The Vet Vault 3.2.1.
10 November: A nifty little nerve block for a very common procedure, avoiding panic for a common complication, and what we can learn about fear from spiders.
3 Clinical pearls.
The 3 'pearls' are all from our clinical podcasts. Sign up here for the easiest way to keep your clinical knowledge fresh.
1. A handy little nerve block for a very common procedure.
Episode scheduled for later this month. With Dr Toby Trimble
We did this masterclass episode with anaesthetist Dr Trimble about fancy ultrasound-guided nerve blocks, but the block he taught me that I'm likely to use most often is this nifty digital block for those really painful broken toenails:
You can block the distal phalanx using a digital block by injecting a bit of lignocaine on either side of the lateral aspect of the digit.
This will allow you to remove and treat a broken nail under sedation, rather than GA.
More importantly - Dr Toby feels that we’d get better procedural and post-procedure comfort, and hopefully avoid the terrible ‘foot-phobias’ that many patients develop after a traumatic nail injury.
“We underestimate the behavioural impact of patients that have GA nail bed infection or a nail avulsion. We see them, and they're absolutely fine, and then they come back next time and they're really frightened to come into the practice.”
2. Pro tip for the caudal maxillary dental nerve block.
Episode 86 in the Surgery feed. With Aaron Forsayeth.
Pearl 1 reminded me of the dental nerve block episode we did last year, and of the photos that Dr Aaron sent me 3 days after we recorded:
Aaron had discussed possible complications of dental blocks in the episode, including retrobulbar haematoma formation after a caudal maxillary dental block. Of course, 3 days later this happened to him! Here’s his advice for if (when!) it does happen to you:
If you accidentally lacerate a vessel you can get quite a large haematoma, which can prolapse or even proptose the eye. Can be very scary!
Just keep the eye moist. If it's quite bad you can do temporary tarsorraphy.
It'll usually be back to normal later on the same day.
“You haven't done anything wrong. Something just hasn't gone exactly right.”
Note: It is ALWAYS important when you place a local/regional block to draw back before you inject - you don't want to give intravenous local anaesthetic.
3. A useful resource.
Yet to be released episode on palliative care. With Dr Shae Cox
You know how tricky it can get when your patient is on multiple drugs, like your geriatric patient with 5 health issues, or that critical patient on the tree of life. In stead of spending in hour in Plumbs looking up possible drug interactions, type in your meds in this site, and it will check for possible interactions for you.
2 Other things.
1. How to kill the ANTs
ANTs = Automatic negative thoughts.
A few key points from this episode From The Diary of a CEO podcast with Dr. Daniel Amen.
Negative thoughts a neurological habit - a habit that can be broken.
Strategy to ‘kill the ANTs’:
Whenever you feel sad or mad or nervous or out of control, write down what you’re thinking, and then ask yourself:
Is this thought absolutely true?
How do I feel when I have this thought? How do I act when I have this thought? What’s the outcome of the thought?
How would I feel if I didn’t have the thought? How would I act if I didn’t have the thought?
What’s the outcome of not having the thought?
Take the original thought (my wife never listens to me!), and turn it to the opposite (my wife always listens to me.) Ask - could THIS be true?
By directing your thoughts you’re no longer a victim, and you’re directing your mind towards habitually having more positive thoughts.
2. The 7 reasons why we don’t become the best in the world.
From The Dip by Seth Godin
You run out of time, and quit.
You run out of money, and quit.
You get scared, and quit.
You’re not serious about it, and quit.
You loose interest or enthusiasm, or settle for mediocre, and quit.
You focus on the short term, in stead of the long, and quit, when the short term gets too hard.
You pick the wrong thing to be the best in the world at, because you don’t have the talent. (You = your team, your company, or just you.)
1 Thing to think about.
This is a picture of the spider that lives in our house. (Don’t click it if you don’t like spiders!)
It’s her second summer with us - we recognised her by the two missing legs when she re-appeared a few weeks ago as the weather started warming up. (I had to Google ‘how long do huntsman spiders live?’ to make sure that it’s not just another six-legged large hairy spider. It’s up to 3 years, in case you were wondering.) She currently spends her downtime in the pantry right above where we keep the bread, but at night she’ll pop up in random spots wherever she’s prowling for bugs, or even the occasional gecko, as we discovered one morning when confronted by the grim sight of the back half of a gecko hanging from her pincers.
There’s a reason why I posted that photo as a link and not just directly on the post: I know that many of you would not appreciate opening an email only to be confronted by the image of a spider, and some of you wouldn’t bother reading the rest of the post. I might even see a few cancellations from the email list. In fact, I’m pretty sure that some of you are thinking: ‘How have you not burnt your house down knowing that that thing is roaming the house at night!?’
The most entertaining arachnophobe I know is one of the nurses I work with - we’ll call her Amanda, because, well, that’s her name. (Amanda, if you read this - don’t click on that photo!) Amanda is almost entirely fearless - there’s not a feisty feline or cantankerous canine that she won’t wrangle, and I’ve seen her cuddling snakes large enough to swallow my youngest child. ALMOST entirely fearless, because every time she finds even the tiniest little eight-legged critter (or when they find her, because they always do!) she goes all red and then pale and then green, and then invisible - as in - you can’t find her. So our roles switch and I get to feel like the hero for a change: “I’ll remove the big bad spider Amanda, and while you wait - Satan the hyperthyroid tortie needs another enema…
But Amanda isn’t alone, right? So why does my family happily tolerate a large and pretty scary-looking spider in our house? It’s logical really - I know she’s not actually dangerous, and we’re on the same team: she eats the bugs that I despise. Don’t get me wrong - I never love accidentally discovering her newest hiding place. The first morning I reached for the bread and was met with two angry raised fuzzy legs and bared fangs I may have said a few rude words. But now that I know she’s there we’re cool. Sometimes we have chats. (Podcasting can get pretty lonely, you know.)
I didn’t always like spiders. As a kid, I was appropriately terrified, as most humans are. There’s a very rational component to our sometimes irrational fear of spiders. Back when we were developing into the species we would later become, our evolutionary ancestors would have learned very quickly that certain spiders in your tree or your cave could be bad for the survival of your genes, so the lesson was clear: rapid eight-legged scuttly movements = bad = get-the-f-out-of-here or squish-it-if-you’re-brave. Panic first, think later was the surest way to avoid pain and death. I think we’re born afraid of spiders - it’s programmed deep in our amygdala, along with ‘avoid large toothy things that live in open bodies of water’, and ‘don’t speak in front of gatherings of humans in case they laugh at you and kick you out of the tribe’.
I remember the day my innate arachnophobia started receding: I was around ten years old, mincing around in a bookshop waiting for my mom to finish work. I picked up a book called *Spiders of South Africa* for the same reason that we read horror stories - I wanted to be thrilled by how deadly these little beasties were. But page after page showed only pictures of fascinating, sometimes beautiful, and boringly harmless creatures. I had to search a while to find the two or three dangerous spiders, and I was a tad disappointed to learn that even those caused very few hassles to humans. (Except if you live in Sydney, in which case your fear of spiders is probably totally justified!) Something flipped for me that day. I became more curious than scared.
To be clear - I’m not fearless with spiders. I don’t want them ON me - I’m not an idiot! I always check my gumboots carefully before putting them on, and I still don’t love being in a confined space with them. (I have a story about a huntsman in my car that would make some of you cry.) But I know enough to know which spiders to really avoid, how to not aggravate them, and how to calmly and safely catch and remove them when they are too close for comfort.
But this post isn’t actually about spiders. (Although if it helps you, Amanda, great!) It’s about fear, and what we can learn about it from our fear of spiders:
Most of our fears are grounded in rationality: Spiders CAN be dangerous. In our ancient past, saying the wrong thing in front of the tribe COULD get you ostracised. Trying that new surgery COULD go very wrong.
Many of our fears are massively exaggerated: Most spiders are harmless. These days it’s unusual for humans to cast someone out into the wild for saying the wrong thing (except on social media), and that new surgery could also be the start of something amazing.
Informing yourself about the thing that scares you can go a very long way towards reducing the fear. It’s hard to be curious and scared at the same time.
Exposure is a very effective anti-fear vaccine. Start with a Google search of cute spider images. Practice conflict situations with a mentor. Listen to a podcast about tracheostomies.
There’s one more thing: it has to start with a desire to not be afraid. Sometimes we identify so strongly with our fears that it becomes a part of who we are. We believe that it’s ‘just one of those things’ about us, and we can’t imagine a different way. We not only accept it - we embrace it as our identity. ‘I’m just not brave when it comes to spiders.’ ‘I’m just not a surgeon.’ ‘I could never…’
By all means, be wary of spiders, just don’t let it define you.
---
Much love,
Hubert
How to connect with us:
Connect with our community on the Vet Vault Network for more clinical updates, support, live events and more. Once you’ve joined, you can also download the Mighty Networks app (for iPhone) (for Android) and log in to access our network at any time.
If you are finding these emails useful - do us a favour and forward it to a friend who you think will benefit from it.
And if you are that friend who had this forwarded to them and you want to get more of these emails, then …