A Risky Business

The results of the recent BEVA survey into injuries sustained by equine vets whilst at work will have surprised no-one. Every one of my colleagues has ended up in A&E at some point with everything from minor wounds to serious head injuries. My personal injury list would probably be typical - knocked out three times, stitched up twice (should have been more than that, but equine vets seem to come from the Monty Python ' 'tis but a flesh wound' mould - if it ain't actually hanging off then it's nothing a self-applied vetrap can't cure), a sundry array of black eyes and bruises. I'd like to think that after all these years I can read horses pretty well - I can generally tell when the explosion is imminent. With most horses I know when to push to get something done and when to tactfully retreat. And if my spider-senses fail me I'm generally pretty quick on my feet and can be out of the stable, whether through or over the door, quicker than you can say 'watch out'. So for every time the hoof has actually connected there have probably been another ten or twenty times that I've dodged the bullet and felt nothing more than the rush of air as the horse's foot has flown past my face.

Part of this is an accepted risk of the job. Horses are flight animals and naturally suspicious of anything out of their routine. I don't see them the 99% of the time that they're quiet, happy and contented just being horses. I only see them to inflict something that they regard as unpleasant - whether that be to put a gag on and examine their teeth, give them an injection, a rectal exam or try to place a needle into one of their joints. I went into this job because I like horses, but the truth is, with a few exceptions, the horses don't like me.

The horses I find easiest to deal with are those in professional yards. Racehorses, hunters, top level eventers. These horses may be seen as flighty and difficult by a lot of the horse world, but a horse kept in a busy regime, given plenty of work and, vitally, handled by professionals, tends to be a fairly easy animal for me to deal with. The last point is the crux. Professional horse people make handleable horses. If every second spent with a horse contributes to the sum of its education then having someone with years of knowledge, experience and intuition in charge of the horse 24/7 is like handing the horse a college degree. These are the people that I'm happy to have as my 'wingmen'. There are 5 or 6 of my clients that I would trust implicitly on the head of a horse I'm examining. They know when to distract the horse, when to be firm, where to put themselves in relation to the horse and when to warn me if they get a signal from the horse that it has reached the limit of its patience. They will also respect my safety and if I say I would rather the horse be twitched or sedated then there is no argument. Vets that work in clinics will have staff to work with all they time that they can have this relationship with (not to mention a set of stock to restrain the horse!). Us ambulatory vets have to cope with whoever is there at the time - and it can be a real lottery.

If you asked me to pick the horse which was most likely to injure me then it would most likely be a cob. I'm going to upset a few owners here but the stereotypical nightmare patient is a 15hh cob (big enough to be dangerous, small enough to be manoeuvrable), probably overweight and probably owned by a reasonably novice middle-aged lady. As a rule these horses have very few ground manners, are pushy, bolshy and have probably never been told off or asked to do anything they didn't want to do in their life. Add to that someone holding the horse who is inexperienced in reading the signals, doesn't instinctively know where to stand and probably won't let you use a twitch and you've got a recipe for disaster.

I use a lot more sedation than I used to. I probably sedate around 60% of the horses I do dentistry on now, though I would like that to be 95%! This is not because I'm scared of your horse or taking the easy way out. It's not even because I'm trying to rip you off for the cost of the sedation! It's because I think it's fairer for both the horse and me and ultimately for you, the client. I can do a much more thorough examination and treatment if the horse is relaxed. The horse has a relatively benign experience and it is consequently less stressful for the client. Plus the fact that I can do a better and more efficient job means that they get better value for money. It does not totally remove the risk of injury (one of the times I was knocked out was by a horse which had been sedated) but it reduces it to what I'd consider an acceptable level.

I do think that a lot of the risks that equine vets are exposed to, especially when treating horses out on yards as opposed to in a clinic, are unacceptable. In my ideal world horses would be regularly handled by a range of people, be taught manners and ground rules in a firm but fair way and clients would be lot more accepting of the advantages of correct restraint and sedation. Until such time I'll keep honing my lightning-sharp reflexes and when I get a bad feeling I'll walk away. I've only got one body to last me my working lifetime and sometimes it's just not worth the risk.

To sleep, perchance...

One of the hardest parts of starting to work as a vet in practice is learning to cope with both the lack of sleep and regularly disturbed sleep. We are required by law to provide a 24/7 service, and although some small animal practices have delegated their out-of-hours cover to specialist emergency clinics, this is not really logistically possible for equine practices. This means that, on occasion, the vet that you see at 5pm one evening may have been up and working for 36hrs straight. Quite often I have returned the following morning to re-visit I horse I saw in the middle of the night to find the client surprised to see me, expecting me to have the day off following a night on-call. If only!

To be honest as a new graduate I found this all relatively easy. Sure, as students we were used to working all day in the vet school, going out clubbing at night and turning up to spend the following day in clinics and lectures relatively bushy-tailed, if less bright of eye; all on the briefest of catnaps. And this was long before the advent of Red Bull! Nowadays I'm not sure whether it is age creeping up on me, or whether it has all worn a little thin after a couple of decades of being available to the horse-owing public round the clock, but I'm struggling.

Some colleagues report that they sleep very poorly when on-call, with one ear always half open for the shrill of the mobile phone. This has never been my experience. Like a cat I sleep any time, anywhere. Some would find it impossible to be roused from their bed by a 1am call, return to their bed at 3am and get back to sleep. Not me: my eyes are often closed before my head hits the pillow. I suspect that over the years this trait has served me well.

The cruelest call is the one which arrives 10 minutes after you have gone to sleep for the night. You leap to the phone, convinced that it is nearly morning, only to find that it is just minutes since you went to sleep. The feeling is hard to describe, but it is immensely disorientating. The call that you get just as you are pulling back into your drive after a night-time outing, making you set straight out for another, comes a close second in the cruelty stakes.

Although I am writing, as always, slightly in jest, I do feel that it's a serious subject. We don't get paid any more for turning out at any hour of the day or night. I often feel that I am not working at full capacity the day following a disturbed night. On extreme occasions I have felt unsafe driving and at risk of falling asleep at the wheel. It seems that there is little that can be done about it though. It's a 'suck it up' situation. For equine practices to operate at a staffing level that allowed for separate day and night staff they would have to raise the cost of veterinary provision to a level which the public would not accept. Don't get me wrong, we're not up all night, every night. However there comes a point where chronic lack of sleep and disturbed sleep impacts on your ability to function safely, your ability to provide a top quality service to your clients, your social life, your relationships, even your health. We all signed up for this. We all knew what we were getting ourselves into. We all, to some degree, suck it up and cope. It doesn't necessarily make it an ideal situation though.

Horses for Courses

Over the last few weeks I have been doing quite a lot of vettings. It would seem to be the time of year when people are looking for their equine proteges for the 2015 season. Four year olds have been started and backed and lightly exposed to competition. They haven't had a chance yet to have proved themselves, or to have tried and failed, therefore every young horse is 16 hands of pure untapped potential. Price is usually decided on the basis of breeding and the success of older siblings. A lot of these horses are very impressive in the flesh too and the temptation is there - buy this horse and you are buying your ticket to top placings in eventing, show-jumping or dressage. With an immaculately-bred horse with good conformation who has been started by a professional how could you possibly fail to climb your way to the top of the competition ladder? For those with deep enough pockets, now is the time to buy your way into the dream.

However I am increasingly seeing these horses bought by, put politely, riders whose aspirations don't necessarily match their abilities. It puts me in a very difficult situation as I am not required to give my professional view on whether the purchaser is likely to be capable of handling and riding such a highly strung horse. I might make a few comments about progeny from a particular line being known to be 'hot', but if the purchaser wants to buy a particular horse then that is their choice and they are fully entitled to make it. I do see that fewer of them seem to be involving an experienced advisor in the transaction and this is not a trend that I welcome.

A few weeks ago I vetted a horse for someone who hadn't ridden for over a year and who wanted a youngster to bring on and do a bit of riding club and lower level eventing. Their budget was clearly not insubstantial judging by the value of the horse they had asked me to vet. The horse in question was a four year old with world class breeding on both sides. However both lines were known for their sharpness and 'suitability for professional riders'. The horse was not long imported and newly broken in. It was still weak and undermuscled yet hugely impressive under saddle with enormous paces - a good walk, flashy trot and very balanced, correct canter. It was also sharp as a tack. The professional producer riding it for the vetting had a few 'nearly' moments. Yet the purchaser still wanted it. They were besotted. What could I do? I spoke to the vendor a week or two later and mentioned the unsuitability of the match. He agreed and said he'd tried to get them to buy any other horse on the yard except this one, but they were determind to have it and willing to pay full price.

I'd like to think that this horse will be the perfect horse for the purchaser. That they keep it on a yard with expert help, advice and guidance. That when it is better fed and muscled up it won't be even more tricky to handle and ride. That matching a young, talented and athletic horse with a novice rider with no experience of youngsters will turn out just fine. But I doubt it. I can almost hear the train crash from here.

My job is purely to assess the soundness of the horse for the activities intended, not to cast doubt on the riding abilities of the purchaser. It passed the vetting with flying colours. I said nothing. Was I wrong?

Paying Your Dues

Hands up who pays their vet bills straight away? Hands up who pays them eventually? Hands up who pays them... never?

One of the hardest things in veterinary practice is getting the money in. Particularly hard for us as vets as we have received next to no financial management training. Most of us are, in truth, pretty bad business people. But then we didn't choose this career because of our outstanding financial acumen. And we definitely didn't pick it because we thought we'd get rich. There is an inbuilt sense of guilt amongst vets about actually asking for money. Being seen as caring, and demanding money for our services, seem like rather uneasy bedfellows.

For some reason horse-owners in particular are remarkably bad payers. They are renowned for their delaying tactics and dodges. We understand that emergencies happen and are sympathetic to the sudden unexpected big bill, but a lot of our outstanding debts are for things like vaccinations. Really? We even have a policy of asking for payment at the time of routine treatment, but there is all too often an excuse, and once we're already at your yard it would seem churlish to drive off again without vaccinating your horse just because you 'forgot your wallet' - after all we've already booked that time slot to you and used the petrol.

Most of these people do pay eventually, some spontaneously, some with a little gentle coercion from our office staff. Occasionally, however, there is a client who walks off and abandons their debt completely - this is a little harder to swallow, and I think the tale below is one of the ones that has stung me the hardest.

Poppy was a little old pony with chronic lung disease. Poppy was retired and living out her life quite contentedly. We'd discussed finances with her owner, but to be honest, even with a lottery win there would be no miracles for Poppy. She managed OK day to day on a cocktail of steroids and various other drugs which, while not cheap, were in the grand scheme of vet bills a drop in the ocean. Poppy's owner managed to keep chipping away at her bill - every time she got paid she'd send us a cheque and while her bill never got fully paid off I appreciated her difficulties and her efforts to keep on top of it. Inevitably the time came that we could do no more for Poppy. It was time to let her go. I had actually taken a rare day off the day the call came, but because I had been responsible for Poppy all through her treatment the owner wanted me and only me to be present at the end, and I felt it was doing my best to both the owner and the pony for them to have a familiar face there at such a stressful time, regardless of the inconvenience it personally caused me. The deed was done and the owner was, understandably, very upset. I sat on the ground in the paddock with her for over an hour talking with her about her pony's life and confirming that her decision had been the right one for the pony. I then sent the owner home with a friend to have a cup of tea whilst I waited for the knackerman to come and take Poppy away. I helped him load her up, closed the gate and drove home, physically and emotionally drained.

Perhaps I was naive, but I expected the £50 cheques to keep appearing until the debt was cleared. However the moment I squeezed the owner's shoulder and helped her into her friend's car was the last I ever saw or heard from her. The remainder of the bill for the drugs (not a huge amount) has never been paid and I have never received a penny for my services that day in putting Poppy to sleep. Our letters are returned as 'not at this address', the phone number is no longer connected, the debt collection company have drawn a blank and to all intents and purposes Poppy's owner has disappeared into thin air. I'll be honest, it feels like a kick in the teeth. I have invested years and many thousands of pounds in my education and training. The drugs cost the practice money and have all been bought and paid for. The cost of the drugs used to put Poppy to sleep is not insubstantial without even factoring in my time and petrol. I have to say that the emotional hit is worse than the financial hit. I put a lot of myself into caring for Poppy and supporting her owner. I fielded long telephone calls debating treatment options and prognoses at the expense, often, of my own free time. In short, I cared.

Now I'm sure most of you find the actions of Poppy's owner abhorrent. It is, after all, theft. Without factoring in any professional time we are probably around £300 out of pocket as a result of drugs and fuel not paid for. I have decided that there is little I can do except take it on the chin. However if you ever see a moment's doubt or hesitation in my eyes when you ask if you can pay your bill in installments you know why. Once bitten...

A Case of Neglect?

Some days in this profession are a delight – uplifting, inspiring, motivating. Others are just plain depressing and upsetting. Both can, in their different ways, produce professional satisfaction, even if they don’t both produce quite the same spring in your step. 

A recent afternoon was, unfortunately, an example of the latter sort of day. Two ponies to euthanase, two completely opposing sets of circumstances.  The contrasts may sound a little apocryphal, too convenient and ‘pat’ to be true, but I promise this was a real day. There is no need for embroidered story-telling when life throws up such handy situations all on its own. 

The first pony came care of a telephone call from the council. It had been abandoned in a narrow strip of woodland at the side of a busy A-road with HGVs thundering past. Not tethered or haltered, just abandoned loose. Quite apart from the abject cruelty of the situation, the carnage that could have been caused should this pony have stepped out in front of a queue of 60mph traffic didn’t bear thinking about. Nor did the condition of the pony. She was a cob filly, 3 years old at most, and had had a foal recently. She inevitably had no microchip. Her body condition was best described as ‘emaciated’, in the same way that children seen on news-footage from some far-flung famine can be described as ‘emaciated’. She was severely anaemic, probably in part due to the external parasites that were so thick on her coat that you could barely see her white skin beneath. She had old wounds which had become fly-struck. She also had enough spirit left to give the men from the council the runaround when they tried to catch her. I sedated her and ended her life with as much dignity and respect as I could give her, accompanied by the continuous roar of trunk-road traffic. 

From there I drove straight to the home of a nicely well-to-do family who had some years ago purchased a Shetland pony as a companion for their other horses. Unfortunately years of grazing the wide expanses of rich grass afforded to the hunters had taken their inevitable toll on the pony’s waistline and feet and he had suffered from chronic laminitis for some time; the latest bout of which had come to spell the end of the road. He was the polar opposite of the filly – fat as butter, belly virtually scraping the ground. His bulging eyes told of the unbearable pain in his feet. I ended his life with as much dignity and respect as I could give him, accompanied by the noise of his owners wailing for the loss of their beloved pet. 

Back at the office I pondered the two ponies – two lives cut short by human neglect. The case of the first pony  was clear cut criminal neglect. The only reason that it wouldn’t end in court was the sheer impossibility of finding the owner of the pony. Had this been possible there would certainly have been a prosecution and a lengthy ban from keeping animals. I would have stood up in court and detailed the suffering this pony had endured. The photos would have horrified and convinced any jury that the animal had suffered criminal neglect at the hands of the owner. 

The case of the second pony is a little harder to untangle. Morally the owners believed they had looked after their pony to the best of their ability. They were ‘good owners’. The pony had love, expensive vet treatment, luscious grazing as far as the eye could see, company and shelter. What the owners didn’t have, despite many, many explanations, was an understanding of the needs (or lack of needs) of a small native pony designed to live on barren scrubland. They couldn’t bear to see him looking miserable in the carefully designed starvation paddock so let him back out in the knee-high grass with the end result of inflicting an excruciatingly painful and drawn-out death. 

I apologise for starting this blog with such a gloomy tone and for focusing on the low points of this job. I went home that day pleased that I had been able to act as an advocate for these two ponies who had suffered enough.  I also went home angry at people who were not prepared to look after the needs of animals they had chosen to take responsibility for. But most of all I went home confused as to which of the two cases I found most distasteful. Oddly, I think it may be the second.

Not Quite James Herriot...

Did you want to be a vet when you grew up? Maybe you are a vet. Or a vet student. Or a client. Maybe you're none of the above but are browsing the web on your coffee break, wondering whether anyone else is having a day at work as bad as yours. Rest assured, I probably am.

This is the blog of an equine vet working somewhere in the UK. I have had many years in the profession - plenty of time to hone my cynicism and bad sense of humour. In order to protect my clients, their horses and of course myself, I have chosen to remain anonymous. If you think you recognise yourself in any of my anecdotes, relax. It's probably not you!

This is a chance for me to show people the life of a vet from the other side of the stethoscope. My chance to refute all the claims of 'money-grabbing, heartless, blah blah blah'. Or perhaps my chance to simply lay my stories in front of you and let you make your own mind up.

Either way, clear the detritus of yesterday's lunch from my passenger seat, ignore the wet dog nose poking curiously in your ear and join me on my rounds. Probably best fasten your seatbelt though.