Start by Stopping

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In our last blog we explored the importance of prioritising wellbeing. Wellbeing is the foundation of feeling and functioning at our best, both in and out of work. In this blog, we look at the practicalities of wellbeing as an active process and what that can actually look like day to day.

Whilst there are various definitions, VetLed’s approach to wellbeing is holistic and can be categorised in many ways including physical, emotional, spiritual and social. For now, we want to focus on awareness as a first step to improving our individual wellbeing. 

Awareness? Yes, awareness of your body and mind in any given moment. Awareness of your environment and your interactions with it. Awareness of your tendencies, capabilities and limitations. Awareness comes in many forms and is a good starting point for addressing issues important to your wellbeing.

In the busy world of 2018, it is so easy to be completely caught up in ‘doing’. Doing the best job we can as veterinary professionals, doing the best for our friends, doing the school run, doing our online banking… doing, doing, doing. The problem with doing is that it can result in us living our lives highly focused on what is about to happen and worrying about what just happened. Much of the time, this is done in an ‘autopilot’ state. We forget to be present in the present!

Our brain’s default state is to subconsciously scan for threats and automatically react to them. This served us well in a world in which we depended upon survival, as was the case 200,000 years ago. However, most of the time in our modern world we have totally different ‘problems’ and it is very easy to be overwhelmed by the myriad of demands in our lives (e.g. work, financial, family). Couple this with the constant request for our attention that technology brings and unsurprisingly, our default mode of doing doesn’t serve us as well as maybe it once did. So now more than ever there is reason to sometimes adopt a new mode; that of ‘being’. 

Being is a state which, in many ways, is the opposite of doing. If doing is goal orientated and aimed to lessen the gap between how things are at present and how we want them to be, then being is devoted to achieving no particular goals. In this state, there is no need to be constantly evaluating, instead just allowing and accepting what is, without an urgent desire to do anything differently. 

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What does this mean in practical terms for you every day? Quite simply, it just means to stop what you are doing, to pause and to observe without judgement. This seemingly straight-forward task, like so many things, is actually sometimes quite difficult. Difficult because we simply forget. Until it is rehearsed and becomes routine most of us will need reminders and triggers to take moments such as these. 

‘Being’ is a skill and like any skill, it becomes easier and more effective with practice. Perhaps start by pre-planning a few moments each day when you will be uninterrupted. During that time, plan to briefly pause and observe something without assigning meaning or judgement. This could be how you physically or mentally feel, or simply what you can see, smell, taste or hear.

In essence, this is the foundation for mindfulness practice - something which has wide-reaching benefits and is intricately linked to wellbeing on many levels. However, at its most basic level, the focus is on taking a pause and interrupting your ‘doing’ mode for a few intentional moments each day. This allows us to develop a greater awareness, which is a great starting point. With awareness, we can start to notice our physical and emotional state and from there we can build on the positives and work to improve issues that may be holding us back.

Doing is an essential mode for succeeding and progressing in our modern world but sometimes stopping and taking a step back, whilst not intuitive, can ultimately allow us to ‘do’ more. 

And of course, feel better.

About VetLed

VetLed was founded to provide support to veterinary professionals who are faced with significant challenges every day. The VetLed team believe that creating a compassionate and professional workplace culture that puts people wellbeing and patient safety at the core of everything we do, will in turn, improve animal and people welfare. The VetLed performance approach supports veterinary professionals to maximise their own wellbeing and to fully utilise their skills to deliver optimal patient care.

Grounded in Wellbeing

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In this guest blog series by VetLed (see below) we are going to be looking at wellbeing, and specifically wellbeing within the veterinary profession. This is something which is arguably most relevant in Emergency and Critical Care practice.

On with the blog:

Wellbeing is something that is close to all of our hearts at VetLed, something that drives us, and something that makes up spring up out of bed in the morning (that and the very loud alarm of course!). It could be said that wellbeing, mindfulness, self-care and so on are the buzzwords of 2018, and that may be true. But we truly believe that there are many more layers that underpin these ideas – strip back the buzzwords and you get to some really fundamental notions that could help us all to feel just a little bit better, feel a little bit more well and that can only be a great thing!

As veterinary professionals, it is clear to see how we might feel that striving to meet our high expectations could provide us the ingredients for wellbeing and happiness. We have worked for so long and so hard to gain our highly sought-after qualifications. Surely then this relentless pursuit of high standards is the road to fulfilment?

However, as was identified during the Vet Futures study in 2015, the reality for many is that life in this profession presents many challenges which can affect our wellbeing. This puts into question whether or not success can simply be measured by the achievement of academic and professional goals and whether or not there is another area we could choose to prioritise. 

Extensive research on the topic of happiness proves that higher levels of subjective wellbeing actually improves nearly every business and educational outcome. For example, happier doctors were found to be 19% more accurate when making correct diagnoses.[1] This starts to highlight why addressing our wellbeing should be the priority and form the foundation for success and achievement…and not the other way around. 

The analogy of the safety demonstration on an aircraft serves as a good metaphor; ‘ensure your own oxygen mask is fitted before helping anybody else’. As a profession we see ourselves as providers of care and can be reluctant to look after ourselves or to look to others to take care of us. During a wellbeing campaign at Guys and St Thomas’ NHS Foundation Trust, Dr Farquhar, a consultant and researcher of sleep medicine says that “our patients are always better served by clinicians who have had appropriate periods of rest during their shifts”. Rest and sleep is an essential aspect of wellbeing and this serves an important message as to how looking after ourselves must come first if we are best serve our patients. But we all know that that can be easier said than done right?

Rest and sleep is an essential aspect of wellbeing

Rest and sleep is an essential aspect of wellbeing

Research shows that three-quarters of veterinary sick days in the UK are a direct result of work-related pressure or stress and that as a general working population, only 2 in 5 employees in the UK are working at peak performance.[2] Furthermore, there are numerous cross-sectional studies which provide evidence that wellbeing affects our productivity and ability to work effectively.[3-5] By prioritising our physical and mental state we can improve our ability to perform at our best and provide our patients with better levels of care.

It is not only our performance which is at stake when it comes to wellbeing. More importantly (and not surprisingly) it is also our long-term health. Whilst it might sound almost too obvious to say, attending to our wellbeing has significant impacts on our longevity and quality of life. Evidence shows us that pleasant emotions associated with acts of wellbeing can protect us against the physiological effects of stress [6,7] and a review of 30 longitudinal studies demonstrated a link between the impact of wellbeing on life expectancy similar to that of smoking.[8] Despite this knowledge, it is a human condition to be driven to achieve what we perceive to be important at the time. This makes it all the more important to make attending to self-care and wellbeing a priority and to put plans in place to give ourselves the best chance of fulfilling this intention. 

It is not only ourselves and our patients who are positively affected by our attention to wellbeing. Our colleagues may also be better off, with the subsequent benefits for themselves, their patients and those around them. Evidence suggests that cooperative behaviours are associated with pleasant emotions and that people with higher levels of these emotions are more likely to demonstrate collaboration instead of avoidance or competition.[9]

If we explore a fundamental theory of motivation from Abraham Maslow’s hierarchy of human needs, it’s easy to see the significance of physical and mental wellbeing. Fundamentally, we must feel physiologically and psychologically well and secure, and only then can we focus on accomplishments and achievement. 

Maslow’s hierarchy of human needs

Maslow’s hierarchy of human needs

Over the course of this series, we will be looking at this in more detail and exploring more fully the practicalities of ‘wellbeing’ and what that means to us as veterinary professionals. But essentially and in summary, your patients, colleagues and practice will be better served by a team who feel and function at their best. Wellbeing is the strong foundations, the grounding if you will, that supports and enables all that comes after – it isn’t the pretty flowers growing up the side of the house, it is the solid metre deep footings that the structure is built on. Good foundations lead to stable structures; rocky foundations can lead to landslides! 

But most importantly, you deserve to be healthy and supported to thrive, not simply survive. Being grounded by wellbeing increases the likelihood of subsequent success, therefore starting a positive cycle in which you feel better, function better and therefore achieve more; further reinforcing your foundation of wellbeing from which the cycle continues. 

And long may that cycle continue – allowing you the chance to enjoy the pretty flowers! 

About VetLed

VetLed was founded to provide support to veterinary professionals who are faced with significant challenges every day. The VetLed team believe that creating a compassionate and professional workplace culture that puts people wellbeing and patient safety at the core of everything we do, will, in turn, improve animal and people welfare. The VetLed performance approach supports veterinary professionals to maximise their own wellbeing and to fully utilise their skills to deliver optimal patient care.

References:

  1. Achor, S. (2010). The happiness advantage: the seven principles of positive psychology that fuel success and performance at work. New York, Broadway Books.
  2. BMG Research Employee Panel, March 2017 on Health and Wellbeing at work. Available at: http://www.bmgresearch.co.uk/workplace-health-wellbeing-edition-march-2017/ [Last accessed May 2018].
  3. Donald I, et al. International Journal of Stress Management 2005; 12(4): 409–423.
  4. Robertson I, & Cooper, C. (2011). Well-Being, Productivity and Happiness at Work. Basingstoke: Palgrave Macmillan. 
  5. Ford, M, et al. Work and Stress: An International Journal of Work, Health and Organisations 2011; 25(3): 185–204.
  6. Folkman S. Anxiety, Stress, and Coping 2008; 21(1): 3–14.  
  7. Bränström, R. BMC psychology 2013; 1(1): 13.
  8. Veenhoven, R.  Journal of happiness studies 2008; 9(3): 449–469.
  9. Boehm, J, & Lyubomirsky, S. Journal of career assessment 2008: 16(1): 101–116. 

Monthly Journal Round-Up - May/June 2018

Thanks as always to Lara Brunori DVM CertAVP MRCVS

Clinical practice reviews:

  • MacFarlane, P. (2018) ’Managing perioperative pain in dogs and cats’. In Practice, 40(4), pp.130-140.
  • Bradbrook, C.A. & Clark, L. (2018) ‘State of the art analgesia - recent developments in pharmacological approaches to acute pain management in dogs and cats. Part 1’. The Veterinary Journal (Early view).
  • Bradbrook, C.A. & Clark, L. (2018) ‘State of the art analgesia - recent developments pharmacological approaches to acute pain management in dogs and cats: Part 2’.The Veterinary Journal, 236, pp. 62-67.
  • Hagman, R. (2018) ‘Pyometra in small animals’. Veterinary Clinics of North America: Small Animal Practice, 48(4), pp. 639-661.
  • Clarke, D.L. (2018) ‘Feline ureteral obstructions Part 1: medical management’. Journal of Small Animal Practice, 59(6), pp. 324-333.
  • Clarke, D.L. (2018) ‘Feline ureteral obstructions Part 2: surgical management’. Journal of Small Animal Practice (Early view). 

Clinical studies:

Prospective:

  • Seitz, M.A. et al. (2018) ‘Evaluation for association between indwelling urethral catheter placement and risk of recurrent urethral obstruction in cats’. Journal of the American Veterinary Medical Association, 252 (12), pp. 1059-1520.
  • Ortiz, V. et al. (2018) ‘Evaluating the effect of metronidazole plus amoxicillin-clavulanate versus amoxicillin-clavulanate alone in canine haemorrhagic diarrhoea: a randomised controlled trial in primary care practice’. Journal of Small Animal Practice (Early view).
  • Walters, A.M. ‘Evaluation of the agreement between focused assessment with sonography for trauma (AFAST/TFAST) and computed tomography in dogs and cats with recent trauma’. Journal of Veterinary Emergency and Critical Care (Early view).
  • Ash, K. Et al. (2018) ‘Performance evaluation and validation of the animal trauma triage score and modified Glasgow Coma Scale with suggested category adjustment in dogs: A VetCOT registry study’. Journal of Veterinary Emergency and Critical Care, 28(3), pp.192-200.

Retrospective:

  • Schwartz, Z & Coolman, B.R (2018) ’Closure of gastrointestinal incisions using skin staples alone and in combination with suture in 29 cats’. Journal of Small Animal Practice, 59(9), pp.281-285.
  • Canonne, A.M. et al. (2018) ‘Angiostrongylosis in dogs with negative fecal and in‐clinic rapid serological tests: 7 Cases (2013‐2017)’. Journal of Veterinary Internal Medicine, 32(3), pp. 951-955.

Case reports: 

  • Matiasovic, M. Et al. (2018) ‘Barium peritonitis with abdominal abscessation’. Journal of Small Animal Practice (Early view).
  • Kjaergaard, A.B. et al. (2018) ‘Treatment of carprofen overdose with therapeutic plasma exchange in a dog’. Journal of Veterinary Emergency and Critical Care (Early view). 
  • Leary, M.L. & Sinnott-Stutzman, V. (2018) ‘Spontaneous gastric dilatation-volvulus in two cats’. Journal of Veterinary Emergency and Critical Care (Early view).

For a copy of any of the papers mentioned in this post (personal education purposes only), please email lara.brunori@gmail.com.

Pick of the Month

‘Closure of gastrointestinal incisions using skin staples alone and in combination with suture in 29 cats’
Schwarz, Z. & Coolman, B.R., Journal of Small Animal Practice, 2018, 59(9), pp. 281-285.

Various stapling techniques to close gastrointestinal incisions have been reported in humans and multiple animal species. 

The use of specific devices like linear and circular staplers has been successfully implemented in human medicine. However, their application in veterinary practice is restricted by their high cost, limited availability and size which is often too large for our smaller patients.

The use of standard skin staples instead has been trialled in pigs and successfully used in dogs both in experimental and clinical settings.

According to the authors, this retrospective study is the first publication describing the use of skin staples for closing gastrointestinal incisions in feline patients. 

The study involved 29 cats undergoing gastrointestinal surgeries in a US-based referral centre. Each gastrointestinal incision and closure has been considered separately, for a total of 42 procedures: 

  • 15 gastrostomies 
  • 1 partial gastrectomy 
  • 12 jejunotomies 
  • 2 jejunal anastomosis 
  • 12 colonic anastomosis 

The procedures were performed by four different surgeons with different skill levels: one Board-certified surgeon, one residency-trained surgeon, one surgical resident and one emergency veterinarian. All surgeons underwent a short training session by one of the senior surgeons who was comfortable using the stapling method.

Gastrostomies and gastrectomy were closed with a hybrid technique combining sutures with monofilament material including the mucosa and submucosa and skin staples for the seromuscular layer. 

Jejunotomies and jejunal anastomosis were closed with only one layer of staples while colonic anastomosis was either closed with the hybrid method (when the surgeon could distinguish the mucosa/submucosa from the seromuscular layer) or with only one layer of skin staples. 

Overall 26 out of 29 cats survived at a 12-day follow up. No dehiscence of any of the gastrointestinal closures was reported and the three deaths were deemed not directly related to surgical procedure failure: two cats were euthanised as a consequence of a neoplastic process diagnosis and the third cat suffered a cardiovascular arrest in the immediate post-operative period.

This study, however interesting and bearing encouraging results, presents several intrinsic limitations:

  • A small sample size
  • No control group
  • The decision of using a hybrid or single technique was not randomised and left to the surgeon’s subjective judgment
  • The stapling technique described requires a scrubbed-in assistant which is not always possible in primary/Out-of-Hours practice
  • Stapling was not considered for linear incisions of the small intestine unless already dilated (i.e. from the previous presence of a foreign body)
  • No post-mortems were performed on the deceased cats
  • The follow-up period reported is fairly short and mainly focuses on evaluating the risk of dehiscence for the stapling technique. No long-term consequences have been assessed. There was a brief mention of a few cats (unspecified number) undergoing radiography and followed up to a 6-week period in which the authors found the staples migrating into the gastrointestinal lumen to then be passed with the faecal material.

Conclusion:

In conclusion, this study shows that standard disposable skin staples can be safely used alone or in combination with regular sutures for feline gastrointestinal closures. These techniques can be performed by surgeons of various levels of experience without any significant short-term complications. Nevertheless, further studies with larger samples and longer follow-up periods are needed to confirm the encouraging results reported by the authors.

For a copy of any of the papers mentioned in this post (personal education purposes only), please email lara.brunori@gmail.com.

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