Staying safe amid mobile mayhem

It's 10:30 a.m. and the "lameness exam" that your secretary had allotted 35 minutes for turned into a headshaking horse that took more than an hour to start to work up properly. Add to the fact that you forgot you had promised to castrate the new barn cat the next time you were at this farm. There are nine missed cell phone calls by the time you get in the truck, and in addition to the add-ons that now have to be worked in somewhere in the day, the one forgotten radiograph that you really needed shows motion and will need to be taken again. You run your hands through your hair, if you still have any, and think: "This job is killing me!"

Even though veterinarians traditionally report high job satisfaction, we all have been overwhelmed at some point. But so has every short-order cook, accountant, sheet metal worker, farmer or waitress. We've all felt like our jobs were killing us. But are they really? And exactly how?

Apart from the occasionally overbooked day and the general difficulties of running any business, what are the health risks of working around horses and cattle, and exactly what kills veterinary practitioners?

More than 20 years ago, as part of a class in epidemiology, veterinary students at the New York State College of Veterinary Medicine were treated to a lecture on how they would most likely die. Being young and healthy and naive at the time, it is doubtful that much of what they were told registered. Learning that their predecessors occasionally had suffered from radiation poisoning from old, faulty X-ray machines that were still likely to be found in some practices, or talk of the use of organophosphate pesticides for deworming might lead to significantly more cases of Parkinson's disease probably did not concern these eager soon-to-be practitioners. It has long been said that youth is wasted on the young. Apparently, so are mortality statistics. But some good information does exist concerning the health/life risks faced by veterinarians; these risks have changes somewhat over the last two decades, and a look at what might kill you might just keep you alive and kicking, or at least dodging kicks.

Cancer is always a concern when occupational health risks are discussed because veterinarians are commonly exposed to any number of potential cancer-causing agents. In an article on cancer in veterinarians, Lisa Fritschi of the Department of Epidemiology and Preventative Medicine at Monosh University in Australia, wrote: "Veterinarians come into contact with several potentially carcinogenic exposures in the course of their occupation. These exposures include radiation, anesthetic gases, pesticides and insecticides and zoonotic organisms."

Statistics compiled in California during a 32-year period ending in 1992 showed veterinarians had a significantly higher percentage of melanoma and cancer of the large intestine compared to the general population. Another study of more than 5,000 veterinarians showed increased cancer of the lymphatic and hematopoietic systems, colon, brain and skin. These researchers concluded that equine and other large animal practitioners experienced increased sunlight exposure in their careers causing a heightened chance of developing melanomas, and exposure to ionizing radiation caused an increase in cases of leukemia.

Animal-related injuries are common among both large and small animal clinicians. Injuries to thehands and arms are the most common, but every practitioner has been stepped on at some point. The second photo is a thermographyscan of this unlucky veterinarian’s foot showing the tissue damage and inflammation as a result of contact with a hoof. (The greater white area in the thermograph indicate tissue damage and inflammation.)

Drs. Wiggins, Schercher, Green and Samulus of the Division of Occupational and Environmental Medicine at the University of California-Davis, noted in research published in the American Journal of Industrial Medicine, that 41 percent of the veterinarians in their study reported not wearing badges when taking radiographs. The number of equine veterinarians who take radiographs without proper protective aprons and gloves is unknown, but researchers point to the high leukemia statistics and feel that this is an area where practitioners can help themselves stay healthy by simply following standard radiology safety suggestions.

These same researchers looked at 531 veterinarians and found 64 percent had experienced some type of serious work related trauma. More than 90 percent of female veterinarians studied had been exposed to prostaglandins, and 23 percent of practitioners in the study had been contaminated by Brucella abortus vaccine. Another study published in the Journal of the American Veterinary Medical Association (JAVMA) involved 1,182 veterinarians in Illinois and found that "833 had experienced an accident or zoonotic exposure or both." Brucellosis abortus vaccine exposure and animal trauma were the principal injuries reported, and interestingly, this study showed 50 percent of the veterinarians who responded with one incident had a history of three or more injury incidents, leading the researchers to conclude: "Certain veterinarians are accident/injury/zoonosis prone."

Animal-related trauma is understandably very high among large animal practitioners. Drs. Landercasper, Cogbill and Strutt of the Department of Surgery at LaCrosse Lutheran Hospital surveyed 995 veterinarians in Minnesota and Wisconsin. Almost 65 percent had suffered animal-related injuries with 17 percent of those requiring hospitalization. Hand injuries were most commonly seen followed by injuries to the arm, head, thorax and genitalia. Scalpel injuries to the hand were reported highly. Lacerations were seen in 35 percent of the injuries, and fractures/dislocations accounted for 10 percent of the problems. Dental work was needed in 5 percent of the injuries. Cattle were much more likely (46.5 percent) to injure veterinarians than horses (15.2 percent), but donkeys and mules received special note because they were responsible for many of the injuries to genitalia. Dr. Landercasper and his colleagues also recorded the method of injury and noted that animal kicks accounted for 35.5 percent of the injuries. Veterinarians were crushed in 11.7 percent of the injuries suffered and bitten (3 percent) or scratched (3.8 percent) as well. These researchers also added a category called "other interesting causes" which accounted for 14 percent of injuries. Included in this category were cases of gouging, goring, pushing, head butting, ramming, running over or flattening the veterinarian.

As serious as these animal-related injuries can be, they are no match for another developing cause of increasing mortality in veterinarians: stress. This cause is probably a "sign of the times" as it is also significantly reported in human physicians and among younger professionals under stress in many other types of work. Unfortunately, suicide is occurring at a higher rate among veterinarians than ever before. The increased economic and time-related pressures of the profession are often offered up as possible reasons. Burn-out is a well-recognized entity among veterinarians, and it affects numerous practitioners each year as they struggle to find a balance between job demands and personal life. Many overworked young practitioners on the edge of crisis report feeling that the job they are doing is of little importance. Increasingly large, multi-doctor practices and emergency clinics provide better service to clients but can also reduce the bonding between practitioners and individual clients and pets.

Veterinarians become "interchangeable"; clients move from one year's intern to the next, and the sense of community that existed in the veterinary profession is sometimes diluted. This loss of social support can leave some veterinarians feeling overworked, under-appreciated and alone.

Suicide rates are much higher for veterinarians who have been in practice for less than 20 years. Older practitioners respond that they have ties to their jobs that go far beyond the actual practice of veterinary medicine.

"Many of my clients have become friends over the years," says a Georgia practitioner with almost 33 years of service, "and I still enjoy making my rounds to the farms and catching up on their lives."

This ability to become invested in clients and their pets is seen as protective by some researchers and can lead to higher job satisfaction and possibly lower suicide rates. Interestingly, too, this bonding of practitioner to client/pet translates into more loyal clients, repeat business and a more successful practice. Older practitioners generally enjoy more financial stability and potentially less stressful personal situations, so these statistics might be somewhat biased. Still, it can only be advisable for veterinarians to follow the old adage that encourages one to stop and smell the roses. Developing ties to clients, their animals and the community fosters a feeling of worth and belonging, which can be strong protection against burn-out and suicide.

Being a veterinarian, especially a large animal mobile practitioner, is not easy, and it might even be deadly in some situations. Yet, like all risky endeavors, there are ways to improve one's chances of success and long-term survival. Practitioners should avoid working under conditions of severe fatigue. Working around cattle and horses requires awareness, sometimes quick reflexes and revolves around making good decisions — all of which are negatively affected by fatigue. Driving with distractions or when tired is a very likely way for mobile practitioners to injure or kill themselves. Take a break when needed; have someone else drive for you, and do not stress about getting behind in your day. It might just be the best way to stay ahead in your life.

Use sun block when working outside; wear a hat or other protective clothing, and reduce your very real risk of skin cancer. Make sure your X-ray machine is working properly; use your protective apron and gloves and correctly handle drugs, pesticides and dewormers. Avoid breathing anesthetic gasses, improperly handling chemicals, such as formalin, and be careful when using scalpels and scissors. But perhaps most importantly, learn to appreciate the small moments of fun in your day and the large part you play in the lives of your clients and their animals. Your daily attitude is your best defense, and you can bet your life on it.

Dr. Kenneth l. Marcella is a 1983 graduate of the New York State College of Veterinary Medicine at Cornell University. Marcella served as assistant professor of Comparative Medicine at the University of Virginia Medical Center and started veterinary practices in Virginia and Georgia. He is presently a co-owner of Chattahoochee Equine, a mobile equine practice in Canton, Ga. He has written numerous articles and book chapters and currently contributes to two equine magazines. He has lectured on topics ranging from endurance issues to polo pony injuries and muscle rehabilitation at national meetings including the American Association of Equine Practitioners, the American Endurance Riders Association and the American Riding Instructors Association. Dr. Marcella is a member of the Federation Equestrian International and has served as treatment or regulation veterinarian at events such as the 1996 Atlanta Olympic Games and the 2002 PanAmerican Endurance Championships.