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Veterinary ‘Work-Life Balance’ Debate: Is Burnout A New Phenomenon?

Though many veterinarians around the country blame burnout and stress on increasing caseloads and overbearing clients, one veterinary practice manager questions whether these feelings are actually new.

Bash Halow, LVT, CVPM, suggested that a veterinarian's work-life balance has always been perilous, but that today's vets are expressing their dissatisfaction more.

Halow suggested that several factors may be impacting veterinarians' perceptions, including a constant stream of negative news which may be exacerbating the feeling that the sky is constantly falling.

“Quiet quitting” first came to light in 2021, when Chinese factory workers protested their employment in unstimulating jobs by doing the bare minimum to get by. In the United States, Halow argues, quiet quitting isn't caused by burnout, but because of organizational issues: workplace leaders have failed to keep the employees engaged.

The COVID-19 pandemic brought unprecedented challenges to all workplaces, including veterinary medicine. Staff shortages, new modes of workflow, client and employee angst, and health issues among clinic employees caused managers and employees to check out, often citing a lack of work-life balance as the leading cause.

Halow insisted that the work-life balance debate is mistaken in assuming that more life makes one happier. Instead, he suggested the work must cause employees to feel fulfilled and that they are part of a worthwhile venture.

“The road to happiness is mostly paved inside the borders of vocation, not vacation,” Halow noted.

Halow reiterates that though veterinary medicine can be difficult and emotional, it should not be overwhelming and unfulfilling. If a vet isn't getting the support, organization, and teamwork necessary to find fulfillment in work, it may be time to find access to it elsewhere.

A Tale Of The Two Surgeries That Brought Green Mask From Catastrophe To Happy Retirement

When multiple graded stakes-winning gelding Green Mask shattered both sesamoid bones in his left front fetlock during a workout in 2017, owner Abdullah Saeed Alamaddah and trainer Brad Cox knew that immediate care was needed for the fracture. The gelding was sent to the University of Pennsylvania's New Bolton Center for surgical fusion to stabilize the joint. The surgery, performed by Dr. Dean Richardson, was a success. For many racing fans, that's where the story ended – with a large amount of hardware holding everything together. By July 2018, however, Green Mask underwent a second surgery, this time to remove the plate and screws used to heal the fracture.

Though many of us watching from afar may not realize it, it's not uncommon for surgeons to go back in and remove the metal that was so crucial at the start of healing.

Depending on the type of fracture and the location, fractures are most commonly stabilized with stainless steel screws or plates and screws. Casts or splints, wires, cables, and other items are often used in combination. For Green Mask, Dr. Richardson used a locking plate that was placed down the front of the joint and a tension band cable that measured 1.7 millimeters in diameter placed behind the fetlock. Screws were inserted across the joint in the sesamoids to encourage fusion of the joint.

Surgeries requiring the use of plates and screws are carefully planned, with the first goal being preserving as much of the soft tissue around the area of the fracture as possible to keep the maintenance of the blood supply and to allow for faster healing. Plates are applied to the surface of the bone.

Dr. Richardson uses a combination of top-of-the-line technology and skills to repair every fracture. The use of computed tomography (CT) scans during orthopedic surgery allows surgeons to see the bone, blood vessels and soft tissues to accurately place screws and plates with minimum issues. The use of CT scans lets the surgeon plan and complete accurate reconstruction of fractures and proper alignment of joint surfaces to reduce the chance of arthritis developing and increase the chance of a return to full athletic function. In an injury like that of Green Mask, the goal is comfortable retirement.

A CT scan shows the results of a similar surgery to Green Mask's to repair shattered sesamoids. Image courtesy Dr. Richardson

With major surgeries such as this, the risk of infection is always a concern. Green Mask's injury was significant and involved soft tissue trauma at the same time as the sesamoid fractures. The time and surgical exposure required for the surgery and, most of all, the need for so much metal in the limb to provide stability all increase the risk that bacteria will get into the leg. Any foreign material such as stainless steel provides a surface for bacteria to survive in what is termed a biofilm. Infection associated with a biofilm on plates and bone screws will be difficult to control and can lead to delayed or failed fracture healing.

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There are two reasons why surgeons would perform surgery to first insert stainless steel plates and screws into a fracture and then to remove said plates and screws.

“It depends entirely on the nature of the original injury and the purpose of the horse at the time you're making the decision,” Richardson said.

In simpler cases than Green Mask's, such as a medial condylar of a cannon bone fracture, surgeons use a combination of screws and one steel plate, with the plan to remove the plate after three months.

“The reason you're removing the plate in this case is because the expectation is for that horse to go back and race,” Richardson said. “A horse isn't likely to race well with a large metal plate still on the cannon bone.”

Richardson explained that this is the same case in human athletes—if a plate is used in an area of the human that does a lot of bending, surgeons will remove that plate once the fracture is healed, and the athlete trains to continue activities.

Another case of inserting and removing hardware to repair an injury can be seen in the extended career of 2011 Kentucky Derby winner Animal Kingdom. After Animal Kingdom stumbled in the Belmont Stakes, fracturing his hock, Richardson performed surgery to repair the hock, by using screws to repair the fracture in the right place. The surgery was a success, with Animal Kingdom going on to win the $10 million Dubai World Cup in 2012.

However, there are times when a plate is a permanent fixture on a horse, and that's when the plate is located in an area that doesn't bend a lot. For example, plates involved with repairing a fracture in the ulna (elbow) can be kept in and the horse can return to the track.

Green Mask shows off in his field at Old Friends

“Most of the time, a plate in that location isn't going to cause a problem to a racehorse,” said Dr. Richardson. “However, in other places they will cause issues.

“Clearly that one set of circumstances where the plate is being removed is the planned goal, so you're keeping that in mind from the time you fix the fracture. You would virtually never do that in a horse unless they're going back to being an athlete. If you're putting a plate in and the horse is going to retire to be a broodmare, breeding stallion or pasture horse, we never remove the plates… with one exception.”

That one exception is when there is an infection that is localized to the inserted plate, which is what happened to Green Mask. Once bacteria have formed the biofilm on the steel, and infection occurs at the site of the plate. Systemic antibiotics don't often help, and infections such as these are rarely cured unless the metal is fully removed. In the case of Green Mask, his fracture had fully healed by the time the infection appeared, so it was safe to remove the plate.

“More than 90 percent of the time, if you have a fully healed fracture, or healed joint fusion (arthrodesis), and an infection is present, you go ahead and remove the metal,” says Dr. Richardson. “In nearly all cases, removing the infected metal will result in elimination of the horse's infection and that horse can go the remainder of his lifespan with any further related problems. Just as is true in human fracture repair and joint replacements, infection is the most single most important complication. Fortunately, the rates for this complication continue to decrease.”

The removal of the plate was a success for Green Mask, who later returned to his retirement home at Old Friends in Georgetown, Ky. The only sign of the initial fracture is the mechanical lameness present at the walk and trot. His fetlock is fused, which means it doesn't bend the way a normal joint would, resulting in a hitch in his step, but the joint is free of any signs of infection.

“He's seen as 'lame' because his movement is asymmetrical, but lameness and pain are not the same thing,” Richardson said.

Four years later, Green Mask is enjoying life in a paddock along the regular tour route at Old Friends. He will soon gain a new neighbor with the anticipated arrival of fan favorite Lava Man.

The post A Tale Of The Two Surgeries That Brought Green Mask From Catastrophe To Happy Retirement appeared first on Horse Racing News | Paulick Report.

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Can Ponies Distinguish Human Facial Expressions?

Most humans are good at giving someone a wide berth if they approach with a furrowed brow but how good are horses at interpreting our expressions? Dr. Katrina Merkies, researcher and associate professor at the University of Guelph and her team found out in a study involving 20 lesson ponies and some talented actors.

There has been past research conducted with flash cards, but this is the first study to document the response of equines that were shown happy, sad, angry and neutral facial expressions in person.

“In terms of behavior generally, the right brain processes emotions and particularly negative stimuli,” explains Merkies, “whereas the left brain is more related to social interactions and learned behavior.”

Horses see with the left eye things on their left side and with their right eye things on the right side and unlike humans, there's very little fusion in their optic nerves and they don't really have a lot of binocular vision.

The optic nerve brings information from the eye to the brain and crosses from the left eye to the right side of the brain and from the right eye to the left side of the brain. In horses, because their eyes are located on the sides of their head with largely monocular vision, it is easy to discern what they see with their left eye is processed in the right brain and visa versa.

After initial clicker training took place with the ponies so they would be likely to approach the human actors; two actors presented expressions of happiness, sadness, anger and neutrality.

As hypothesized, the angry and sad faces resulted in the ponies looking at the actors more often with their left eye first. The left eye glance corresponds with the right brain, which is in charge of processing negative stimuli.

Conversely, the ponies more often looked at the joyous expression with their right eye and interestingly the neutral facial expression came up with a 50/50 reaction!

The ponies also had more licking and chewing with neutral faces, and they focused their ears more on the actor and stood farther away from joyous or sad expressions. Another action noted in the study included heart rate, which was not affected by any of the facial expressions presented.

“I think it's important to note that although the horses did respond to the different facial expressions and they clearly distinguish between them that doesn't necessarily mean that they understand what we're feeling or that they feel what we feel,” says Merkies. “They may respond more to an angry face but that doesn't mean that they feel your anger and that there are other things taken into consideration like the way that you move your body and what else is happening in the environment.”

Merkies sums up, “Many different cues factor into how a horse will respond in any moment, but understanding our facial expression is important to social interactions. It's interesting that facial expressions are highly conserved across species, so even though we can have very different physiognomy (we look very different), for example mouse compared to a horse, compared to a human, but facial expressions are fairly similar which is very interesting and very helpful because if you can understand the facial expression from another being or another species, then you can know how to respond appropriately.”

Ramey: Which Vaccinations Are Worth A Shot For Your Horse?

Vaccination is certainly one of the most important interventions in health (human, animal, fish, etc.) that has ever been invented. But not all vaccines for horses are equally effective. Before the time comes for spring shots, I thought I'd give you some information about individual vaccines, and how well they are likely to work.* And by “work,” I mean, how likely they are to actually prevent the disease that they are supposed to prevent.

DISCLAIMER: By no means should you read this article and then go our and ignore the advice of your veterinarian. He or she may be aware of some individual circumstances that might make certain vaccines more or less useful in your area. But with the information below, if nothing else, you can have a good discussion.

FIRST THING: Vaccination is the process whereby a horse can be made somewhat resistant to a particular disease.

SECOND THING: Vaccines are not an iron-clad guarantee that your horse won't ever get sick with that disease.

Vaccines have enabled veterinarians to control and prevent many awful diseases, especially in the pet and livestock industries. However, while I know your horse is important to you, economically speaking horses are not as important as livestock or pets. That's perhaps one reason why there hasn't been a strong reason (read: return on investment) to spend a lot of time on developing and testing vaccines. So, in many respects, the equine vaccine field has lagged behind other that of other species.

It's actually pretty hard to determine how well – or even if – many equine vaccines work. That's because, when compared to most every other species, there's not much published data put out before vaccines are released, and not much data gets accumulated after the vaccines are out there. Otherwise stated, nobody really keeps track once the vaccines are released. That means that the sort of information you'd need to make a fully informed decision (effectiveness, rate of reactions, etc.) for your horse just isn't available. In fact, such aftermarket oversight isn't even required.

The rationale behind vaccination is pretty simple — you vaccinate your horse, you prevent a disease, right? To be perfectly honest, that's not always the case (and not necessarily through any fault of the vaccine).

Many vaccines simply claim to be an aid in the management of the disease, which can be quite a shock when your vaccinated horse still gets sick. The fact of the matter is that no vaccine is perfect. Using vaccinations to prevent disease should be just one part of an overall strategy to control disease in horses, a strategy that might also include such things as:

Isolation of sick animals
Keeping shared environments clean
Quarantine of new animals brought onto a premise

There's a lot more that can be said, of course, about the type of evidence that's (not) available and such, but let's get to the bottom line: which vaccines appear likely to be effective, based on the evidence we have.

EQUINE INFLUENZA (FLU)

In experiments, flu vaccines tend do pretty well at preventing disease caused when horses are challenged with a particular strain of virus. However, most horses don't live in laboratories, at least not the ones I take care of Unfortunately, field data – that is, how well the vaccines prevent the flu in barns, stables, and pastures – is extremely limited, and field trials have not shown the vaccine to be particularly effective at preventing the spread of influenza. In fact, if you consider that horses are pretty widely vaccinated against the flu (except in Australia, where, with the exception of one outbreak a number of years back, the disease doesn't occur), and that flu is still a very common problem, you might be drawn to conclude that the vaccine hasn't been very effective. In general, vaccinated horses will still get infected with flu virus, and even though they may show milder clinical signs of disease, they will still shed virus and so be a source of infection for other susceptible horses.

PLEASE NOTE: If you show your horse, there are many competitions and show organizations that have requirements for flu vaccines – make sure you're aware of them. This fact is independent of vaccine effectiveness.

EQUINE HERPES VIRUS (EHV, Rhinopneumonitis, Infectious Abortion, etc.)

There are three scenarios where your horse may be affected by a herpes virus.

1. Pregnancy. EHV (you don't want me to have to spell it each time, do you?) causes mares to abort their fetuses. And, happily, there is some evidence that EHV 1-4 vaccines (the numbers indicate a vaccine strain) do reduce the likelihood of abortion. However, the vaccines may not work very well if horses exposed to a high dose of the virus, and the rationale behind the five, seven, and nine month vaccine schedule is not at all clear. You'll probably do it if you have pregnant mares, because you'd feel terrible if your mare aborted from the virus, and you didn't vaccinate.

2. Respiratory Disease. EHV-4 can cause respiratory disease that is pretty much indistinguishable from the flu. There's some evidence that vaccination can reduce the severity and duration of respiratory disease after an experimental challenge, but it probably doesn't do anything to stop the spread of the disease, and particularly since many horses are exposed to the virus when they are very young.

In fact, latent (inactive) EHV-1 infection is quite common in horse populations worldwide. It has been estimated that inactive infections exist in something like 90% of the horses in some areas. Otherwise stated, EHV-1 vaccines probably don't do much good because horses are already infected in the same way that people with cold sores are carriers of the herpesvirus. Vaccination doesn't help when you've already got the disease.

3. Neurological Disease. No EHV-1 vaccine has been shown to prevent the neurologic form of the disease that periodically captures equine health headlines, and no vaccine claims that it can prevent the neurologic form of the disease. Period.

WEST NILE VIRUS

There is good evidence that vaccination against West Nile Virus is effective against preventing clinical disease and death in horses. You should follow the manufacturer's recommendations, but in some areas, those areas where there are lots of mosquitoes, more frequent boosting may be recommended in order to maximize the protective immunity. Ask your veterinarian for his or her recommendations if you're in an area where West Nile Virus is a particular problem.

POTOMAC HORSE FEVER (PHF)

PHF is more of a regional disease, mostly seen in the eastern United States. When the disease first came out, a vaccine was rapidly made available, and the early experimental data, which was based on challenge with a selected strain of the disease, was very good.

Unfortunately, there's not much data pertaining to use of the vaccine in the field, and what is there suggests that the vaccine doesn't work very well. That's probably because there are many strains of the disease (as I recall, it's at least nine), but only a couple of strains are in the vaccine. Bottom line is that the PHF vaccine is not likely to provide much protection against disease.

ENCEPHALITIS (Eastern, Western, Venezuelan)

Viral encephalitis is an uncommon, but regularly seen problem that mostly occurs in the eastern United States (VEE doesn't occur in the US, but it's occasionally crosses the southern border with Mexico). If your horse gets encephalitis, he simply isn't going to get better, so vaccination is your best strategy to prevent the disease. Ask your veterinarian for the best vaccination schedule in your area. The vaccine is very effective.

STRANGLES

Frankly, there's very little evidence to suggest that strangles vaccines work. In fact, most of the world doesn't vaccinate against strangles. In addition, strangles vaccinations have among the higher incidences of vaccine reactions. If you're using the intranasal vaccine, it's also possible for your horse to get sick from the vaccine strain of the bacterium. There are some newer vaccines that sound promising, but they're not here yet.

I don't recommend that my own clients use the strangles vaccine. And as I said at the start of this article, the vaccine is certainly not a substitute for hygiene, quarantine, and control measures. CLICK HERE for the 2018 position paper on strangles from the American College of Veterinary Internal Medicine (which does not advocate vaccination).

TETANUS

It works. Vaccinated horses survive tetanus infections, and non-immune horses die. We're not sure how long the vaccines last, but evidence from other species suggests that it's measured in years. Your horse is going to get plenty of opportunities to be vaccinated against tetanus if you, like most people, use a combination products (e.g., “Four-Way”) and there's no evidence that it will hurt him if he gets vaccinated against tetanus every year.

EQUINE VIRAL ARTERITIS (EVA)

EVA is another annoying viral disease, and vaccines are used in distinct regions of the world. These regions generally not include the US; they're not allowed to be used in the UK. That said, it does seem that the vaccine is effective at preventing the carrier state in vaccinated colts. However, safety concerns about the vaccine exist, the safety of vaccinating pregnant mares is up in the air, and there are some worries about vaccine-caused disease. It's also pretty much impossible to tell if a horse has been vaccinated, or if it's been exposed to disease: this can be a concern if you're planning on shipping a stallion internationally.

RABIES

In some parts of the United States, those with high rabies activity, it's advisable to vaccinate your horse. Plus, in some states, it's the law. The available vaccines are effective, and in areas where there is rabies in the wild population, it's important. Plus, you can get rabies from a horse. Why take that chance?

HOMEOPATHIC NOSODES

You may not have heard of these things, and they aren't common, but they're out there. Nosodes (which are not, in fact, homeopathic), are prepared from high dilutions of infectious agents, material such as vomitus, discharges, or fecal matter, or infected tissues. Curiously, the founder of homeopathy, Samuel Hahnemann, decried the use of such preparations and was even a supporter of smallpox vaccination. There is no evidence at all to suggest that homeopathic nosodes have any effectiveness. To the contrary, there is one case reported in the human literature where a patient followed her homeopath's advice and took a homeopathic immunization against malaria before traveling to an endemic area. The patient promptly got malaria. Nosodes have also failed to protect puppies against parvovirus.

I think that it is of note that the British Faculty of Homoeopathy acknowledges the effectiveness of vaccines and recommends their use in humans. Seriously, just don't bother with them.

Heck, don't bother with homeopathy, either – CLICK HERE to see why.

A QUICK NOTE ABOUT TITERS – In some circles, people are trying to decide whether or not to vaccinate their horses based on a measure of immunity in the blood. Those measures are called titers. It sounds like a good idea, but there's actually no information in horses to suggest that a certain titer equals disease prevention. Seems like a good idea, but, in reality, nobody really knows what a particular titer means for a horse.

Oh, one more thing — don't fall for all of the negative stuff that some people say about vaccines. They aren't 100% effective at preventing disease, but they don't cause widespread harm, either. There are a lot of dopey things said about vaccines – CLICK HERE to read about some of them.

So there. The bottom line is that some vaccines are likely to help your horse(s) – others, not so much – and that nobody really keeps track. That's why it's important to work with your veterinarian to establish the ideal schedule for your horse – he or she should have a good idea of particular problems in your neck of the woods.

Dr. David Ramey is a vocal advocate for the application of science to medicine, and—as such—for the welfare of the horse. Thus, he has been a frequent critic of practices that lack good science, such as the diverse therapies collectively known as “alternative” medicine, needless nutritional supplementation, or conventional therapies that lack scientific support.

This article original appeared on Dr. Ramey's website, doctorramey.com and is reprinted here with permission.

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