Guen Bradbury is an anaesthetist in a critical care facility that provides anaesthetic and technical support for medical research on large animals in studies that aim to help critically ill human patients
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AS a response to a polite dinner party inquiry about what I do, ‘I anaesthetise pigs’ is guaranteed to raise a few eyebrows.
I undertook my veterinary degree at Cambridge, where I intercalated in pharmacology. I chose this subject as I found it difficult and thought that an extra year might be a good idea. I battled through the first half of the year, mired in complex molecular papers, and it was only when I started to revise that everything started to fit together. That satisfying overview didn't last long, of course, as much of the information that I painstakingly learned has since been superseded or disproved. This experience motivated me to apply to the Leadership Program for Veterinary Students at Cornell University, which offered me the opportunity to learn more about career possibilities, debate solutions for public health problems and develop the confidence to challenge conventional rhetoric in the wider veterinary field.
After graduation, I spent a happy two years in the north west in a first-opinion small animal practice, where I set up and ran a behaviour clinic. Animal behaviour had always been an interest of mine, and there was a niche – most of the cases I saw could not afford referral and had no other options. Having always owned rabbits, I was surprised by the number showing stress behaviours that were rarely perceived as a problem by the owners. Both of my rabbits were clicker trained so I set up a YouTube channel (Pewterrabbit1) and website (https://bunnybehaviour.wordpress.com) to provide free individually tailored advice. I have had e-mail discussions and Skype consultations with clients from Scandinavia, the US, the Philippines and even Trinidad.
An advertisement for a clinical anaesthetist at the Royal (Dick) School of Veterinary Studies piqued my interest – I enjoyed clinical practice but missed the intellectual stimulation of academic work. I started as a clinical anaesthetist in the Hospital for Small Animals for six months, where I also organised and ran a series of seven well-attended lectures on aspects of clinical animal behaviour: at that time, there was no formal animal behaviour teaching. It's crucial that vets have a basic toolkit of knowledge about animal behaviour to enable them to give advice on common problems.
I then moved on to working full-time at a critical care facility that provides the anaesthetic and technical support for medical research on large animals. In this role I am responsible for induction of anaesthesia and monitoring of animals to ensure optimal levels of anaesthesia and physiological stability during a range of studies, some of which are for extended periods of time. We work as a team to ensure that expert cover is available throughout these studies. I had to learn about the state-of-the-art monitoring devices, including bispectral index, facial muscle electromyography and cardiac output measurement via lithium dilution, along with more basic anaesthetic and analgesic management of pigs.
In my day-to-day job, I've anaesthetised pigs for a number of terminal and recovery experiments, for embryology and resuscitation experiments and various toxicology studies. For short anaesthetics, the focus is on recovery with minimal pain and distress; for the long terminal anaesthetics, close monitoring of anaesthetic depth becomes far more important. Some experiments require clinical judgement for intensive care management – managing distal airway obstructions, pulmonary dysfunction, arrhythmias, hypovolaemic shock, raised intracranial pressure and cardiac arrest. I spent some time with the intensive care nurses in a human hospital to learn about their management of critically ill human patients – those patients that our studies aim to help. The study for which I was employed was a preclinical trial of a bioartificial liver device to partially take over hepatic function in patients with acute liver failure – this added an additional challenge of maintaining haemodynamic stability with an extracorporeal plasmapheresis circuit (removing blood to separate the plasma, which was passed through a hepatocyte scaffold and returned to the body).
Use of animals in research in the UK is controlled by the Animal Scientific Procedures Act (1986), which was amended in 2012 to transpose European Directive 2010/63/EU. The principles of the 3Rs are a central focus of this revised legislation and therefore for those working with animals in research. The 3Rs are replacement of animal use where possible with in vitro studies or computer models; reduction, where the number of animals used is reduced to the minimum required to fulfil the scientific objectives; and refinement of procedures involved to minimise pain, suffering or distress. The role of veterinary surgeons in refinement is obvious. However, the input of veterinary anaesthetists, surgeons and pathologists can also help with reduction, ensuring that an anaesthetic regime is employed that is likely to be successful, that good surgical technique is employed, and that the maximum information can be extracted from every animal. There are obviously significant ethical discussions required around these areas of work. Before any animal studies are undertaken the proposed research is described in a Project Licence application, a large document that is reviewed by both Local Animal Welfare and Ethical Review Bodies and the Home Office before authorisation. It has been interesting to see this process at work in comparison to the processes we can see around ethical decisions in clinical practice and this may be an area that the veterinary world could take much from. In considering the ethics and challenges of this work, I've been lucky to work with Eddie Clutton, whose encyclopaedic knowledge of anaesthesia and ethics is matched only by his exuberant passion for pigs.
Laboratory animal work has historically not been seen as a desirable career choice for young graduates. However, you should consider this career path if you enjoy working with a variety of species and clinical challenges, if you enjoy the support and camaraderie of a team environment and you want to make a difference to a lot of animals and people.
The more involved I became in the welfare and ethics of animal experimentation, the more interested I became in the research community outside our facility. I reviewed the recent literature for current trends in the reporting of postoperative pain management in recovery experiments in laboratory pigs. The results were pretty shocking – only a minority of papers describing painful recovery experiments also mentioned postoperative analgesia. This sparked a range of reviews looking at poor reporting of different aspects of management of these animals – from inappropriate use of antibiotics as surgical prophylaxis (wrong route, drug, duration), to prolonged presurgical starvation protocols, to justifications for neuromuscular blockade and paralysis (to ‘stop the pig biting the endoscope’). This was eye-opening. Animal research in the UK is highly legislated, and rightly so, with strong public opinions on animal welfare. This is fundamentally important, but we can't let animal research be outsourced to countries with more lax laws. The way to prevent such animal violation is to ensure that publishers of such science have as stringent guidelines for essential details in either methods or online data supplements as are written into the UK legislation to promote high standards in animal experimentation world-wide.
As a recent graduate, I was fortunate to be invited to the BVA parliamentary dinner at the Scottish Parliament in 2014. There is no such thing as a free dinner, however, and I soon found myself part of BVA's marketing campaign. It's inspiring to be a part of an organisation that represents our views to government and in the media, but it's up to us to make sure we communicate our views. I was surprised, when attending both the Vet Futures event in Cambridge and the Parliamentary dinner, how few vets there were of my own age. We are the ones who will benefit or suffer from the changes in the profession over the next 30 years: as young vets, we need to be investing in our future.
And what now? I'm having another career change due to my partner's relocation. In July I'm joining a technology company, where I'll be using the skills from my veterinary degree in yet another way. I still enjoy supervising first-year Cambridge vet students in anatomy; I have been asked to do some preclinical behaviour lectures; I field questions from my rabbit website and I'm working on publishing more ethics papers. I seem to be accumulating academic and veterinary preoccupations to add to my list of hobbies. Or perhaps that should be hobby-horses!
I guess my advice to young vets would be to see the bigger picture. With the long working hours and stress of practice life, it's easy to become focused on day-to-day mundanity. Try raising your head, taking on challenges and realising that you can change the world. Even if it's just one pig at a time.