Week 50 and counting….down!

Congress is only just around the corner.  I’ve been scrolling through the programme penciling in all of the sessions that I’d like to attend.  Although having said that I think that David Mountford will already have put paid to any plans that I might have with the meeting schedule that he will have already created.  However, there’s always the Encore Room to catch up with lectures afterwards.

Dave Rendle (Congress Chair) along with the Congress Guardians has chosen such a varied array of topics and speakers that it’s hard to choose.  It’s great to see all of the familiar faces but also refreshing to see individuals presenting at BEVA Congress for the first time – not to mention their apprehension, which strikes a chord.  It reminds me of the first time that I presented at Congress back in 1998.  I was presenting during the final session on the Saturday afternoon in Birmingham and had been working back at the practice throughout that Congress and was on duty up until lunchtime on the Saturday.  I remember getting a slightly panicky telephone call from Stuart Thorne, a then student steward who’d seen practice with me that summer, at about 1pm enquiring of my whereabouts because the “Speaker Preparation Room” boys were getting a little twitchy.  I was still in the bakery in Tewkesbury - I suppose that I have always been a bit lastminute.com.

The main reason for my reference to this is the fact that the session Chair back in 1998 was John Hird, who is also chairing a session at this year’s Congress.  For those of you who don’t know him, John qualified in 1970 and became the first holder of a Diploma in Veterinary Anaesthesia four years later.  He then practiced in Halifax (Hird & Partners) up until the mid 90’s when he retired from the partnership and joined the VDS.  During his tenure at VDS he was author of their notoriously entertaining Newsletter.  Following his recent retirement from VDS he is now back at the practice as a consultant providing his anaesthesia expertise.  He also acts as a consultant for Abbott Animal Health. In fact it was via this connection that I met up with John last week.

We’ve had a fairly torrid time in our anaesthesia department recently having experienced more complications than we’d like to have and definitely more than we’re used to.  This trend has focused our minds and has lead to a review of our protocols. I know that Hird and partners have been using sevoflurane since the early 2000’s when it was first introduced there by Ian McCormick when he was there. I’ve used it on a handful of occasions and have been impressed with it and thought that we should trial using more of it.  However, none of the other anaesthetists at TCEH have used it so I thought I’d arrange some in-house training – enter John Hird courtesy of Abbot Animal Health.  My experience is that the recoveries aren’t any quicker but are generally smoother…. but there’s always the one that bucks the trend!  Another feature of sevoflurane is that it is eye-wateringly expensive, which will need to be justified to my partners.  However, when considering the cost / benefit ratio – what price can you put on an unexpected fatality?

We had a full day at TCEH with John and four very enthusiastic anaesthetists.  It was uplifting having everybody huddled around the head end chatting away, whilst a surgical procedure was being undertaken somewhere else on the patient, almost as an after-thought!  John’s enthusiasm was infectious and it was really inspiring to see him back in a clinical setting full of energy and passion about his subject.  At the end of the day I probably had more questions than answers but it’s comforting and re-assuring to hear of other people’s experiences good and bad, some similar and some dissimilar.  It makes you realise that it really isn’t an exact science.  There are no safe anaesthetics just safe anaesthetists.

John modeling some laser-safety glasses with his entourage

Another striking feature of our anaesthetic regimen is that, along with most other practices / hospitals / clinics, we task the responsibility of anaesthesia (one of the most important jobs in the theatre – but clearly not as important as the surgeon, lest I forget) to probably the most junior member of the veterinary team.  We train them up and then after 18 months to 2 years they move on and the process starts over again.  Also, as with driving, anaesthesia needs flare and empathy, almost a sixth sense; you can teach somebody to drive but it doesn’t necessarily make them a good driver – I should know!  Is that right for the patient?  Is it fair to burden a recent graduate with that level of responsibility?

I’m eagerly anticipating what light Eddie Clutton can shed on this subject in his Plenary lecture at Congress next week – “Anaesthesia in Horses: illness, pain, broken legs and death”.  I suspect that he will probably also ask more questions than he provides answers.  The anaesthesia sessions on Saturday morning will be another chance to hear about any lessons that we’ve learnt over the years.  There is also a chance for those of you who are relatively new (and old) recruits to attend the later morning session, “Anaesthesia for Dummies” chaired by John Hird – you are all most welcome into the fold; surgeons need not apply – maybe that was the reference to Dummies.

Back to Civvy Street…almost.

There have been no BEVA days away from TCEH this week, which has been different, enlightening, refreshing and not to mention…hard work!

I was on call on Tuesday night this week.   I’d swapped it with David (Blakey) so that I could be off on Thursday night.  As always seems to happen whenever you initiate swap, it was a bugger of a night on call.  A medical colic early evening followed by 2.30am, “…old horse down in stable, can’t get up…”  Who looks at their horses at 2.30am?  On arrival at the yard the yard owner, a 60ish year old farmer who’s diversified into a livery yard had arrived back at 1am with a load of straw and had found the horse down in the stable.  After 90 minutes the horse was still down and yours truly was summoned.  As soon as I arrived I recognised the unfortunate patient as one who’d made an appearance at the BEVA Geriatric Medicine Course, which we’d hosted at the Hospital in 2013 and 2014 because of his severe bilateral carpal DJD.

In his attempts to stand he’d now managed to scramble onto the concrete corridor outside the stable and was in lateral recumbency.  It was obvious that we needed to get him from the unsure footing of fresh straw (which had been provided by the farmer before I arrived) on concrete (a place of danger) to the dry paddock adjacent to the barn (a place of safety).

“Shall I get the tractor?” said the farmer.

“Er, no!” I replied.

“Do you think he needs putting down?” he retorted.  I suppose that might resolve our problem, I thought - my bed was still calling.

“Ian, I know we might be feeling strong but I think we need some muscle.  I think we need to call the Fire & Rescue Service to help”.  My suggestion induced a predictable searing pain in the farmer’s wallet, “What will they charge?”  I’d worked with and knew the local FRS crew on several occasions in the past and had recently asked that very same question to which the answer had been, no.  I let the farmer call 999 in order that the appropriate station was mustered.  They arrived within 20 minutes and were absolutely “bloody brilliant”.

We all knew our jobs and worked quietly, quickly and efficiently.  Within 40 minutes and after plenty of sedation, cotton wool filled ears, the perfect roll over onto the rescue glide and a lot of grunt we dragged the gelding into the paddock and left him to his own devices to stand when he was ready; which he did some 3 hours later.

The point of this story is that without the help of the FRS I’d never have managed to achieve the rescue.  To me it was the fruit of almost 10 years of labour developing Large Animal Rescue coming to bear, which made it such a pleasure to be part of it.  What concerns me though is that if this incident had occurred in an area serviced by North Wales FRS, no such help would have been available.  From the 1^st April this year, North Wales FRS decided to discontinue Large Animal Rescue and Rope Rescue both of which are deemed to be non-statutory services - http://www.nwales-fireservice.org.uk/large-animal-rescue/frequently-asked-questions-large-animal-rescues-and-rope-rescues.aspx.  What would I have done? – the farmer’s tractor may have been deployed; euthanasia may have been the only “humane” option; more importantly one of us could have been seriously injured attempting the rescue.

The farmer’s request about charging is also very relevant.  At the most recent Chief Fire Officers Association (CFOA) Animal Rescue Practitioners Forum there was much discussion about North Wales FRS decision and although all of the other FRS present at the meeting declared that they had no intention of withdrawing the service, a handful of FRS’s were starting to charge for it.  Upon enquiry the approximate figure mentioned was £300 per appliance (which may include up to 8 people) per hour, which I think is extremely good value for money.  However, it is something to bear in mind if you do call for their help.  Furthermore, I’m not clear in my own mind whether deployment of this kind of assistance would be covered under a Vets Fees Insurance Policy.  Maybe that’s another job on the list!

I was back home by 6am but by then sleep was never going to happen again that night!

Incidentally the owner was not present throughout.  The farmer said she was difficult / impossible to contact at night – thank heavens for small mercies.  When I met her at the yard the following morning I did enquire with my unsurprising sardonic humour, whether she’d had a good night’s sleep. 

The unfortunate victim of the previous night’s drama was none the worse for wear other than some fairly large abrasions on his dependent side.  I did recommend to the owner to try and avoid stabling him at all again in the future in order to prevent a repeat of the crisis.  He is a native after all and is far less likely to come to any harm well rugged-up in a field than he is inside on a straw bed on concrete.

But finally a massive thank you to the Hereford and Worcester FRS Animal Rescue crew from Pershore, you were great - keep up the good work; even the farmer was full of praise for you the next day.

Week, “I don’t know what” and counting …down.

Just over 1-month to go to Congress in Liverpool.

** STOP PRESS – YOUR LAST CHANCE FOR EARLY BIRD REGISTRATION FOR CONGRESS **

Everything is falling into place, which isn’t by good fortune but is due to the hard work, commitment and coordination of the staff at BEVA HQ.

The Scientific Programme that Dave and Lesley have devised has maintained if not surpassed the exceptionally high standards of previous year’s Congress’, https://www.beva.org.uk/congress/Sci-Prog. 

New for this year is the Practical Dentistry Demonstration Area running throughout Congress in the Commercial Exhibition Area.

In addition, calling all physios, chiros, osteos, etc. etc. – on Saturday we are running a full day of 4 sessions on the Veterinary / Physiotherapy Interface and we would like as much engagement as possible with Equine Physical Therapists to enable us all to see things from the “other side”.  Although in the interests of horse welfare, which has to be our priority, we should always be working on the same side - this may be a good starting point for our discussions.

Luise & I are both off this week.  We’re heading up to The Lakes for a couple of nights and en route we’re calling in to the caterers we have engaged for the Annual Ball who are based near Manchester to do some food and wine tasting.  We haven’t had the conversation yet about who’s driving the second leg of the journey!  I think it’s a good idea to have Luise, Tom & Lucy there to balance the menu otherwise we’d be having something like Calamari to start followed by Steak and Chips.  Tom (Hollow Legs) Harrison is extremely excited about the prospect of a never-ending supply of food to sample.  If you have any comments to make about the menu on the night please feel free to discuss them with Luise?

To book your place at the Early Bird Rates please click here - http://www.beva.org.uk/congress/booking/form  

Post Number 24.... And Counting!!

Just on my way back from our Annual Strategy meeting held at the RVC, Hawkshead Campus.  We were in the Conference Rooms above the main restaurant.  The campus looked stunning, probably helped by bright sunshine, clear blue skies and over 20 degrees.  There were students relaxing on the lawned areas “studying”, just as we used to!  I did have a text conversation with Prof. Josh Slater who said, “The sun always shines on Potters Bar”!

In keeping with tradition, our incoming President, Mark Bowen chaired the meeting.  There were a few absentees due to other commitments and unforeseen problems, which is understandable but we were lucky to have Paul Jepson and Michael Sadlier who were both attending their last Council meeting.  Michael Crane from the Donkey Sanctuary who couldn’t be there is also approaching the end of his term on Council, which means there’ll be places for some “new blood” to join in September.

Joining BEVA Council

https://www.beva.org.uk/aboutus/MeetTeam/Council/JoiningCouncil

Nominations to join Council in September are now open.  Last year the number of nominations exceeded the number of places and therefore an election took place for the first time in several years.  A common accusation we (Council) hear is that BEVA Council is considered by some to be “an old boys club” (beer drinking, rugby playing, sexist etc.).  My shoulders are broad enough to weather that kind of stereotyping but I think that Vicki, Lucy, Gayle and Hannah (see photo of Council Members) were particularly affronted about being referred to in that way!  If you really think it’s like that, which I agree isn’t representative of the profession in 2015, then please step up to the plate and make a difference.  BEVA is a truly democratic organisation, which strives to provide what its members want…it’s your choice.

One of the main topics for discussion and review at the meeting was the results of the recent member survey.  Over 550 people completed the survey, which I understand is an excellent response rate.  Those who didn’t respond missed out on the chance to win free Congress registration.  The feedback we get is vitally important to improve the services to our members.  It is really re-assuring to know that over 90% of our members are either “satisfied” or “very satisfied” with the Association – we must be doing something right!  But could we always do better – “the enemy of good is better”?

One of the funniest responses we had was to the final question, “Is there anything you’d like to tell us about?”.  The answer was, “I think that I may have Superhuman powers but I haven’t been able to tell anybody until now….”.  Great to see that the profession still has a sense of humour…. I assume!

During the meeting I was also chastened about the lack of my Blog over the last few weeks and months…. I really have been up to my eyes in it recently both with BEVA and the practice.  This included a difficult foaling in the middle of last week, (legs back and a small colon prolapse / intussusception), which resulted in a (very strong) orphan foal L…with attitude.  What was also amazing was the response to our posting on Facebook for a foster mare; within 48 hours we’d had 120,000 hits.  We found a mare quite promptly and after lots of seriously hard work by the nursing team over 4 days they bonded and are due to go home soon.  I believe the foal has now got her own Twitter account!

Week 23... And Counting

This has been a week of vet school tours.

On Monday I visited Vienna Vet School, https://www.vetmeduni.ac.at/en/, as part of BEVA’s vet school tours.  This was our first time visiting Vienna as part of the Vet School Tours.  Our point of contact there is Edmund Hainisch, who many of you will know.  Edmund is a larger than life character, both physically and as a personality.  I know I’m not “man mountain” but I’m not small either and he totally dwarfed me (see below).  He (eventually) graduated from Vienna, which is close to his hometown, in January 1996 after a prolonged undergraduate career (his choice), which was interspersed with some long distance lorry driving to fund his studies!  He explained that as an undergraduate he had stumbled across a copy of Equine Veterinary Education in the university library.  He was immediately struck by the quality of the publication and it enthused him to find out more about EVE, EVJ & BEVA.  He arranged to visit the UK and to see practice at Fellowes Farm with Peter Green, stopping off in Newmarket on the way to watch the horses work on the gallops.  He was enthused by equine practice in the UK and was also struck by the close network and camaradery of UK horse vets through BEVA (Peter Green was a BEVA Council member at the time).  Following graduation, he successfully applied for an intership at Liphook (Jeremy Mantell was the BEVA President at the time), followed by a surgical residency at Liverpool, finally returning to Vienna in 2005.  During his time at Liverpool he was coerced into Sarcoids by DCK and is now doing some fantastic research work in the lab at the vet school investiagting immunotherapy for the prevention of sarcoids, with some really exciting results.

In the foyer of the hotel with Edmund – my kids thought we looked like father and growing son!

I left Vienna early on Tuesday morning to do a full round of calls followed by a colic referral that night…..

The following day I drove to the University of Surrey to visit the new Vet School http://www.surrey.ac.uk/vet.  Chris Proudman, the Head of the School, who still commutes weekly from Merseyside had invited me as BEVA President.  I’ve known Chris for years as he was a Resident at Liverpool with Luise back in the early 90’s; I’m sure there are a few embarassing stories to tell on both sides.  Although the new buildings for the Vet School, the Pathology labs and the Large Animal Teaching unit are still under construction the first tranche of 45 students are about halfway through their first year.  They are due to take possesion of the new buildings later this summer.  The whole project is costing in the region of £60 million with a business plan to break even in about 10 – 12 years.

Chris was explaining that the rise of Surrey University has been driven by the “newish” Vice Chancellor, who pledged, when he took over some 8 years ago that he would elevate the University of Surrey into the top 10 of the University league tables within 10 years (it was lying in about 60^th place at the time).  Remarkably, he achieved 7^th place in 7 years.  I do have concerns about the number of veterinary graduates, which the British University system is producing.  However, there is obviously still a need for them and more besides; there was an equal number of non-UK RCVS registrants in 2014 as there were UK registrants, i.e. new graduates.  Therefore there is an argument that we should be filling the UK job vacancies with graduates trained to the exacting standards of the UK vet schools.  Furthermore, I think that with somebody like Chris at the helm at Surrey Vet School I am very confident about the quality of the end-product and I wish them well.  

Chris with his new company car

Week 22?! and counting....

Most of March so far has been pre-occupied with trying to sort out the £227,000, which was stolen from the practice bank account, through our Internet banking, at the end of February.  I don’t mention it with any hint self-pity but bring it up to try and warn you all about the devious methods used by the fraudsters.  It’s amazing how much you learn, once you’ve been a victim.  The front page of one of the Sunday Times supplements, which went to print just over a week later was entitled, “Why Friday is the most dangerous day for fraud.”  The reason being is that after about 4 pm on a Friday the majority of banks’ fraud lines are closed until Monday morning.  This gives the fraudsters all weekend to move their ill-gotten gains from the bogus account to which it has been moved from the victim’s account, without the fraud department being available to be contacted to freeze the aforementioned account.  http://www.thesundaytimes.co.uk/sto/business/money/Consumer/article1527879.ece?shareToken=19135c367b19ac3a111d31237f45ea92

User beware - if you get any exceptional phone calls from the bank on a Friday afternoon, especially from a man called Peter, who duped us, (a name he uses regularly, we’ve now been told) it could be a hoax.  I’m sorry to tar all “Peter’s” with the same brush but I’m still smarting (a lot) about it. 

We are currently in negotiations with the bank, which have offered to refund half of the loss.  I will elaborate on this scam at a future date, once we have reached a settlement.

At the beginning of March, I went down to London to attend the National Equine Forum (NEF), which was held at the Institute of Mechanical Engineers at 1 Birdcage Walk, which is just a stone’s throw from the Houses of Parliament.  My trip coincided with one of my colleagues, Becky Wall, having to go to the RCVS to sit the practical and theory part of the CertAVP examination in Diagnostic Imaging; so I chaperoned her to and from the venue.  Obviously it involved a trip on a Boris Bike and we did a bit of sight-seeing, passing Buckingham Palace en route, which I think put Becky in relaxed mood for her exam.

Obviously at the end of the day, when we met up again it was all death and destruction from Becky…she’d done really badly, couldn’t answer any of the questions, it wasn’t at all what she expected, nothing she’d revised came up, she was going to fail, bla, bla, bla!  She received confirmation the following week that she’d passed, with flying colours…but in her opinion didn’t deserve to!  That is such a girly thing to do….I remember well that if I said I’d failed…I’d failed and deservedly so.

Back to the NEF; it’s the 23^rd time the event has been held and it is growing year on year.  The aim of the forum is, “To host an annual assembly of individuals who reflect every area of the equestrian industry, to hear presentations from experts on diverse and topical aspects of the industry and allow them to share their views.”  Effectively, the who’s who of the horse-world…. and Monty (David Mountford our CEO) and me.  High profile attendees included the NEF president, HRH the Princess Royal and Lord de Mauley TD.  The main topic of discussion for the day was the need for the “industry” to implement a robust and workable equine ID system, which has been pinpointed as the cornerstone for equine health, welfare and management in the UK.  There was a debate, chaired by Roly Owers, which included representatives of the Chief Veterinary Officers of the four UK countries.

Full report about the NEF: -

https://www.beva.org.uk/news-and-events/news/view/716

Incidentally, I had arrived at the NEF fashionably late, at the same time as Celia (Marr), who is always great value, which meant we were seated together.  The catering wasn’t what we were used to in that the mid-morning and mid-afternoon breaks were “comfort breaks” with water only and no coffee, and no coffee at lunchtime either – WTF, no caffeine!  At the mid afternoon break Celia and I sloped off to Café Nero, which was just around the corner for our fix.  I was fine with an Americano but Celia ordered two double Espressos’ – even the guy servings’ jaw dropped.  Respect – I bet she can eat 3 Shredded Wheat too….  No wonder she achieves so much in a day; with that much caffeine who would be able to sleep?

Week, I’m not sure what, but still counting….just.

One of the reasons for my failure to write Blogs is that the interval between my weekly hospital visit for my “bee desensitisation injections” (mentioned in Blog 8) has been extended to every 4-6 weeks, which means that I have no longer got 2 – 3 hours to kill every Monday morning.  I was very sceptical about the whole process of the desensitisation injections but I have to say it seems to be working.  The first injection I received was equivalent to one hundredth of a bee sting, which stimulated a really marked reaction over the first 36 hours, which remained for 3-4 days.  The dose increases weekly; my most recent injection was equivalent to 2 full bee stings, which induced a minimal short-term reaction.  In a perverse kind of way I’d say I’m almost looking forwards to being stung during this season’s hive inspections.  If I don’t appear for sometime it could be that my optimism about the success of the treatment is somewhat misguided. 

February was a really hectic month.  It started with the tail end of a weekend in Stockholm at the Nordic Equine Veterinary Conference (NEVC), mentioned at the end of my last blog, www.nevc2015.se.  This is only the second time this event has been held, the first one was held 3 years ago in Denmark.  It is a collaborative venture between the Scandinavian countries Denmark, Norway and Sweden’s Equine Veterinary Associations, which is hosted in rotation between the countries every 3 years.  The format is very similar to BEVA but just on a smaller scale. There were approximately 400 delegates and 2 sessions running concurrently.  There were several International speakers including Andy Durham, Patrick Pollock and Caroline Hahn from the UK.  The Conference organisers were extremely welcoming and hospitable, for which I am most grateful.  I am no linguist but understand that the Swedish, Norwegian and Danish languages are quite markedly different and for that reason the respective nationals will often communicate in English…they really do put us to shame.  Furthermore, all of the lectures were delivered in English – and a bit of Scottish. 

At their formal Congress dinner on the Saturday night, one of the highlights was that each countries delegate’s had to get onto the stage and sing a song or rhyme from their country as chosen by the organisers.  Fortunately, by the time that it was the UK’s turn they were all too legless to remember or had lost the will to live and therefore we didn’t have to sing “Old Macdonald Had a Farm”.

En route to the Conference, between the airport and the hotel, approximately 40 miles by train at 0100hrs, I managed to lose my mobile (I promise that alcohol did not play a role).  It did cause me a lot of angst initially but by the following morning I accepted my fate and the following 5 days, without a mobile, was quite a liberating experience – you should try it sometime.  However, there were numerous missed calls, voicemails and texts, when I was finally back on air.  My period of radio-silence coincided with the airing of my BBC Countryfile interview about West Nile Virus (WNV) & African Horse Sickness (AHS).  Not surprisingly, most of the voicemails were mocking, disdainful and derisory – I would expect nothing less!  I also received several sardonic emails; the one from Dave Rendle (Congress Organiser) was entitled, “I’ve just choked on my supper”

The following weekend involved a trip to Pisa to SIVE (the Italian Equine Veterinary Conference).  Again the hosts were extremely welcoming and hospitable, for which I am extremely grateful.  The Congress size and delegate numbers were very similar to Sweden with 3 sessions running concurrently.  A familiar face presenting was Michael Schramme and also Karen Richardson from The Donkey Sanctuary.  Again the majority of presentations were delivered in English with simultaneous translation available.  Talking to other delegates it was clear that the economy in Italy is struggling with the inevitable effect that will have on the equine sector, including vets.  In addition to that Italy has a staggering 13 vet schools.  Unsurprisingly, the economy is currently unable to sustain the number of graduates entering the profession and a large number seek employment elsewhere in Europe.  The number of new RCVS registrants from outside the UK (predominantly Europe) is approximately equal to the number of registrants from within the UK, i.e. new graduates.

On my way back from Pisa, I stopped off in Paris (as you do) and met up with Renate (Weller) to attend a, “Radiographic Expert Veterinarian Meeting”.  That’s why I took Renate, I was definitely the monkey; but there was relevance to the membership about harmonisation amongst European vets about the significance of radiographic findings at PPE.