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It’s veterinary practice not perfection!

As a veterinarian (and recovering perfectionist), I can say that perfectionism is a common trait had by those in our profession.  I think if I polled a room of 100 veterinarians, more than 90 of them would self-identify as perfectionists.  Perfectionism is a personality trait that characterizes a person striving for flawlessness who sets excessively high performance standards for themselves and others.  It is often accompanied by overly critical self-talk and profound concerns regarding other people’s views or opinions.  There are some positive attributes of perfectionism as it can motivate people to succeed and achieve goals; however, in its maladaptive form, it can drive people to attempt to reach unattainable ideals or maintain unrealistic expectations.  When perfectionists do not reach their goals or meet expectations, psychological distress and even depression can result.

There are three types of perfectionism: self-oriented, other-oriented, and socially-prescribed.  Self-oriented perfectionists are driven by the need to avoid personal failure.  They set rigid and high standards for themselves that they adhere to at all costs.  They tend to be very self-critical and often suffer from imposter syndrome, which is the persistent fear of being exposed as a “fraud”.  Perfectionism and imposter syndrome often go together, especially in high-achieving female professionals.  In those individuals, perfectionism is the result of believing that success is merely due to luck, timing, extreme hard work, or the ability to deceive others into thinking they are more intelligent or competent than they really are.  Other-oriented perfectionists are judgmental and critical of others.  As such, they tend to set unrealistic expectations on their partners, children, friends, and co-workers.  Socially prescribed perfectionists believe that others hold them to higher standards than anyone else and that they can never measure up to the standards set for them.

I would venture to say that the majority of veterinarians are self-oriented perfectionists who set extraordinarily high standards for themselves and believe that the only reason they got to where they are today is because they have consistently met those high standards.  Unfortunately, holding fast to these beliefs can be very detrimental in the long term and can exacerbate burnout and compassion fatigue, common problems in veterinary medicine.  A recent study investigating trait perfectionism in Australian veterinarians found that those who were perfectionists had a higher vulnerability to moral distress when faced with a triggering stressor event.  In other words, a perfectionist veterinarian who is met with the agonizing task of euthanizing a sick pet whose owners cannot afford medical care will experience a higher level of psychological distress.  And unfortunately, moral distress is considered a leading cause of compassion fatigue in veterinary medicine.

It’s time for veterinarians to let go of the unrealistic expectation of saving every animal that walks through the door, making every client happy, being best friends with every co-worker, and never making a mistake.  The sooner than we can let go of these unattainable beliefs, the better off we will be; and the longer we will survive in this profession.  Because let’s be honest, veterinary practice is difficult enough without it having to be perfect.

Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher who also has an invested interest in the health and well-being of veterinary professionals.  She organizes Veterinary Wellness Workshops & Retreats for veterinarians, technicians, and other veterinary care providers.  To sign up for newsletters containing information regarding these events and veterinary wellness topics, please click here.  More information can be found at www.criticalcarevet.ca/wellness.   

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Helpful tips for spring cleaning your veterinary hospital

The first day of spring has arrived, which means winter will soon be a distant memory.  For many of us, this also means “spring cleaning”, or the chance to get rid of things we no longer use or need in order to make space in our lives.  Gretchen Rubin, best-selling author of The Happiness Project and Happiness at Home, says that “outer order contributes to inner calm”.  This is a common realization that she (and many others) have had and is surprisingly not emphasized by many positive psychologists or other wellness advocates.  I can attest to the feeling of serenity that occurs once I’ve cleared the clutter from my apartment or cleaned off the top of my desk – it’s almost as if I have more space to breathe and accomplish what I need to do.  Ultimately, that messy desk or house might seem trivial, but getting control of that space or area of your life can have tremendous benefits for your emotional and environmental well-being.  Essentially, getting control of your stuff can help you to feel more in control of your life.

Clutter-cleaning expert and best-selling author of The Life-Changing Magic of Tidying Marie Kondo says “Many people get the urge to clean up under pressure, such as just before an exam.  But this urge doesn’t occur because they want to clean their room.  It occurs because they need to put ‘something else’ in order.”  I’ve experienced this myself after a chaotic event has ensued in the ER.  For example, I recall when a dog came in to the hospital after being hit by a car and then arrested.  After performing CPR and other life-saving measures, the owners decided to euthanize the dog.  After our team debrief, I found myself madly rushing around the ER to “clean up” the mess.  One of my technicians said to me “we’ll look after that, go get your records done” and I remember saying “I won’t be able to concentrate on anything else until this space is clean again.”  In a way, cleaning the ER was a way of calming my mind and regaining order after what had been an intense experience.

If your clients walk into your waiting room and see pamphlets or magazines everywhere and a cluttered shelf of food or other merchandise, they’ll feel the same inner chaos that you and your staff feel when you walk into your cluttered office or break room.  Here are some pointers to help you tidy up at work:

  • Get rid of unnecessary pamphlets, posters, or other things in the clinic and ensure that information and items are kept to a minimum so as not to overwhelm clients and staff.
  • Never label anything in the clinic as “miscellaneous” – if there isn’t a specific space for something, it should be thrown away.
  • Be aware of freebies, swag, and give-aways from conferences that can accumulate and become clutter. Find a use for these items or give them away – better yet – don’t take them in the first place.
  • Rather than spending time filing papers or finding places for things, ask yourself if you really need them or if they can be discarded.
  • Sometimes clutter sticks around at work because it’s not clear who it belongs to or who might be using it (e.g., outdated textbooks or journals). Ask around and see if anyone wants or uses these things and then throw them away.
  • When several people use one area of the clinic (e.g., the kitchen) and no one person is responsible for keeping it clean, people tend to become messy and careless. Establish a system (e.g., assign people to clean specific areas or enforce people cleaning up after themselves) so that common areas can be kept tidy and clutter-free.
  • Get rid of unnecessary paperwork. Are there piles of printed journal articles or proceedings or other notes that could be scanned and electronically filed or simply recycled?  Consider the consequences if you do not have it and need it (i.e., could you find it on VIN or somewhere else online).
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How to Cope with Shift Work in Veterinary Practice

As a small animal emergency and critical care specialist, one of the least desirable parts of my chosen specialty is the requirement for shift work, which essentially means working any shift scheduled outside of “normal” working hours.  As I become more stubbornly adhered to my early-to-bed and early-to-rise schedule, I find myself less able to stay awake during swing/evening or overnight shifts.  It seems that I am not alone as there are several studies investigating methods to increase alertness during swing or overnight shifts.  Some of these include sensory stimulation such as bright light, sound, music, or decreased ambient temperature (i.e., everything I’ve done when driving late at night in order to prevent veering off the road), which only function to increase alertness short term.  Other options are available, each with their pros and cons, and are discussed in more detail below:

Caffeine is probably the most heavily studied natural pharmacologic intervention and has been shown to consistently improve alertness and the ability to stay awake when consumed during overnight shifts. Most studies have investigated a dose of 2-4 mg/kg, which is the equivalent of 2 cups of regularly brewed coffee for the average person, consumed twice during a shift. While the results are positive, the negative effects of caffeine intake must also be considered including trembling, tachycardia, anxiety, nervousness, digestive disorders, and sleep disruption. Additionally, people adjust to the stimulant effects of coffee, which necessitates repeating or increasing doses and subsequent side effects. For most people, caffeine should not be consumed less than 6 hours before bedtime, in order to reduce interference with sleep.  Also, coffee or black/green tea is the preferred caffeine source rather than energy drinks, which often contain very high amounts of sugar, leading to large swings in the glycemic index that can further exacerbate fatigue.

Regular breaks provide pauses for social interaction (e.g., checking in with co-workers) and physical activity (e.g., moving around, stretching) and varying work activities decrease monotony.  Both of these techniques are frequently used to enhance alertness and wakefulness during overnight shifts. While some studies suggest these should occur as frequently as every 90-120 minutes, there is little consensus regarding the recommended duration and frequencies of breaks and task changes.  Thankfully, veterinary practice (especially emergency work) is already quite variable, so unless you find yourself sitting in front of the computer completing records or doing other monotonous tasks for hours at a time, work activities are usually already varied for us!  Even so, taking regular breaks to stand, stretch, breathe, drink water, or watch a funny YouTube video  are recommended.

Short rest periods are the most recently studied and strongly advocated method to enhance alertness during overnight shifts.  These are typically in the form of naps, which is sleep that occurs during the shift and is 25% (or less) than the duration of sleep after the shift is complete. Naps or short rest periods are often used in anticipation of sleep loss or deprivation in order to sustain alertness during a sleepless period (i.e., before the overnight shift, if possible).  Benefits of short rest periods including reducing sleep loss and re-setting the biorhythm, thus counteracting the negative effects of sleep deprivation on the cardiovascular and gastrointestinal systems.  Studies demonstrate that the benefits of napping can be seen with as little as 5-20 minutes, but that 1-2 hour naps demonstrate even greater effects. The largest effects on reducing fatigue and enhancing alertness are seen when a nap is taken during the nadir of the night shift (between 1AM – 4AM), rather than at the beginning. A perceived disadvantage of short rest periods is a decrease in “main sleep” after the night shift (although total sleep remains unchanged); however, some people consider this to be beneficial given that more time can be spent doing “daytime” activities. Sleep inertia, which constitutes 10-20 minutes of hypovigilance and performance impairment, can occur upon wakening from a longer nap (> 20-30 minutes), but can be reduced by implementing techniques such as bright light or loud noises upon wakening. Nonetheless, studies suggest that even when sleep inertia occurs, night shift napping is associated with improved performance and decreased sleepiness.

So, what should you ask your boss for during your next staff meeting?  How about a new coffee machine and a comfy bed to put in break room?!

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I’m a veterinarian and I make mistakes…

As I prepare to give my lecture on “Disclosing Medical Errors” to veterinary care providers in Calgary this evening, I recall what is still to date the most difficult experience of my veterinary career.  It was when I realized that a mistake that I made killed a dog in our intensive care unit (ICU).  As vulnerable as I feel now sharing my story, I am doing it because I want others to know that even as veterinarians, we are not infallible; we are human and we make mistakes.

I was a third year small animal emergency and critical care resident at the time and working in a busy ICU at a renowned veterinary teaching hospital in North Carolina.  I remember the events as if it were yesterday.  The ICU was full, I was sleep deprived, and I was facilitating the placement of a nasal feeding tube for a dog named Laci that was under the care of a medicine resident in the hospital.  It was a Friday afternoon and everyone was busy and it was one of those times when everything that could go wrong did go wrong.  I asked one of the technicians to place the feeding tube and then take an x-ray so that I could confirm the tube was in the right place.  The first x-ray showed the tube was indeed in the correct place, but the end of it was kinked.  I asked the technician to pull the tube back slightly to allow the end to flip forward towards the stomach and then repeat the x-ray.  Unbeknown to me, the tube was removed completely and replaced.  When I went to review the second x-ray, in haste, I only looked to see that the tube was directed towards the stomach (and that the kink was removed) and made the mistake of not reviewing the entire x-ray to ensure that the tube was correctly placed in the esophagus and not the trachea (airway).  It was this mistake that led to Laci getting fed food into her lungs.  And it is for this reason that she experienced cardiopulmonary arrest and died overnight.

Those events took place almost 10 years ago now and I am certain I will never forget them for as long as I live.  What happened after the error was discovered (after Laci died) was agonizing.  The owners waged a lawsuit against the university and everyone involved, which went on for years.  A complaint was filed with the North Carolina Veterinary Medical Board, which correctly identified that despite following the standard of care in this situation, I had made an error in interpreting the x-ray.

I recall berating myself for the mistake and telling myself I didn’t deserve to practice veterinary medicine.  I remember questioning all of my medical decisions that I made for weeks.  And I remember being terrified to interpret x-rays for months.  But most of all, I remember thinking about how I would feel in that situation if it were my dog in the ICU who died as a result of a medical error.

It is because of my experience that I lecture to veterinarians and other veterinary care providers the importance of disclosing medical errors to clients.  In my situation, despite telling my advisor what happened immediately after it was discovered, the owners were not notified until days after they had lost their beloved family member.  I am certain that this only served to fuel their desire to file a lawsuit.  Research shows that in human medicine when medical errors are disclosed and involved personnel apologize that family members are much less likely to sue.  Contrary to what some might think, ignorance is not bliss when it comes to medical errors, because the only person who benefits from not coming clean is the person who made the mistake.

While the process of telling a client about an error that was made is extremely difficult, especially if it resulted in an adverse event or death, in the end, full disclosure is the best for everyone.  It allows the animal to receive the treatment that it needs, in an effort to lessen the medical consequences of the error.  It helps to explain otherwise unanticipated problems that the animal might be exhibiting after the mistake is made.  It strengthens the relationship between the veterinarian and pet owner, who will trust that the veterinarian will be honest with them no matter what situations arise.  And it reduces the emotional distress for everyone involved and helps bring closure and understanding to an already difficult situation.

Most importantly, it allows us to learn from the mistake and make changes in hospital protocol or policy to help prevent the error from happening again.  After my mistake, the hospital in North Carolina implemented the “Laci Rule”, which stipulated that every feeding tube would have its proper placement confirmed with an x-ray interpreted by a radiologist before any feedings would commence through the tube.

My final plea to everyone in the veterinary profession who at some point realizes that they made an error that harmed a patient is to please exercise self-compassion and forgiveness.  We are human and we make mistakes.  It is how we handle these mistakes that defines us as veterinary care providers; not the mistakes themselves.

 

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Five Ways to Survive Marathon Veterinary Shifts

We’ve all been there…those shifts scheduled as 10 or 12 hours that turn into 14, 16, or even 18 hour shifts!!  And the worst part is that we’re often scheduled for another shift the next day (or a few hours after we finish)!  These so-called marathon shifts can often leave us feeling physically spent, mentally exhausted, and emotionally drained.  Especially if we have the extra added stress of dealing with any heart-breaking euthanasias, challenging cases, or difficult clients.  But the bottom line is that we rarely have the option to adjust our schedule, such that we must find a way to forge ahead, survive the shift, and prepare for the next one.

In order for veterinarians and technicians working in emergency practice to survive these grueling shifts, there are some things that can be done to help support the body, nourish the mind, and keep the emotional meltdowns at bay.  Remembering these five pointers can help to ensure that even if the shift is never-ending, YOU WILL SURVIVE! 

  1. Hydrate! The importance of staying hydrated during a long shift cannot be over-stated.  This means drinking good old-fashioned water…not pop/soda, juice, coffee, tea, or energy drinks!  While the occasional caffeinated beverage, especially towards the beginning of the shift, is acceptable (especially if this is habit for you), consuming multiple caffeinated or sugary beverages will only serve to worsen your hydration and cause glycemic highs and lows, which can lead to fatigue, headaches, irritability, and even gastrointestinal upset.  In order to stay hydrated, bring a water bottle with you to work and ensure that you every few hours, especially if you are working up a sweat or drinking caffeinated beverages.  You can even set an alarm on your phone to remind you to drink water if needed.  And recognize that if you have not peed in the last 8 hours, you probably need to be drinking more water!
  2. Pack healthy snacks. Too often veterinarians and technicians do not make healthy choices when it comes to eating during shifts, whether it’s because we want to “treat” ourselves to junk food given the lengthy and difficult shift or because clients or co-workers are bringing in unhealthy snacks like donuts, cookies, and other carbohydrate-rich and sugar-filled treats.  Unfortunately, these also lead to massive fluctuations in our blood sugar, which is not ideal.  Instead, pack healthy foods in small portions that require no preparation and can be eaten between appointments or when sitting at the computer.  Examples include a banana or orange, apple slices (with or without peanut butter), lightly salted popcorn, cut vegetables (e.g., carrots, peppers, celery, grape tomatoes, snap peas with or without hummus), crackers with cheese, natural almonds or cashews, and Greek yogurt.  The key is that they are healthy, quick to eat, and low in preservatives or added sugar.
  3. Get a good sleep before. The importance of sleep cannot be emphasized enough.  Without 7-9 hours of sleep before a lengthy shift, you are bound to feel tired, foggy, and less able to cope with some of the emotional ups and downs that occur in practice.  Unfortunately, especially with shift work, falling asleep (and staying asleep) can be difficult and is something that requires good sleep hygiene and what many people refer to as “setting the stage”.  Try to adopt a routine that begins 30 minutes before you go to bed, regardless of where or when you sleep, so that your body is cued to begin winding down.  This routine could include turning down the lights or closing the blinds, making a glass of chamomile tea or warm milk (contains L-tryptophan, which helps to trigger sleep), turning off all electronic devices, and then doing a relaxing activity such as reading a book, stretching, tidying up your living space, meditating, or practicing gentle yoga.  Only when you are relaxed and ready to sleep should you actually go to bed.
  4. Take time to breathe. So often during these long shifts we adopt the habit of shallow breathing, which can contribute to anxiety and fatigue.  I can remember several emergency shifts when, towards the end, I would feel the need to gasp for air, almost as if my body had forgotten to breathe for several minutes!  As many times as possible during the day, take a moment to take a deep 4-5 second breath that fills the upper and lower chest and belly and then release it with a slow 5-6 second exhale.  Repeat this 3 times before returning to work and try to do this several times during the shift.
  5. Don’t forget to debrief. Debriefing is an important way to check-in with yourself at the end of your shift to determine what went well and what you could have done differently.  It’s also the time to talk through any distressing events, check that tasks are completed, hand over the care of your patients and clients, and say your goodbyes.  Finally, to symbolize the end of your work shift, it is important to de-role by taking off your name tag, scrub top, work shoes, etc. or use other personal rituals to signify that the shift is done and you are now out of role.
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The Costly Consequences That Veterinarians Face Being On-Call

It’s one of the biggest reasons that I left my job as an assistant professor at a veterinary school – the time that I was required to spend on-call.  As one of two small animal emergency and critical care faculty members, I spent approximately 26 weeks of the year and almost 50% of my weekends on-call.  I remember those weekends well – feeling stuck within the 15-minute driving radius around the veterinary school, turning down plans with friends, and often spending time working in my office because I was going to be “at work anyways”.  Thankfully, our senior resident would cover some weekends as well.  This provided a bit of a reprieve, but there is no denying the toll that this amount of on-call had on me.  And this is nothing compared to the sole practitioners and practice owners who spend 100% of their lives on-call!

Veterinary care providers are often required to be on-call, which typically means that they can be outside of the hospital, but remain available and close enough to be contacted for advice over the phone or to come in to the hospital if needed. While being on-call allows people to leave work rather than staying on the premises 24/7, it is not without its costs. When on-call, people must plan their lives around their schedule, including limiting behaviors that would otherwise interfere with their ability to work (e.g., enjoying a glass of wine with dinner), or foregoing activities that might make them inaccessible (e.g., going on a hike out of cell-phone range).  For the longest time I remember skipping yoga classes in the evenings that I was on-call, because I was not allowed to bring my cell phone into the studio!  Obviously these accommodations take their toll and can make self-care very difficult.

The unpredictable nature of being on-call can also generate a great deal of stress when home life is interrupted and people are required to shift to their professional role at any time. I can remember being out to dinner with friends and having to excuse myself to take a call from a resident or ask for my food to-go so that I could rush back to the hospital.  In addition the effects on lifestyle and interactions with family and friends, research has shown that on-call work also has a major influence on health.  Studies demonstrate that regardless of whether a person is “called in” while on-call, workers are more tired, tense, and “unwell”, and have higher salivary cortisol levels the morning after an on-call shift, compared to after not being on-call. There is also research in the UK to suggest that physicians performing on-call shifts have worse mental health and a higher incidence of anxiety and depression compared to physicians that do not have on-call duties. And while less commonly discussed, there are reports of medical professionals citing concerns for personal safety due to leaving home alone at night to attend work.  Is it any surprise that physicians who work on-call often cite it as the first or second leading stressor in their work?

Many people who work on-call regularly experience variations in their work patterns, in addition to being expected to work at night or for longer than normal hours in total. When veterinary care providers are required to spend time on the phone or, even worse, back in the hospital for hours in the evening after their regular shift, this can add a tremendous amount of time to the work-week, further digging into time spent with family, friends, or pets, as well as time dedicated to self-care.  Interruption of sleep, which is such an important part of health and well-being, is another major component of on-call work, especially for those who are on-call nights or weekends and can be called in to tend to emergencies occurring at all hours. During nights spent on-call, studies show that people have greater difficulty falling asleep and staying asleep, and that less sleep occurs if “at home” while on-call versus “away” (likely due to family and home obligations that interfere with sleep).

So, what is the solution to the on-call obligation?  I’m not sure there’s an easy answer.  The nature of veterinary medicine is that pets can become ill or injured 24-hours every day and the reality is that there are practitioners who service large rural areas that do not have access to a nearby emergency clinic out of hours.  In those situations, time spent on-call is unavoidable.  But ideally it would be limited or shared amongst nearby neighboring practices or colleagues.  Additionally, it is very important that time spent away from work (when not on-call) be truly “off” duty time, in order to allow the mind and body time to recharge while fully engaging with family, friends, and self-care; because ultimately veterinary care providers who do not take time for self-care will not be able to care for their clients or patients either.

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How to form healthy habits rather than simply setting resolutions in 2017

For many of us, the start of a New Year means setting resolutions for things we would like to change about ourselves in order to live a healthier life.  Typically these relate to stopping “bad” habits such as eating unhealthily, not exercising enough, not getting enough sleep, or smoking.  However, statistics suggest that despite 40% of people setting New Year’s resolutions, only 8% of people actually achieve them, while the vast majority abandon their efforts before the end of January.  This is a sobering statistic that causes many people to avoid making resolutions altogether, which can lead to the perpetuation of unhealthy habits.

What I prefer to do is to look at the New Year as the perfect time to form healthier habits.  In other words, rather than looking at your health and wellness goals in 2017 as resolutions, why not consider them new habits?  Below are ten strategies for habit change from Gretchen Rubin, author of Better Than Before, a book all about habit formation.  Each of these strategies helps people to form new habits (or break old habits), and thus will allow you to incorporate healthy habits into your life long-term.

  1. Foundation: In order to change other habits, it is important to ensure that your foundation habits are under control. This prevents you from becoming physically or mentally depleted, which gives you the energy and self-control to follow healthy habits more effortlessly.  The four Foundation habits are getting enough sleep, getting some exercise, creating external order (removing clutter), and managing eating and drinking.
  2. Clean slate: Any time a new situation emerges in your life such as a New Year, new job, new home, or new family member, it is the perfect opportunity to introduce a new habit. Take advantage of this opportunity to start a new healthy habit such as bringing your lunch to work each day.
  3. Abstaining: For many people, moderation is difficult and abstaining is easier. In other words, if you have difficulty indulging in something in small quantities (e.g., eating just one piece of chocolate), it is better to abstain altogether.  Use this strategy to decrease unhealthy habits such as eating too many snacks or sugary treats (i.e., avoid them completely).
  4. Convenience: Make it as convenient as possible to engage in healthy habits and difficult to engage in unhealthy habits. For example, keep only healthy snacks at work or pay a little more money to go to a gym or yoga studio that is close to your house.
  5. Monitoring: Keep track of the habit(s) you are trying to change such as how much/what you are eating and how often you are exercising. You can do this by keeping a keeping a journal or wearing a pedometer/activity monitor.  You can also monitor eating by watching your portions and not snacking out of the bag or container.
  6. Safeguards: Anticipate temptations or changes in routine and plan ahead. For example, what will you eat when dining out with friends?  Or how will you maintain your exercise routine when traveling for work or vacationing?
  7. Accountability: For many people, forming new habits is easiest when there is external accountability. Ask a friend or family member to call you on unhealthy habits or engage in your healthy habits with you (e.g., plan to go to a yoga class together).
  8. Pairing: This simply means only doing one activity when you are doing something else. For example, watch Netflix only when you’re on the elliptical or treadmill or eat only when you are sitting at the dinner table.
  9. Scheduling: For most people, having something in your calendar or agenda means that it is more likely to get done. So, consider signing up for work-out or yoga classes ahead of time so that you are more likely to go.
  10. Loopholes: Watch out for common loopholes that will derail your habit formation strategies. Examples include the tomorrow loophole (what I do today doesn’t matter, I’ll start my new habit tomorrow), one-coin (what difference does this one treat or one trip to the gym make?), and fake self-actualization (you only live once, so I better not pass this up!).
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Ten Tips for Staying Well This Holiday Season

The holidays are upon us!  While this time of year is exciting and energizing for many people, it can be exhausting and illness-provoking for others.  It is important that we do not get lost in the hustle and bustle of traveling, buying presents, entertaining family and friends, attending parties, and other holiday shenanigans and ensure that we take steps to preserve our mental and physical health.  Here are ten tips to stick to when working to preserve your well-being during the busy holiday season.

  1. Maintain a healthy diet: We are bombarded with chocolates, baking, and many other goodies this time of year, whether given as gifts from clients or co-workers, or served during holiday parties. It is nice to indulge in your favorite treats occasionally, but this time of year we often fall into the pattern of unhealthy eating.  If possible, make an effort to limit sugar intake by requesting your holiday espresso beverage “half-sweet”, restricting your alcohol intake, and limiting the number of treats that you eat.  It also helps to eat as many vegetables as you can (always choosing vegetables over fruit, which is a natural source of sugar), in order to fill yourself with healthy food that provides much-needed vitamins and allows you to feel more “full” so that you eat fewer treats.
  1. Get out in nature: Making time for a walk in the woods or a trip to the mountains can be incredibly therapeutic this time of year. Just 15 minutes in nature decreases cortisol concentrations by 15% and 2 hours increases mental functioning including attention span and memory by 20%.  So plan to bundle up (if needed) and head outside for a dog walk, hike, snowshoe, or cross-country ski in nature.
  1. Find time to exercise: So often this time of year we move exercise to the bottom of our list of priorities. This can have detrimental effects on our mental health and can leave us feeling sluggish, tired, and anxious.  Many people have the misconception that unless exercise is performed for at least 30-60 minutes, the benefits are minimal.  In fact, recent studies demonstrate that short bursts of high intensity exercise (20 second sprints on a stationary bike or treadmill with 2 minutes of rest in between for 10 minutes) has equal physical health benefits compared to 50 minutes of steady aerobic exercises (maintaining a steady moderate pace).  This means that even if you have just 20 minutes in the morning to exercise, plan to do something high intensity and know that you are getting the same benefits as someone jogging for almost an hour.
  1. Practice mindfulness: Mindfulness, the non-judgmental awareness of experiences in the present moment, has a plethora of benefits including decreasing stress (no shortage of that during family visits), improving processing of emotions (which can run high this time of year), shortening the duration and severity of colds (who doesn’t get sick during the holidays?), and improving sleep (very important – see #10). With all of these benefits, how can we not justify taking moments out of our day to pause, tune into our senses (smell, sound, touch, taste), and notice thoughts and sensations as they arise in our mind and body?  When you find yourself waiting in line or stuck in traffic, take a moment to bring attention to your breath and body and tune into yourself.
  1. Meditate: Meditation is a way to formally practice mindfulness and has the same benefits as mentioned above. While there are many myths and misconceptions around meditation and who can “actually do it”, the reality is that anyone, anywhere, anytime can meditate.  All you need is 5 minutes of quiet stillness when you can sit or lie down, bring awareness to your breath, and notice the sensations and thoughts that arise.  Then without attaching to the thoughts or sensations or letting them carry you into a series of other thoughts or stories, let them go and bring your attention back to your breath.
  1. Don’t forget to breathe: So often we rush through our entire day engaging in shallow breathing only to feel exhausted and depleted by the time the evening rolls around. Deep conscious breathing has many benefits including improving energy levels, activating the parasympathetic (restorative) nervous system, improving digestion, relieving tension, and reducing reactivity.  Place a hand on your belly and chest and notice where the movement is more predominant.  Then see if you can take 5-10 deep belly breaths when you consciously pull air deep into the chest, move your diaphragm down, and expand your belly.
  1. Connect with others: Satisfying social connections allow us to have a more positive outlook on life, form more secure attachments, have more constructive interactions, and engage in more efficient restorative behaviors. While there is no shortage of social engagements this time of year, very often they are filled with contrived superficial conversation with people we do not know well.  It is important to continue to make time for the people in our lives with whom we have healthy relationships, so be sure to schedule coffee dates with close friends and family members in between all of the other busy holiday gatherings.
  1. Make time for play: Play time is not just for kids! Benefits for adults include stress relief (releasing endorphins), improving brain function, stimulating imagination, and improving relationships and connections with others.  Play time is when you forget about work and commitments and are social in an unstructured way.  Examples of ways to engage in play including playing board games, going out for bowling or karaoke, and having unstructured time at the park to build a snowman, make snow angels, or have a snowball fight (assuming you live somewhere with snow!).
  1. Schedule downtime: Downtime is more than doing laundry or catching up on household items in between holiday chaos. It is inactivity or doing nothing that has a pre-determined goal.  The benefits of down time are numerous, the most important of which is to take a break from the stress and anxiety of decision-making, which is considered a “limited resource” brain activity.  For a few moments during each day, consciously engage in doing nothing and surrender to letting your mind wander in any direction that it chooses.
  1. Get enough sleep: Sleep is probably one of the most important activities that we do during the day, despite it feeling like a “pointless waste of time”. During sleep, our memories are consolidated, tasks replayed, experiences integrated, and emotions processed.  Without the recommended 7-9 hours of sleep per night, we are at risk of a weakened immune system, impaired brain function, moodiness, and many other physical health problems.  So, while it is tempting to cram as many activities as we can into our holiday schedules, be sure to maintain your typical sleep regimen by setting an alarm for bedtime, turning off electronics 1-2 hours before bed, and limiting caffeine intake within 6 hours of sleep.
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Do you know how to properly wash your hands?

You’re probably reading this title and thinking to yourself “of course I know how to wash my hands!”…but do you really? Or maybe you know but you don’t actually do it? About 40% of women and more than 60% of men admit to not washing their hands after using the bathroom and many more just do a quick rinse without properly cleaning and drying their hands. Neither of these situations is acceptable when it comes to practicing proper hand hygiene! But why does it matter? Well…aside from the obvious, which is that having unwashed hands is gross…it is detrimental to your health. Practicing proper hand hygiene is the most effective way to reduce the risk of contracting a cold or flu virus.

People who do not properly wash their hands are more likely to become sick, which is why I wash my hands obsessively when I’m traveling and coming into contact with so many other people and their germs. I’ve even had people joke about my “thorough” hand-washing in the bathroom and I just smile I say “I’m a bit of a germaphobe”. But in reality, I just don’t want to get sick! And if you don’t want to get sick either, follow these simple steps to ensure that you are practicing effective hand hygiene.

1. Wet your hands with warm water and apply enough soap to ensure that all hand surfaces are lathered thoroughly (i.e., 2-3 pumps).
2. Vigorously rub soap all over the surfaces of the hands and wrists including the palms, spaces between fingers, back of hands and wrists, fingers, fingertips, and thumbs for a minimum of 15 seconds (i.e., sing “Happy Birthday to You” twice).
3. Rinse hands under warm running water.
4. Pat hands with a paper towel (do not rub them) until they are completely dry.
5. Use the paper towels to turn off the faucet and then discard the towels.

Alcohol-based hand sanitizers are an acceptable alternative to hand washing, except after using the bathroom or before/after handling food. The steps for proper alcohol-based hand sanitizer use are as follows:
1. Ensure your hands are not visibly soiled and are dry before use.
2. Apply enough product to the palm of one hand sufficient to cover all hand surfaces. Depending on the size of your hands and the dispenser used, usually 1-3 pumps are enough. There must be sufficient product to cover your hands and keep them moist while you rub them together for 15 seconds.
3. Vigorously rub product all over the surfaces of the hands and wrists including the palms, spaces between the fingers, back of the hands and wrists, fingers, fingertips, and thumbs.
4. Hands must remain wet with the product for a minimum of 15 seconds (i.e., sing “Happy Birthday to You” as per above).
5. Continue rubbing the product all over the hands until they are completely dry.
6. Do not wash hands with soap and water before or after applying alcohol-based hand sanitizer.

If you practice proper hand hygiene you will help to prevent the spread of disease to others and will hopefully protect yourself from the cold and flu this season. Sing it with me – happy birthday to you, happy birthday to you…

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Seven Tips for Veterinarians and Technicians Working Overnights

Overnight shifts have always been the bane of my veterinary career, starting as a student when I was required to work overnight emergency shifts and continuing on through my small animal rotating internship and emergency and critical care residency. And it seems like the older I get, the less of a “night person” I am – very clearly a lark rather than an owl! Human nature would suggest that I am not alone; people are diurnal, which means that they tend to sleep during the night and stay awake during the day. Unfortunately, night shifts disrupt this circadian rhythm making wakefulness and consolidated sleep difficult to achieve.

The circadian rhythm relies on synchronizers to maintain a normal cycle, the most powerful of which is light, which affects the secretion of hormones that stimulate sleep (e.g., endogenous melatonin). Other stimuli such as exercise and exogenous (over-the-counter) melatonin can also have an effect, although most studies demonstrate that these have less of an impact. If you are a shift worker who is scheduled for overnights, there are certain things that you can do in order to help regulate. Follow these researched tips in order to manage difficulties adjusting to working nights:

1. The sleep-dark period should be strived for as soon as the shift is complete. This can be implemented by wearing dark sunglasses outside after the shift and using black-out blinds in the bedroom to reduce exposure to any sunlight.
2. Go to bed as soon as possible after the night shift (within 1-2 hours). This allows time to achieve the most sleep and reduces exposure to daytime light, which inhibits sleep. While it can be tempting to run errands or work-out after a night shift ends, postponing daytime sleep forces sleep to occur at an even more inappropriate circadian phase and results in exposure to more daytime light.
3. Exposure to bright light during the night shift is as important as shifting the sleep-dark period to the day time. Bright light during night shifts should be blue light; longer exposure (up to 6 hours at the beginning of the shift) is best, although 3 hours duration or even 20 minutes per hour for the first 6 hours have also shown beneficial effects. The spectrum and intensity of light have been studied, with no firm consensus as to what is best.
4. In the days leading up to night shifts, shift the sleep schedule later in order to wake-up at least 3-4 hours after the end of the night shift. For example, if the overnight shift is 6PM – 6AM, then the 8-hour sleep schedule should be shifted to 2AM – 10AM or later. This makes the transition to day sleep easier with the addition of early daytime darkness and wearing sunglasses during the commute home.
5. Melatonin appears to only have beneficial effects in select few people taking it in the morning after night shifts. This is probably because the problem is not usually falling asleep, but rather staying asleep after night shifts. It could also be due to daytime light exposure or lack of night shift light exposure, both of which will counteract the effects of the melatonin. If taking melatonin, know that a 0.5 or 1 mg dose is sufficient for most adults, and that the doses found in many drug stores or pharmacies (up to 10 mg tablets!) exceed what the body needs.
6. It takes approximately 3-5 days to adjust to night shifts. This means that shift workers scheduled for 3 or fewer night shifts in a row should not use phase-shifting (shifting their clock). Instead, they should rely on other tools such as short rest periods (i.e., naps) and caffeine consumption to ensure wakefulness during night shifts.
7. Permanent night shift workers should try to maintain a daytime sleep and nighttime working schedule. Many permanent night shift workers continuously rotate between sleeping during the day during work shifts and sleeping at night during days off, which can make it difficult to fully adapt to night shifts. Ideally, permanent night shift workers should try to delay their sleep cycle enough that they are waking up 3-4 hours (or longer) after they would be going to sleep after a night shift (i.e., going to bed at 3 or 4 AM and sleeping for 8 hours).