Can animal interaction help animal health workers develop resiliency and recovery?

Petting a dog or cat feels great after a hard day at work, doesn't it? Helps you bounce back. Am I right? There's a good reason for that. The human-animal bond may be one of the best prescriptions for what ails many animal health workers.

Veterinary professionals need a lot of resilience. The American Psychological Association website says resilience is exemplified by adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress. In a typical day of practice we may get exposed to each and every one of those more than once.

Remember Tubthumping by Chumbawamba? "I get knocked down, but I get up again. You're never gonna keep me down!" That's the spirit! What if that's not quite enough? The lyrics go on, "He drinks a whisky drink, he drinks a vodka drink, he drinks a lager drink..."

Sounds like the veterinary school lesson I was taught about how to deal with hard times. Buck up and soldier on!

That method has been taught since around 400 BC when Hippocrates established objectivity and stoicism, AKA clinical distance, as a central tenet of professional medicine. Not a new idea! The problem is that method is ineffective for many veterinarians and may exacerbate fear, shame, and isolation, making things worse.  

Personally, I need a lot of resilience and recovery. The word "resilience" has Latin origins meaning to spring back or rebound. I also need "recovery" or restoration to health from sickness. I've had to bounce back and recover from substance use disorder (SUD), compassion fatigue (CF), and burnout (BO), among other things. In an effort to decrease the stigma associated with these conditions I'm going to tell you a little about my path.

When I was a boy I injured my dog when trying to train her not to dash out the gate. In my unskillful impatience I slammed the gate into her side. She yelped and limped. I felt awful. But her body language told me right away that she forgave me. By the next day she seemed fine.

Months later, when she developed a leiomyosarcoma in her spine, I asked the veterinarian why it happened.

"We really don't know, but sometimes trauma can trigger cancer," he said.

I told nobody, but I knew I had caused my dog's disease. The decision to become a veterinarian followed soon thereafter, as did my experimentation with marijuana, LSD, and alcohol. Guilt drove my bus to veterinary school and private practice, but I did not deal with that guilt, much less acknowledge it, until my first few years of recovery from SUD.

The human animal bond is a powerful healing force, but it's not all unicorns and bubbles. As with love of any kind, there will be negative emotions associated with the inevitable loss of the object of that love, especially if one makes a mistake and hastens that loss. We are human, so that means that we will all make mistakes no matter how hard we strive for perfection.

My childhood experience set me up for striving for perfection followed by suffering from shame. This dynamic duo, perfectionism and shame, sets the stage for CF and BO. I held myself to a high standard, was ashamed when I didn't achieve goals, held others to high standards as well, and worked hard to get them to perform better. I was sometimes difficult to get along with as a practice manager and owner.

My recovery from SUD while a solo practitioner was not easy. I had a lot of help. After a few years of SUD recovery I found I needed to sell my practice. In my case, CF manifested most prominently when I euthanized pets with children present. I suffered memory lapses.

I had an odd feeling when I saw the client at the grocery.

"How's Fluffy doing?"

"You euthanized Fluffy last week, Doc."

I learned not to ask such questions when I had that odd feeling upon seeing a client. I often recalled the euthanasia as I walked away from the client. Apparently my brain protected me from the pain of remembering the event when in front of the client.

I had dreams about pets and clients. I took cases home with me, sometimes in my head, other times literally. I was anxious, on edge, and jumped at unexpected noise. In addition to having CF, which is acute and associated with a particular client or pet, I also had BO from too much to do and not enough time. I neglected my family. When I was with family and friends I often did not pay attention to those in front of me, instead I worried. I was in a nearly constant sympathetic, fight-or-flight, state. I did not recover from CF while still a practice owner. Instead I sold the practice.

I wonder if I knew then what I know now about CF and BO if I would have been able to stay in practice full time. Since selling I've done relief work, technical service veterinary work for industry, worked as a medical writer, and most recently I've been consulting and coaching about SUD, CF, and BO.

I don't think that owning a dog or cat, petting it, caring for it, and receiving its love in return is the whole answer to developing resilience or recovery, but it sure helps. There is so much work involved in recovery. I had to establish a multitude of new routines to improve my physical and mental hygiene. But matching up the signs and symptoms of SUD, CF, and BO with the psychosocial and psychophysiological effects of the human-animal interaction (HAI) (which is easier to quantify and validate compared to human-animal bond) reveals some interesting observations, as described in a review paper by Beetz, et al.

Isolation is a feature of SUD, CF, and BO. We've all noted that HAI has a social catalyst effect. Best way to meet people? Take your dog for a walk in the park. According to studies cited by Beetz, et al. human smiles, sociability, helpfulness, responsiveness, and conversations occur more often when animals are present. And patients with SUD get along better with their therapist when an animal is present.

Have you had a friend or relative in the midst of the disease of SUD? If so you'll know that one of the characteristics of folks with raging SUD is that they lie and do not trust others. Building trust is imperative. Students rate a psychotherapist who has a dog as more trustworthy. In fact, people in general are more trusting of others in the presence of a dog. Children in a classroom with a dog have more empathy.

Folks with SUD, CF, or BO are often depressed. Having a dog present reduces depression and improves people's mood. Elderly caring for a canary have reduced depression and improved quality of life.

Increased stress is a hallmark of BO and CF. Hence the rubber meets the road when we consider the anti-stress effects of HAI. There are decreases in cortisol, epinephrine, and norepinephrine when a pet is present. HAI is associated with decreased blood pressure, heart rate, and reactivity to stressors. With HAI there is increased heart rate variability, which is characteristic of being in a more relaxed, parasympathetic-tone state. With HAI there is reduced fear and anxiety, and in stressful situations, calmness is increased.

I believe that contact with pets, my own and those of friends and clients, made my recovery easier than it would have been without and will strengthen my resilience as I move forward. My belief is as much experiential as it is intellectual. 

All I have to do is feel fur in my fingers, look into those eyes, and see them squint when I hit just the right spot to confirm the importance of the human-animal bond to my mental and physical health.

Beetz, Andrea, Kerstin Uvnäs-Moberg, Henri Julius, and Kurt Kotrschal. 2012. "Psychosocial and Psychophysiological Effects of Human-Animal Interactions: The Possible Role of Oxytocin." Frontiers in Psychology 3: 234. doi:10.3389/fpsyg.2012.00234.

Important veterinary profession leadership info - Courageous vulnerability helps reduce stigma

At the recent American Association of Veterinary Medical Colleges Veterinary and Health Wellness Summit, Gene Crumley, Director of Leadership Development at the UC Davis School of Medicine, gave a keynote presentation on organizational leadership. He addressed the importance of  leaders having a strong ethical compass, a sense of stewardship, a need to attend to the culture of the organization, a need to maintain a healthy sense of curiosity, and finally, demonstrating “courageous vulnerability.” What a gutsy term -- courageous vulnerability!

I interviewed a couple of American Veterinary Medical Association (AVMA) leaders about the summit in general and Crumley's statement in particular. Thomas Meyer, DVM, AVMA President, agreed with Crumley, saying, “What needs to be woven into organizations is a culture that allows people to admit their mistakes without fear of punishment.” The only way that will happen is if leaders are courageous and vulnerable enough to speak up and admit when they make mistakes and praise their associates and staff for following suit.

In fact, honesty and vulnerability can be frightening when practiced. People need to be supported when they act courageously like that. The result is tremendous strength.

Also in agreement with Crumley, Janet Donlin, DVM, AVMA CEO, said, “Transparency, honesty, ethics; these we hold dear in veterinary medicine.” Isn't that a wonderful statement?

Donlin suggested collaboration is essential for the profession to continue progress, hence her participation in the Veterinary Wellness Steering Committee along with Adrian Hochstadt (AVMA), Mike Cavanaugh (AAHA), Libby Wallace (AVMA LIFE), Christine Jenkins ( Zoetis), Doug Aspros (AVMA PLIT), Ted Mashima (AAVMC), Laurie Fonken (CSU), Kathy Ruby (WSU), Jen Brandt (OSU), Ralph Johnson (VMAE), Mia Cary (NAVC), Mark Olson (AAVSB), David Little (WVC), Christine Shupe (VHMA), and Rebecca Rose (NAVTA).

I hope these leaders can display courageous vulnerability, transparency, and honesty as they work together to face the current situation that the veterinary profession is in. I imagine many of these leaders realize that our prior tendency to stick our heads in the sand because impairment of veterinary professionals is a sensitive subject didn't work. I hope our leaders continue to move forward and truly address our problems.

There is an ongoing stigma in our society and our profession that deters individuals from seeking help for mental health disorders including depression and substance use disorder and addressing other problems such as financial difficulties, compassion fatigue, and burnout. That stigma is pervasive and entrenched. Certainly having leaders step up, admit the difficulties they've faced, and describe what recovery from those difficulties has looked like will help reduce stigma. Recently the veterinary profession has shown a tremendous willingness to change and fully address wellbeing. I am quite hopeful that this willingness will continue.

This post expands on information provided in this dvm360 article, AAVMC wellness summit: Progress made and a path forward.

Article I Wrote About Recent Veterinary Wellness Summit

I wrote an article about the fourth annual American Association of Veterinary Medical Colleges (AAVMC) Veterinary Health and Wellness Summit held in Fort Collins, Colorado, at Colorado State University (CSU) Nov. 4-6. It is available at dvm360. Check it out! That convention was the best one I've ever been to.

Would you rather be right or loving?

Have you heard the expression, "Would you rather be right or happy?" Recently a slightly different question was posed to me that is much more meaningful. I was asked, "Would you rather be right or loving?" This is a much more powerful question especially relating to my relationship with loved ones who, according to my evaluation and my judgment, have an impairment of one sort or another. At one time I thought it was important, when dealing with a loved one who was on diversion after being charged with a drug offense, to turn them in after they had a relapse. This plan of attack was met with resistance, thank goodness. I did not end up turning them in, but the incident led me to start going to Al-Anon. It's taken me a long time to see that I was wrong. The reality is that I was unhappy, with myself, my lack of accomplishments, and my inability to financially support my family to my satisfaction. My personal insecurity, led me to be over controlling of my loved ones. I was so over controlling that I lost my ability to act in a loving way. It's taken me a long time to see this, a little over 17 years, but now I am in a position where I can finally apologize for my mistake and amend that behavior to the best of my ability. Twelve-step work makes that possible. I'm so grateful for 12 step programs and the outside help that's been necessary for me to grow so I can continue to be of more and more service to my family and friends.

Obama's Compassionate Clemency Policy Rocks!

President Obama granted clemency to 240 felons in earlyAugust and 111 more later in the month, almost all of whom were in prison on drug-related charges. This is welcome news, particularly for those serving heavy-handed crack sentences. Let’s hope for an ongoing trend away from punitive correction of people who suffer with substance use disorder. Punishment of people with mental disorders is expensive, ineffective, and inhumane. The latest round of commuted sentences brings the total number of clemencies to 673 people. It is time to stop the War on Drugs because it has been both ineffective and costly for the government. 

Doing nothing would be better than what we’ve done the last 40 years or so. Hopefully some of the money wasted on the War on Drugs can be reallocated to providing caring and thoughtful treatment instead. It is time for us to turn the tiller away from harsh drug sentences and toward decriminalization and compassionate therapy for people with these mental disorders.

Gabor Maté thinks AA is a bit too spiritually fundamentalist.

I'm reading In The Realm of Hungry Ghosts: Close Encounters With Addiction by Gabor Maté, a well-referenced treatise on many types of addiction, which keeps the reader interested with personal stories and vignettes. His approach is compassionate. It is fascinating, if a bit wordy, although he’s got a lot to say, so trudging through the pages has a definite payoff. He focuses on trauma as the reason that people turn to addictive behaviors to relieve pain.        

      

Dr. Gabor Maté's image from his website

   

I found an interesting recent interview of him that brought up his impression of 12-step programs. I hope you’ll take 11 minutes out of your day and listen to it. I’ve been thoughtfully chewing on his responses. Personally, I believe the study of the 12 steps can help anyone who has an intractable behavior problem that they want to change. Really, I’m all about the 12 steps, my friend.      

Screenshot from Youtube link to interview

Maté said that practice of 12-step programs can be helpful, but described the following problems: 1) 12-step programs completely ignore trauma, even though Bill Wilson was traumatized as a child, 2) people are often forced into 12-step participation, even though coercion is counterproductive, and 3) 12-step language of God is a fundamentalist relic of a punishing God that people may not want to embrace.    

      

Alcoholics Anonymous 

non-copyrighted logo 

While I fully agree with his first two 12-step program criticisms, the third response made me wonder what kind of 12-step groups he has been exposed to. I understand his concern in that area. The AA third step is, “Made a decision to turn our will and our lives over to the care of God, as we understood Him.” Even though the “as we understood Him” addendum was inserted, italicized in the Big Book and on placards that hang in AA halls to stress its importance, and cited as an example of the spiritual, not religious, nature of AA, Maté’s impression of AA’s God is not unique. 

So those are my thoughts on Maté’s interview. What did you think?

What is your experience? Are mental health and substance use disorders treated fairly?

The Mental Health and Substance Use Disorder Parity Task Force wants to hear about your experience with mental health and substance use disorder treatment services.

Now is the time to speak up. Comments open through Aug 31, 2016. What has been your experience regarding trying to get treatment for yourself or others? Did the insurance company treat you fairly or treat you differently than if you had been trying to get treatment for diabetes or a broken leg?

Click here and share your experiences!

"THIS IS WHAT DEMOCRACY LOOKS LIKE!"

I'm sorry. I think my old hippie nature is showing through. :-) 

Why don’t we always do what we know is good for us to do?

I have trouble sleeping and know that if I practice yoga just before bedtime I’ll get to sleep quicker, sleep deeper, and sleep longer. Easy, right? Not so much. I’m not sure why, but adding yoga to my pre-sleeping routine has not been easy.

When I was a kid my folks took me to parties and rather than put me down for bedtime would let me just run out of energy and fall asleep, wherever. I often slept under the coffee table, right in the midst of all the action. They prided themselves in letting me raise myself. Although that resulted in many advantages, such as self-sufficiency, I still tend to want to stay up until I fall over because I don’t want to miss any action. 

For the last 6 weeks I’ve been monitoring my behavior-change success, or lack thereof, using a phone app, Way of Life. I use the free version, which can be used to track 3 behaviors. I’m tracking Exercise, Meditation, and Yoga. My exercise routine has improved dramatically since I started walking with a friend every morning. Often we meditate after finishing our walk, but not always. My friend is not a yogi though, far from it. He’s pretty down to earth. When I looked at my results in the app it became apparent that I was doing great on exercise, pretty good on meditation, and simply lousy on yoga. I think this shows the power of having an accountability partner.

Regarding yoga, last night I did great. I had about a 30-minute yoga session followed by 7 ½ hours of sleep, the most I’ve gotten for a long time. This morning I ask my friend to consider yoga with me every night at 10 PM. He was having none of that.

I am convinced, intellectually, that I need yoga at night for my wellbeing. My unconscious, reptilian-brain, little-kid “elephant” does not know that though. He wants to keep going until he drops. My conscious, frontal lobe, adult “elephant rider” needs to train the elephant. I am open for elephant-training suggestions.

Following the 12-step pattern, I realize staying awake ‘til I drop is an unmanageable habit I am powerless over, an insane pattern to continue, and yet I believe there is hope and turn to another power for help – you (Steps 1-3). I often hear the One speak through others. In fact, I have come to rely upon it. For me yoga is part of the meditation practice mentioned in the 11^th step. So, got any thoughts on how to increase my success at incorporation of yoga into my nighttime routine? I’m all ears; elephant ears in fact.