Tuesday, 6 December 2016

What is a good job? Fulfilling your hierarchy (Part One)

It is not uncommon to be asked “why did you become a vet?” And with a certain exasperated sigh and life flashing before the eyes thousand mile stare, your answer will be stock: “I care about animals.” When perhaps really what you actually meant was “all those years ago, I did care about animals, science and medicine excited me, knowledge excited me, I thought the money would be good, vets drove a good car, and…….. there was a certain level of kudos.”

But when asked 10 to 20 years later, you realise it was all smoke and mirrors. You still do care about animals. But do they care about you? Do they **$!

Almost every survey on the veterinary profession returns depressing figures of poor job satisfaction, and with it the unedifying relationship with mental health. In any other profession, this would and should not just set alarms bells ringing but call in the fire brigade.

In 1943 an American psychologist Abraham Maslow presented the theory that human actions are directed toward goal attainment (“A Theory of Human Motivation”). This is a theory of psychological health predicated on fulfilling innate human needs in priority, starting from mere physiological subsistence, to belonging to a social circle, eventually in pursuing your talent and culminating in self-actualization.

Maslow’s Hierarchy of Needs has often been represented in a hierarchical pyramid with five levels. The base levels are considered physiological needs, while the top levels are considered growth needs. Vitally, any lower level needs must be satisfied before higher-order needs can occur, and if the deficiency needs aren't satisfied, the person will feel the deficit, with potential clinical results, and this will stifle his or her development.

* Physiological – air, food, water, sex, sleep.
* Safety – security of environment, employment, resources, health, property.
* Belongingness – love, friendship, intimacy, family.
* Esteem – confidence, self-esteem, achievement, respect.
* Self-actualization – morality, creativity, problem solving.

When Maslow's hierarchy is applied to work situations, it implies that managers/partners/directors have the responsibility, firstly, to ensure the deficiency needs are met. This means, in broad terms, a safe environment and proper wages. Secondly, it implies creating a proper climate in which vets can develop their full potential. Failure to do so often results in frustration, poor performance, low job satisfaction, and increased withdrawal from the organization and even within the individual. Achieving it would mean the reverse; a motivated, engaged and happy vet and the practice would be regarded as a more considerate, supportive and interested organisation.

Importantly good leaders/managers need to have this level of understanding if they are to be in a position to motivate. And to be a good leader and manager you need to recognise that people are different and at different stages in their development or hierarchy. Some people come to work to earn money (existence needs) but have no desire either to get on with others (belongingness needs), or earn promotion (growth needs). Others work to meet people and have a personal challenge and sense of achievement (belongingness needs). Others work to gain experience to get promotion (growth needs). For others, it may be a combination of these. How you go about influencing or motivating these needs is up to you and depends upon the person. For example, existence needs may mean simply paying someone enough, belongingness needs may be improved communication, recognition and praise; and growth needs may be training, encouraging creativity, involvement in practice decisions, new challenges etc.

So to return to the title – “what is a good job?” A good job is one which satisfies your needs. Your needs at the time and your potential needs as you develop.

Ben Sturgeon

Wednesday, 30 November 2016

The Five Freedoms: Useful Facts? Or Just Words?

I have a new word for you, “hyper-normalisation”, well maybe not that new (Alexei Yurchak 2006, Everything was Forever, Until it was No More: The Last Soviet Generation) but describes a failing system, a system everyone knows is failing, but as no one can imagine any alternative, the “pretence” of normality is maintained. Over time, this delusion becomes a self-fulfilling prophecy and the “fakeness” is accepted as real.

In 1965, the UK government commissioned an investigation, led by Prof Roger Brambell, into the welfare of intensively farmed animals, partly in response to concerns raised in another book, this time by Ruth Harrison (Animal Machines 1964). The outcome of the report were the five freedoms:

Freedom from thirst, hunger and malnutrition
– By ready access to a diet to maintain full health and vigour

Freedom from thermal and physical discomfort
– By providing a suitable environment including shelter and a comfortable resting area

Freedom from pain, injury and disease
– By prevention or rapid diagnosis and treatment

Freedom from fear and distress
– By providing sufficient space, proper facilities and the company of the animal’s own kind

Freedom to express normal behaviour
– By ensuring conditions which avoid mental suffering

These five freedoms have been adopted world wide and also form the basis of two key pieces of animal welfare legislation in the UK, The Protection of Animals Act 1911 which states “to cause unnecessary suffering by doing, or omitting to do any act and” The Animal Welfare Act 2006 which goes further by introducing a “duty of care” not only to avoid conditions, that may lead to suffering, but also to promote positive welfare.

The sharp among you will note that five freedoms are, in fact eleven and importantly are all outcome measures. The freedoms are not legal precedents either but only represent an ideal or a kind of check list to assess the quality of a husbandry system, realistically the definition “freedom from” should perhaps be interpreted as “free as possible from.” Furthermore the five freedoms cannot really capture the current knowledge of biological processes or predisposing situations which may affect welfare, especially in horses.

A simple example of this would be in the failure of the freedoms to address the potential for long-term problems. Fulfilling freedom from hunger or freedom from thermal and physical discomfort or freedom from pain, injury and disease highlights the shortfall possibilities of a stabled horse. In such circumstances horses will experience periods of effective starvation (usually overnight) as well as generally receive concentrate high energy feed and by nature of their confinement, be exposed to potentially harmful air spaces. Furthermore, a comparison between feral and stabled horses shows feral horses spend 60% of their time eating, 10% lying, 20% standing and 10% in other activities, whilst stabled horses eat 15%, lie 15%, and stand 65%. This is a clear change in normal behaviour as well as potentially predisposing to long term health issues such gastric ulceration, abdominal pain, various stereotypies, and inflammatory airway conditions although it could be argued that such horses receive a high level of “stable management”.

The implication is that any true “outcome-based” guidelines on welfare advice should include or consider chronic indices of a failure to cope with physical and emotional challenge.

This latter point is perhaps highlighted in the fifth freedom: Freedom to express normal behaviour. This is perhaps the most interesting or controversial because this is the only “to” freedom, the others all being “from”. The freedom “to” must bring into question what “is” normal behaviour? Freedom to roam, freedom to compromise the welfare of another horse, complete sexual freedom? Arguably a horse demonstrating behaviours relating to pain such as napping, ducking, refusing to jump, failing to yield are all “normal behaviours” yet they are in response to noxious stimuli to which a horse would unlikely present itself voluntarily. This approach however, leads to sophistry, is best avoided but has led to the evolution of the five freedoms to the Five Domains categorizing nutrition, environment, health, behaviour and mental state. The main change with the Five Domains is the acceptance that animals can express rewarding behaviour or positive experiences as well as negative ones hence determining its overall welfare status, and is the basis for the emerging science
of “equitation”. It highlights for example whip use where a horse is “just being corrected” or “encouraged” and questions whether the benefit outweighs the cost? Importantly it makes us consider the things we do on the mental state of horses under our care.

Let me finish with another new word, in fact according to the news the most used word (thanks to Brexit and Trump) this year, and again from another book (Ralph Keyes 2004, Post Truth). Post-truth refers to the rebuttal of factual evidence with reliance on emotional disconnection from those facts. We as vets see the evidence of a failure to consider or uphold the timeless principles enshrined by the five freedoms; gastric ulceration, inflammatory airway disease, stereoptypies, stress fractures, tendon failures, displacement activities, laminitis to name a few. Acting as the bastions of welfare; physical and mental, is in our remit and as scientists and medics we should not ignore the information at our disposal, what is happening in front of us, nor what is factually emerging.

Ben Sturgeon
BEVA Ethics and Welfare Committee Member

Wednesday, 25 May 2016

The Coming Storm? Horse Genetics and You

The date is significant – 6th of May 2016, this may be the date that horse racing changed, the date equine sports medicine changed, the date that we all changed a little.  What happened? The announcement by Hugo Palmer of his decision to withdraw 2000 Guineas winner Galileo Gold from the Epsom Derby was informed by the results of a genetic test.
Of course the marketing people for the test were pretty happy –
“It is not the first time that a key decision to race a horse in the Derby has been made based on a combination of traditional methods and our genetic tools.”

“Hugo has a clear understanding of how to combine the scientific information with his deep knowledge and understanding of the horse to ensure it is given the optimal opportunity to perform at its best.”

“We firmly believe that equine genetics will enhance the Thoroughbred breed by allowing owners and trainers to understand more about how to get the absolute best out of each individual horse for both racing and breeding.” 
Whichever way you look at it, such tests are here to stay.
The modern Thoroughbred can be traced back some 300 years to the arrival, in England, of 3 stallions in the 17th and 18th centuries, providing the paternal genetic basis for the entire breed.  The natural athleticism has been selected for, and enhanced by breeders ever since, aided by management, nutritional and environmental influences, producing the modern equine athlete.  Whilst calculated environmental influences play a large role (up to 65%) on a horses’ development, a significant proportion then lies in athletic inheritance.  It is however, both damning and interesting to note that winning times in the Classic Thoroughbred races, have improved little in over 100 years.
The successful mapping of the horse genome in 2007 has provided a tool for evidencing apparently desirable traits such as speed and muscle development along with detrimental genes (Webbon 2012).
 Equine Genetics Table
The commercial applications are already evident in some breeds and breed societies such as Foal Immunodeficiency Syndrome in Fell and Dale Ponies, in Lavender Foal Syndrome and Combined Immunodeficiency in Arabs and perhaps most significantly, due to potential numbers involved, in Polysaccharide Storage Myopathy in a variety of sports horses.  The genetic tool then would have a potential influence upon carrier identification influencing breeding &/or upon the long term environmental impact, husbandry, diet and training schedules that may occur in for example, carriers of PSSM genes. As a result, we can only hope to improve their direct welfare and reduce the potential for severe cases of homozygous matings.
This is extremely encouraging and the additional use of SNP (Single Nucleotide Polymorphism) has allowed mapping of single base variations between DNA sequences and ultimately identification of sequences within “phylogentically superior” horses that may be used as markers for their “superiority”.  Most notably this has identified myostatin (MSTN) as a genetic marker and provides the thrust of commercial interest due to performance implications and was the basis for Galileo Gold’s withdrawal. 
As highlighted, despite years of “trained eyes” looking over horses and selecting the best apparent traits, winning times in the Classic Thoroughbred races, have improved little.  Why this is, is hard to say other than be flippant in the skill of the apparent “trained eye”.  Of significance is the use of such genetic tests to influence the breeding program.  Using the gene test to inform stallion selection (selecting for sprinters with homogeneous MSTN foals known as C:C) for each mare, one breeder decreased his proportion of T:T foals (those best suited to longer distances) produced from 18.0% to 6.8% in 1 year (2011), decreasing it further to 4.3% in 2 years (2012). Notably, of the 30 male foals produced in 2012, none had a T:T genotype.  This speed of change is incredibly rapid when compared to simple “eye-ball” or “self-selection” breeding.
The question is are we promoting natural selection or genetic engineering and what does this mean?  How will it impact on horse numbers and their treatment (especially if their “genetic blue print” is not deemed advantageous), on the acceptance of blood screening at sales for example, or in the doomsday scenario on future loss of heterogencity within the Thoroughbred breed especially, leading to more potential cases of “selected” diseases such as laryngeal hemiplegia.
Irrespective, the opportunity to breed horses with greater muscle mass will appeal with the opinion that if “we” provide the apparent best horse, the rest is up to you.  This will influence practical breeding with breeders attempting to optimize progeny to a specific genotype, to breeders with foundation mares and stallions utilising genetic profiles to financial advantage, and importantly to trainers and owners in influencing sales decisions, veterinary pre-purchase examination protocols, as well as then reducing operational costs by introducing tailored exercise programmes for individual horses.
However, a genetic “result” does not make a phylum.  Heritability is variable and highlights that individual differences may be attributable to genetic differences.  This provided me with the dismay I felt as I heard Mr Palmers’ decision.  The heritability variation makes environmental factors very important and emphasizes that the presence of a specific gene or variant, with its proposed advantages, is specific to a particular population in a specific environment and emphasizes the continuing need for appropriate veterinary advice on training, environmental and disease modification aspects.
Interestingly, the heritability of complex diseases are or have also been elucidated:
• Rhabdomyolysis 0.43
• Laryngeal hemiplegia 0.23 – 0.61
• Osteochondrosis 0.24 – 0.52
• Recurrent Airway Obstruction 0.30
• Behavioural traits 0.23 – 0.28
• Conformational traits 0.16 – 1.00
and again these are becoming part of the overall “genetic assessment”, based on a blood sample with increased cost, but should highlight that such conditions do not or are not simply under genetic control and that veterinary advice is still vital.
It is however, not all crazy geneticists and it is quite rightly a principal goal of the Horse Genome Project to benefit the health and welfare of horses and they have many current projects including:
– Athletic performance
– Cervical Stenotic Myelopathy
– Contracted Foal Syndrome
– Congenital abnormalities/infertility
– Fracture and Tendon Injury
– Laminitis
– Lavender Foal
– Osteochondrosis
– Recurrent Exertional Rhabdomyolysis
– Stereotypic behaviour
I certainly feel that whilst this is at least in its relative infancy we need to ensure that we as vets in the field understand or consider our role in this, as advocates for animals, for correct medical procedure and explanation, and as modulators of expectation not only based on the results of a black and white test.

Thursday, 25 February 2016

The ethics of sports medicine and treatment or the challenges in balancing the demands of competition with the duty of care to the equine patient

Firstly perhaps, a couple of quotes; from the magus of them all Hippocrates who opined “science is the father of knowledge but opinion breeds ignorance” and from the esteemed surgeon Sir Wiliam Osler; “it is much more important to know what sort of patient has a disease than what sort of a disease the patient has.”

For fear of appearing flippant, the challenges faced by a vet in balancing competition with patient care lie largely in communication.  This does not mean singularly that the vet dictates to the owner/carer/trainer/jockey but, as in the trial of Mr C versus Broadmoor which, highlighting autonomy, transformed the face of all medical advice; defining that the owner/carer/trainer/jockey must both understand and comprehend any medical information supplied providing “informed” consent.  Unfortunately, vets have somewhat surrendered this and their Aesculapian authority on the bonfire of their own vanities, removal of previous professional boundaries, and upkeep of finances, and have also been pressurised by the equine owning publics’ cessation of understanding of the origins of husbandry (Rollin 2006) where animals, not only horses, were viewed as greater than that of an object to provide pleasure or work.  Indeed Immanuel Kant pointed out that one of the fundamental dictates of moral law is to treat objects of moral concern as ends in themselves, not merely as a means.  This is an extremely valuable and fundamental point and whilst attitudes are changing, as set in a prescient case in 1979 in New York, Corso v. Crawford Dog and Cat Hospital, in which the judge declared that a “pet occupies a place somewhere between a person and a piece of personal property,” it is in this myriad of competing pressures that we work, and this sorrowfully is before we even consider the horse.  In this capacity we become and largely can only be advisors to the competitor.  Whilst acute and traumatic injury (often related to repetitive failure) is comparatively easy to manage and implement treatment, with owners actually observing clinical improvements, it is here perhaps where we have already failed.  Our primary aim should be in preparatory and prophylactic medicine requiring greater input at all stages of the equine athlete’s life. 

            The financial and time pressures placed upon however, a competitor or trainer means that such idealism is rarely met or largely ignored, unless the horse has already achieved at an elite level; even to the level where husbandry levels are insufficient (promoting dental disease and lower airway disease for example), and this is conferred to the treating vet who’s role is to return the animal to pre-injury levels of competition with expediency.  At a recent course I attended, a highly respected Newmarket “racehorse only” vet quoted “our role is not to get the horse better, it is to get the horse back on the track.”  I’m sure he would add several caveats but the implication is inclement and highlighted in Contemporary Issues in Bioethics (Benson and Rollin 2004).  Although the aim is to return the animal “healed” it is very difficult to always provide complete evidence of true healing due to the lack of sensitivity of several routine techniques such as ultrasonography of tendon or ligament tissues and radiography of bone, with emerging techniques such as UTC and higher modality imaging (CT, MRI and to a lesser extent scintigraphy) both providing evidence of true healing and more accurate diagnoses (and hence therapies).  That injuries such as SDFT tears and SI desmitis have a relatively high recurrence rate presently, and that medical issues such as LAD, EIPH and various myopathies and neuropathies still remain as an almost accepted “occupational hazard” of the equine athlete shows just how far we still have to go.

            Despite all this our duty of care remains paramount and is defined not only in our Hippocratic Oath, in the Animal Welfare Act 2006 and highlighted, although only with “guidelines” in the Codes of Professional Conduct.  Whilst the aforementioned pressures of finance (from owner and practice ownership), societal distortion of a horse’s role, implications of rest and treatment on short term career results and even on long term career advancement when involved in team sports, impose parameters in which we work and balance care of the individual with achieving competitive status; by careful, sensible and reasonable communication and education of the client, advocacy can be achieved.  The only area of which we cannot balance is that of long-term health of an aged or ageing athlete.  That occupational related disease is expected does little to affirm its acceptance and again the high incidence of for example, metacarpo-phalangeal and sacroiliac osteoarthritis, questions whether our goals are toward short or medium term health stability or to promotion of life long (i.e. 25-30 years) wellness (Dunn et al 2007).

            Practical and specific examples of such dilemmas include the use of various joint therapies in an obviously deteriorating joint to allow continuing competition, in the reluctance to adhere to exercise regime for musculoskeletal exercise programmes to achieve a “faster” return to racing, in the cost implications of non-use of supposedly superior therapies such as stem cell treatment for tendon lesions or of medical treatments for common conditions such as gastric ulceration, in the promotion or “benign ignorance” shown when presented with unethical treatments such as pin firing, through to pressure to vaccinate late due to competition rules.  In each situation our role as the animals advocate in awakening moral awareness is key.

Ben Sturgeon
BEVA Council Member 
BEVA Ethics and Welfare Committee Member

Monday, 8 February 2016


The last weekend in January saw over 200 students travel from the UK, Ireland and Europe to the University of Nottingham’s Sutton Bonnington Campus for the third annual Student Equine Veterinary Association’s symposium. BEVA also joined in the fun, with the weekend incorporated lectures, practicals, a trade show and of course a black tie dinner, all organised by a fantastic team from the Nottingham Equine Veterinary Society.

BEVA were well represented at the event with current President Mark Bowen heading some of the practical sessions along with our Senior Vice President Andrew Harrison; current Junior Vice President Jonathan Pycock giving an engaging talk on Reproduction; while this year’s Congress Chair Gayle Hallowell and Hannah Yeates, a member of BEVA Council, also contributing to the weekend’s CPD programme. 

The BEVA Office exhibited at the trade show, with lots of new members recruited and the EVJ Bookshop enjoying a tremendous weekend of sales. Popular books included the Saunders Equine Formulary and our Joint Injection Guide. If you missed out on purchasing any books (We ended up selling out of everything by Sunday lunchtime!) remember you can order and browse here

BEVA sponsored two sessions throughout the weekend, Richard Hepburn’s Neurology lecture and a talk from Hannah Yeates on Alternative Careers within the Equine Veterinary Industry, with Hannah even slipping in some photos of Madonna into her presentation! Both sessions were very well received, with Richard showing some brilliant videos which should help aid diagnosis for the attendees in the future and Hannah's presentation delivering options that many did not exist!

The event also gave the BEVA team lots of inspiration, with the vodka luge high up on our list of things we NEED at the Annual Dinner for Congress!

We look forward to travelling to Liverpool for next year's SEVA Conference! 

If you have an event you think BEVA may be interested in attending/supporting then please email lara@beva.org.uk

Tuesday, 19 January 2016

What benefits do I get by becoming a BEVA Member?

So you have got your BEVA membership but do you really know how many great benefits you have now inherited?! BEVA is continually trying to make our services better for you, so we add further benefits each year as well as reviewing the ones we already have. If you have ideas as to what you would like to see please make sure you contact us - membership@beva.org.uk

On offer at present we have:

  • 50% off our wonderful CPD program! Our courses range from regional meetings to core skills workshops, advanced level specialist courses over three days and our popular Clinical Workshops. The BEVA CPD features over 50 courses each year with new additions coming all the time and if you think we are missing something let us know your course suggestions and if yours gets added to our calendar you can come along for free!
  • Discounted entry to BEVA Congress and reciprocal member rates at other conferences worldwide. So as well as soaking up everything BEVA Congress has to offer why not sample AAEP, the London Vet Show or a trip to Australia for EVA Congress at a discounted rate?
  • Unlimited access to Equine Veterinary Journal and Equine Veterinary Education. As well as hardcopies of our world renowned journals each month you have access to the ENTIRE back library of both journals in the BEVA Members Area and EVE/EVJ Apps. A popular addition to this in recent years has been the EVJ/EVE Podcasting series, which are perfect for you to listen to in the car between calls... earning CPD in otherwise wasted time… what more could you want!
  • The BEVA Apps. We have previously been told that it is worth joining BEVA for these alone! The four BEVA Apps (which will be joined by a new addition shortly) presently cover Equine Drugs, ‘How to’ Techniques, Equine Lab and Joint Injections.
  • Our comprehensive webinar library. Still hoping to squeeze in even more CPD? Then make use of our Webinar library on eBEVA.org A new webinar is added each month and you also receive a discount to view previous Congress webinars!
  • Discounts at the EVJ Bookshop. Our EVJ Bookshop stocks many titles not available anywhere in the UK as well as some old favourites. With new titles available each year and special promotions make sure you use this brilliant resource!
  • A FREE Legal Helpline. Our 2015 Members Survey revealed Members believed they would benefit from a free legal helpline so in 2015 we launched one! More details here
  • Discounted Private Medical Insurance and Income Protection. BEVA teamed up with PG Mutual in 2014 to offer you these great benefits! Surely essential cover for an equine vet?!
  • Our Membership Offers Page. These is the newest of your benefits and gives you access to hundreds of discounts and offers. Planning a trip to the cinema, a holiday or buying a new car? You can get discounts to all of these here! (log in required to gain access to Members Area)
  • Access to up-to-date information and news. BEVA has a bi-annual hardcopy newsletter, a bi-weekly E-News and of course our Members Area and Practice Portfolio on the BEVA website. All are aimed at keeping you up to date on the latest news and information within your industry.

Wednesday, 11 March 2015

Wheezes and Whistles

You’ve missed the rhubard and its too early for the Dante but force yourself …

come to York – April 16th 2015.

York Racecourse, the Historical Knavesmire, home to some of the greatest and most unusually named events in British Flat racing, The Musidora, The Dante, The Nunthorpe and of course, The Ebor.

Why is that heavey pony not getting better ? Have I made the right diagnosis?

Should I be advising an overground scope for that point-to-pointer and what should I expect to get from it ?

BEVA moves north for the Spring Workshop, a new look at everyday problems  - respiratory tract disease; second only to orthopaedic problems for compromising performance in all types of horses.

Course organiser, Rachael Conwell, unashamedly, almost managing to set up shop in her back garden, has brought together a mixture of practitioners and leading researchers in the fields of respiratory medicine and surgery. Reviews of current practice, top tips on how to manage tricky cases as well as up to the minute research on what lies around the corner for treating RAO and managing “Roarers”. Edinburgh University’s Dr Scott Pirie will bring us right up to date on airway diseases whilst Professor Richard Piercy from The Royal Veterinary College will lead us through his latest research on Recurrent Laryngeal Neuropathy. Saf Barakzai and Tim Brazil will address making this work in practice.

Make the most of your BEVA membership this Sping, whether it is rhubarb, racing, roarers, John Smith’s or the Vikings…come to York…see you there Thursday 16th April.