Case Study: Bilateral fractures a common complication in toy breeds

Meet Merlin, the Chihuahua cross whose magical skills weren’t enough to prevent injury when he jumped out of a car!

Merlin was referred to Dr Peter Young for management of bilateral non-union fractures of the distal radius and ulna; a not uncommon complication of such fractures in toy breed dogs.

Merlin, an 8-year-old male Chihuahua cross presented with a history of jumping out of a car 2 months prior. Immediately after the incident, he was taken to a local clinic, where bilateral radiographs of radius and ulna were taken. They showed fractured bilateral tibia and ulna in the distal 1/3 of the diaphysis. Both legs were splinted at the local clinic.

2 months after the incident Merlin presented to the referral vet with bandages on both front legs. Merlin was unable to bear weight on either front leg. When palpated both front legs felt unstable. Radiographs of the tibia and ulna were taken of both legs in lateral and dorsopalmar position. These showed signs of delayed bone healing and malalignment. There were signs of decalcification of the ulna and radius distal to the fractures.

Clinical and radiographic examination showed that the fractures had not healed, the fracture ends had not been retracted to normal position and there was still instability around the fractures.

The left radius and ulna were hypertrophic with a fragment overriding, and the right radius and ulna were atrophic, also with a fragment overriding. Surgery was recommended in order to obtain complete bone healing.

The surgical procedure chosen was external fixation of the atrophic non-union mid shaft fracture of the left radius.

The dog was placed in dorsal recumbency. The intercarpal joint was located by inserting 2 needles in the medial and the dorsal joint space and detecting joint fluid. A k-wire was drilled through the distal radius in a lateromedial direction just proximal to the joint space. A ring fixator was applied on the wire and another k-wire was applied in a dorsopalmar direction. The carpal joint was manipulated to confirm that there was no accidental articular insertion of wires. A 2 cm incision was made over the dorsomedial part of the fracture. The cephalic vein was identified and protected at all times. A transverse osteotomy was made at the location of the chronic fracture and the distal and proximal parts were aligned. The distal part was rotated 30 degrees so the supination was neutralised. 2 positive threaded pins were applied 11 and 40 mm proximal to the osteotomy in a lateromedial direction and 2 pins were applied 7 and 27 mm proximal to the osteotomy. Each pin was locked on to a bar with clamps connecting the two pins and the fixation ring. Alignment was checked. A 10-degree medial angle at the osteotomy site is detected and an adjustment on the fixating configuration was made to correct that. All bolts were tightened, and the skin was sutured with Premilin 3-0.

A soft dressing was applied to control swelling.

Radiographs were planned for 3-4 weeks post op; these will determine when the external fixation can be removed.

The right leg went on to heal spontaneously once Merlin could ambulate on the left.
With the increasing popularity of toy breed dogs in our densely populated cities, cases like Merlin are not uncommon.

VetPrac is excited to offer a workshop that will equip you to appropriately manage cases like Merlin and hopefully reduce the risk of complications such as non-union fractures.

The Fine and Fiddly Fracture Workshop will be held at UQ Gatton on April 12-13, 2019. To register for this amazing workshop, click here. For more information, check out the brochure.

Nurture Your Self-Confidence & Increase Performance

Dear Colleagues,

VetPrac contributes to helping veterinarians prepare for their technical roles by offering a lot of opportunities. It’s exciting to hear about these success stories as you grow in your professional roles but confidence is an area that seems to hold us back. As high achievers we look to our exceptionally talented and trained peers or predecessors and often think – “Oh, I can’t do that. I’ll never be that good. I haven’t the time to get those skills” We do this because it’s easier to stay in our comfort
zone and more often than not, lack the confidence.

“With the realization of one’s own potential and self-confidence one can build a better world”
~ The Dalai Lama

But what is self-confidence and how do we know we have it? Or how do we bet more of it? It requires trust and self-belief. It permeates our thoughts and feelings defining our actions and the outcomes of those actions. Low self-confidence limits us. The Online Psychology Dictionary defines self-confidence “Our self-assurance in trusting our abilities, capacities, and judgments; the belief that we can meet the demands of a task.”  Self-confidence is clinically determined by “The Self-Esteem Formula”, “The Self-Efficacy Theory”, and “The Self-determination Theory”.

While it has never been the scope of VetPrac to advance what the veterinary community knows about psychology, I find it fascinating that we are only limited as a community by our self-belief and confidence. We are intelligent and capable. I don’t think many clients look at us collectively as a group and think anything less. If there was a zombie apocalypse I know I’d feel much safer in a group of vets (preferably mixed practice) than any other contingency in society. So, where’s the gap?

I read constantly about the personal gripes we have about how we are perceived by clients, business partners, managers and family members across all forms of media. This bothers me. I have never met a veterinarian under 40 who isn’t disappointed with some part of their life because they played it safe.

In 2018 I learned to ride a bike. I’d never tried something others explore in their childhood because of my self-confidence and I didn’t trust my balance. It turns out I actually have great balance. I also didn’t trust I could steer, break and pedal at the same time or when required. It turns out, it’s actually not that hard once a good teacher explains the fundamentals and supports you. Once someone I trusted showed me and showed me I could do it, I believed it and I did it.

Confidence is a shareable trait. It’s a communicable condition that can be nurtured. It permeates everything we do and its potential is exponential and shareable.

We would like to help the veterinary community build self-confidence in 2019. Dr Cathy Warburton is a coveted speaker and trainer on this topic. In 2019 She will be leading small classes online about “How High Achievers Succeed” as well as a special “Balint group” for analysing difficult clinical situations. These exclusive small group sessions are available to anyone in the community. Balint Groups are for those who want a new and better way of processing clinical experience.

We also have this year the ‘VetTalk Communication Workshop‘ with Dr Sandra Nguyen. No one is born with excellent communication skills, we develop them along with all our other talents. The theory behind good communication can be learnt and practised.

Regardless of what you hope for yourself in 2019 if you have healthy levels of self-confidence you will be better equipped to succeed. Check out our workshops that offer training and understanding about self-confidence HERE.

‘Coping with Stress and Burnout as a Veterinarian’ Excerpt

Coping with Stress and Burnout as a Veterinarian by Dr Nadine Hamilton

Psychologist Dr Nadine Hamilton, founder of the charity Love Your Pet Love Your Vet, has spent the last ten years researching why the mental wellbeing of vets has become so compromised and what can be done about it. In her new book Coping with Stress and Burnout as a Veterinarian she presents an examination of the problem, the ways vet mental health is influenced by their daily work and the science we can use to tackle it head-on. Drawing from the fields of positive psychology, acceptance and commitment therapy, career construction theory, and resiliency studies, she outlines a promising new weapon in the profession’s fight against suicide.

Below you will find an excerpt from the book. This is a book for every veterinarian, veterinary student, veterinary nurse and those that care for them.

Book Excerpt

When you ask a veterinarian about their job most will answer along the lines that it is a rewarding, but challenging and demanding career. They might also say that to be successful you must have a passion for or a clinical interest in animals, have great interpersonal skills and possess a strong work ethic. Many vets will happily recount a childhood passion for animals or a childhood pet that led them to eventually pursuing a career as a vet.

Not surprisingly then, many people have the perception that being a vet is a wonderful job because you get to play with kittens and puppies all day long. There is also a perception that becoming a vet means you will be very well paid. Certainly, most pet owners’ experiences with vet bills lead them to believe that someone is making a good living.

Sadly, these assumptions are not the stuff of reality. While it can be a rewarding and satisfying career, there is also a ‘dark side’ to the profession for the unwary.

Veterinarians have long been considered the guardians of animal welfare and health. In earlier times, they were required to work in professional isolation at all times of the day and night and expected to work with all species of animals. Today they work in an ever more diverse environment and ­specialist areas. The effects of working long hours, performing euthanasia on animals, emotional pressure, financial issues, unrealistic expectations, and dealing with distressed clients place considerable stress on both the vet themselves and their families at home.

Failure to cope with stress can lead to emotional problems such as depression and suicide, physical problems such as psoriasis and being vulnerable to infection, and behavioural issues such as irritability and anger. Working the unsocial and long hours that are generally required, juggling the emotional involvement with patients but also being able to detach from them emotionally, as well as the need to be self-critical but balancing this with the ability not to be too critical, can be a risk factor to the onset of depression. With a lot of vets tending to be perfectionists, there is also the risk of many practitioners being workaholics without strong support systems. This can lead to a tendency for vets to hide things that are bothering them and continue to push on, ignoring their symptoms.

Within Australia a veterinarian will commit suicide approximately every 12 weeks. In the United Kingdom, rates of suicide have been reported at least three times the general population rate. In the United States, recent research by the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health concluded that when compared to the general population in the United States, female veterinarians were 3.5 times as likely and male veterinarians were 2.1 times as likely to commit suicide. Similar statistics have also been reported in New Zealand, with the New Zealand Veterinary Association stating that the vet profession worldwide is one of the leading professions in suicide rates.

Research has shown that a person’s coping strategies to deal with stress can cover the range from dangerously self-destructive such as drug and alcohol abuse to highly effective evidence-based strategies stemming from applied psychology such as mindfulness and positive psychology. Yet research specific to the veterinary profession has been thin on the ground. Little has been done to provide well-researched, appropriate, and adequate intervention strategies for vets other than the provision of telephone support, crisis lines, and limited cognitive behavioural therapy strategies.

If we are to progress research into vet wellbeing and attempt to find effective solutions that can help prepare and empower those within the profession to deal with the realities of working as a vet, we need to delve deeper into the real-life issues that are hindering wellbeing. Dealing with ‘band-aid’ solutions or ‘tip of the iceberg’ situations is extremely unlikely to generate significant, lasting, psychological change. We need to get to the core or root of the problem and deal with these issues (as uncomfortable as this may be for some people) if we want things to change effectively. This concern is not going away and can no longer be hidden under the table with an ‘all is well’ attitude.

The reality is that whether we acknowledge the sad, hurtful, and even traumatic things that have happened in our lives or not, it doesn’t change the reality of what happened. The more you avoid dealing with them, the bigger and more powerful they can seem. When you can safely acknowledge and accept the reality that they happened, and work through these issues with someone qualified to help you through this, real change can occur. This is where I strongly advocate for support from an appropriately qualified and experienced professional (such as a psychologist and/or psychiatrist) to help distressed vets work through their issues in a safe, supportive, and caring environment.

What is also needed are effective proven and beneficial programs being provided to vets to assist them in dealing with the everyday demands of their profession — a psychological toolbox of resources they can refer to when required.

About the Author

Psychologist Dr Nadine Hamilton has spent the last ten years researching why the mental wellbeing of vets has become so compromised and what can be done about it. In her own private practice, she has helped many vets develop better coping strategies to get on top of stress and psychological fatigue to avoid burnout and suicide. She also works with veterinary practice managers and owners to increase wellbeing, productivity, and retention in the workplace. She is also the proud founder of Love Your Pet Love Your Vet, a not-for-profit charity raising awareness about the issues within the veterinary industry and reducing stigma in veterinary professionals seeking help. 

If you’d like to purchase ‘Coping with Stress and Burnout as a Veterinarian’ head HERE today.

Feeling Unsure? Could Joining Our Balint Group Be For You?

Having a glass of wine at the end of the day or losing yourself in social media or streaming services is a quick and easy way to wind down at the end of the day. It feels like it helps – and it certainly may, but only in the short term and when used intermittently.

The problem is that alcohol and avoidance can actually make things worse in the long term.

If you are looking for a way to manage your job stress and build work satisfaction, a way that goes to the source of the stress and is helpful in the long term AS WELL as the short term, maybe you should consider joining our Balint group?

You and a group of your peers will meet monthly from May to October to debrief challenging work situations – to support and learn from each other. All members of the veterinary team are welcome. Each of the Balint Group six sessions will run for 1.5 hours and there is no preparatory work or homework.

A Balint group could be helpful for you if you identify with any of the statements below;

-You are travelling well and want to stay that way
-You find your work demanding and regularly go home feeling emotionally exhausted.
-Euthanasia is getting harder and harder.
-Other people’s behavior and decisions are perplexing. You often think the worst about their motivations.
-Thoughts of cases or conversations churn around in your mind, even when you have left work.
-Your family and friends are worried about your stress levels and questioning why you work in the industry

Committing to a group and being willing to share your experiences takes energy, effort and courage. And the energy, effort and courage will be worthwhile as you gain support, understanding and ideas on how to do and see things differently.

Peer support programs are being recognized as needing to be standard in high-risk organisations1. Mental ill-health statistics identify the veterinary industry as a high-risk industry.

Is it time for you to make the investment in a peer support program?

Sign up to our on-line Balint group this 2019. Register HERE. For more info, check out the brochure.

Creamer et al (2012) Guidelines for peer support in high-risk organisations: An international consensus study using the Delphi method. J of Traumatic Stress, 25, 134-141

Don’t stress – Dr James King will be there to help you navigate to success!

VetPrac is delighted to announce that James will be joining our education team in 2019. James is a final year small animal surgical resident at Veterinary Specialist Services, Carrara, Queensland, and brings a great balance to the team. He believes in constantly challenging oneself in order to improve one’s surgical skills. We think James will be a great partner to assist you in your journey out of that comfort zone that many of us are too scared to venture out of!

Let’s get to know James a little better, before he makes his debut as an educator with VetPrac at the Fine and Fiddly Fractures Workshop at Gatton on 12-13 April 2019.

What inspired you to become a veterinarian and then choose surgery as a specialty?

“I grew up witnessing the passion my father has for the veterinary industry. Once in practice, it was the surgical cases that excited me the most and sparked my interest in pursuing a surgical residency”.

In your opinion, what makes a good workplace?

“A strong and respectful working relationship between all staff which generates both an efficient and fun work environment; a workplace which encourages continuing education and growth and one that encourages a work-life balance”

Your first job as a vet was at VSS Carrara and you’re now doing your surgical residency there. Many vets travel overseas to the UK or USA to do their specialist training. Did you consider relocating overseas to do your specialist training?

“I was always very committed to pursuing a surgical residency and would have happily travelled both interstate and overseas if required. However, I was incredibly lucky (I believe right place right time) to be offered a residency with VSS Carrara, a team I already knew from my internship. I was also very happy that the position came with a huge surgical case load and meant that I did not have to relocate from my home on the Gold Coast, a place which I consider to be paradise.

Australia, UK and US all offer fantastic residency programs, and there are always different advantages to each one. Individual candidates will find themselves better suited to different programs – i.e. private practice vs academic university setting. In my case, I felt a private clinical residency with a fast pace and large case load would suit me better. It is a great team to work with and the case load fulfils my strong interest in minimally invasive surgery, orthopaedics and neurosurgery. As I said though, I was very lucky in this opportunity, and would have happily relocated overseas if the opportunity presented itself.

I was also very lucky in that taking a position with VSS meant remaining in a location that is close to family, friends (and beach) and has thereby allowed me to maintain a work life balance.

Residencies are a big undertaking and a lot of work and study for a long period of time, so it is important that the program and practice is one that is well suited to you. Most importantly though, one that also allows you to continue your hobbies outside of work.”

What is still your biggest challenge with being a surgeon?

“Never being satisfied with skills, knowledge and procedures performed and always wanting to push further”.

What is the best advice you have ever received regarding improving your surgical skills?

“One of my mentors said to me: “you will never stop learning and evolving, so remain open to all new literature and experiences, push past your comfort zone, and you will always feel challenged”.”

Any advice for new grads?  What about general practitioners that wish to pursue further education in surgery to small breeds and cats?

“At face value, surgery seems to be primarily a practical skill but there is also a huge amount of theoretical knowledge required to make decisions peri-operatively. Being able to confidently perform surgical procedures is such a rewarding part of being a vet and it is an area that is constantly evolving. Workshops, conferences and continuing education are vital for all who wish to improve their surgical skills because they provide a setting to discuss your experiences with other surgeons, discuss literature and most importantly develop your surgical skill set, knowledge and decision making”

Do you have any pets?

“My fiancé and I have an 8-year-old German Shepherd named Phoenix, a 2-year-old crazy Labrador named Bosco, and a cat named Ivy. I am at the bottom of the pecking order in the household”.

What do you like to do for fun in your spare time?

“I like anything involving the outdoors, keeping fit, and traveling. By far my favourite hobby is surfing at our local beach”.

Why not join James in challenging your surgical skills, and register for the VetPrac Fine and Fiddly Fractures Workshop at Gatton on 12-13 April 2019. Register HERE. For more information, check out the brochure.

Dr James King can be contacted at jamesking@vss.net.au or 0412262316.

Written by Alison Caiafa

Peer Support Is Helpful But I Need More

Could a Balint Group be the more you are looking for?

You, like most of us, will have people in your workplace that you feel comfortable talking with – discussing your challenges and the times that you feel inadequate or have a poor outcome, as well as sharing your successes.

Awesome! Effective co-worker support is a partial antidote to workplace stress and we know that talking it out it is far more effective than are wine and avoidance.

But there are times when the assistance of your colleagues is not enough;

-Maybe you are doing the informal debriefing between cases and this is helping keep stress at bay, but, with all the will in the world, regular more formal debriefs are elusive.

-The practice may be going through a busy patch and everybody is stretched and a little frazzled or maybe your practice is consistently busy with many people in survival mode – doing what they need to do to get through the day and not having the energy for anything extra. You might not want to ask a colleague to spend some time with you debriefing what has happened today or this week. You don’t want to be a burden.

-Maybe the practice leadership does not see the value in debriefing and doesn’t prioritise spending time on it.

-You may not feel safe with your colleagues, worrying that you will be seen as weak or as not being a coper or being a whinger if you don’t appear decisive and under control.

What to do then?

Your family and close friends will be a great support – but sometimes even they will get tired of hearing about it, or they may not really understand your concerns or your difficulties.

Have you considered a Balint Group?

Well, probably not – because as best we can see, this is not something that has been available in the veterinary world before.

VetPrac and Make Headway have got together to introduce this new form of support group to the veterinary profession in 2019.

Why Balint?

In reading and attending workshops on burnout in the caring professions, Cathy kept hearing about Balint Groups and how they could help people to process the events they encounter at work. After twenty years in emergency work, she had a lot of these cases sitting there with no real outlet. How exactly do you process the traumas, the sadness and the guilt you encounter on a daily basis without taking it on yourself or hardening your heart and becoming like a robot??

Google confirmed that Australia does have a Balint society, many functioning groups and an annual conference. Attendance at the groups and conference revealed that they do help and that they are an intervention that is readily applicable to the vet profession. Leadership training ensued.

What exactly is a Balint group?

Balint groups are facilitated peer discussion groups where health professionals come together to talk about their experiences and interactions at work. The focus is on feelings and relationships – the management of the case serves simply as a background to this exploration.

They can be conducted on-line or in person and each group has about ten regular participants meeting on a monthly basis. The groups are safe, supportive and confidential.

Why might you want to join our VetPrac Balint Group?

-To talk about the cases and interactions that weigh heavily on you – the ones that continually creep into your mind when you are not at work or you are trying to sleep.

-To share your experiences with your colleagues and know that you are not alone

-To see situations from a different perspective, increasing your compassion for others

-To expand your capacity for dealing with “difficult” people

-To reduce your stress levels and prevent burnout

Our Balint Groups will run on-line monthly on a Monday afternoon between May and October. All members of the veterinary team are welcome. Each of the six sessions will run for 1.5 hours and there is no preparatory work or homework.

Why don’t you make signing up to our on-line Balint group the thing that you do differently to manage your stress and increase your well-being in 2019? Register HERE. For more info, check out the brochure.

VetTips Canine Sports Medicine and Rehabilitation

Tip 1: There are a lot of dogs who perform or work.

Australia and New Zealand have a very large ratio of performing and working dogs enrolled in competitions or “employed” per capita.

Some of these sports include; Agility, Obedience, Tracking, Conformation, Rally, Freestyle, Flyball, Disc Dog, Dock Diving, Weight Pulling, Canine Nose Work, Lure Coursing, Greyhound Racing, Herding, Field Trials, Hunt Tests, Earth Dog Tests, Fox hunting, Pig Hunting, French Ring Sport, Mushing and Carting.

Working dog jobs include; Search and Rescue, Detection, Police, Patrol, Protection, Herding, Farm Dogs, Service Dogs, Canine Actors. They use health care providers who understand the specific nature of their work who are as motivated as they are in maintaining their health for competition and elite performance.

Tip 2: When you position any dog for accurate musculoskeletal and neuromuscular examination make sure you do the following.

-Control the head – the weight goes where the head goes
-Keep the collar behind the ears to control the head.
-To move a forelimb, hold the dog by the elbow, with index and middle fingers on the cranial/caudal aspect of the elbow, and move the head to the contralateral side.
-To lift a pelvic limb, hold the dog by the tarsus, with index and middle fingers on the cranial/caudal aspect of the tarsus, and move the head to the contralateral side
-Stand the dog so that the radius/ulna and the metatarsals are perpendicular to the ground
-Head should be up and looking ahead
-Don’t put your hand under the dog’s abdomen as that makes the dog straighten its rear legs – hand under ischiatic tuberosities
-If the dog doesn’t want to stand with both rear legs back, just position it with one rear leg in the correct position.

Tip 3: Strength Training Exercises

Strength Training Exercises which can be fun, relationship building for owners and animals and introduced to dogs recovering from injury or as a preventative for weakness include but are not limited to: Forelimb; Wave, Wheelbarrows, High Five, Handstand, Backing Upstairs, Tugging Low, Ball Pushing and Digging, Core Muscles; Beg, Beg/Wave, Crawls, Diagonal Leg Standing, Stand/down/stand, Backing Upstairs, Roll Over, Roll Up and Incline, Wobble Board, Ball Pushing; Pelvic Limb; Beg/Stand/Beg, Jumping Vertically, Pulling Forward Against a Stretch Leash, and Tugging High.

To learn more about Musculoskeletal and neuromuscular examination, diagnostics, health, and treatments join the VetPrac Canine Sports Medicine and Rehabilitation Workshop August 30th – 1st Septemeber in Brisbane. Where we will practice techniques on patients in an intensive three-day workshop. Register TODAY, places are filling quickly.

Case Study: Fracture Repair by Dr Penny Tisdall

Are you confident in your practice to repair challenging fractures in toy breeds and cats?

With the increased popularity of toy breeds, presentations of challenging fractures to veterinarians are becoming more frequent, and the skills specific to these cases are not taught at university.

The following case study, provided by Dr Penny Tisdall, a highly experienced small animal specialist surgeon, demonstrates some of the complications that might arise when repairing fractures in toy breed dogs.

Sootie is a 3.5-year-old female neutered Maltese cross. She presented with a non-weight bearing lameness of her left forelimb, with a history of the owner having stood on her foot that morning.

Initial radiographs show a short oblique fracture of the radius and ulna with a short distal fragment.

Surgery was performed using a 1.5 mm locking T plate (Synthes). The fracture ends were well aligned, and repair allowed some load sharing although the fracture was not compressed. In this application the 3rd distal screw was cortical rather than locking due to the proximity of the fracture line. All screw holes were filled in the proximal fragment in this case, although theoretically there may be no advantage to using more than 3-4 screws.

Sootie was discharged with a soft bandage support for 10 days, and prescribed Carprofen for 10 days and transdermal fentanyl for 3 days. The owners were advised to limit Sootie’s activity by using cage style rest with leashed toilet breaks.

Sootie was reviewed 2 weeks post op and showed excellent clinical function. Her sutures and the padded dressing were removed. The owners were advised to continue strict rest for Sootie.

4 weeks post op Sootie presented with an acute onset of recurrent non-weight bearing left forelimb lameness; the owners reported that she had been confined but that she jumped around in the crate. Repeat radiographs show a plate fracture.

Potential reasons for plate failure include:

1.Plate fatigue

-The 1.5 mm locking bone plate is thin but was considered an appropriate implant for a dog of this size; implant choice was constrained by available implant selection, bone size and presence of a short distal fragment. A short working length of the plate by placing three screws distally and filling all available screw holes may have concentrated stress at the fracture site and on the implant. This is called stress concentration. Ideally locking plate fixation relies more on the principles of elastic plate osteosynthesis where longer less rigid fixation is used. This distributes stress over the length of the implant.

-Excessive activity? The owner denied that Sootie had been excessively active.

-Relatively delayed healing? There was reasonable biology in this dog and minimal trauma to cause fracture, however in toy breed dogs there may be reduced bloody supply to the distal radius.

2.Non-compression

This was used because of the fracture configuration, and the implant limitation of only one dynamic compression plate site.

3.Screw Density and Position

May lead to stress concentration in the plate.

Secondary surgical repair and revision was undertaken. The T plate was replaced using new screws and the same screw holes. The principal of “open but do not touch” was used; this aims to limit disruption to soft tissues and blood supply by use of minimal handling and tissue disruption. A 4-hole 1.5 mm ulna locking compression plate was applied to the ulna with cortical screws to protect the plate and an autogenous cancellous bone graft was performed; this was collected from the ipsilateral humerus. Consideration could have been given to reducing the number of plate screw holes that were filled around the fracture site to reduce stress concentration.

At follow up, Sootie showed good clinical progress at 5 weeks.  This case demonstrates that when using locking plates we need to understand that the principals of fixation are not identical to those we have established using dynamic compression plates.

With the rising ownership of smaller pets in Australia, VetPrac is offering a course specifically focused on surgery in toy breeds and cats, and is delighted to welcome back Penny as a supporting tutor at this workshop. Led by Dr Stanley Kim with Dr Peter Young and Dr James King also supporting, Penny will share her vast experience in the surgical repair of fractures in our smaller patients at the Fine and Fiddly Fractures Workshop at Gatton on April 12-13, 2019.

The focus will be on the practical considerations for trauma in small breed dogs and cats, and the purpose designed instrumentation and equipment required. Practical sessions will allow workshop attendees to perform surgical repairs of commonly seen complex fractures of toy breeds, such as the distal radial fracture like Sootie’s, and humeral condylar fractures, in a safe, supportive, fun and friendly environment.

To register for this amazing workshop, head here. For more information, check out the brochure.

Peer Support As A (Partial) Antidote To Workplace Stress

We all know using alcohol to settle down at the end of a workday or soldiering on and pretending that everything is okay when actually you are a tangle of emotions and stress, are unhelpful in managing workplace stress. And most of us now also know it can actually amplify it. So, how can we as veterinary workers, manage the emotion and stress that our work creates as we deal with suffering and loss, unrealistic clients, ethical dilemmas, workload, financial pressures etc.?

How can we counter the high levels of mental distress that our profession is dealing with?

As more becomes known, the answer will surely be multifactorial. However, one thing we do know is that seeking support from colleagues is a super effective and readily accessible coping strategy.

Numerous studies in veterinary and non-veterinary workplaces, highlight the role of co-worker support in increasing well-being and job satisfaction while buffering the potentially negative effects of workplace stress. (eg Wallace and Lemaire 2007, 2013, Wallace 2014, 2017, BVA Voices 2018)

And, unlike alcohol and avoidance, talking with people that listen, understand and empathise with our work-related problems, and offer support and encouragement, helps us to feel better BOTH in the short term and the long term.

“A problem shared is a problem halved” – as the old saying goes.

Talking with our colleagues can help to;

Normalise the challenges we face. We are not alone in both loving and loathing veterinary work at times. It helps to know that other people are challenged too, and often by similar things to you.

– Structure our thoughts – the simple process of taking the thoughts that are swirling around in your head and arranging them into a coherent “story” to impart to another person helps to structure and make sense of what has happened.

– Understand and label how we are feeling – reducing the intensity of the emotions experienced and giving us insight into our actions

– Get another perspective on what happened from somebody who will have experienced something similar in the past. They may help to widen your view and see other factors that contributed to the events, increasing your tolerance and compassion.

– Brainstorm solutions to the problem

Informal, on the fly conversations are great and these are ideally supplemented by regular, more structured debriefing sessions. Maybe, you could set aside a part of your staff meeting to talk about a challenging ethical dilemma or client communication around finances? This helps to get everybody on the same page and reduces uncertainty when faced with a similar situation in the future. Maybe, you could buddy up with a safe person in the workplace and spend 15 minutes after work once a week talking through your work-related challenges and successes? Maybe, you feel safer or more comfortable sharing with a prior work colleague or friend from uni/TAFE?

Could scheduling a regular time to debrief work situations be the one thing you do differently in 2019 to actively manage your stress and increase your work satisfaction and longevity?

Why don’t you join Dr Cathy Warburton at Makeheadway for the Veterinary Balint Group held monthly across 6 sessions between May 6th – October 6th 2019? The Veterinary Balint Group Program is for all members of veterinary health care teams who want a better way to process and understand difficult clinical or communication experiences.  For more info, check out the brochure. Register HERE.

Written by Dr Cathy Warburton

How Do You Manage The Tough Days In Practice?

There are some days in practice that are amazing – you see patients making progress, the team works well together, the clients love you and you even get time to have lunch and a bathroom break before you leave on time. You head home to enjoy your time with family, friends, pets and/or hobbies. Amazing!

There are other days though, that don’t feel so good and others again that can be downright emotionally demanding.

1.Maybe you are having a run of Doctor Death and you feel like it would be better for that nice owner with their nice pet to see another vet – one that deals in life rather than death.

2.Or maybe your schedule looked OK until you had those couple of emergencies which, whilst fun and satisfying, threw everything else into disarray.

3.Or maybe you had just one too many of those clients that want everything done for their pet and money is no object (red flag, red flag) or want you to provide treatments that you feel are not in the best interests of their animal or were just plain difficult to deal with.

What do you do at the end of those days? Days where you feel sucked dry and have nothing left to give.

Do you withdraw – sitting on the couch distracting yourself with Facebook or Netflix in an effort to turn your brain off? Or do you head straight to pour yourself a glass (or two) of your tipple of choice?

Avoidance and alcohol consumption are examples of coping strategies that we can use to reduce the discomfort we feel after a stressful day in the clinic. And using strategies such as these makes sense, as they can make us feel better in the short term and they take little effort and energy.

The problem is that whilst these coping strategies provide an escape and can make us feel better in the short-term, they don’t go to the source of the stress and therefore are not helpful in the long term.

The stress and emotion is still sitting there, it is just masked – dulled by the effects of the alcohol or perhaps nicely compartmentalized into a little box – but there all the same. Ignoring it does not make it go away! It builds up inside us and eventually will escape the boxes we are trying to contain it in.

But unfortunately, the problems don’t stop there. A recent study1 in veterinarians has shown that frequent use of avoidance and alcohol as coping strategies to manage workplace stress can actually amplify the harmful effects of some job demands and increase levels of emotional exhaustion, burnout and suicidal thinking.  

Avoidance and alcohol don’t just not help, they actually hinder our response to workplace stress.

The good news is that we can all learn to use more helpful coping strategies. Having supportive relationships with your work colleagues and talking about work stresses, challenges and successes with people that understand what you are going through is a good place to start and we will pick up on this theme in subsequent blogs.

So as we move into another year, now may be the time to take stock of the coping strategies that you are using to recover from tough days in the clinic.

If you are frequently using alcohol to cope with the stress of the day and/or internalizing the stress  – what is one thing you could do differently in 2019 to actively manage your stress and increase your work satisfaction and longevity?

Why don’t you join Dr Cathy Warburton at Makeheadway for the Veterinary Balint Group held monthly across 6 sessions between May 6th – October 6th 2019? The Veterinary Balint Group Program is for all members of veterinary health care teams who want a better way to process and understand difficult clinical or communication experiences.  For more info, check out the brochure. Register HERE.

Written by Dr Cathy Warburton

1.Wallace (2017) Burnout, coping and suicidal ideation: An application and extension of the job demand-control-support model, Journal of Workplace Behavioral Health,32:2, 99-118
DOI: 10.1080/15555240.2017.1329628