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Life after graduation - Hannah Bills-Brown

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Life after graduation - Hannah Bills-Brown

24th May 2018

The past few weeks I have been rapidly expanding my knowledge and skills. I have now passed my probation period at my practice and am happy to say I will be staying as I am thoroughly enjoying myself. After coming back from BSAVA Congress I felt motivated to get stuck in again having flooded my brain with new information. And what a Congress it was - so many good speakers and lectures! Particular highlights for me were the neurology lectures by Jacques Penderis and the eye surgery wet lab where we used pigs’ heads to practise on. I haven't had the chance to practise any of these skills as yet but I'm hoping to use them soon.

A few things I have accomplished in the past few weeks are a cystotomy, splenectomy, blood transfusion, and lots of pyometras! Work seems to have become a lot busier lately, which I am enjoying,  and the cases we get are pretty varied. I have a case at the moment which I finding particularly challenging. She is a 15-year-old Westie who I diagnosed with Cushing’s disease and diabetes a couple of months ago. So far, we have managed to get the Cushing’s disease under control but her diabetes is proving much more difficult! Thankfully, her owners are very committed to everything that needs to be done so I am hoping that I can keep her good quality of life going a bit longer.

Something new I learnt this week was that toads are toxic to cats! A toxin called bufotoxin is produced in the parotid glands of the toad that sits behind the eyes and bulges up when the toad feels threatened. The most common presentation is excess salivation and frothing at the mouth but it can escalate to vomiting and neurological signs. Fun fact of the week!

 

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26th March 2018

This week I have been ultrasounding guinea pigs and cuddling baby rabbits!  The guinea pig had bilateral alopecia, was in fairly poor body condition and had a large abdomen that you could feel numerous small lumps in. Our first thought was cystic ovaries but we decided to ultrasound to be sure. The image below confirms our suspected diagnosis - you can clearly see all the ovarian follicles. Thankfully she survived the spay and is recovering well at home. 

I also had an unexpected trip back to the Royal Dick Vet School a couple of weeks ago when I was on call with a seizuring 10-year-old Labrador. Thankfully, I had support from one of my colleagues who was also in the building as, needless to say, it was a new and nerve-racking experience. What I found the hardest was trying to treat the dog with the owners there. They were understandably very upset as they had never seen a dog seizure before (neither had I!) but the noise and panic in the room wasn't helping the dog, or Holly and I focus on calculating drug dosages in our heads. It's fair to say although a lot of diazepam went into the dog, there was also a lot spilt on the floor! We had no iv phenobarbitone so resulted in giving iv propofol boluses and took the trip to the vet school in my car to get to ICU. Not how I wanted to make my first visit back, but I was incredibly grateful to see the ICU nurses again. Unfortunately, because there was no known toxin ingestion, a brain tumour was the most likely diagnosis which MRI confirmed :( 

The BSAVA guidelines to dealing with a dog in status epilepticus are now pinned on the noticeboard for my future reference! These can be found in the Practical and Clinical Skills section of the BSAVA PDP resourses and may come in use one day. 

My most recent CPD has been on the new cytopoint injection which I have subsequently used in a few cases with encouraging results. I have also attended another Young Vet Network CPD on ocular emergencies which was great for a bit of revision on topics such as glaucoma, melting ulcers and anterior uveitis. It has encouraged me to try and look into more animals' eyes to try and get better at recognising what is 'normal'. 

At work my six-month probation period is nearly over. I'm thoroughly enjoying it and feel like I have a good work-life balance having recently joined a local netball team....so hopefully they'll keep me on! 
 

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26th February 2018

The last few weeks have been a big learning curve for me at work.

I've been seeing a few more complex medical cases - some diabetics, cushinoid dogs, few dogs with pancreatitis and even a cat with a linear forgein body! The more I see these sorts of cases, the more I'm honing my skills, particularly history taking. At university they drilled it into us that taking a history is one of the most important parts of a veterinary consultation and you should not skimp out on it. Day by day I'm getting a better understanding of the types of questions to ask to maximise the information I can extract from the owner. This then helps me plan the next steps out to get a diagnosis. Not going to lie, I frequently have a nice long listen to the heart while trying to formulate a vague plan in my head to present to the owner...!

I often feel there is pressure from the owner to give them an answer there and then, which can be quite overwhelming, and after speaking to my colleagues they also get this impression from owners. They just have the experience to know that this usually cannot happen and explained to me that as I progress I'll find ways of communicating this to owners so they're on the same page and understand the need for further diagnostics other than just my eyes and hands!

As well as the usual neuterings, I have done some difficult dentals and had to dig a few roots out despite trying my hardest not to snap them! One of the most interesting surgeries I have done recently has been a lump removal on a guinea pig. With the help of the BSAVA Exotics Formulary and digging out my university notes on exotics anaesthesia, we managed to achieve a good plane of anaesthesia throughout the procedure. The lump was almost as large as its head, ventral to the neck (near some essential structures!) and took a lot of patience while doing the dissecting. I now fully appreciate the thickness of cat and dog skin because doing intradermals in the guinea pig was pretty difficult, but in the end I managed to get a neat looking wound and felt happy achieving something I'd never done before.  

I attended my first Young Vet Network CPD on Dental Radiography by Norman Johnson which was great! It was nice to meet some of the young vets in the area and was well worth the treacherous drive in the snow to get there. The CPD was really useful as my practice has recently bought a new dental radiography machine. We didn't get a lot of dental x-ray teaching at university so this more in-depth explanation about how to get the best views was needed for me to be confident to use the x-ray machine effectively. I now need to buy a skull so I can get used to the particular machine we have in practice. 

I am planning on attending BSAVA Congress this year. Unfortunately none of my colleagues are going but I'm hoping to meet up with some uni friends to have a good catch up. There looks like a good spread of lectures and I'm booking onto the Basic Eye Session as this is something that I'd like to start being able to do to increase my surgical repertoire.

I'm looking forward to my week off soon when I'll be traveling south to visit my family then heading back up to the Lake District to enjoy some walks with the dogs. 

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19th January 2018

This week has been a great first week of the year at work! I am loving having the freedom to do more and more surgery - especially getting some difficult bitch spays under my belt. 

One of the dogs I operated on this week was a seven-year-old Cocker Spaniel - a lovely dog but with a BCS of 7/9. As soon as I made my first cut into the skin, I could tell that it she was going to be an oozy one. Thankfully, Holly, another vet in the practice, scrubbed in to give me a hand to get good exposure so I could get my ligatures nice and tight and sleep well at night!

I also have a bittersweet story to share. On Thursday, a family came in to see me wanting their new cat to join our VIP plan and get vaccinated. This cat had been with them for six months having at first been seen in their back garden. A few weeks of leaving food out for him and he was soon happy to relax in their house and play with their other cat. Unfortunately I found that he was in fact microchipped and that his owners were registered at our practice! He had been registered as missing for six months. So as heartbreaking as it was to tell the family who had brought him in that they couldn't take him home, it was a treat to be able to phone the owners and tell them the good news who after six months had given up hope. Moral of the story ... get your cats microchipped as it can lead to a happy ending even six months down the line. 

Next week I'm going on some dental x-ray CPD run by Norman Johnson with the Young Vet Network in the West of Scotland. My practice has recently purchased a new machine so hopefully I'll come back knowing how to make good use of it. 

I am already looking ahead to BSAVA Congress having now booked it off at work. This year it is running from the 5th-8th of April. The programme is looking good-  take a look here- and I am thinking about trying one the small group sessions this year. 

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5th January 2018

Christmas over already... the weeks are beginning to pass by quickly now!

Recently I have been getting my hands stuck in with some more routine surgeries, pyometras and now have a couple of foreign body removals under my belt with assistance from my colleagues.

One that has been a special case for me was a Labrador that had eaten a corn on the cob. After a dodgy looking abdominal x-ray we quickly opened him up to find some very angry looking guts containing the offending corn - surgery went well and no guts had to be removed. However this was followed by a worrying week where he took much more time than expected to bounce back, and showed evidence of peritonitis. Thankfully, after a couple nights on call with a cocktail of intravenous drugs (it was like being back in the vet schools ICU?!) he pulled through. It was one of the most fulfilling experiences so far in my career to see him back for his last visit with us bouncing around and looking incredibly excited over the chicken treats I had for him that he had turned down in the days after his operation.

As expected we had the usual Christmas rush which pushed my time management abilities! I have been getting quicker but there was a day where every man and his dog (and cat) in West Lothian seemed to be ill. It felt a bit demoralising seeing the waiting room times stacking up 30-40minutes, but thankfully we got through it with some help from the receptionists cleverly rearranging some vaccinations.

I am feeling right at home at my practice now, making new friends and feeling more comfortable having clinical discussions with everyone. I am due my review session with my bosses soon and they have asked me to research practical CPD courses that I would like to attend next year. The BSAVA have some great practical ultrasound days which I think I'll be enrolling on as this is something that I'd like more experience in. 

New Year’s was spent in Aviemore ceilidhing, playing in the snow with the dogs and staggering home to a home-made pavlova. As for New Year’s resolutions - I'd like to aim to watch two webinars a week, use my weekends to explore more of Scotland and, of course, the usual aim to get fitter in 2018!

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20th November

Busy, busy, busy! 

So I've been a bit quiet lately... but for good reason! I have recently taken the decision to change jobs and I started my new one two weeks ago. It was a hard decision to move so soon after starting but for a couple of reasons I felt like it was the best decision for me at this early stage in my career. I feel like I have settled into my new job well - it is a larger practice and much busier but I think that is going to suit me more. I was never one to want to be sitting around with not a lot to do! A change of job has also meant a change of flats so that has been keeping me busy as well. 

On the veterinary side of things I have been starting to steadily fill in my PDP step by step. BSAVA have begun to add to their PDP resources and having experienced my first seizuring dog the other day I quickly refreshed my knowledge using the top tips pages they have provided here (Emergency and Critical Care/Seizures). 

On top of all the change I had a little mad moment and decided to adopt a little stray cat. Her name is Dottie and she's a little angel - definitely one of my better life decisions :) 

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24th September

Having seen a lot of dogs with problems like diarrhoea, itchy skin and kennel cough, my confidence has rapidly grown with the basic day-to-day consults. I’ve found that I am developing my own way of explaining common treatment options to owners and bit by bit, getting rid of the vet jargon which can confuse the owners. It’s a nice feeling when you start to do things for the second time around as it’s not so daunting! I’m certainly feeling less stressed by the fact that I’m the vet making the decisions. Initially, I found it strange that I was making decisions without any help, but as I became exposed to more things in practice I’ve learnt to trust my instincts and trust in my knowledge. 

This week I have started doing more neutering which is something I really enjoy. Having been lucky enough to have done a fair amount before beginning work, surgery is one element of my job I feel confident doing. So having eventually found the tiny cat uterus, (always helpful to get through the peritoneum!) my first cat spay as a qualified vet went smoothly. Last week I also did my first aural haematoma surgery on a very excitable staffie dog that previously had surgery on his other ear. Getting the tension on the sutures was a bit of guesswork, however with guidance from my boss it all went well. With the first post-op check done it was looking good so fingers crossed!

Hannah_dogs_Sept_17My colleagues and I attended some evening CPD delivered by Dr. Sarah Caney on hypertension in cats. This was incredibly helpful and has resulted in my practice purchasing a condensing lens for indirect ophthalmoscopy. I’m hoping to crack it out for obliging animals at their annual vaccinations to try to improve my knowledge of what a normal fundus looks like! She gave some really good suggestions on interpreting blood pressure values, taking into consideration stress and any target organ damage, which has increased my confidence in being able to spot the signs and accurately diagnose and treat hypertension in the future. I do quite enjoy doing CPD along with the job; I find it less stressful than vet school in the way that you can relax and absorb the information without worrying that you’re going to be tested on the content in a few weeks time. Dr Caney also told us about her website vet professionals. I’d highly recommend the free videos on feline medicine and as a result I may be using some of my CPD allowance to take one of her modules on chronic kidney disease in cats. 

Last weekend I was paid a visit by my parents and my two dogs (pictured here). Having not seen them since starting work it was lovely to have a catch up and some much needed doggie cuddles. Next week I am down in Birmingham for my first vet graduate programme CPD. I’m looking forward to meeting some more graduates to hear of their experiences of their first few months in practice and meeting some new people. 
 

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7th September 2017

Since the last time I wrote I have had dentals galore.. not sure if that's a good or bad thing, but either way I'm certainly feeling more confident taking canines out. 

I'm slowly getting to grips with the practice computer system and my consults are getting shorter and more efficient (thank God said the receptionist!). After having a confidence crash with intubating last week, my boss has been great this week supporting me through all the intubations which has made me feel much better about it. I've realised that I always need to make sure that I have a good light source behind me because I struggle more when I can't see what I'm doing clearly. Hannah_Blog_SC

One of the most difficult aspects of the job so far has been dealing with money and charging - something we don't get exposed to as students as its not our responsibility at the time. After having a client be confrontational towards me because she disagreed with the prices, I have come to realise that the challenges in veterinary medicine are not always clinical! On the other hand it has been great over the past weeks forming relationships with clients - it is great when you feel that you've helped and that people value your advice. 

BSAVA Scottish Congress was this weekend and I thoroughly enjoyed myself! I hope those that went enjoyed the Gala dinner and ceilidh .. I certainly did.. and maybe the wine a bit too much. I'd really recommend it next year for those that didn't go. It's a great way to keep up to date with new ideas and refresh things which you've forgotten since final year. I particularly enjoyed Norman Johnston's lecture on lingually displaced mandibular canines as I had seen some the week before in a litter of puppies, so it was very relevant to me. I'm looking forward to being part of the Scottish committee this year and helping out more now I have graduated -
the team (pictured above) are a great bunch of people!

This week I need to crack on with filling in some of my PDP, so I get into the routine of doing it. I am also getting a lovely visit from my parents and dogs which will be nice as it is the first time I've seen them since I started working - so many stories to tell! 

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21st August 2017

Well my first week in practice done! As expected it was filled with many highs and lows but thankfully the highs outweighed the lows.  I'm currently going through a two week induction period where I'm able to be gradually introduced to the ethos of the practice and to understand its day-to-day running before I get let loose on my own consult list. It has allowed me to get used to the things they don't teach us at vet school like invoicing, making estimates and getting to grips with the computer system. These things are what seems to take me the most time and is often the reason why new grads run over on consults. A fear for me is running late but at the same time I want to be giving my clients the time they deserve - this is going to be a hard to balance over the coming months while I get used to time management in consult. 

One of the most enjoyable parts of the week was taking off a difficult lump on the face of a young lurcher. With not a lot of skin to play with and some important structures below, I was pleased to have my boss there scrubbed in for guidance on exactly what I should be doing. Although I have a decent amount of neutering experience I have not taken many lumps on during my training at vet school, so I learnt the importance of pre-planning my cut when there is limited skin!

In order to improve my surgical planning and suturing my boss came up with a very innovative idea and presented Sam (another new graduate) and I with an uncooked roast chicken each with 'lumps' on to remove. After we'd managed to stop laughing we sat down and began removing the 'lumps' with adequate margins realising it was going to be much harder than it looked!

Something I am finding difficult is comparing the speed I am doing work at compared to vets which have been in practice for many years... of courses I am a lot slower. But as my colleagues kindly reminded me this week  - I shouldn't be so hard on myself because it is my first week and I'll only get faster. So don't worry if you're starting out and feeling the same way.

The highlight of the week has to be seeing one our nurses' incredibly cute bernese mountain dog puppies coming in for their second vaccinations. Puppies never fail to put a smile back on my face!

I'm looking forward to attending the Scottish Congress in Glasgow with my colleagues on 2nd and 3rd September to get my first lot of CPD as a qualified vet. The programme has now been released and I am particularly looking forward to the head trauma lecture by Emily Thomas and the VPIS poisoning lecture, as I think these will be really useful. 

I have one more induction week left to make sure I know all the practice policies and become a wiz with the computer system. I look forward telling you more about my cases when I get my own consulting list and my own clients!
 

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26th June 2017

My name is Hannah and I’m a veterinary graduate of Edinburgh University (what a relief it is to finally say that!). I’m writing my first post from a hammock in Italy where I’m putting my feet up after completing the first four days of the Tour du Mont Blanc. 

I’m a Shropshire lass but will be starting my veterinary career in South Lanarkshire near Glasgow as a small animal vet. The practice I’m working for is a rural three vet practice at the heart of the community - exactly the type of close knit practice I'd envisaged myself working at. There is also another graduate vet starting with me, Sam, who was in my year at Edinburgh. I’m looking forward to having someone around who’ll be in the same boat as me, making the transition from being a student to a working vet. I'll tell you more once I start working in August but I’m very excited to get going! 

Since fourth year of university I‘ve been part of the BSAVA as the junior and then senior rep aiming to increase awareness of BSAVA membership and how much it can help both when you are a student and once you have graduated. Most recently they have launched their PDP (Professional Development Phase) Resource Bank to aid graduates like me - I will be sure to make use of this once I begin completing my own professional development phase record. I really like the employer support section, it’s great for new graduates to direct their mentors to for them to gain more knowledge about the PDP and get advice on how best to support and coach a new grad in their practice. 

A bit more about me... At home my family have two border collies and two cats who I thought I'd mention as I'm sure their photos will feature at some point! Outside of vet school I enjoy most sports, especially netball and tennis, and I'll be hoping to join some local clubs to complement the job. 

Once I begin my job in August, I shall be aiming to post every two weeks to keep you updated with the highs and lows of starting life in practice. Before then I shall be reviewing some course notes to get back up to speed since finishing University and ensuring I have the BSAVA App Suite downloaded for quick access to the BSAVA formulary for once I start work. 

Now to continue my nap in the hammock, take in the beautiful views of the Mont Blanc Massif and find a place to live...

That's all for now folks! 

Hannah 
 

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