Over and out!

Well, the intention had been to write BumpVet 9 just prior to 'bump' becoming 'a baby'... but with typical antenatal misjudged expectations I didn't find the time! Funny that (honestly, what was I thinking - I've done this before after all).

So to backtrack a few weeks, baby arrived safely on 24th March after a slightly harrowing elective Caesarian (I won't put you off your breakfast, but haemorrhage, "swaaaabs!" and the final scene of William Wallace in Braveheart is probably all you need to know...). I thought I'd be straight into the swing of things second time round, like a seasoned National runner returning to Aintree - I knew what to expect this time. I'll be doing the obligatory practice visit avec baby in the first week, then attending meetings in week two... driving week three - it'll ALL be fiiiiine. Eugh... what a berk. 

A few years older and with a two-and-a-half year old added to the mix, this was enough to nearly tip me over the edge... and what happened to second babies, especially boys, being easier? This miniature version of my husband on a bad day the morning after an enthusiastic army reunion was giving me hell on a stick. So I'm afraid all my good intentions of running a 'guess the weight' competition, squeezing in another BumpVet blog and generally being a productive BEVA member was almost vacuumed out the window like BA 5390's pilot (Google it - the pilot held onto the window frame for over twenty minutes until the co-pilot could land the aircraft... amazeballs!). 

However, I definitely deserve points for effort (or idiocy perhaps)... Last week I merrily decided to attend a meeting with the baby... not my brightest idea but the oxytocin was in full flow and I was convinced that he's ALWAYS so great in the daytime when we're out and about... he loves being in a new environments... oh yeah... wrong! He carried out auditory GBH on the lug holes of everyone in the building for most of the day, particularly in protest of the juicy bits of the meeting which I was really hoping to get stuck into. Having said that he did allow me 5 minutes to eat some sandwiches and chocolate biscuits, so not all bad. 

But, note to self... don't take baby where I might want to get something constructive done - just because I've done this bit of mothering before doesn't mean he's done this bit of being a baby before. As a result I've come to terms with the fact that I'm not going to get much done in the next few months - these babies are more time consuming than I remember (perinatal amnesia really is nature's way of getting you to repeat the process). All commitments are on hold. Projects I was sure I'd get "tied up" in the 5 weeks off before baby arrived have not even seen the light of day. My laptop has gathered dust (I'm writing this one-handed on my iPhone at 3am, whilst feeding - currently my sole mode of communication). 

I did break the promise to myself by attending a teleconference at the office this week, with the baby latched on throughout... I forgot it was supposed to be a Skype conference, but thankfully the camera wasn't working for most of it and when it was my boob was suitably cropped out of view. There's no way of disguising the unmistakable sound of a baby feeding though...

Do I sound frustrated... probably. Do I long to go to a meeting undisturbed... sort of. Do I feel like I am not delivering on my extra-familial commitments... absolutely. But... I look into those big blue eyes and hear that "kuh kuh kuh" of him feeding and those feelings melt away like those share-size bags of Maltesers that I have taken to disposing of lately.

Work is important and my desire to work has not diminished in the slightest. In fact I feel an increasing need to bring home the proverbial rashers. The nest building instinct is strong and with it an even stronger determination to succeed at my career. If not for me then for my children. 

I'm going to make the most of this year off because by billy-o, after that I'll be going at it hammer and tongs as I'm hungry for my family and I want to make this career one that's really worth having. But then there's always the alternative options - I heard Mars is recruiting tasters... 


Anyway, thanks all for reading, this is BumpVet signing off... over and out.

Lucy Grieve

Not Tempting Fate

Well that was an interesting week! Having been so pleased with myself for "staying safe" so far, I hope I am not tempting fate! I encountered three rather uncooperative patients who warned me that I was not doing such a good job of "staying safe" as I thought! The first came in the form of a 12hh, 26 year-old pony. I had seen this creature about a year ago and knew he needed sedation in order to get near him with a dental gag, but I didn't recall anything worse than that and he looked another year older and as if butter wouldn't melt. The owner had reported some behavioural changes of late, hence the visit. So off I went to check his eyes, etc... and we decided to test his ACTH, perhaps run a general profile and so forth. So I set about performing venopuncture of his left jugular, only to be met by a demonstration of his ability to walk on his hindlegs. It seemed innocent enough at first, although the owner was doing little to try and control or restrain him, standing mostly behind me holding only the end of the lead rope... I persevered, trying my trusty neck twitch over the jugular trick which nearly always works and tensions the skin sufficiently so that they often don't feel the needle go in. But this pony knew that trick and up he went higher and higher, leg over the rope several times, eyeing up the field shelter exit. He contacted my elbow several times, hard enough to make me wince but not enough to put me off. I tried for an intramuscular injection, however his next trick proved a little unsavoury. Whilst up in the air, spocking out with his beautifully small but quick feet, he spun round in a bid for freedom, taking the loosely-held leadrope across my neck as he went. The owner surprisingly kept hold and I felt as if I was going to be decapitated! So we decided this was not safe and I suggested some oral sedation with detomidine. The owner warned me he was difficult to worm but she had managed with patience - she thought she would have a better chance if I absented myself. So I gladly left the field shelter, checking regularly to see how much progress was being made amidst the moonwalk shuffling of feet that could be heard through the wall. However the passionately performed paso doble had found the pair migrating out of the field shelter and traversing the field at a fair speed... so the owner requested we call it a day. She agreed to attempting oral sedation, perhaps in food, on another occasion then we could arrive when the sweet little darling was a bit less "fired up". I wasn't sad to hear that it was all over, although I don't like giving up in these situations. The pony clearly needed a stronger handler in order for this procedure to be carried out safely, so I vowed to return the following week with a member of the practice technician team. Unfortunately, the owner then called to say she could not do the following week and could we make it the week after. I tried to conceal my elation as I told her that I would be on maternity leave by then and so the task would fall to my colleague. She expressed concern that he may be more difficult with a man, but I was thinking that it won't make much difference and I am confident that two expert pairs of hands can make light work of this pony!

The second horse came with much more warning. I was called to take some bloods for export from a few broodmares at a local stud. When I arrived the superbly professional team were waiting and when they realised it was pregnant old me they expressed some concern over one of the mares who was very needle-shy. We had a quick briefing on how difficult she was, what was required, and whether we would we need to call another vet. I said I was happy to try given their excellent planning but obviously if there was any risk to any of us we would need to have a rethink. They got the twitch on her with a bit of a fight and we gave time for it to work. When she was looking suitably subdued and happened to be right near the doorway I took the opportunity to place the needle and start drawing blood. Unfortunately the contorted position of her neck made the jugular flat and obscured by bulging brachio- and sternocephalicus muscles. It was a nightmare to try to get blood from! Then just as we were filling the last tube she took off and the vacuum was gone. So the incredibly skilled handler regained control and this time we had the other jugular towards me. I went in and with better positioning of the neck managed to get the last tube easily and without the horse really noticing. Phew, done! Should I have called a colleague? I really don't know but I can say I felt complete trust in the stud staff and knew that we were all looking out for each other by observing for signs that she was going to react violently. If only they'd been there for the 26 year-old pony...

Then came the third problematic equine in less than 48 hours... in the form of a donkey, would you believe. I had also attended to this little beast before so knew he could be a stubborn sod, but clearly he was having a particularly bad day. His routine dental required sedation which had been tricky to administer last time but not impossible. Unfortunately he knows that being handled is a precursor to something that he will not enjoy. So even attaching the leadrope was a challenge and in any case it had no influence over the direction he moved in or where he decided to stand. He used his little donkey companion as cover and when that did not work he resorted to turning his backside on us (and he does kick, so a threat not to be ignored!). Once we had cornered him and I could get to his neck he tried rearing, but he found this too much effort and resorted to barging off across the stable. This pantomime continued for too long, with several successful needle placements abandoned because he body-slammed us against the wall, pinning my arms so that I could not operate the syringe before he took off again (and I am no rookie with young and needleshy types but these horses were seriously extracting the proverbial urine!). I started to worry about his tricks as I was pretty uncomfortable a couple of times and he wasn't going to budge whilst I was anywhere near his neck. So we abandoned trying the intravenous approach and tried an intramuscular injection, however this had minimal effect despite a hefty dose and a long wait... I think he was pretty angry by this point although I find donkeys' expressions hard to read - what does a furious donkey look like? Perhaps I should have tried IM sooner, but it was hard to gauge his adrenaline levels. Then a sizeable man turned up to see the owner and he offered to help but he too could not anchor this remarkably strong ass and so we decided enough was enough, and besides I was running very late for my next appointment. The owner agreed to reschedule to a date when one of her other equid's flu vaccinations was due, and so she could administer some pre-appointment oral dosing. However this date will be after my maternity leave starts... damn. No seriously I'd like to see this one through also but there's no point in letting one's pride take over.

So I have changed my attitude to the remaining days of work before I finish - I won't be too celebratory about how well I've handled the pregnancy and workplace dangers just yet... Perhaps I'll be more thorough in inquiring about any new horse I'm going to see and less blasé about those patients who I know can be tricky. So good riddance to the broodmare, may we never meet again, and to the other two devils incarnate, this beef is far from over...

Nearing the end....

The last couple of weeks have involved a lot of lunging... The wee bun in this oven is defiantly positioned to prohibit any kind of bending at the middle. I often forget and it is only when I am halfway through scrubbing some fetlocks for injection that I realise the increasing hypoxia is becoming problematic. And so an awkward, bump-between-the thighs, lunge position has to be adopted. Now this is all very well, but it becomes hard to keep your tibiae in a location that is not risking a hefty crack should the horse decide to try to get rid of its irritation.

As a result I now take help with me for these procedures... this often comes in the form of one of our super technicians. Having someone highly skilled in the para-veterinary specialties of holding horses (properly!), understanding sterility and knowing what all the equipment is called and what you are going to need next, is such a vital part of any equine practice and now more than ever I appreciate the five star team we have. On days when I am feeling really indulgent I even ask the most recently qualified vet on the team if he would like to come and assist me. He is always willing and is now used to my frequent invites having been my radiography body-double since I found out that I was pregnant. This truly has taken the pressure off carrying out those procedures, whilst allowing me to maintain continuity with my clients and cases. The same young graduate has been doubling up with me on call, meaning I do not have to rectal colics or attend any physically tricky calls without a second pair of hands to carry out the tasks I can no longer safely perform (I don't think it is physically possible to use a stable doorway to protect my vast abdomen during rectal examinations any more!).

With only a few weeks left before I take some annual leave and then begin maternity leave, I feel confident that I can see out the rest of my time working as a pregnant equine vet without any further changes to my day-to-day work. I am sure that at the current rate of increasing waistline, were I to work longer than 34 weeks gestation I would certainly be struggling to manoeuvre behind the wheel of my car let alone carry out a PPE or more than one routine dental a day. It is not for want of trying - I can tell you now I will cry when I leave work on that last day (hopefully I'll hold it together until I have left the premises...). I love my job, it keeps me sane, challenged, satisfied and... well, happy! Without it I am going to feel like half of myself, and while I know this is all for a wonderful cause and that newborn will soon be filling any voids that have developed, I can't help feeling a little sad. I would love to work up until my due date, but it would be for selfish reasons. There is no way I could be doing flexion tests and joint medications the day before I give birth. Maybe some women can, but I'm huge already and why put myself, the baby, my clients, their horses and my employer at risk of dealing with the consequences if something goes wrong - it would be hellish for all involved. Some might say that carrying out these procedures at 34 weeks is still too high risk - but the truth is, these procedures always carry a risk to anyone performing them, not just the pregnant and I hope that I am adept at calculating that risk and knowing when not to do something. I may be prone to the odd bout of bravado but I hope I've kept my head fairly well screwed on when it comes to the baby's safety.

The key for me is gauging your individual circumstances and the risks you face every working day, not just when you are pregnant. Once you are pregnant those thresholds obviously change but only you can determine at what point they become unacceptable and a lot of this is relative. I have seen colleagues put themselves in crazy, dangerous positions, which I would not even if I was not pregnant. So there is some element of knowing one's own boundaries and then adjusting them accordingly when pregnancy overlays the risk assessment. I do not doubt I have placed myself and my unborn baby in positions of increased risk these past 7 months, but I have probably done the same getting in the car every day and driving down the motorways, A-road and country lanes... or having that sneaky bit of tapas with the cured meats and unpasteurised cheese, or that night I made no effort to prevent my Prosecco glass being topped up. I liken it to advising a client at a PPE - what constitutes acceptable Vs unacceptable risks differs from individual to individual. However, when we work for an employer and as a member of a team we agree to take on personal risk in exchange for the income we earn and the support we receive. Would you knowingly lay yours or your child's life on the line for any job, probably not, but we all accept a degree of risk all of the time. I made a friend laugh recently when I said I couldn't work in London - all that commuting on the terrorist-threatened Underground and walking along diesel particulate-polluted streets... then I realised the absurdity of what I said considering the line of work I have chosen... I think I'm the one most likely to end up hospitalised through my career choice!

And so my plan is to make it safely to 34 weeks, still carrying out the majority of my normal duties, then I'll be putting my feet up for a month (well on the days my daughter will remain in nursery at least!) with my trusty laptop for company, finishing off all the myriad of non-clinical projects I've been struggling to complete between work and toddler. I might even squeeze in some BEVA webinars to keep my clinical addiction satisfied... only a methadone for the real thing of course but I'll take my daughter to visit the village ponies for some much needed equine interaction. As for the clients, I shouldn't admit it, but I've told the best ones they can keep in touch... I'll miss those evening texts about Bob's arthritis, Millie's latest qualification for Regionals, Ernie's most recent bumps and scrapes, and Albert's latest growth spurt - after all they feel like extended family to me.

Everything Works Both Ways

Now well into my third trimester I am really resembling a walking beachball in a Musto blouson jacket... which I have discovered is the only winter work jacket that fits a pregnant equine vet. On the plus side Musto could use this as a selling point for those with rotund abdomens or a portly build (any Musto reps reading this - can I have a free jacket to replace the one I'm rapidly wearing out?!).

It is business as usual and while I can't say that I have  been blocking hindlimbs all day, I have really found pleasure in taking the 'easy calls'. Vaccinations may not usually be my idea of a professionally taxing workload but boy do you learn a lot about your clients by taking that time to chat. I'm now fully up to date on the local equestrians' births, marriages and deaths (or more accurately affairs, divorces and changes in dressage trainer). I'm also up to speed on their horses' aches, pains and needs. I've had some wonderful chats about worming and poor performance which generated positive changes in management, lameness investigations and strengthened client-practice bonds. So this "down-time" has been quite productive I think!

During an informal meeting with one of the practice partners to carry out my latest pregnancy risk assessment, I was able to reflect on my different experiences of working whilst pregnant. Having had a fairly unpleasant experience with my first pregnancy when I was employed elsewhere, I had to pinch myself on realising how enjoyable things had been this time. Not once has anyone made me feel "guilty" for being pregnant or unable to carry out the riskier aspects of our work, not once have I felt that my job may be at stake because I was pregnant, and not once have I felt I could not talk to any one of my bosses or colleagues about issues. I wonder how many other people can say that. I voiced my gratitude at being looked after so well. The reply surprised me, not because I didn't believe it but because it made me sad. My boss said if only all pregnant employees were as willing to find the balance with their employers as I had been. Apparently previous practice experiences had been mixed. This is not an uncommon complaint with partners of some practices telling of employees who seemingly using pregnancy as a way of evading doing their fair share of the work. I find it hard to fathom why anyone would do this. If you have fallen out of love with your job then pregnancy is not a good cover behind which to hide. No wonder some employers are wary, who could blame them with those kinds of experiences?

So while much emphasis is placed on the employer's duty to the pregnant employee, I am glad to see that MumsVet is striving to make employees realise that being happy and pregnant at work is not the responsibility of your boss, but the product of an honest, fair and determined relationship between both parties (I know it sounds like such a cliché but it's so true!). Hopefully the more we all talk about this, the more individual vets will realise how they can play their part in acting appropriately and making it work. For every bad taste left by one's actions there are people following down the line who will be treated differently as a result of assumptions derived from the consequences of your poor actions... we all have a duty to make our profession a happy (AND SAFE) working environment for all involved. As a champion for productive (pregnant) equine vets everywhere, it can work for both employees and employers if there is open and constructive communication between both; we all have the same aim of providing excellent patient care and a quality service to clients but we need to look at the opportunities posed rather than perceived threats of pregnancy.

A new birthing position?

When a call came in to castrate two unhanded gypsy cobs I was the only one in the practice who was free. The secretary asked whether this is something I would be happy to do, but was clearly prepared for me to say no. I said I was happy once the drugs were in the vein but may need help with that bit! A colleague was in the office and immediately offered to do them for me, but I am still feeling fairly able-bodied (bar a bit of hypoxia when bent double for too long) and so was keen to do them if it was workable with some help at the start (meaning they could continue with their calls that were already booked in). So before I knew it I had said colleague coming out to help knock them down, a student and a visiting vet (who is a good friend also) all coming out to lend a hand. You couldn't ask for better support than that! With the help of a discussion beforehand to get the owner to administer some Sedalin prior to our arrival, we managed to sedate and induce the ponies easily enough and the balls were satisfactorily removed. I discovered that the round rump of a gypsy cob also provides quite a nice rest position for a ever growing baby-bump... perhaps a new birthing position that doesn't require those ginormous inflatable balls?

The Frustrating Case

When I was called out to see a weanling who was lame behind I had my reservations about whether I would manage but I was happy to have a go and hoped it would be an easy one. When I arrived the owner and his son were holding onto a pair of colts in a large stable. I chatted about the history before stepping inside to introduce myself to the wee bairn, who was clearly suffering from some pain in his hind leg. After letting him sniff my arm I went to reassuringly rub his wither only for him to leap four feet off the ground taking his elderly handler on a safari of the deeply strawed stable. I was just about to choose my waiting ground carefully when the second weanling kick-started into action. The next thirty seconds felt a lot longer while I tried to duck the flying hooves and dodge the blindly panicking beasts with their determinedly clinging handlers. It was quite a show and I was trying to control my rising alarm over how I was going to see this case through 'in my condition', determined as ever not to admit defeat too early on.

When order was restored I tried again only to be met with a similar response from the weanling's typically fast hindlimb. This little fella was not going to let me touch his quarters let alone examine his distal limb - this was going to be tricky. I asked about his character and whether this was at all normal. The son casually informed me that the colt had never had his legs touched before. I stopped all attempts and tried to hide my disappointment at the situation. I was genuinely surprised that no one had thought to mention this already - I wondered how they expected me to deal with this? In a non-pregnant state I may have persisted a little longer, however surely no one can be expected to teach a weanling how to tolerate having it's legs handled in one visit whilst said horse is already feeling vulnerable with a painful hind limb? It was this thought that made me realise that pregnancy is not a reason to start becoming safety aware. We should be doing it all the time! Pregnant or not, this was a less than ideal situation to be in and I was never going to be able to examine this horse's leg without the help of some hefty sedation. And even then, should clients be expecting us to put ourselves in these positions because they have not put in place the appropriate training to allow examination of their animals in such circumstances? Or is that too much to ask? I think it would be reasonable to expect to be warned at the very least.

This reminded me of the time a friend's husband, who is a pilot, was complaining about the local small animal vet who had asked him to start muzzle training the rescued terrier he and his wife had recently acquired, after it took a violent dislike to being vaccinated. The pilot was outraged that someone would shirk from doing what he believed he was paying him/her to do. He compared it to asking one of his passengers to fly the plane for him. My attempts to liken it more to asking him to fly with a violent drunk in the cockpit fell on deaf ears... clearly deliberately putting ourselves in the firing line is seen to be part of our job, unfortunately.

Needless to say, examination of the weanling following sedation was fruitless and while I suspected this was a foot problem the volume of "Domo and Torb" required to touch the leg rendered the weanling's response to palpation and hoof testers inconclusive. This really was a frustrating case that provided a perfect example to me of how pregnancy does not always create "special requirements" for practicing as an equine vet. However it does highlight issues we all may face any time and perhaps it should make us consider them very carefully.

Thinking for two

When an owner is informed you are on your way to their emergency and they request that the practice sends someone else, you immediately panic and think, "uh oh, what have I done wrong?". So I was relieved to hear the client was actually looking out for me rather than refusing my attendance through dislike! She said her horse was wild and she was sure it would crush me as I tried to attend to it's hind foot abscess... apparently she would never forgive herself if anything happened to me! However, if one of the non-pregnant vets were to go out and be crushed that apparently was fine! Not sure I felt ok with this but I obliged in turning my car around and let a colleague go out instead, feeling somewhat embarrassed at someone else having to put themselves in danger. I expressed my feelings to the secretary who reminded me that I had to look after my unborn baby, not myself. And the colleague who went out instead was absolutely lovely about it - seeing the funny side and reassuring me that she'd do the same if the tables were turned, and I confirmed that I would definitely do the same for her. A box of chocolates is sitting in the car waiting to be delivered to her desk.