An honest look at common stressors in the profession
As Dr. Kinnarney indicates in his September 1 President's Column,1 we need to talk about mental health in the veterinary profession, but the conversation should start with an honest assessment of the nature of being a veterinarian. In my experience, being successful in clinical practice, especially in equine practice, requires devoting the overwhelming majority of your time, energy, and emotions to the demands of the job. There is no life balance, and the expectation that you should be achieving some sort of life balance is just one more reason to feel that you are not succeeding. This profession tends to select for motivated, self-sufficient individuals who too frequently suffer the financial pressure, fatigue, and emotional toll alone. At the last American Association of Equine Practitioners meeting, there was a discussion group for veterinarians working in small practices. It was amazingly helpful just to hear other veterinarians talk about the fact that they were facing the same pressures.
Brenda D. Linman, dvm
Madera, Calif
1. Kinnarney J. A question of wellness: it's time to find some answers. J Am Vet Med Assoc 2015; 247:430.
Addressing ongoing diversity concerns
The recent JAVMA News story “Grant aims to give minorities a boost in whitest profession”1 quoted percentages of racially and ethnically underrepresented students at US veterinary colleges from internal data provided by the Association of American Veterinary Medical Colleges for 2014. Unfortunately, there was an error in the data reported for The Ohio State University College of Veterinary Medicine that grossly understated our percentage of students in those categories. For 2014, underrepresented students represented 10.2% of all students, approximating the US median, and for 2015, they represent 11.3%. This is still not where we want or need it to be for our college and for the profession's vitality, sustainability, and ability to serve the needs of society.
Embracing diversity in our students, faculty, and staff is one of our college's core values. In 2010, JAVMA News described the critical need to work towards changing the face of the profession by stating “[e]mbracing diversity is vital if the veterinary profession is going to continue to fulfill its mission of serving all of society and all animals to the best advantage.”2 This remains true today. We recognize the research demonstrating convincing evidence that innovation and group performance are enhanced by diversity,3 and we anticipate that the “wicked” questions and challenges facing the profession today will only be successfully answered and addressed through truly diverse teams.
The veterinary profession has unfortunately and accurately been labeled as the “whitest profession.” This is something that we must change. To best serve our communities and society, our profession must embrace the broadest definition and fullest spectrum of diversity from racial, ethnic, religious, gender, sexual orientation, gender identity, socioeconomic, demographic, and all other groups.
As dean of the college, one of my first priorities has been to create a new position in the college's administration: Associate Dean for Faculty and Staff Affairs, Inclusive Diversity, and Planning. We believe that diversity is a fundamental component of excellence and, as such, is not optional but rather is both necessary and desired. We must work as a college, within our profession, and with others to meet the changing needs and expectations of society.
Colleges of veterinary medicine must work collaboratively and with the Association of American Veterinary Medical Colleges, AVMA, and others to address the factors that are likely contributing to insufficient diversity among those applying and being admitted to veterinary school and, thus, among those graduating and entering our beloved profession.
Rustin M. Moore, dvm, phd
Dean, College of Veterinary Medicine Ruth Stanton Chair in Veterinary Medicine The Ohio State University Columbus, Ohio
1. Grant aims to give minorities a boost in whitest profession. J Am Vet Med Assoc 2015; 247:453–454.
2. Kahler SC. The changing face of the profession. J Am Vet Med Assoc 2010; 236:368–369.
3. Catalyst. Why diversity matters. Available at: www.catalyst.org/knowledge/why-diversity-matters. Accessed Sep 14, 2015.
Instructions for Writing a Letter to the Editor
Readers are invited to submit letters to the editor. Letters may not exceed 500 words and 6 references. Letters to the Editor must be original and cannot have been published or submitted for publication elsewhere. Not all letters are published; all letters accepted for publication are subject to editing. Those pertaining to anything published in the JAVMA should be received within one month of the date of publication. Submission via email (JournalLetters@avma.org) or fax (847-925-9329) is encouraged; authors should give their full contact information, including address, daytime telephone number, fax number, and email address.
Letters containing defamatory, libelous, or malicious statements will not be published, nor will letters representing attacks on or attempts to demean veterinary societies or their committees or agencies. Viewpoints expressed in published letters are those of the letter writers and do not necessarily represent the opinions or policies of the AVMA.
Frustrations with flawed focus
During the past year, whenever we talked to members of the Student AVMA, two inextricably linked issues—debt and wellness—seemed to come up more often than any others. Similarly, although many topics were discussed over the course of the Student AVMA House of Delegates meeting in Boston this past July, including membership benefits, cultural outreach, and accreditation, the volume of questions and concerns regarding economic strain and mental health was unequaled. In fact, at the end of the Student AVMA meeting in March, when we asked delegates what concerned them most, more than 80% identified the same two issues: debt and wellness.
What then to make of the fact that the issue generating the most discussion during the last AVMA House of Delegates meeting wasn't debt or wellness, but accreditation? To us, that doesn't sound like a recipe for financial security or mental health. Nor, in our opinion, does it sound like the best way to protect, promote, or advance the profession for future generations.
We've heard lots of talk recently about how the continuing increase in debt-to-salary ratios for new veterinary college graduates is unsustainable, but few, if any, solutions. The financial stress associated with these high ratios undoubtedly contributes to student concerns about mental health. Everyone in the profession has heard of, if not been touched by, the high rates of substance abuse, depression, and suicide among veterinarians. These are real problems. Yes, they are multifactorial and not entirely understood, but we cannot accept the status quo, and it is time to work toward a healthier profession.
We were somewhat frustrated, therefore, at the amount of time spent during this past AVMA House of Delegates meeting rehashing the issue of accreditation. We are encouraged, however, that during its winter meeting this coming January, the House will set aside time to discuss concerns related to debt and wellness. At this critical time, we need visionary leadership and an openness to healthy debate, discussion, and ideas—no matter how radical their nature. Let's start working more like a team. Let's change the culture of leadership to one that demands progress.
As officers of the Student AVMA, our highest priorities are listening and responding to the needs of students. As future members of the AVMA, we ask only the same thing that anyone asks of their leaders: to be heard.
Matt Holland
President-elect, Student AVMA Urbana, Ill
Jessica Carie
President, Student AVMA Fort Collins, Colo
Freshwater harmful algal blooms and cyanotoxin poisoning in domestic dogs
Freshwater harmful algal blooms (HABs) of cyanobacteria (blue-green algae) are occurring with increasing frequency and wider geographic distribution in lakes, ponds, and rivers worldwide.1 Factors influencing these increases include nutrient overenrichment, climate change, food web changes, and altered hydrology.1 The US Environmental Protection Agency recently reported that 17 states issued toxic algae and health advisories for 81 freshwater bodies during July 2015.2 Harmful algal blooms were detected for the first time at Lake Mead National Recreation Area in 2015, where staff were contacted by two persons who reported illnesses in pet dogs that swam in the lake.
Freshwater HABs usually occur in nutrient-dense, warm, slow-moving water, typically during summer and fall. Blooms can appear as visual discolorations in water or as surface scum, appearing as paint-like slicks or clotted mats; they are usually light green to dark brownish green but can range from red to reddish brown. Cyanobacteria can produce cyanotoxins that affect persons, pets, livestock, and wildlife that swim in or drink water from algae-contaminated sources.1 Dogs are at high risk because they often are attracted to the odor of algal scum and might eat algae mats, swallow contaminated water, or lick their fur after water contact.3
Signs of cyanobacterial toxin poisoning depend on toxin type (hepatotoxin, neurotoxin, or dermatotoxin), toxin concentration, amount consumed, animal size, and exposure route. Ingestion of substantial amounts of cyanotoxin can result in severe illness requiring emergency care. Commonly reported signs of hepatotoxin (eg, microcystin) poisoning include vomiting, diarrhea, anorexia, jaundice, abdominal tenderness, and dark urine.2–5 Death resulting from liver failure can occur within days after exposure. Neurotoxins (eg, anatoxin-a) cause excessive drooling, disorientation, seizures, and respiratory failure.2–5 Death resulting from respiratory paralysis can occur from minutes to hours after exposure. Dermatotoxin poisoning can result in a rash or hives in exposed animals.2–5
A diagnosis of cyanobacterial toxin poisoning is based primarily on a history of exposure; clinical signs; analysis of vomitus, stomach, and fecal contents; and results of histologic examination of liver, kidney, and brain specimens.4
Cyanobacterial toxin poisoning can be fatal in animals if untreated. Prompt veterinary care is critical for animals with hepatic or neurologic signs and should include supportive care.4,5 No antidote to these toxins exists, but experimentally, oral administration of cholestyramine has shown promise in dogs.4,6 Induction of vomiting ≤ 2 hours after ingestion can minimize absorption of ingested toxins.4 Oral administration of an activated charcoal slurry can be helpful by binding toxins if cholestyramine is unavailable.4,5
Veterinarians should consider water exposure and travel history as elements of a dog's medical history. Veterinarians can determine their state reporting requirements for HAB-related illnesses by visiting their state's website or the Environmental Protection Agency's website.7 The CDC is currently developing the One Health Harmful Algal Bloom System, where public health officials will be able to report data on human and animal illnesses.
Cara Cherry, dvm, mph
Division of Scientific Education and Professional Development CDC
Biological Resources Division/Wildlife Health Branch Office of Public Health National Park Service Fort Collins, Colo
Danielle Buttke, dvm, phd, mph
United States Public Health Service One Health Coordinator Biological Resources Division/Wildlife Health Branch Office of Public Health National Park Service Fort Collins, Colo
CAPT David Wong, md
Epidemiology Branch Office of Public Health National Park Service Albuquerque, NM
Margaret A. Wild, dvm, phd
Biological Resources Division/Wildlife Health Branch National Park Service Fort Collins, Colo
1. Lopez CB, Jewett EB, Dortch Q, et al. Scientific assessment of freshwater harmful algal blooms. Washington, DC: Interagency Working Group on Harmful Algal Blooms, Hypoxia, and Human Health of the Joint Subcommittee on Ocean Science and Technology, 2008.
2. US Environmental Protection Agency. CyanoHABs news 2015. Available at: www2.epa.gov/nutrient-policy-data/cyanohabs-news-2015. Accessed Aug 25, 2015.
3. New York State Department of Environmental Conservation. Dogs and harmful algal blooms (HABs). Available at: www.dec.ny.gov/docs/water_pdf/habspets.pdf. Accessed Aug 25, 2015.
4. Merck. Overview of algal poisoning. Available at: www.merckvetmanual.com/mvm/toxicology/algal_poisoning/overview_of_algal_poisoning.html?qt=cyanobacteria&alt=sh. Accessed Aug 25, 2015.
5. Minnesota Department of Health. Harmful algal bloom-related illness information for veterinarians. Available at: www.health.state.mn.us/divs/idepc/diseases/hab/vet/index.html. Accessed Aug 25, 2015.
6. Rankin KA, Alroy KA, Kudela RM, et al. Treatment of cynobacterial (microcystin) toxicosis using oral cholestyramine: case report of a dog from Montana. Toxins 2013; 5:1051–1063.
7. US Environmental Protection Agency. States with freshwater HABs monitoring programs. Available at: www2.epa.gov/nutrient-policy-data/states-freshwater-habs-monitoring-programs. Accessed Sep 14, 2015.
