shelter medicine

by Jyothi Robertson Jyothi Robertson No Comments

Veterinarians and Suicide

This week’s blog post is one of utmost importance in the veterinary community – suicide in veterinari­ans. Not as oft-discussed as it should be, it’s becoming clearer with time that members of the veterinary medical field are prone to experiencing burnout, depression, and extreme levels of stress.

In a recent article from early September, NPR explored this topic, heading to San Francisco to speak with Dr. Carrie Jurney (DVM, DACVIM) to discuss a nonprofit she works on the board for, Not One More Vet. The statistics she discusses concerning stress and death in the field of veterinary medicine are alarming:

“The Centers for Disease Control and Prevention found male vets are 2.1 times as likely and female vets 3.5 times as likely to die by suicide compared with the general population. The much higher rate for women is especially concerning as more than 60% of vets are women.”

From a study in the AVMA journal, 400 veterinarians out of the 11,600 that have died from 1979 to 2015 died by their own hand.

Jurney even clarifies this from her own experience – out of 85 graduates in her class (2005), 3 have committed suicide.

How does this happen? Why are those in veterinary medicine so likely to take their own lives? There are a few speculated factors that can lead to this. Firstly, the stress of succeeding throughout medical school, an average $140,000 in debt for the average graduate, and median $94,000 made yearly can make for a debilitating mindset of digging out before a career even has a chance to take off.

Burnout in the medical world is extremely common, but there are several specific stressors unique to the field of veterinary medicine.

Veterinarians on average make half as much as physicians but attend schools of equally marked prestige, meaning comparable tuitions, and likelihood of student loan debt with half the efficacy of paying them off.

Ignoring these initial heavy obstacles into the career of the veterinarian, there is the work itself – often dealing with stressed out animals, stressed out owners, and sometimes, very dire situations.

Trying to mend the injuries and illnesses of patients who don’t know what is going on, in addition to their guardians being emotionally heightened can makes for a lot of pressure in even the most routine visits.

Veterinarians and Suicide, JVR Shelter Strategies

Coupled with long hours, underfunding, and understaffing, the day to day life of a veterinarian involves baseline stressors much higher than most medical professions.

Sometimes, there is a brief respite from these stressors when the veterinarian’s work is successful and ends in an animal leaving happy and healthy, but then again, results can be unpredictable, and the emotional investment can make for crushing lows. Immediate access to euthanasia drugs also poses a risk in conjunction with these other factors.

Jurney recalls a dog with chronic disks that she treated with emergency surgery – after many hours, the dog, unable to walk when he arrived, left walking and much improved. However, a few days later, the dog passed due to a complication from both the initial genetic problem and from the surgery to improve his disks. This was truly a painful moment for Jurney:

“I have to be honest — this is gut-wrenching. You came to us to see why the job is hard, and there is no better example than this. I am devastated. I’ve cried through many moments of my mother in law’s birthday dinner tonight because my mind is with Reuben and his poor owners. I wonder if there is anything I could have done differently. Even though I know I did everything I could for him, I still wonder if I could have done more.”

Veterinarians and Suicide, JVR Shelter Strategies

From my own conversations with veterinarians globally, an additional factor at play appears to be our professions comfort level with euthanasia. Vets are faced with making euthanasia decisions on a daily basis, unlike other medical professionals. We see animals that are suffering and in pain, have that pain and suffering relieved by end-of-life choices that their owners make and that we act upon. We are comfortable with the process of euthanasia (technically speaking) and understand what occurs from a physiological standpoint. Depending on if we are working in animal shelters or not, we may be making these choices on a daily basis on healthy and unhealthy animals alike. Death is not a foreign concept to veterinarians. It is one that they discuss and internalize on a daily basis in their work.

Isolation can also take its toll – due to the aforementioned long hours, and sometimes geographically, the veterinarian in question will be hundreds of miles from another vet, meaning they are the only professional in the area licensed to care for animals. Even still, many practice alone – making for even busier, more stressful, and lonely careers.

In an ironic twist of fate, data collection by Kim Repp and medical examiner Charles Lovato shows a peculiar cycle where in some instances, suicidal people will bring all their animals to a shelter. This happens frequently enough that those in the shelter and veterinary community often undergo training to recognize the signs of stress and depression that can lead to suicide, with no avail in the numbers they lose themselves.

This trend of the veterinary community subjecting themselves more and more to stress and isolation is directly linked to the higher rates of suicide, depression, and anxiety. Luckily, there are important ways to create a capacity of care for members of the veterinary community.

Veterinarians and Suicide, JVR Shelter Strategies

Nicole McArthur, founder of Not One More Vet, works to provide a safe place for veterinarians who understand the stress of the industry to speak with each other, share their insights, feelings and worries, and create a network of care and support.

The more networks that allow for veterinarians to share their feelings and feel heard by others who understand the struggle, the easier it will be to destigmatize these hardships of the industry and work together to find solutions and self care.

There are also methods that veterinarians can utilize in their day to day lives to create a capacity to care for themselves the same way they care for their patients. More to come on that soon!

Veterinarians and Suicide, JVR Shelter Strategies

by Jyothi Robertson Jyothi Robertson No Comments

Animal Hoarding: Part Two

In this post, I’ll continue my exploration of animal hoarding behavior. I’ll focus specifically on what the veterinary community can do to observe, prevent, and report such behavior.

If you want to stay vigilant about hoarding and contribute to solutions, here are some things to consider and inquire about before supporting an organization or a rescue client:

  • How many animals are currently in the organization?
  • How many animals have been adopted within the last year?
  • What does the animal intake look like on a yearly / monthly basis?
  • What are the average, median and longest length that animals in the organization stay?
  • Do they have a 501c3 and/or a current 990 form?
  • Do they have a Board of Directors and a clear mission statement?
  • Is there a physical location associated with the rescue, and are visitors allowed?
  • Is the rescue foster-based or shelter-based? If shelter, how many employees are there?
  • How are members or fosters selected and screened?
  • What are the adoption and intake processes like?
  • How is their relationship with the local veterinarian and animal control organizations?

Animal Hoarding: Part Two, JVR Shelter Strategies

These questions can give you an insight into the legitimacy of the rescue and if there are any warnings concerning hoarding behavior or connections to clients who hoard.

Of course, the behavior of the owners isn’t the only giveaway. Seeing animals for the following reoccurring problems can be a sign that they aren’t being cared for properly:

  • Matted hair with numerous ectoparasites (fleas and ticks)
  • Overgrown nails
  • Untreated wounds and scars
  • Broken or ground down teeth
  • Lesions from urine scalding
  • Missing fur
  • Ear infections
  • Appearing very dirty and smelling foul

These symptoms can be manifestations of further complications including abscesses, respiratory diseases (often accompanied with coughing and discharge), feral or unsocial behavior, gastrointestinal problems caused by infectious parasites, and even more. All or some of these symptoms in tandem seen across multiple animals could be a clear giveaway to hoarding behavior.

Animal Hoarding: Part Two, JVR Shelter Strategies

After a few visits with clients bringing animals in under these conditions, there are a few extra observable conditions to look out for on their behalf:

  • Their bills add up
  • They keep bringing in animals once without ever following up
  • Multiple animals seen for symptoms listed above
  • Asks for extra medication for other animals in household
  • Will take extreme measures to preserve the animal’s life, even removing from care
  • Claims to have found or received multiple animals in their present condition
  • Vague, avoidant answers

Staying vigilant to these signs can keep those in the veterinary community from enabling hoarding behavior and even actively halting it. The behavior of hoarding is harmful to both client and animal, and taking the time to ask these questions and train on the patterns of behavior help to keep animals happy and safe.

Animal Hoarding: Part Two, JVR Shelter Strategies

by Jyothi Robertson Jyothi Robertson No Comments

Animal Hoarding: Part One

Over the past few months, I have been invited to speak at three national conferences: the Pacific Veterinary Conference in Long Beach, CA; the World Small Animal Veterinary Association Conference in Toronto, Canada; and the American Veterinary Medical Association Conference in Washington D.C. I covered a range of topics that I plan to outline in my upcoming blog posts, starting with the topic of animal hoarding.

In my series of lectures concerning the topic of animal hoarding, I explore several situational definitions and signs to identify and prevent animal hoarding. As veterinarians, we represent the first line of defense against this treatment of animals.

Beginning with how animal hoarding is defined, the situation isn’t always as simple as owning an atypical number of animals. To explore this definition further, we use the acronym FIDO:

  • Failure to provide for the animals in question
  • Inability to recognize this failure and its effects on animals, people, society
  • Denial or minimization of the problem
  • Obsessive persistence to continue to accumulate animals

This was a classic hoarder case not a rescue hoarding with over 170 cats inside the residence. Photo from HSUS.

Being cognizant of these factors will not only help to solve the problem, it’s important to remain vigilant so that we can support our patients, the animals, as well as our clients, especially when the client is not properly caring for their animals.

If encountering animal hoarders and treating their animals seems like an unlikely situation, it may be more likely than you think. A sample taken of 54 cases showed 32 repeat investigations into the owners. The hoarder in question may not seem obvious as well – up to 75% of this sample was shown to be unmarried women, generally well educated with at least some college, and many from caregiving backgrounds. There were a variety of income levels, but many of the sample subjects were on disability, retired, or unemployed. Concerning age, the study saw that most began hoarding in their 30’s, and nearly half were over 60. That said, we now have many cases of very well-educated people in animal hoarding situations.

As the study shows, the profile of a hoarder is not so obvious visually! Next, we will discuss which profile traits of a hoarder we can identify! A preoccupation with animals is a given, but this may take many different forms – usually this preoccupation takes up most of their time and money. There’s an element of companionship that comes with owning one or many pets, but a hoarder has little social contact with others, potentially relying on animal companions instead.

Some reasons as to why people commonly hoard include rescuing them from euthanasia, feeling a special ability to communicate with the animals they surround themselves with, and the traits of pathological altruism intersecting with an unconditional love of animals.

In many cases, these situations and reasons aren’t exclusive from one another. See the venn diagram below to understand how this can manifest:

Animal Hoarding: Part One, JVR Shelter Strategies

Let’s explore some of the hoarder profiles listed above:

Overwhelmed Caregiver – Of the three profiles listed above, the overwhelmed caregiver is usually more firmly rooted in the reality of their situation – and has some awareness of the problem. They acquire animals more passively, and their situation is usually attributed to a change in their circumstance. They may have kept acquiring animals because they are unable to problem solve and are socially isolated and not receiving advice or feedback from others. However, this profile usually has fewer problems with authorities than other cases.

The Exploiter – This type of hoarder usually collects animals based on their use, not because of any empathy or compassion towards them. This can go hand in hand with sociopathic tendencies. They are indifferent to harm caused to the animals and tend to ignore other’s concerns about their behavior. In some cases, this can even be paired with manipulative or cunning behavior to cover up their actions, including a charismatic personality to deflect criticism. Some exploiters even claim to be experts to justify their actions to control the situation.

The Rescuer – This hoarding profile usually comes from a self-driven mission which eventually leads to unavoidable compulsion. The mindset that only they can provide care leads to active acquiring of animals that they are looking to save. In some cases this can be a sign of a bigger emotional disruption, such as a fear of death. As the number of animals acquired rises, they stop being able to rescue and follow up by adopting, leaving rescue only care. The illusion of proactive care in this situation can be enabled by networks of people in similar situations. The resulting echo chamber can fuel delusions and pathological altruism.

Animal Hoarding: Part One, JVR Shelter Strategies

Above, we can see a shift in the trends of causation for these certain profiles of hoarders and where some symptoms of their hoarding hold greater weight comparatively.

In its first revision since 1994, the DSM-5, or Diagnostic Statistics Manual of Mental Disorders, ed. 5, hoarding behavior is now classified as a disorder. Recognizing hoarding is a big step in treating the disorder, as the DSM-5 is a standardized resource for licensed U.S. mental health specialists who can treat its symptoms consistently and at a deeper level. It also allows for comparison between the prevalence of cases, risk factors involved, and the results of different treatment methods.

In Part 2 of my blog series on animal hoarding, I will discuss what we can do as veterinarians to prevent and solve for this behavior.

 

References

Ung JE, Dozier ME, Bratiotis C, Ayers CR. An Exploratory Investigation of Animal Hoarding Symptoms in a Sample of Adults Diagnosed With Hoarding Disorder. J Clin Psychol. 2016;73(9):1114–1125. doi:10.1002/jclp.22417

Frost RO, Patronek G, Rosenfield E. Comparison of object and animal hoardingDepress Anxiety. 2011;28(10):885–891. doi:10.1002/da.20826

Frost, R. O., Patronek, G., Arluke, A., & Steketee, G. (2015). The Hoarding of Animals: An Update. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/addiction/hoarding‐animals‐update

Frost, R. O., Steketee, G., & Williams, L. (2000). Hoarding: a community health problem. Health & Social Care in the Community, 8, 229–234. https://doi.org/10.1046/j.1365‐2524.2000.00245.x

Frost, R. O., Tolin, D. F., & Maltby, N. (2010). Insight‐related challenges in the treatment of hoarding. Cognitive and Behavioral Practice, 17(4), 404–413. https://doi.org/10.1016/j.cbpra.2009.07.004

Levy HC, Worden BL, Gilliam CM, et al. Changes in Saving Cognitions Mediate Hoarding Symptom Change in Cognitive-Behavioral Therapy for Hoarding DisorderJ Obsessive Compuls Relat Disord. 2017;14:112–118. doi:10.1016/j.jocrd.2017.06.008

Lockwood, R. (1994). The psychology of animal collectors. American Animal Hospital Association Trends Magazine, 9, 18–21.

Nathanson, J., & Patronek, G. (2011). Animal hoarding: How the semblance of a benevolent mission becomes actualized as egoism and cruelty. In B. Oakley, A. Knafo, G. Madhavan, & D. Wilson (Eds.), Pathological Alltruism (pp. 107–115). New York, NY: Oxford University Press.

Patronek, G., Loar, L., & Nathanson, J. (Eds.) (2006). Animal hoarding: Structuring interdisciplinary responses to help people, animals and communities at risk. Boston, MA: Hoarding of Animals Research Consortium.

Patronek, G. (1999). Hoarding of animals: An under‐recognized public health problem in a difficult to study population. Public Health Reports, 114, 82–87. https://doi.org/10.1093/phr/114.1.81

Patronek, G. J., & Nathanson, J. N. (2009). A theoretical perspective to inform assessment and treatment strategies for animal hoarders. Clinical Psychology Review, 29(3), 274–281. https://doi.org/10.1016/j.cpr.2009.01.006

Steketee G, Frost RO, Tolin DF, Rasmussen J, Brown TA. Waitlist-controlled trial of cognitive behavior therapy for hoarding disorderDepress Anxiety. 2010;27(5):476–484. doi:10.1002/da.20673

Reinisch AI. Characteristics of six recent animal hoarding cases in Manitoba. Can Vet J. 2009;50(10):1069–1073.

Reinisch AI. Understanding the human aspects of animal hoarding. Can Vet J. 2008;49(12):1211–1214.

Patronek GJ. Hoarding of animals: an under-recognized public health problem in a difficult-to-study population. Public Health Rep. 1999;114(1):81–87.

by JVR JVR No Comments

Diplomate!

WaterIt’s official!

The studying paid off and I am now boarded in Shelter Medicine, the newest speciality in the American Board of Veterinary Practitioners ( ABVP ).

Congratulations to all my amazing colleagues who passed through the hoops also!

#ABVP

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