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Climbing back on the proverbial horse

After attack or injury, return to veterinary work may be daunting


August 15, 2012
By: Phyllis DeGioia
For The VIN News Service



Photo by Dr. Colleen Brown
The 90-pound patient that bit Dr. Colleen Brown during a house call was a recently diagnosed diabetic with an adrenal mass.
After a 90-pound German shepherd mix sunk his teeth into her right hand and pulled her across the room, Dr. Colleen Brown’s sense about her job as a veterinarian inevitably shifted. 

For two weeks, the house-call and relief veterinarian in Mesa, Ariz., was dogged by nightmares. In her waking hours, she approached work tentatively. 

"I politely declined house calls at that time and used extreme caution while working relief," Brown recalled. "I was nervous and apprehensive. ...  I could even sense my patients were aware of my nervousness. I think it took a month or so to 'get back in the saddle,' so to speak." 

Attacks or injuries from accidents involving animal patients may be an occupational hazard for veterinarians but that doesn’t make recovering any easier. Often, physical recuperation is faster than the psychological healing. Emotional repercussions may linger and color how veterinarians feel about specific types of patients or situations, and even work in general, long after the event is past. 

In Brown’s case, it’s been only 4-1/2 months since the day she was called by a new client to see a recently diagnosed diabetic dog with an adrenal mass. The client said to bring a muzzle. All the same, what happened was unexpected. 

Brown said she briefly met and petted the dog, then spent about an hour talking with the owner while the dog was in another room. Then, as the veterinarian was seated, writing notes, the owner brought in the dog, unmuzzled. The dog growled, lunged at the veterinarian’s hand, chomped down and would not let go for what seemed like forever. 

At that moment, Brown, a lifelong dog lover, operated on bare emotion. She burst into tears from shock, trauma and pain. The owner provided a towel to try to staunch the bleeding and offered to take her to the nearest hospital, five minutes away. She opted to drive herself there. “I just wanted to go alone,” she explained. 

"I cried all the way to the emergency room, in the emergency room, in X-ray and up until the pain meds began to work,” she recounted. “Crying from a bite in such a manner is unusual for me." 

She had three deep puncture wounds in the right hand — her dominant hand. Fortunately, no bones or tendons were broken. 
 

Photo by Ken Brown
Dr. Colleen Brown was back to work within a week of being bitten but overcoming lingering jitters took much longer.
Physically and logistically, the episode could have been worse. The dog owner’s homeowner’s insurance paid for Brown’s medical care and missed work. She did not need physical therapy or follow-up care. 

But emotionally and psychologically, recovery was more complicated. 

Brown related her experience on a message board of the Veterinary Information Network (VIN), an online community for the profession. Ten days after the attack, she reported: 

“Since this bite, I have had two house calls where I had assistants and was still scared to death and/or couldn't get a blood sample or express anal glands,” she wrote. “One was a pit bull that I have seen five times and never had an issue, and the other was a new patient German shepherd. I know I am gun-shy now and they can probably sense it. I even went horseback riding the other day and the horse was leery of my hand, no joke! He kept sniffing it and wouldn't go faster than a walk."  

Four months later, Brown continues to be cautious. If an owner won't allow her to restrain an aggressive or fractious pet with a muzzle or sedative, she declines to provide services. She is revising her paperwork so that new-client forms ask about aggressive or fractious behavior. The new forms will address safety for the patient, the pet owner and the veterinarian.  

Attacks and injuries have a way of leaving lasting effects. A close call 17 years ago still influences how Dr. Lynda Bacon of Grayson, Ga., feels about female Rottweilers. In the pivotal case, Bacon had met the patient as a puppy, who was well-behaved throughout her series of puppy exams and shots. When the dog came in for a checkup at age 1, Bacon figured they were friends. She crouched down, opened her arms and said, "Sheba! There's my girl! Come here!"  

The dog happily licked her face in greeting, stepped back a moment then suddenly, with no warning, snarled and lunged for Bacon's face.  

The owner, a prison guard who had Sheba on a leash, yanked her away just in time. 

Years later, Bacon said, "I'm still not good with Rotties, particularly females. Really, any time a dog jumps up to lick me in the face. It doesn't interfere with my job. It's just that little flinch that is out of proportion to what's going on. It would be one thing if she had given me any warning at all. She went from licking to a snarl. A less muscle-y owner would not have not been able to get her back in time."  

Bacon continues to work on tempering her fear. "I had a female Rottie this week that I was totally fine with and I thought that was a good step," she reported. 

For large animal veterinarians, greater risks come not from teeth but from hooves and half- to one-ton bodies.  

Dr. Christy Corp-Minamiji of Davis, Calif., has been around horses since she was 10 years old. She once had to be hospitalized after being kicked in the chest. Two days after being discharged, she was back at work. Three weeks later, she was kicked in the chest again. Like most large animal veterinarians, she's been concussed, run over and stepped on. None of that bothered her. She figured injuries are part of a large animal veterinarian’s job.  

What stays with her is a seemingly innocuous incident that required her to stay out of work for three months. A prospective buyer had asked Corp-Minamiji to give a horse a pre-purchase exam. Simple enough. She was picking up the horse's legs, palpating them and testing range of motion.  

“This horse had been a little bit antsy but not terrible,” Corp-Minamiji said. “I picked up the back leg and he fought me and he was trying to pull it away. I held on and pulled a little and he half-heartedly tried to kick me. At some point my fingers got splayed. I was on the horse's left, facing his hind end. I had his leg in my left hand, and he pulled it to my left. When he did that, my little finger got abducted to the outside, and I heard the crack and thought, ‘Oh dear, this is going to hurt.’ 

“I put the exam on hold while I taped my fingers together and tried not to vomit, because that's just not professional."  

Her fifth metacarpal had an oblique fracture from midway to near the wrist. Corp-Minamiji had expected to need just a finger splint, but ended up in surgery to plate the fracture. She also needed three months off for physical therapy, significantly more time away from work than she'd ever taken for an injury.  

When she returned to practice, she was surprised by how nervous she felt. 

"I found I was much more cautious around horses ... than I expected to be," Corp-Minamiji said. "I would sometimes take a technician with me whereas before, I might not have. Hard to tell if it was concern for my own safety or whether I could get the job done, as both were definitely factors. During the next six months, it did get easier, but it really surprised me that the nervousness was there at all. It surprised me to find I was hesitant to pick up back feet. I sometimes had to force myself to do something that used to be automatic.”   

Her response to the accident left a bigger impression than the injury itself. “The fear was shocking,” Corp-Minamiji said. “It didn't cripple me, I didn't have nightmares, but I was surprised that (the incident) caused any hesitation and nervousness. As Franklin Delano Roosevelt said, ‘The only thing we have to fear is fear itself. ’ ” 

The emotional repercussions of being injured may be minimal or significant enough to qualify as post-traumatic stress disorder. According to Dr. Michele Gaspar, a veterinarian and therapist in Chicago, the trauma of being bitten or attacked can shake a person to the core.  

“Getting bitten gets at three issues," Gaspar said: "One, it's a personal sense of violation. ... Two, it strikes to the core of 'Do I know what I'm doing? Did I do everything possible?’ Three, you can take all reasonable precautions and there's still an element of danger. It's part and parcel of our work. For some people, it's very hard to get back on that horse after a bite; it depends on our own makeup."  

If the memory of a bite causes a person to become overcautious or hypervigilant — taking caution to an extreme degree — Gaspar suggests therapy.  

"If you feel you can't share with your colleagues if it's bothering you, then you need to talk abut it (with a professional),” Gaspar said, “It doesn't have to be impacting your life on a grand scale like (causing) insomnia or eating issues or crying jags. If it's nagging you, then you need to talk about it.” 

And the sooner, the better, she advised: “Trauma needs to be dealt with as soon as possible after the event, not six months or a year down the road. If you keep this stuff bottled up, it will bite you in the butt. It will bite you bigger than if you had dealt with it.”  

When Brown posted on VIN about being bitten on a house call, she did naturally what Gaspar recommends. She talked about what happened, her feelings and the financial outcome. Brown said she does not feel a need for professional therapy.  

Gaspar notes that an important component of healing is self-compassion. “You may not have looked out for every single variable, but the bottom line is, you can't,” she said. "We can do our best but our best cannot guarantee a good outcome.”



VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email news@vin.com.



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