Mental Illness In Veterinary Medicine

Being a vet is hard.  We are faced with numerous mental and psychological challenges every day.  Practice managers and owners have the stresses of the business as well as medical management of cases.  With everything we go through in our careers it probably shouldn't be a surprise that vets are more likely to have clinical depression and be suicidal than the general population.

 

This topic has been discussed more frequently in veterinary circles since the suicide of animal behaviorist Dr. Sophia Yin in September, 2014.  We as a profession are realizing that this is a serious problem and which we should all be aware.  Those of us who have suffered from some kind of psychological problems can be comforted in the fact that we're not alone, and that there are resources for help in overcoming these challenges.

 

The study was released February 13th and was conducted by the CDC in conjunction with several veterinary partners.  It surveyed 10,254 veterinarians across the US using the Kessler-6 psychological distress scale, which screens for serious mental illness.  Here are some of the key findings.

• 6.8% of male veterinarians and 10.9% of female vets had serious psychological distress.  That compares with the US population as a whole of 3.5% males and 4.4% females.  Veterinarians are about twice as likely to have psychological illness as an average American.
• 24.5% of male vets and 36.7% of females experienced episodes of clinical depression after graduation.  The lifetime prevalence among Americans is 15.1% for males and 22.9% for females.
• 14.4% of males vets and 19.1% of female vets reported suicidal thoughts.  The rates in the general population are 5.1% and 7.1% respectively.
• 1.1% of male vets and 1.4% of female vets had actually attempted suicide.  This is actually lower than the US population, but for a potentially tragic reason.  Because veterinarians have such easy access to drugs they are more likely to be successful in suicide attempts than the average person, meaning that there would be fewer people alive to respond to the survey.
• The three primary sources of stress reported were practice management responsibilities, professional mistakes and client complaints, and the general demands of veterinary practice.

The American Veterinary Medical Association is beginning to take a serious look at mental illness in the profession, and will address it at the annual convention in July.  The Association of American Veterinary Medical Colleges will host its third Health and Wellness Summit this coming November, focusing on veterinary students and recent graduates.  In Great Britain the Rocal College of Veterinary Surgeons agreed to spend 1 million pounds (about $1.5 million) on this topic.

I am so very glad that psychological illness is being treated seriously in the veterinary profession, especially considering how much higher the rates are among us compared to the general population.  I can personally attest to the stresses of the profession, and if I had received the survey I would have been included in several of those statistics above.  Looking back I've always had a tendency for depression and mood swings, which reached a peak in veterinary school.  I've had suicidal thoughts over the years and have been on antidepressants for more than a decade.  I'm definitely a poster-child for the issues currently being discussed.  I understand these problems on a very personal level.

Thankfully my issues have rarely been severe, and I've been well managed for years through a combination of medication, prayer, and therapists/psychologists/psychiatrists.  I still have periods of becoming depressed but they are not as bad as what I've faced in the past.  And you know those three stressors mentioned in the study?  Yep, those are the reasons I still have episodes.  I get depressed over cases, especially if a client complains or the case doesn't go well.  I get depressed about the long hours and hard daily grind.  And I get depressed when business isn't meeting expecations. 

So what do we do?  I'm glad that there is a growing awareness and that veterinary organizations in several countries are working to investigate and address mental illness.  I'm eager to see what comes out of these seminars and studies, and hope that it will help many of my colleagues who may not have been as successful in managing the illness as have I.  But it really boils down to friends and family intervening with the vet, and the vet themselves being aware of the problem and seeking help.  There has often been a stigma placed on mental illness, as if we who have it are somehow "bad" or screwed up.  It took me a long time to come to terms with my own illness and be comfortable talking about it.  I'm glad that I had a lot of support from my wife and faith to help me seek the help I needed. 

If you're reading this and you are a vet or know a vet who suffers from mental illness, be encouraged.  Help is out there and you don't have to do it alone.  Many of us (heck, a whole third of the profession) have similar problems.  Here are a couple of quick resources.

Resources through the AVMA

National Suicide Prevention Lifeline:  800-273-TALK (8255)

 

Does Being A Vet Tech Shorten Veterinary School?

Here's a question from a reader that ties to Emily's questions from a few days ago.

 

Hello my name is Nicole and I'm currently trying to decide whether I want to go to Vet Technician school or straight into Veterinarian school. My main question is if I were to go to Veterinary Technician school would this take years off if I wanted to later on go to Veterinary School?

 

If you haven't already, go back and read my response to Emily from earlier this week, as it may help in your decision.  I've also answered similar questions over the years, so searching keywords in this blog may give you more information.

 

The simple answer is, no being a veterinary technician does not reduce the amount of time you spend in veterinary school.  At least that's true in the US, and I can assume in most other countries (I only know the US system).  One of my classmates was a technician before she entered vet school, and she did the same program as the rest of us.  The education and subjects are indeed very similar, so having gone through tech school may make vet school easier since you've learned much of it.  However, vets go into much more detail, especially on diagnosing and treating cases, so it's not a completely comparable education.  If you wanted to do both, you'd spend 2-3 years becoming a technician, then another four in vet school. 

 

Having first worked as a tech may help your chances of being accepted into vet school, as this kind of experience and training is certainly something the admissions department considers and values.  You may also find that even though the pay is less, so is the debt and the pressure.  This is often a better option for some people, and one in which they find significant personal satisfaction.

 

 

Lacking Passion For School And Science

Here's an email from Emily.....

 

I am currently a sophmore at Western Michigan University studying Biology and am running into a rough patch during undergrad. All of my life I have loved animals and have thought I have wanted to be a Vet. I even have job shaddowed my local small animal veterinarian and loved every minute of it so I thought this will be the perfect job for me, but now I am doubting my choice.

I was always good in school during high school and got a 3.84 GPA at the end of it and I enjoyed my science classes. Then I started college, my first semester I did great! All A's and B's, then came second semester taking General Chemistry and Molecular and Cellular Biology, I studied hard and ended up getting two DC's on my transcript and retook them the next semester and got B's in both subjects. This brought my GPA down to 3.04. Anyways I am just about to finish my sophomore year of college and am starting to question my choice in pursuing a veterinary career. I love animals, but I feel like my passion for science and school work is definitley not what it used to be. I find it very interesting but I am not good at it and also adding another four years to my college career seems frightening and I have read blogs about people's live in vet school and it doesn't get any easier. I am thinking of becoming a Vet Tech, but my parents discourage me saying that I am smarter and should try to pursue my original dreams of becoming a Vet. How do you think I can decide between the two careers, Vet tech seems like the easier way out, but still rewarding, just less money. But Vets don't make that much considering the amount of money they put in for their education. I am in a pickle, I just don't know if I have the passion for school to succeed in vet school.

 

First, I'd suggest doing some keyword searches on this blog, as over the years I've talked a lot about the pros and cons of a veterinary career and whether or not it is worth it.  You'll find similar questions to yours and various answers that I've provided.

 

Simply put, if you don't have a strong passion for being a vet, don't do it.  Going through vet school was the hardest and most challenging thing I've done in my life, and that includes having studied for and received a Master's Degree just before that.  Vet school is actually more grueling than human medical school because you have to know so many different kinds of anatomy and physiology.  For four years you'll have little to no personal life and won't have time to hold down more than a part-time job.  Once you graduate you can expect long, hard hours and make a fraction of what you really should make.  Current average debt load coming out of vet school is around $160,000, yet average starting salary is around $60,000.  A recent study showed that the return on investment (ROI) for veterinary school is so bad that an average vet will be 65 years old before they break even for the amount of money and time they put into their education.

 

So with a bleak picture like that, how do we do what we do?

 

Passion.  Passion for pets, passion for medicine, and passion for the people who have pets. 

 

This is not an easy job, and it can be a struggle for newly graduated vets to make a living nowadays.  But it can still be very rewarding, which is why people continue to do so.  My rewards are not from my salary, though I'm paid decently.  I keep doing this because I get to make a difference in the lives of people and pets, I get to teach and train my staff, and I simply find medicine and surgery to be fascinating.

 

Stop and think for a few minutes.  What is it about veterinary medicine that excites you?  Are you comfortable with the idea of doing surgery every day on pets?  Do you think how a body works is really cool?  Do you want to interact with people and teach them how to be better pet owners?  Can you handle when cases don't go right or when a client refuses needed care?  Are you prepared to work you tail off to make a comparably small amount of money? 

 

There is nothing wrong with changing your mind about your career.  You have to have a huge desire and passion for science and school in order to survive a veterinary education.  No, we really don't like all of the study, but it's a necessary evil and you need to see this as a true calling rather than simply a job.  Because you have to look back on it after graduating and being in practice and ask "was it worth it?"

 

Becoming a veterinary technician is not a second choice!  It doesn't mean that you aren't smart enough to be a vet!  I have known many techs who have just as much intelligence as the veterinarian for whom they work.  Becoming a vet doesn't mean that you're "smarter" than a tech.  Many people chose to be a tech as their first choice, and are happy in that career.

 

Do some soul-searching, Emily.  If becoming a vet seems like more work and hassle than you are willing to do, then it's not going to be a career in which you are happy.  Besides....you can become a technician and still go on to vet school later if you decide that you really do want to be a doctor.

 

That actually brings up a related question by a reader, which I'll post in a few days.

Wild Poop And Pond Water

This is a question I received from Crystal....

 

A recent question from another reader regarding horse poop is somewhat similar to my question. We have a variety of wildlife that come through our yard. Our puppy has sniffed out wild turkey and wild rabbit poop and it is in her mouth before we can get her away from it. We are trying to teach her to leave it but so far have not been succesful. We are concerned about what she might pick from eating these nasty treats.

We also have a koi pond that she likes to drink from. We are providing clean water in a dish outside for her but drinking from the pond is more fun.

Should we be concerned about either of these?

 

In either case you can have a risk of bacterial contamination, leading to digestive upset.  The koi pond may not be as much of an issue if you have good filters, but then you have to worry about any chemicals that are placed in it.  However, if it's safe for fish to live in there probably isn't a big risk for a dog.

 

A bigger concern with the wild animal feces would be parasites, especially from mammals like rabbits.  Several intestinal parasites (worms and single-celled organisms) have rodents as intermediate hosts and eating the feces could transfer those parasites to your dog.

 

Unfortunately there is little you can do to prevent your dog from eating these "treats", since it's so common around you and she is so fast.  I would recommend training her to a "leave it" command so that you can stop her with verbal orders.  Any good trainer can help you with this kind of training.  You should also make sure to have her feces checked by your vet twice annually to screen for parasites.  Keeping her on heartworm prevention should help prevent against a few intestinal parasites (especially roundworms and hookworms) but there is no preventative that will cover absolutely everything.

The Missing Doctor-Actor

Yes, I've been a bit AWOL from this blog for the last several weeks, but I'm now back to writing.  I typically write entries for my blog during slow periods at work or evenings at home.  Business has really picked up in the last two months (a good thing!) keeping me from having time to sit down at a computer during the day.  Additionally, I've been in rehearsal for a play which just finished its run this past weekend.

My whole family does community theater, and though it's an interest of mine it is a real passion for my wife and daughter.  Most of my evenings for the last few weeks have been taken up with rehearsals or performances, typically after work.  Recently I have been leaving for the clinic at around 8:15 in the morning, working until 6-7pm, then driving to the theater where I would stay until 10-11pm.  That made for some very long days!  And I didn't feel like doing much when I finally did make it home about 15 hours after I had left.

The play I just finished was Exit The Body, a mystery farce and one of the funniest plays I've had the pleasure to be part of.  It was especially enjoyable as my wife was cast as my wife in the play, so we got to do the show together and act "mushy" on stage.  My character was a bit of a departure for me, a rather effeminate or "fopish" New York socialite in the fashion industry.  It was a great part and one that allowed me to stretch my comedic acting skills.

Here are photos from one of the rehearsals.  Nobody is in costume.  I'm the one on the left with the beard.

And here's a picture from backstage at one of our performances.  The guy in front on the left is one of our friends in the theater, Mike.  The beautiful woman in the middle is my wife.

These are some photos from the show.  For some reason I get my picture taken when I'm near those doors on stage right!

And a group photo of the cast and crew.

Several of my clients know that I participate in community theater and have asked about coming to shows.  One of them has taken to calling me "doctor-actor" whenever I see him.  This time one of them actually did show up, and she had a great time.

There will be auditions for another play in a few weeks, and we're going to try out for it.  This one is a comedy, Duck Hunter Shoots Angel, written by Mitch Albom (who did Tuesdays With Morrie).  We'll also likely be cast in Arthur Miller's classic The Crucible later this year.  But for now things have calmed down and I can get back to a regular routine!

Questions From A Prospective Vet Student, Part 4

New readers may be a bit confused at the title of this post.  About four years ago I answered a series of questions from someone wanting to enter vet school (Here, here, and here).  I recently received some questions from a different person, but thought it could actually fit with the previous discussions.

 

I am allergic to cats and am very interested in veterinary school and working with dogs. I am open to allergy shots, but do most veterinary schools mind this?

 

A vet school isn't going to care that you're taking allergy shots as long as it doesn't interfere with your studies and clinical duties. This is something that should be discussed with your own physician or allergist, as it may be a big issue of your allergy is severe.

 

I went to a very good University for undergraduate studies, however my GPA was around a 3.0. It is difficult to gauge which schools, if any, I should consider applying to. If I do not get in the first time, is it easier to get in if I receive a masters or vet technician certification first? What about working in a clinic for a year?

 

To be perfectly honest, a 3.0 isn't competitive. Most vet schools accept 80-100 students per year, and there are typically 300-500 applicants for those positions. Competition is pretty fierce, and GPA is a quick and easy way for the admissions department to weed people out. I'm not saying to avoid applying, but be aware that there is a good chance of getting denied. Working for a vet won't overcome a comparatively low GPA. A Master's might! However, I absolutely would not recommend getting another degree unless you really wanted it and would consider using it instead. Getting a Master's Degree simply to get into vet school will possibly be a waste of time and money.

 

I do not have all of the required courses needed for most veterinary schools, as I am missing a biotechnology course. Can I take this course during the DVM program or do I need to complete it before, and where can I take those courses once I have already graduated undergrad?

 

You're going to have to get all required courses before applying.  I can't rule out the possibility that a school might make an exception, but you'll have to check with each individual admissions department to see if this is the case.  I really would expect that a school simply would pass you by, especially with a 3.0 GPA.  There are much more competitive students who would have completed their requirements and it is simpler for them to consider those candidates rather than make an exception.

 

I actually had a similar situation!  While my undergraduate GPA was 3.495 and therefore very competitive, I wasn't able to get my last organic chemistry course before the registration deadline.  I was faced with either taking a year out of school and working, or getting a Master's Degree.  At the time I was strongly interested in animal behavior (and still am), so I decided to pursue a MS in Ethology with the thought that I might actually go on to a PhD.  While in the program I decided that I didn't want to do research and ended up going to vet school.  But I was considering not being a vet so the Master's program wasn't a place-holder decision for me.  I also took my last organic chemistry class while getting the MS and was able to qualify for vet school.

 

Best of luck!

Sinuses Or Esophagus? What To Do Next?

Here is a recent question from Joanne....

 

My husband is a cardiac surgeon and I am a PA. We therefore tend to have differential dx in our head when there is a problem with our canine kids.

 

We have a now 5 yo neutered yellow lab named Oliver.

In July 2014 Oliver started to reverse sneeze on a daily basis approx 2-4 times a day. He had bilateral clear nasal discharge and started swallowing at night when he slept. He sounded as if he had a cold when breathing.

We took him to the University of FL to be seen by IM. Bloods and urine WNL. They took him in the back for an exam. The resident dx Oliver with allergies. No meds were given.

 

There was no reverse sneezing Aug, Sept or Oct. it started again in Nov and lasted 3 weeks.

I began to notice that Oliver sounded as if he refluxed at night (GERD) and again sounded like he has a cold when he breathes.

March 1st at 3 a.m. And 5 a.m. He vomited clear thick mucous. At 6 a.m. He vomited mucous streaked with blood. His stool also had some blood in it.

 

At that point we brought him to a specialty hospital to be seen by critical care. During all of this he was acting normal and wanted to eat and drink. Bloods, urine, fecal were normal as was an abdominal ultrasound.

Dx was reflux and he was placed on sucralfate 1 g po bid ac and pepcid 20 mg qhs for 2 weeks. Reverse sneezing stopped as did night time reflux. Fifteen days after the tx ended his sx's began again.

I questioned why an eval of his esophagus wasn't done either via barium swallow or upper endoscopy and was told that we usually don't do that since vomiting blood doesn't have the same implications as it does in a human. I'm not a vet but I don't buy that reasoning. Please explain if you could.

 

So now we are on sucralfate 1 g po bid ac and pepcid 20 mg po q12h for 3 weeks. Then d/c the sucralfate and continue peocid for 2 weeks then d/c all meds.

 

Today Oliver was having a Beams dehydrated fish skin treat which is about 5 inches long and an inch wide and rigid. He put the entire piece in his mouth and he usually chews it. This time he attempted to swallow it and started rapidly swallowing to no avail. The treat was not visible in his mouth but luckily I was able to put my fingers down his throat to grab it and pull it out.

 

When I did there were a few specs of blood on it with clear thick mucous. I am assuming that just like a person, with his repeated swallowing, the treat could have scratched the mucosal surface causing it to bleed. Can that assumption hold true for dogs?

 

Oliver seems to produce a large amount of clear thick mucous which he is always swallowing and again sounds as if he has a cold since last July when all of this started. I am at a loss since a university dismisses it as allergic rhinitis and a specialty hospital critical care vet does only an abdominal ultrasound without evaluating the esophagus.

Local vets do not have the capability to scope. How useful is a barium swallow in dogs? I am assuming it would delineate a mass if present as it does in people by indicating what we refer to as an "apple core" appearance. Wouldn't this also tell us about his esophageal motility as well as stomach emptying?

 

Are these symptoms due to diet? I asked my local vet who admitted she hasn't a clue about nutrition. Right now I am at a loss.

 

 

Interesting case, Joanne. And I don't think you're off base with your concerns and thoughts. While there are significant differences in anatomy and physiology of dogs and humans, there are also a lot of similarities.

 

I would start by investigating the cause of the reverse sneezing. There isn't anything about reflux that would affect the sinus passages. However, problems in the sinus passage could drain down into the throat and esophagus. Reverse sneezing is typically due to minor sinus irritation and isn't harmful by itself. Usually over-the-counter antihistamines are sufficient to help the symptoms. But this sounds like there is something else to the case. And I could see a situation where the persistent nasal drainage is leading to reflux and esophagitis.

 

Based on your descriptions, if this was my patient here's how I would proceed.

1. Sedate/immobolize and do radiographs of his skull and sinuses. Any good general practitioner should be able to do this. While it won't typically give you a specific answer, you can see destruction of the nasal turbinates and possibly an increased radiopacity in one area to indicate a mass effect. This may help you localize if there is a lesion in the sinuses.

2. If that doesn't give a clear answer, refer to a facility with a small, flexible endoscope. This is commonly used to go into the pharynx and then retrograde above the soft palate to visualize the caudal nasal sinuses. At the same time the endoscope could be used to evaluate the esophagus and stomach.

3. A barium swallow is really most effective when done with fluoroscopy, which not even many referral practices have. You may have to end up at a veterinary college for that. It's the only way to actually see the true motility of the esophagus. And upper GI barium series could determine gastric emptying time and could potentially outline an esophageal mass, but could also miss a small mass. I'd rule out the sinus problems before focusing on the esophagus, as it seems like it all started there.

4. If none of the above gives answers, then a CT or MRI would be indicated to get better imaging of the inside of the sinuses and look for subtle changes.

 

As medical professionals you and your husband know that some cases aren't exactly straightforward. The patient and the clinician must both be politely persistent in pursuing the diagnosis. I certainly think that empiric treatment has it's place, and that's what's being tried. But when that doesn't work you go to the next step. If you strongly requested any of the above diagnostics, I'd be surprised if any vet would refuse to do any of it. Other than minor risks inherent to sedation or anesthesia all of these procedures are safe and minimally invasive to non-invasive. I would agree with the other vets that upper GI studies aren't first on our list and we don't jump at these diagnostics for a potential case of reflux. However, if the symptoms persist we have to re-consider doing them.

 

I don't see that the reverse sneezing would be in any way related to diet. While I'm no expert, I do find pet nutrition interesting and can't think of any dietary disorder that would lead to sinus inflammation. Reflux could be related to it, but I don't know that this is the primary problem.

It's always hard (if not impossible) to make a diagnosis based merely on a written description. But I can certainly see a situation where there is a mass or foreign body in the nasal passages that are causing drainage into the esophagus. In fact, that makes the most sense to me based on the description. My thoughts might change after looking at Oliver myself, so I'll hedge my bets a bit.

 

In the end, a lot of this depends on how much you are able and willing to do. All of these diagnostics aren't cheap, but they are absolutely possible in veterinary medicine. You might want to respectfully and politely push for more advanced diagnostics. But keep in mind how you or your husband would feel if a client pushed you in this way. There is an appropriate way to do it.

 

I hope some of this helps, and I hope you can get Oliver's problem figured out!