Chronic illnesses are classified as conditions for which there is currently no cure, that require long-term medical treatment and management with drugs and other therapies (Kings Fund, 2021). An estimated 26 million people in the UK have at least one long-term health condition, with 10 million people affected by two or more (Pharmaceutical Services Negotiating Committee (PSNC), n.d.; British Veterinary Nursing Association (BVNA), 2021). In the veterinary industry, one in 14 people report they have a disability or chronic health condition that limits their ability to complete daily work tasks, while many more may be uncomfortable admitting it (Cawston, 2020).
Often, chronic conditions and illnesses are immediately considered to be those that are obvious and perhaps, visible. However chronic conditions and illnesses also include those that are ‘invisible’, for example, attention deficit hyperactivity disorder (ADHD), anxiety, Asperger's syndrome, autism, bipolar disorder, chronic pain, chronic fatigue syndrome, Crohn's disease, Ehlers Danlos syndrome, endometriosis, fibromyalgia, coeliac disease, depression, diabetes, lupus, Lyme disease, multiple sclerosis, rheumatoid arthritis, schizophrenia, Tourette's and many more (UKS Mobility, 2016; British Veterinary Chronic Illness Support (BVCIS), 2021a; BVNA, 2021).
There is an overlap when considering the definition of disability and chronic illness — a disability is defined as ‘physical or mental impairment that has a substantial or long-term negative effect on a person's ability to do normal daily activities’ (UKS Mobility, 2018), while a chronic illness is described as a condition that cannot be cured, requires lifelong management and limits a person's quality of life (NHS Wales, 2011).
The effects suffered from the variety of chronic illnesses and diseases is even more diverse than the conditions themselves, and can include long periods of pain, fatigue, gastrointestinal disturbances, insomnia, anxiety and depression, ‘brain fog’, and mobility issues (BVNA, 2021). These symptoms affect the individual in both their personal and professional life (BVCIS, 2021a), and are often compounded by a lack of empathy from employers and colleagues, as they do not appear obviously unwell or needing support in the working environment (BVNA, 2021). This can create increased pressure on the individual, as they learn to cope with their limitations and symptoms, while battling a reduced level of self-worth and potentially poor emotional wellbeing (BVCIS, 2021a), as well as their own anxiety about their ability to fulfil their job role (BVNA, 2021).
This paper is written to give a brief insight into a selection of invisible chronic illnesses, and portray the challenges faced by the sufferers of these conditions. It also discusses how conditions may be interlinked in some cases, as well as some of the coping mechanisms, or work aids used to help, in an attempt to raise awareness and bolster support for those individuals newly diagnosed, their co-workers and support network.
Spoonies
The colloquial term ‘spoonies’ has been adopted by many suffering from chronic illnesses to describe the debilitating effect of limited physical and emotional energy that chronic pain and fatigue can have, resulting in a finite resource available on a daily basis. Individuals who learn the value of their total ‘spoons’ of energy available for the day can then divide the necessary tasks and those superfluous activities to conserve and prioritise appropriately (BVCIS, 2021a). This encompasses everything from getting out of bed, making dinner to washing your hair (Davidson, 2018).
In the workplace this can include a change in working hours, tasks, or roles within the workplace, or for some a change from clinical profession altogether, to help maintain a work–life balance, while still adhering to the RCVS code of conduct and ‘take reasonable steps to address adverse physical or mental health or performance that could impair fitness to practise; or, that results in harm, or a risk of harm, to animal health or welfare, public health or the public interest‘ (BVCIS, 2021a). Spoonies may find friction from their employers arises from taking sick days, attending appointments, reducing working hours or altered duties while navigating the appropriate laws and legislations (BVCIS, 2021b), and that is presuming they feel they can approach their employer, and request assistance, are heard, matter, and are not a hindrance (Figure 1) (BVNA, 2021).
Endometriosis
Endometriosis is little understood condition, where cells similar to those lining the womb migrate to other areas in the body, and cause inflammation and pain local to the area the lesions are found, and can infiltrate other organs, commonly the bladder and bowel (Endometriosis UK, 2021a). Commonly reported systemic symptoms include pain and fatigue, ‘brain fog’, anxiety and depression (Taylor, 2020). The condition affects approximately 10% of women and those assigned female at birth in the UK, and has a varied response to hormone treatments, surgery and pain relief although research into new treatments is ongoing (Endometriosis UK, 2021b).
Crohn's
Crohn's disease is a condition that causes inflammation of the gastrointestinal tract, commonly the ileum or colon, and affects the body's ability to absorb nutrients and eliminate waste in a healthy manner. The symptoms can be constant or cyclical, and as well as abdominal pain, diarrhoea and fatigue, it can cause weight loss and a loss of appetite, oral ulcers, arthritis, episcleritis, renal calculi and anaemia. Like all long-term chronic conditions, it is very individual and sufferers will find strategies that suit others may not help them (Crohns and colitis UK, 2021). Stress can initiate flare-ups of the symptoms, which can be difficult to manage in the veterinary environment (Hargrieve, 2021).
Neurodiversity
Neurodiversity is a term used to describe a variance in brain function in some people, enabling them to think differently from the way the majority expect (BVCIS, 2021a). It is estimated that 30–40% of the population are neurodiverse (ADHD Aware, 2021). Conditions that fall into this category include ADHD, autism, dyslexia, dyspraxia, dyscalculia, dysgraphia, Tourette's and other tic syndromes (BVCIS, 2021a), and many people with one neurodevelopmental condition will have another (ADHD Aware, 2021).
Autism affects approximately 700 000 people in the UK, and as a spectrum can influence different people in different ways; it can include a difficulty interpreting verbal and nonverbal cues in social interactions, a preference to routine, or finding a particular repetitive behaviour calming, over or under sensitivity to stimuli, an intense focus on hobbies, and a tendency towards experiencing anxieties (National Autistic Society, 2021).
Dyslexia causes issues with reading, writing and spelling (NHS, 2018a). Dyscalculia causes a persistent difficulty in understanding numbers, making estimations and general arithmetic, and often occurs concurrently with dyslexia (British Dyslexia Association (BDA), 2021). Dysgraphia causes a difficulty in handwriting, and often occurs concurrently with dyslexia and ADHD (International Dyslexia Association (IDA), 2021). ADHD is a condition that affects people's behaviour, and can cause issues with inattentiveness and hyperactivity/impulsiveness (NHS, 2018b). These types of conditions can make working environments challenging, but small changes can help — using lists and visual aids to support people who find these tools easier, using screens to filter computer screen lights and make them less stimulatory, encouraging regular exercise, as well as relaxation, and ensuring individuals feel supported and valued in the workplace (NHS, 2018b).
Developmental coordination disorder (DCD) or dyspraxia causes a lack of coordination, and specific physical movements may be difficult, or an individual may appear clumsy (NHS, 2019).
Mental health
Mental health is known to be poor in the veterinary industry, most notably contributing to the high levels of veterinary suicide, alongside the high expectations from clients and workload (Mind Matters, 2019). Research is ongoing into the negative experiences within the veterinary industry, to reduce and prevent exposure to these experiences for future veterinary surgeons and veterinary nurses (Clise et al, 2021a).
The Mind Matters initiative exists to raise awareness and acceptance of all forms of mental health; running courses for employees and employers, giving people the tools and knowledge to feel supported and confident in asking for assistance, proven by the increase in calls to the Vetlife Helpline, which have increased by 500% in the last 5 years (Mind Matters, 2019).
While ‘imposter syndrome’ is a relatively new term, the experience of feeling unreasonable levels of self-doubt and fear of discovery is tied in with the level of identity attached to the role held in the veterinary industry (BVNA, 2021).
Burnout is described as involving emotional exhaustion, negative attitudes, and reduced efficacy. In veterinary surgeons, rates of burnout between 27 and 50% have been recorded, with contributory factors including long working hours, high client expectations and negative home–work interactions and profession-specific dilemmas (such as euthanasia), which can all contribute to anxiety, depression and poor job satisfaction (Mind Matters, 2019).
Stress
A Royal College of Veterinary Surgeons (RCVS) survey revealed that just under 90% of veterinary surgeons found their work stressful (Mind Matters, 2017), with stress and fatigue, and poor work–life balance rating as the highest demands (Clise et al, 2021b), and clinical outcome, pressure and experiences, working hours, conditions and remuneration rating as the most negative aspects of the veterinary industry (Montoya et al, 2021). While some stress is healthy, when it becomes excessive it can be a contributory factor in illnesses, including cardiac, cancer, irritable bowel syndrome (IBS), eczema, migraines and other chronic illnesses (Woollas, 1999).
Stress itself can have a variety of seriously debilitating effects, from back pain, muscle pain, gastrointestinal disturbances, insomnia and anxiety, palpitations and poor immune system leading to cyclical periods of colds and flu (Woollas, 1999).
Fears around admitting unbearable levels of stress at work, or that coping mechanisms are insufficient are often linked with low self-worth, the anxiety of stigma, labelling and a loss of respect or capability in the workplace, at a time when confidence and self-esteem are already likely at an extremely low point (Woollas, 2019).
Compassion fatigue can feel commonplace in the whole of the veterinary workforce, as ethical decisions, moral dilemmas, and poor outcomes of treatment are all inevitable at some point. While front-line staff may feel unsupported by management (Bonnema, 2017), it is vital that all staff practice effective self-care, and to encourage others to ask for help and advice when they need it. Services such as the Vetlife helpline are available for registered veterinary nurses (RVNs) as well as veterinary surgeons, and confidential services such as the Samaritans are available outside the veterinary industry (Bonnema, 2017).
Limited licensure
The BVCIS is a peer-led support group for those within the veterinary industry suffering with a chronic disease. The Limited Licensure proposal is a scheme that would allow veterinary professionals to undertake some rather than all veterinary activities according to their individual competencies. The BVCIS responded to the Limited Licen-sure proposal with concerns that it may create a ‘two-tier’ system, where those veterinary surgeons and RVNs with chronic conditions or disabilities are treated differently, de-valued or discriminated against within the profession (Cawston, 2021), instead of supplying those with an appropriate support network and self-regulation, while tackling the already present discrimination within the community (Imrie, 2021).
Self-care
Vetlife (2021) advised that the most vital aspects of a ‘personal first aid kit’ should include quality sleep, healthy eating, hydration, exercise, relaxation, personal relationships and early establishment of the working hours and conditions the workplace demands, as well as the support provided.
Mind (2021) discussed how many people find maintaining a working pattern helps by providing routine, purpose, enjoyment, a social contact and a source of income. This is all provided that the working environment does not aggravate the condition, either physically or mentally, and that any adjustments requested are provided. The British Veterinary Association (BVA) (2019) has insisted that ‘presenteeism’ or working when too unwell to function appropriately is not the right course of action, and raised concerns from a recent survey that 65% of veterinary surgeons in clinical practice have worked when they felt too ill to do so, most commonly because of fears of letting down the team. Cawston (2020) encourages those suffering with chronic or debilitating health conditions to put themselves first, understand their worth both as a veterinary industry team member, and as a human, insist on the right to take rest breaks, utilise flexible working, and have reasonable adjustments made in the workplace where these can help.
It is also vital to find that network of reliable people, who understand your condition, and can help when you need it, fully knowing you may not have the energy to repay that favour (Davidson, 2018).
For those who find flexible working impossible or their current clinical environment detrimental to their chronic health, locumming is an alternative to leaving the industry. While some people may find the stress of finding locum positions too high, it gives freedom to allow individuals to choose their hours, type and remuneration of their work, providing the individual is honest and open about the type of issues their individual condition can present (Impey, 2020).
Conclusion
Developing any physical or mental condition that is limiting in personal or professional life creates periods of uncertainty and questions self-worth and emotional stability (BVCIS, 2021). But those with support networks, coping mechanisms and healthy responses can continue to work (Woollas, 1999), provided that discussions on physical and mental health in the workplace are no longer seen as taboo (Bonnema, 2017), and the individual affected receives understanding and acceptance from their colleagues and management. After all, chronic illness by its very nature makes individuals particularly resilient (Hargrieve, 2021), provided that individuals can be honest with themselves and colleagues about how adjustments can be made to suit their particular chronic illness (BVCIS, 2021). Above all else, in an industry where our main skill is showing compassion to others, we all need to remember to show it to ourselves (Gorman, 2020).