October, 2018 | ergovet

Veterinarian of the Year

Just over a week ago, I had the honor of receiving the Association of Shelter Veterinarians 2018 Veterinarian of the Year Award. I’d learned that I would be receiving the award a couple months before, and at the time had been pretty stunned. Me? Seriously?

As you know from this blog, I do research and writing projects, some with other people, and more on my own. Since I work on my own, outside of any institution or organization, I don’t have committees, approval, or funding (except on a few projects I’ve worked on with others, for which I have written grants), I don’t have an institutional mission telling me which research topics are of interest to the university, a big donor, or the board of directors, and which topics may be too uncomfortable, difficult, or controversial. For me and my interests and tendencies (i.e., doesn’t always play well with others; has trouble recognizing the preeminence of authority figures), this has mostly been convenient. It has allowed me to follow my interests of the moment, to ask and then try to answer awkward or thorny questions, and to wander.

But it has also meant that I often don’t know how many people have even noticed what I’ve written, if they have read it, and what they think of it. It also means that I have learned to become my own publicist. Thus, I’m writing this braggy blog post in the same way that I worked on press releases for my last two papers– putting it out there because if I don’t announce my own accomplishments, who will? (OK, probably ASV will later, beyond their post in a closed Facebook group, but I want to show off now!).

The Award

Here is a description of the award– this is its first year, so I’m the first recipient:

2018 ASV Veterinarian of the Year Award

Established in 2018, this award recognizes remarkable members of the Association who have been outstanding in their role as a veterinarian to improve community animal health and wellbeing. The ASV’s intent in conferring this award is to bring attention to excellence in shelter medicine by recognizing those who serve as exceptional role models of the profession. Veterinarians serving in municipal, private, and/or non-profit shelters and other community animal endeavors are eligible; current ASV Board Members are ineligible. The award designee will receive a plaque, a shelter medicine textbook, and a $250.00 donation to an organization of his/her choice.

The award was presented at the ASV annual reception in Tampa on October 11, in conjunction with the ABVP (American Board of Veterinary Practitioners) conference and the ASV annual meeting.

Elizabeth Berliner used an appropriate amount of humor while sharing details of my nomination.

Elizabeth Berliner submitted the nomination and described some of the my work– from pot bellied pigs to Shelter Animals Count to ergonomics and of course spay neuter.

Way too excited to be here. Also, maybe Brenda shouldn’t have given me her extra drink ticket.

I gave a bit of an acceptance speech, the main gist of which was, “The research that I do is all about you– the shelter and spay neuter vet– because I want to support what you do, and who you are, because you are super cool.”

Later in the evening, the ASV presented this year’s Meritorious Achievement Award posthumously to my friend Kelly Farrell, who died last year but had been one of the most forward-thinking spay neuter vets I’ve ever met. Her family came to accept the award and it was sad, touching, sentimental, lovely, and heart-wrenching.

How do I have time for research?

I think sometimes people with “regular” jobs (meaning, 5 days a week working for someone else) assume I must do the same, and that any research or other work that I do is on top of this standard work schedule. That’s not really the case– here’s how my work schedule actually works.

My Spay Neuter Work

I love my spay-neuter work, and also, it keeps me “honest” (meaning, grounded in the reality of daily practice) in my research. But because of the model of spay-neuter that I do, I only actually do surgery about 110 days a year.

When I was starting my clinic in 2006 and being mentored by Leslie Appel of SOS in Ithaca, NY, Leslie recommended that I do MASH spay neuter just 2 days a week. She had started her MASH clinic working 5 days a week, then 4, and it was too much, even for her energetic, extroverted self, with the long work days in addition to the lifting, packing, unpacking, driving, etc. I have found that for me, three days of surgery in a week is do-able, but is also enough. With holidays, vacations, conferences, and odd weeks containing Saturday clinics (Saturdays, of course, count both for the week before and the week after), this works out to my 110-120 annual clinic days.

I’m also inventory, boss, budget-master, and book-keeper/accountant, making it a legitimately full-time job, but as time has gone on, these tasks get easier since the clinic schedule, budget, and mission barely change. What this means is that often, I have time on my hands to think, listen, explore, and learn.

My Research

It never would have occurred to me that I could do research and write scientific journal articles on my own without being part of a university or other institution. But back in 2007, when I was a part of the first Spay Neuter Task Force, I got involved with a project to analyze and publish shelter intake and euthanasia data from New Hampshire and Austin TX (since I already had years of NH data). Julie Levy, the experienced but overcommitted researcher in the group, recognized a potential time-management boon and offered that I could be first author if I wrote the paper. I jumped at the opportunity, and thus with her guidance and that of Jan Scarlett, I learned the ins and outs of writing and revising, peer review and eventual publication. Once I had been through the whole process with one journal, it was suddenly conceivable that I could do it again, and on my own. So when I found a question that kept coming up in the spay neuter community, and when I could figure out a way to find (or at least get closer to, and explore) an answer, I did so.

But Why?

During lunch at the SAWA/ National Council on Pet Population research day in 2016, a university researcher asked me why I did research if I didn’t have to. As we talked it was clear to me that what she resented about her own work was the impositions of the university structure, rules, and systems on her research. Whether it was funding or approvals or imposed timelines, the system made research a hassle rather than fun. By doing research outside of such a system, I’ve avoided a lot of that hassle (also, by doing survey-based research outside of an institution, I’ve been able to avoid needing to find an independent human subjects committee to evaluate and approve my research). So I get to learn deeply about a subject and ask interesting questions. What’s not to like?

But Library Access…

How do I get access to journal articles without being part of a university? At home, I have the same limitations as any other internet user. But like many people, I live just a few towns away from a university. And like many universities, it has a library that allows everyone access. When my list of otherwise inaccessible articles on Google Scholar gets long enough, I head on over to the university library and download to my heart’s content. It’s not as easy as having access at home, but it works, and it’s sometimes fun to have an excuse to spend a few hours hanging out in the fancy university town, drinking soy lattes and eating ciabatta.

Life outside

And of course I have a life outside of veterinary medicine: family, pets, walks in the woods, video games, novels, binge-watching Netflix.

So anyway, thanks to those who chose me for this award, and thanks to all of you who have participated in or read or shared my research. I hope you’ve gotten as much out of it as I have ♥

My other accomplishment on October 11: Achieving level 40 in Pokemon Go. This has required countless hours of antisocial behavior staring at my phone. Just ask my mother or my wife.

Surgical hand hygiene

Several years ago I went to a continuing education lecture with a “surgery updates” session, and the thing I took away from it was this: that waterless surgical “hand rub” formulations are more effective than traditional wet scrub with chlorhexidine, betadine, or the like at reducing skin microbes on surgeon’s hands.

The speaker said that not only were these products more effective, but that they were also cheaper than wet scrub. This sounded great, so I looked up prices and realized that the price comparison was only true if one was comparing pre-packaged sterile chlorhexidine-impregnated scrub sponges to the waterless products. For those of us who were using chlorhexidine scrub “straight from the bottle” on reusable scrub brushes, the waterless hand rubs were much more expensive.

What are surgical hand rubs?

Surgical hand rubs are generally alcohol-based and may also contain chlorhexidine. These products aren’t the same as over-the-counter alcohol-based gel hand sanitizers or similar products. Some of the companies that make surgical hand rubs also make similarly-named hand sanitizers for non-surgical use—basically, for hospital worker hand sanitation. For example, Sterillium makes a Sterillium Rub Surgical hand scrub as well as a Sterillium Comfort Gel– the first costing $75-$125 per liter, the second costing about $18-$30 per liter. The lower-cost similar products may be tempting to purchase, but they generally aren’t capable of killing as many microbes as their surgical counterparts, and may also contain user-friendly emollients that may increase acceptance but decrease effectiveness.

How have surgical hand rub formulations been made accessible?

In order to address the problem of cost of surgical hand rub in developing countries, the World Health Organization published guidelines on local production of suitable formulations to be used for waterless surgical hand preparation. However, the WHO formulations failed to meet the European standards in certain measures of efficacy and duration of activity, so other authors developed updated hand rub formulations based on WHO formulas that meet European standards. When we wrote The Association of Shelter Veterinarians’ 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs, we included reference to these Modified WHO guidelines for hand rub formulations as an acceptable method of hand preparation in HQHVSN programs.

For the spay neuter veterinarian (or any veterinary surgeon) with limited budget, these modified formulations sound amazing: affordable, simple, effective, used safely in human surgery all over the world. But as soon as you look at the front page for necessary ingredients, the task gets daunting. Where do I find 99.8% pure isopropyl alcohol or 96% ethanol? What if I don’t need 10 liters at a time? What if there was a way I could make the same end product as in the modified hand rub formulation paper, but entirely out of ingredients I can buy over the counter at the local Walmart?

So I started doing some math and realized that I could mix bottles of two standard concentrations of drugstore isopropyl alcohol to make the 80% (volume/volume) (equivalent to 75% weight/weight) isopropyl alcohol recommended by the modified formula article without ever having to add water to the formulation. By using commercially available pre-measured sizes and concentrations of alcohol, the process of mixing is super simple– once I’ve mixed the alcohol, I use syringes to draw up and add the appropriate amounts of peroxide and glycerol.

Glycerol may be sold over the counter as Glycerin. It is the same product. One bottle will last you quite a while.

Here is the final formulation:

Modified World Health Organization isopropyl alcohol surgeon hand rub

1 quart (946 mL) 91% isopropanol

1 pint (473 mL) 70% isopropanol

62 ml H2O2

10.8 mL glycerol (also called glycerine)

Mix all ingredients together–I use a clean gallon jug for mixing and storage of the formula, and dispense into a repurposed hand sanitizer dispensing bottle for daily use.

Yield 1492 mL 79.9% (v/v) isopropanol with 0.1246% H2O2 and 0.724% glycerol

Results

I’ve been using this hand rub formulation for several years now. Of course, as with any waterless hand rub or scrub formula, it’s important that you have removed any gross contamination (in all senses of “gross”) from your hands before using the formula.

I have appreciated how easy it is to re-scrub compared to when I used water and chlorhexidine scrub to prep my hands for surgery. I don’t re-scrub between each surgery, but I will if I break sterility during my surgery day or if the indoor temperature is hot and my sweaty hands won’t go into my non-powdered surgical gloves. The isopropyl alcohol smell with this formulation is strong, so be ready for that. The skin on my hands hasn’t been bothered by the formulation and is actually less dried out than when I used chlorhexidine scrub, even though I use this product more often (again, because of the simplicity of scrubbing out and scrubbing in).

I hope you find this information useful!

Journal of Incidental Findings and Freelance Inquiry (JIFFI)

This year I’ve been thinking a lot about academic publishing: the process, access, and rights, the built-in delays. If you’ve been following this blog, you know I’ve had two articles published this year in peer-reviewed academic journals (see here and here). While I’m proud and excited to have been able to get my articles published, it’s also led me to contemplate some things that aren’t ideal about the current world of academic publishing.

Some background

Academic journal publication may be open-access or subscription-based. With open-access publishing, the article is available for free online to any reader. While this sounds fabulous for everyone—readers read for free! more people see my article!—the expenses of operating such journals are payed for using publication fees. That means that the authors of the paper have paid a fee to the publisher—from a few hundred to a few thousand dollars, from what I’ve seen—in order to submit their article. For those working for institutions, these fees may be paid for by the institution. For grant-funded studies, grantors may pay the fees. For those of us doing research on our own, these fees are a substantial barrier.

There has been a proliferation of open access journals with the internet, and credibility varies from highly reputable to highly questionable. A sting by Science Magazine several years ago revealed some serious lack of review at many (though not all) of these new journals. So while publication in a reputable peer-reviewed journal (whether open access or subscription) lends real credibility, publication in a similar-looking but sketchier journal doesn’t actually add any value or legitimacy to the content.

For subscription journals, the process is free to the authors, since the cost of publication is paid by the subscribers. The problem then becomes providing access to all the people who would be interested in or would benefit from reading the article. Different subscription content journals have different rules about how articles may be shared. In some journals like Anthrozoös, authors are allowed to publish the accepted version (not the formatted, final version) of the manuscript on their own website (as I did) or academic repository and share a limited number of free links to the article. In other journals like JAVMA, the subscription-only content is much more restricted and any sharing requires permission.

The Delays

There can be quite a delay in getting research published in subscription academic journals. Open access journals generally have faster times to publication, perhaps because their online-only format is not space restricted, and no hard-copy printing and distribution system is needed. The delay in getting research published can mean that data may be out of date and useful findings are withheld from readers, perhaps even for years. “Years” may sound extreme, but it took 2 years 4 months after submission—1 year and 8 months after acceptance— before our JAVMA study was finally published last month. From what I understand this may not be unusual for subscription academic journal articles.

What’s missing from “the literature”

Every good research publication tells a story, and every research study collects data that may be interesting but are tangential to the story. Perhaps data are collected as a step in an eligibility and randomization process or as background information, or surveys contain fields that are never analyzed. Comparisons that could be made aren’t. Information that exists is never shared.

And what about quick, small studies? Student research, or small independent surveys? When do these ever see the light of day?

What if there was a place where we could publish those bits and pieces*, the small studies, the “spin off” version of the main show? Someplace without the expense or delay of current academic publishing, where the research may just be interesting if not always deeply meaningful or revolutionary. Or, if not a single place or site, then a new standard convention of academic knowledge-sharing.

And so I have created: the Journal of Incidental Findings and Freelance Inquiry (JIFFI), an imaginary publication that exists right here. It is fast and free, reviewed by my peers after publication. No study too small or scope too narrow. (Also, it took me an entire morning of cat spays to come up with that journal name and acronym)

Of course the internet is a place with massive quantities of buyer-beware information – but is that any worse than never-shared information moldering on a floppy disk? Or for that matter, expensive publication in a sketchy/ poorly run open access journal? It seems to me that getting information out there is more valuable than waiting to figure out a more “legitimate” forum in which to publish.

In that vein, I will be aiming to use this space to publish some of the previously unpublished bits and pieces that I think could be helpful to some people. Some of my previous posts, such as Surgery Packs and Suture in HQHVSN would “qualify” for JIFFI as well, and I’ll create a tag and category for these posts on this site.

I’d love to see other people who do research, whether formally or informally, get their small or incidental results out there for others to use too.

*Credit for the initial idea of a journal that would publish these “other” findings goes to my recent co-authors Jan Scarlett and Julie Levy, from a conversation in early 2016 as we were preparing the final version of our recently published JAVMA study.