Go to any gathering of equine practitioners and scan the crowd. You will see a lot of lean, rugged, well-muscled folks. You’ll be struck by their energy, their intensity and their buoyant “can do” attitude. Most of the talk you hear in the hallway will center around horses, practice and the meeting talks. However, if you listen hard, you will hear a few war stories about someone’s recent close encounter with a rowdy colt or ill-tempered broodmare. A few of the attendees always seem to be walking around with a leg or arm “done up” in the latest orthopedic soft cast device. Some of the older attendees might walk with a little hitch in their stride.
No hard statistics are available to quantify injury occurrence in career equine practitioners, but many of us do experience injury or disability at sometime during our careers. This article will give you some pointers on common challenges of injury, rehabilitation and return to work.
Equine Practice and Disability
The career of an equine practitioner is a physical one, involving certain risks. The nature of the diagnostic work we do demands a lot of lugging, bending, kneeling and lifting of heavy equipment. Treatment of routine conditions often puts us in close proximity to the kicking, biting and striking ends of very large and unpredictable patients. Certain motions that stress our joints and ligaments are repeated many times every day as we restrain and work on horses which are less than cooperative. Ambulatory practitioners might drive several hundred thousand miles during their careers, thus are at increased risk for motor vehicle accidents.
Hand and shoulder trauma, ligament damage of high-motion joints, bruises and fractures are examples of acute injuries that can occur in horse doctors. Repetitive strain injuries, including carpal tunnel syndrome, rotator cuff problems, lower back strain and knee and hip joint inflammation, are not rare.
Some injuries or problems might have an element of chronicity and will be aggravated by ordinary issues of aging--arthritis, sciatica, osteoporosis, vision loss, altered reaction time and a general “slowing down” might hinder our abilities to work as the years march on. Gender-linked concerns such as menopausal issues and prostrate problems can pose special concerns for older female or male practitioners. And lastly, some of us will suffer from chronic ailments such as heart disease, cancer, diabetes, or chronic renal or respiratory disease that are unrelated to practice.
Medical problems are difficult for anybody, but equine practitioners face a particular challenge when we are hurt or sick as we need to have most of our physical faculties functioning to ply our trade. Rarely do we have an option to transit to desk work while we recover. Disability that results from injury, repetitive motion syndromes or chronic or progressive disease can take away our livelihood, either for a short term or a long one.
So how do we cope when we get derailed for one reason or another?
A Personal Saga
An article like this one should be written by someone who has “been there, done that.” That description fits--in August of 2000, I was hurt badly by a horse.
Ironically, the injury did not happen on the job. It happened on a vacation. I was riding a cowpony on a big cattle ranch in south central Montana. The horse was just green broke. He didn’t want to cross a dry creek bed, and he let me know it--he reared, flipped over backward and landed on top of me. When he stood up, I was in a heap on the ground, unable to move. My pelvis was fractured in several places, one hip was cracked, and my sacroiliac joint was separated from my spine. I sustained serious blood loss as many of the large vessels in my abdomen had ruptured from the impact.
I will spare readers the details of my rescue and emergency treatment. Suffice it to say it was a miracle of critical care, coordinated transport and extremely skilled surgery. I spent one long week in the trauma unit of the Deaconess Hospital in Billings, Montana, then flew back to the East Coast to recover at home.
The next several months were spent basically immobilized. It was two months before I stood for more than a few seconds, and three months before I walked a few tentative steps with a walker. Recovery from that point involved a lot of patience, determination and daily trips to physical therapy sessions or the gym. It was a long haul, but in late December 2000, four months after the injury, I returned to my day job as an equine ambulatory practitioner.
At the time I got injured I had spent 17 years in general practice. Today, life is a bit different that it was “pre-accident,” but I am lucky that I still can do my job. I’m a little stiff and creaky, but I still show up every day!
The details of my injury and recovery were dramatic, but the lessons I learned were universal ones. The concepts are valuable for anyone employed in a very physical job that becomes incapacitated. This list sums up the big themes:
If you are completely disabled for a time, somebody will need to take care of your patients.
- I was blessed with a pair of associates and an intern who immediately stepped up to the plate. I am forever in their debt for their service during that difficult time.
- In other instances, i.e., when solo practitioners are injured, it is great if area colleagues can help out, yet do so in a way that preserves the DCPR relationship that was pre-existing between the injured vet and their clients.
- Whether your help comes from your own business or from the outside, having good medical records and a staff who can access and transmit the information is invaluable.
If you are completely disabled for a time, somebody will need to take care of YOU (and your family if you have one).
- In my case, my family and closest friends immediately rallied to my side, providing round-the-clock help for a month, and frequent visits after that.
- Your health care system probably has provisions for some care in the form of social service and therapy visits. However, navigating the system can be challenging. Persistence pays.
- Details will extend beyond your own physical needs--you might need help to clean your house, run your farm, pay your bills, shop, etc. Those who have a strong independent streak must learn to accept help.
The sky will not fall if you have a support network of colleagues, family and friends, and a decent health insurance plan.
- If there is a silver lining in a major health challenge, it is the fact that you find out just how many friends you have! And some of those clients that you have served in their darkest hour will come out of the woodwork for you.
- Accept help gracefully, but be clear about what you really need. Your practice can alert people as to what they can do. Specific lists of “little things” (errand running, house or farm chores, rides to appointments, etc.) are helpful, and avoid the challenges of too much rich food landing on your doorstep.
- If someone helps you or sends you a thoughtful note, write and thank them. You probably have plenty of time on your hands to do this.
- Whatever health insurance plan you choose, read the fine print to make sure you are well covered for catastrophic care. In my case, my plan covered the costs of a chartered airplane rescue, multiple ambulance trips, critical care including imaging, transfusions, emergency surgery and a hospital stay, all in a state outside my home. It also covered home health assistance and therapy visits in my own state plus the purchase of a wheelchair and motorized hospital bed.
There WILL be dark days.
- Accept them. The next day is usually better.
- You can throw something or cry, it’s OK as long as it is just once or twice. Just try to make sure no one is in the way. Better yet, hold your outburst till you are all alone.
Recovery may be dependent on good physical and occupational therapy, competent medical care and simple true grit.
- The last quality is the most important.
- If someone tells you to do 10 repeats of an exercise, do 20. Tomorrow do 30. Your muscles have memory, and they were in hard use prior to your injury. Hard work will stir that memory.
- No pain, no gain.
A positive attitude may trump a guarded prognosis.
- The average equine practitioner has a lot of that racehorse quality called “HEART.” Never underestimate what that can do!
- We are used to being in situations where life is not ideal (cold barns, bad lighting, cranky horses and owners, flat tires, you name it). As a result we are a resourceful and generally plucky bunch.
- We have seen nature work miracles with our patients. Our medical experience should bolster our faith in the future.
- Most of us are tough as nails and used to being a little banged up!
The initial rehabilitation is step one. Complex medical issues usually come with lifetime adjustments. Several other issues influencing personal and professional wellness come into play once the initial crisis is over and the return to work is at hand:
Finances (personal and/or practice) may be strained short term or long term.
- A good disability policy is the best safeguard for buffering personal financial stress. I had a policy with a 90-day waiting period, but it also provided “transition benefits” to ease my return to work. I ended up with about four months of benefits, which was sufficient to tide me over.
- Disability insurance, like health insurance, is best reserved for catastrophic situations. To keep premiums affordable, bank a 3-6 month cash reserve to cover living expenses, and choose a longer waiting period for your disability benefits to kick in. But read the fine print and make sure your policy provides good long-term coverage if you need it.
- You should pay the disability premiums yourself and not claim them on your tax return so that any benefits that are paid out are not taxed.
You may face some life long physical compromise after you recover.
- If so, you will need to adjust your life and practice to live with that compromise. In my case this means taking great caution with parts of practice that strain my lower back. This includes most lameness work, work with foals, and anything that makes me bend, kneel or stoop.
- Sometimes it is necessary to switch to a less-strenuous form of practice. I now do less of the above sorts of work than I did before.
- The emotional consequences are significant when you realize that some of your “parts” are forever changed. If necessary, seek professional help for coping skills.
Good health habits, especially exercise and attention to your own wellness will be a non-negotiable part of your “post injury” life and career.
- Any serious personal challenge is a wake up call--it reinforces the importance of cultivating good health. The basics of health never change--good nutrition, regular exercise and a good social network. Spending time on hobbies and outside interests is a big part of wellness too.
- Exercise will need to be tailored to take into account the physical effects of your previous disability. You might not be able to run a marathon, but a good physical therapist can help find routines that work best for your circumstances.
Remember, sometimes you just have to rest.
- This is intuitive for most people, but might be a difficult concept for hard-charging horse doctors. Get used to it. Rearrange your professional life to accommodate time for rest if you need it.
- For me, the 80/20 rule was in play: 80% of the time, injury-related difficulties got better with exercise. Twenty percent of the time the only thing that helped was rest. Each individual needs to listen to their body to find what works for them.
- Recognize your limitations and don’t push yourself when you are not at your best. Learn to delegate to others.
Prevention and Preparedness
Taking a few precautions now might prevent acute injury and stave off the cumulative damage that tends to occur after several decades of work. Sensible precautions are not expensive or difficult. They are simply habits that take a little thought and practice.
Start by doing whatever you can to make each call as safe as possible. Use reasonable physical and chemical restraint for your patients. Train assistants to help you carry out your diagnostic and therapeutic procedures. Make a habit of practicing good ergonomic principles right from day one. Take the time to set up tables to elevate your equipment, and use appropriate protective equipment for work that is hazardous, i.e., wear goggles and ear protection when running a power float and use a helmet if collecting semen. Wear a radiation badge for imaging, and follow all OSHA guidelines for handling chemicals in your office. Watch the position of your back and knees when doing procedures such as dentistry and lameness exams. Use caution in lifting and driving. Your posture and work will be helped if you exercise regularly, keep your weight in check, and cultivate cardiovascular fitness, flexibility in your spine and strength in your core muscles. Remind yourself to reschedule when you are too tired, distracted or slow in your reaction time to be safe. If conditions aren't ideal for safe working on a horse or the horse is just plain dangerous, don’t take foolish risks just to prove a point. Also, stay off the roads when weather conditions preclude safe driving to a call.
Remember to plan for the possibility of getting injured or disabled. Spend what you need to buy good insurance for both health care and disability income. Be serious about setting a side a solid nest egg of savings and building a good social support system. Try to flesh out a practice operation plan that will be in force if yourself or a key colleague is sidelined. Nurture good relations with your family and friends. Collaborate with colleagues. And last but no least, make sure that work is never the only thing in your life!
The following list summarizes 10 guidelines that are good pieces of advice for equine practitioners--the first five principles concern prevention of injury and the final five address being prepared to cope if an accident or problem does happen. Heeding these principles is good common sense no matter what direction your work with horses takes you:
Ten Commandments of Injury Prevention and Preparedness in Equine Practice
- Learn to read horse behavior. If a situation feels like it is getting dangerous, DON’T TRY TO BE A HERO. Stop and reassess. Regroup and proceed only if you think things are going to be safe.
- Safety first at work. When working with horses always position your body so you are at least risk of injury and have an “escape route”. Use tranquilizers, physical restraint aids and local anesthesia as appropriate.
- Learn good ergonomic habits NOW. Use “props” to improve safety and lessen repetitive stress. Practice sensible lifting of equipment and horse body parts. Maintain good posture. Take some time to set up tables to elevate your equipment to avoid back strain--excellent portable collapsing models are available through www.stonewellbodies.com and www.champagnetables.com
- Use skilled technical assistance whenever possible. A trained assistant can handle a fractious animal better than an inexperienced owner. Help on the road lessens repetitive strain from setting up and dismantling diagnostic equipment. Paid drivers allow for some rest between calls or safe use of cell phones and computers.
- If you are extremely tired DON’T DRIVE. The only thing we deal with that poses more physical hazards than our patients are the big trucks and SUVs we use to get to our calls. These giant vehicles can hurt us or even kill us if we are driving in an impaired state. Extreme fatigue affects driving competence as much as being under the influence of drugs or alcohol.
- Buy good health insurancethat has comprehensive coverage for catastrophes. Tax advantaged Health Savings accounts and plans with higher deductibles, but solid catastrophic coverage, are good plans to review.
- Buy good disability insurance with benefits that will pay the income you need for a long time. Disability insurance is expensive, but not as expensive as going without any income for a long period. Choose a realistic monthly income benefit, factoring in inflation; higher benefits become more affordable with the selection of a long waiting period.
- Keep 3-6 months of living expenses as savings in an accessible, liquid form. A good vehicle for savings like this is a conservative investment account that you can write checks on. Two low-cost financial service firms with excellent web service and a variety of offerings are Vanguard and Fidelity—they can be accessed through www.fidelity.com or www.vanguard.com
- Make fitness and good health a priority. It is a fact that people who are fit recover from all kinds of health problems much better than those who are not. A healthy lifestyle leads to sound mental health, and this is a great resource in times of adversity. Muscle memory and visualization of “where you want to go and what you want to do” are all enhanced by previously established good habits.
- Nurture a strong support network with colleagues, family and friends. A good social network will foster good mental health, a key building block in the toolbox needed for facing adversity. Having a broad range of people willing to go to bat for you in your hour of need is an invaluable treasure. Friends will provide humor and perspective at the time you most need it.
I hope that readers of this article never need the advice it contains. Read it as a cautionary tale, though, because statistics show that one in eight people suffer disability at some point in their lives no matter what career they choose. Even if you never face a major injury or health challenge, I guarantee that someday one of your close colleagues will end up “benched” for a while. When that happens, don’t be shy. Write a note, call them up, clean their house, rake their leaves or walk their dog. Make dinner for the vets who are providing relief work or better yet, do some of that relief work. Sometimes it takes a village to keep our community of equine veterinarians afloat!
Finally, let’s keep everything in perspective--while the career we have chosen does pose some risk, it is also a life that keeps us fit and engaged, constantly immersed in nature and physically active. We work on beautiful animals and have interesting and varied clientele. We have dynamic and energetic colleagues and work that is challenging and stimulating. It is a good life even with the risks involved. We are all well advised to celebrate the blessings of our profession while remaining cautious and watchful of the unique challenges therein.
Here is to a career of happy and safe horse doctoring!
This article was derived from a piece originally written for the AAEP Personal and Professional Wellness Task Force. (2007)