referrals – Word of mouth is still one of the most powerful marketing tools today. You can give your customers a push to recommend your clinic by offering a reward if they do so. For example, for every new client that signs up through an existing customer, you could give the existing customer a 10% discount off his or her next vet bill.
  • Start a blog – Having a website is one thing, but you can take it to the next level by adding a blog. This is the way to show your veterinary expertise, setting yourself apart in the industry. You can share posts about veterinary news, customer stories, pet care tips, and anything else related to pet care and health. Create original, interesting, and engaging posts, which people will want to read. Not only does this show you as an expert in the industry, but it will benefit your SEO strategy too.
  • Get customer testimonials – Ask your satisfied clients if they will provide you with a testimonial. You will find that most will be more than happy to do so. You can use these testimonials in a number of different ways – from including them in magazine ads and brochures to social media and websites.
  • Be active on social media – This leads onto the last point perfectly; make sure you are active on social media. This gives people the opportunity to get closer to your practice than ever before, which harvests loyal customer relationships. Don’t simply post a string of promotional messages – engage with your customers and post interesting messages about the industry in general. You could also run a competition for increased exposure, with winners getting a pet basket, a bag of pet treats, or something else for their pet.

Looking After Your Dog Post-Surgery

Every dog is different, so there’s not really any standard procedure when it comes to helping your friend through the post-operation process. But here’s some general advice that you should definitely take on board for when your dog is ready to come back home after a gruelling procedure!

Follow the instructions!

First and most important of all: your vet will give you instructions (usually written) that will give you specific advice on dealing with the recovery of your dog. You need to ensure that these instructions are followed to the letter, no matter what other options you try!

Look into further healing options

There tend to be a lot of options when it comes to speeding up the process of healing. This may come in the form of creams and other medications that help the wound heal quicker, or things that help your dog get to sleep and thus limit dangerous activity, or even canine laser therapy. Whatever option you consider, you should definitely consult with the vet first; you don’t want to do anything that may end up disrupting the process further!

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Limit activity

Too much activity can result in pain, wounds reopening, or other problems that will prolong the recovery process. So you need to consider the activity your dog usually takes part in. Jumping up on sofas and chairs needs to be limited. Keeping them away from other dogs as well as small children may be ideal for the first couple of weeks, as they tend to get very excited by both. Walks should be a lot slower as well as shorter; you may want to consider going on two brief walks per day instead of a long one. Consider having your dog spend some time in a small and confined space while they relax.

Check the sutures frequently

Dogs aren’t exactly known to report to your immediately if something goes wrong with their sutures! Proper surgical wound care is essential if you want to make sure the recovery is as fast and comfortable as possible. Antibiotic or antiseptic creams may come in very handy, but simple salt water washes may do the trick. (The vet will probably have given you some advice here!) You need to ensure that your dog doesn’t lick or scratch at their wound; if this means getting one of those funny cones on their head, then so be it!

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Maximize comfort

When it comes to post-op comfort, there are at least three things you need to consider. One is temperature. In the first few days following surgery, dogs will have a hard time sensing temperatures. This doesn’t mean that they’re not getting cold or hot, however. You need to keep an eye on your pup and get a feel for their temperature so you know when to adjust the temperature accordingly. The second is the bedding your dog uses. A lot of people use quite cheap bedding for their dog because they know that dogs can basically sleep on anything, but now might be the time to invest in something a little more luxurious. Last but not least is your presence! Don’t stray too far from your friend; this will help them stay calm and happy.

The prevention education of vet school that no one tells you about

Jenni Falconer and her dog Alfie

Something that many people do not realise is that vet school is not all about treating diseases or cool surgeries to put animals back together again. A lot of it is about learning how to stop animals getting sick in the first place. This training involves both infectious diseases as well as parasitic diseases – in fact vets are often better trained in this area than human doctors.

It is often said than an ounce of prevention is better than cure, and in the case where it is so simple to do there is little reason not to. However, a survey of 1056 dog owners carried out in February 2017 shows that whilst some people know what dog parasites exist, they do not know the risks.

Over a third of these dog owners said they never think about the parasites their dog may be hosting even though they sleep in the same bed, sit on the sofa together or even lick their face. In fact one in four people didn’t realise that their pet could have parasites without them even being visible.

One of the reasons that so much effort goes into prevention is that sometimes parasites and diseases can affect both animals and humans as a zoonosis. So helping to protect a pet against these parasites in turn also helps protects you and your family especially for those with children. So let’s take a quick look at some of the types of parasites out there, what people think, and what really is true…

Most dog owners are worried about lungworm with 82% of people knowing that it could be fatal to their pet. However 43% also believed it was a big risk for humans, this is not true as it is actually harmless to humans.

Ticks were second on the list with 36% saying they were worried about them, however less than half realised that ticks could cause death because of the diseases they can transmit. Just 28% realised that ticks could also be harmful to humans as they can transmit Lyme disease.

The most dangerous parasite came bottom of the list with just 15% worrying about roundworms and only 7% believing they could be harmful to human health. Roundworms of the Toxocara variety can cause big problems in humans if their eggs are swallowed such as blindness or neurological disease with children at most risk.

Prevention for these parasites has become easier with palatable oral chews available as well as spot-on medications so you can still interact as your dog as normal after the treatment. With so much at risk it was a surprise that the Pet Parasite Action survey found 1 in 6 hadn’t treated their dogs for parasites in the past year.

Your vet is trained to support you in helping to keep your pet healthy, and there are many options of different treatments. Their expert guidance and support can really prove priceless.

Take the free test to protect your pet at

Pet Parasite Action Protect your pet

The price of graduation…

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Today I became Dr Chris, Doctor of Veterinary Medicine. Yet the only difference between yesterday and tomorrow is a piece of paper…

I am not sure what the price is for this piece of paper. It’s cost me a lot yet the euros that were spent feel so insignificant today. I moved to a new country to get it. I paid with 5 years of my life. Weeks where I was so tired that I didn’t even know what day it was. Nights where instead of my bed I was in cold stables, or stood at an operating table. Days where I didn’t have time to eat. Christmases spent in surgery. Nights spent reading books. Hours on planes to conferences and practice.

Patients that have made me so happy, patients that have made me bleed, and patients that have made me cry. Patients that have died. Patients that have survived. And the patients that have surprised.

The days where I doubted myself. Where I wondered if I deserved to be here with other such smart people. Where I wondered if I was even good enough to be here at all. Days where I felt overloaded with impossible amounts of information. Days where I just wanted to give up and sleep.

The state exam days where I felt I knew nothing and had to force myself to go and be judged. Not by what I could do… but by what I could remember… usually with no sleep… my brain below average performance… Knowing I could be asked anything…

The mental and physical scars that the journey to get this piece of paper has inflicted are still fresh… yet today I walk away having survived, having overcome, and having become a doctor.

This piece of paper is priceless. It gives me permission to keep on learning…

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What this pet guardian wants vets everywhere to know…

What every vet needs to know

Recently there has been an “Every Time” post going around social media to try and raise awareness of the risk of suicide in vets and how owners contribute. Tonight though I found a pet guardian that had written a response that I just had to share for every vet everywhere so please share and help make sure your vet gets to see this.

Rachel Allen wrote…

This makes me quite sad. I love my vet. Our family have been with him for over 20 years and he has saved many of our pets lives.

Here is my response for my vet, and to vets everywhere.

For every self-centred, ignorant and demanding client there are many more of us who;

See you handle our beloved pets with the same love, tenderness and respect that we show them.

We notice you are never quick to push us out the door and that you have time to listen to our, possibly often, trivial concerns.

We notice, and are thankful, for how you take the time to explain our pets situation in terms we are understand without frightening us to much.

We notice you don’t drive a Mercedes or Lamborghini. We know that practice expenses are high. We imagine liability insurance to be a depressing figure. We know that your university fees are extraordinary and that you are working to pay them back.

We value your time when we call to ask for some quick advice, we try to limit such intrusions so you’re not inconvenienced. We really appreciate every second of your time.

We know that the cost of our vet bills are high, we know the prescriptions are high but, we also know that’s not your fault. Some of us are literally handing over our pay checks to pay for our beloved pets needs but we do so because we love our pets. We harbour no ill feelings towards you as they are our pets and their expenses are our responsibility. It is not your responsibility to pay for them.

We never forget that you have saved our pets lives. Sometimes many times. Sometimes we aren’t even aware of what you go through to save our pets but we love you for the fact that they are able to live another day.

We know that when the time comes you will be there to make sure our beloved pet does not suffer any more pain, that you will help them over that rainbow bridge. We know you will do your best to console us when this happens and we will wonder how much of our pain you will share in that day. We will hope that you know that we are forever grateful.

For every client that brings you grief, please know there are far more of us whose lives you have changed for the better. Every time you fix our beloved pets, every day extra that we get to spend with our pets, because of you, are days that we treasure.

You allow us more joy than you may ever know. For that, for everything you do, we thank-you. ❤