Painful and stressful events - and the values of EMS - Veterinary Practice
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Painful and stressful events – and the values of EMS

Dr David Williams continues his series with a discussion on ‘pain’ and takes a look at the way we skirt around issues in killing animals and ways of saying goodbye in small animal practice.

MY 16-year-old son Jack has always been somewhat of a daredevil. Bungee jumping, free running, long-boarding – he loves a good adrenaline rush!

Long-boarding, by the way, is what you might call upmarket skateboarding, faster and more furious, but without any easy mechanical way of slowing down as far as I can see.

In the flatlands of Cambridgeshire, however, you’re not going to get much speed up. Take your long-board to Pembrokeshire though and you can really zoom down the hills there. Which is just what Jack did and only managed to stop at the bottom by crashing onto the verge.

Together with Blair and Bush in Iraq, he hadn’t exactly developed an exit strategy! He came back covered in deep cuts and grazes but surprisingly not in the least concerned. If it had been up to me I would have suggested not trying such stunts without protective clothing but what do I know? I am merely the dad and at 16 if he is adult enough to decide the fate of a nation perhaps he can be left to plot his own down-hill fate!

What really surprised me as he returned without so much as a whimper was that these considerable injuries seemed not to cause him any pain at all. But I should have remembered the physiology of acute reaction to noxious stimuli shouldn’t I?

Ten minutes later Jack was in agony, once the adrenaline rush had subsided and the endorphins coursing around his brain had calmed down. Here was a perfect example of the biological basis of the lack of pain response immediately after injury. This was the reason why the IEP report of the badger culling last year suggested that badgers might not feel pain for five minutes after being shot.

The expert on pain responses, Patrick Wall, whose excellent little book Pain is well worth reading, became interested in this phenomenon while treating soldiers in the Korean war. They came off the battle field with severe injuries but not in pain until later.

The same was true of Henbit, the thoroughbred who won the 1980 Epsom Derby after fracturing its cannon bone in the last furlong but who accelerated past its competitors to finish victorious before limping off to the winners’ enclosure.

Mental block

The brain blocks out pain responses in a stressful situation where fighting or fleeing might be a lifesaver.

Jack joined this endorphin-embraced post-trauma population because of the excitement of careering down the Welsh hill. But observing that five-minute halcyon period made me wonder whether the IEP were right in thinking that badgers have the same pain-free period.

They aren’t in a stressed state while wandering through the wood before their fateful shot so to my mind would not be in such a state to benefit from high endorphin and adrenaline levels. But how can we in our armchairs know what it is like to be shot when you are not expecting it?

A quick surf through YouTube produced some disturbing videos from the States of dogs being shot in the street, and they uniformly showed the animals writhing and howling in pain.

Obviously, badgers shot in the chest with devastating effects are killed straight out. But I can’t believe that those incorrectly targeted who then disappear into the undergrowth have five minutes before they feel any pain.

So a second year of culling has started, hopefully more effective and more humane than last year’s.

Interesting the words we use isn’t it? The government has sanctioned another cull, not a kill. We put pets to sleep don’t we, rather than killing them. And laboratory rodents are sacrificed, not killed.

A recent book, Blue Juice, by US professor of sociology Patricia Morris, has explored the euphemistic culture of veterinary euthanasias. She looks at the way we skirt around issues in killing animals, particularly looking at the issues surrounding “saying goodbye” in small animal veterinary practice.

She examines the way we “negotiate” death, the problems of encouraging owners with an old ill animal in pain that should be relieved of its misery and on the other hand dealing with the owners who want to get rid of their perfectly healthy pet who is now surplus to their requirements.

She talks from a States-side perspective when complaining that students do not get sufficient teaching on this critical area but even on this side of the pond I worry that while students get lectures and role play activities on dealing with the euthanasia consultation in vet school, the time students actually encounter it happening is while on EMS.

Having a student seeing practice, as we used to call it, can be a great experience – for the most part I love the interaction with an enthusiastic student and I well remember the enjoyment of seeing practice myself, even though that was over 25 years ago.

But at stressful times, having a student alongside can add to the difficulty of the situation, and dealing with a client during a euthanasia consultation is often the most difficult of these times.

Talking to students, it appears a number are excluded from euthanasia consultations and perhaps there is a good reason for that. Yet it is really important that students see how vets deal with this important time.

Perhaps this shows the importance of students on EMS discussing what happens in such consultations with the vet beforehand as well as afterwards. But how much do we actually structure EMS, encourage students to talk to vets about what to expect in consultations, or do we just leave it to happen naturally?

I aim to talk to my students before they go out on EMS about what to expect, what aims to have and how to behave. I chat to them on their return about whether those goals have been realised and how they can improve their learning experience in the next vacation.

But I wonder if we support vets taking on students for EMS quite as well as we might? Discussing that I fear will have to wait for a future Perambulation as my next client is patiently sitting in the waiting room!

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