BUSINESS OF PRACTICE: MANAGING THE HEALTH OF YOUR PRACTICE AND PERSONNEL


some chemicals because of its rapid growth and de- velopment, particularly early in pregnancy when its organs are developing. Changes in your metabo- lism also may increase how quickly you absorb some substances. When pregnant, changes in your im- mune system, lung capacity, and even ligaments can increase your risk of injury or illness. In addition, because of physical changes, the personal protective equipment that you could wear correctly before pregnancy, such as a lab coat or lead apron, may now not fit properly. It is important to discuss possible job hazards


with your physician. Although most women are able to safely do their job throughout pregnancy, sometimes they must adjust their job duties tempo- rarily, or take extra steps to protect themselves and their babies. Your ability to continue working through your pregnancy depends on your overall health, the health of the fetus, and what sort of work you do. Many aspects of your job may be safe to continue through the entire pregnancy. Others may be fine at the beginning of pregnancy, but un- tenable near the end. Later in pregnancy, some duties may need to be changed or stopped. Some- times your schedule or hours may need to be changed. As you continue working, the goal is to stay safe and comfortable.


Specific Risks in Veterinary Medicine


Radiation While taking radiographs, you may be exposed to small amounts of radiation. If you work in a mixed practice, exposure can also occur with use of radio- active iodine treatment for hyperthyroid cats or in a hospital setting with the use of fluoroscopy. You may decide to try to eliminate the risk during your pregnancy by avoiding these duties, but for equine practitioners, especially in smaller practices, this may be impossible. If you choose to ask other staff members to pick up your radiology duties, it makes sense to discuss with your boss if there are other ways that you can still be productive by picking up other tasks. If you are the practice owner, don’t expect others to work longer and harder to do these tasks for you without some compensatory action. This could be monetary, extra time off, or by you performing some of their usual tasks. For those who cannot avoid taking radiographs,


take steps to reduce the risk. Radiation exposure during your entire gestation should not exceed 500 mrem. The most dangerous time for radiation ex- posure is following conception (pre-implantation) up to the eighth week of pregnancy.1 Many pregnant women wear the same protective equipment while taking radiographs as they normally do, including an apron, thyroid shield, and lead gloves. How- ever, because of changes in body shape, a wrap- around lead apron may be better suited. In addition, wearing an additional dosimeter badge at the level of your uterus can provide more specific


measurements of exposure to the fetus. If you will be taking radiographs while pregnant, review the reports from your dosimeter badge for the last year to ensure that your equipment and radiation safety techniques are protecting you from excessive expo- sure. As always, keep the time of exposure as short as possible, maximize your distance behind the gen- erator, or in hospital settings, be out of the room or behind appropriate shielding. In some equine practices, nuclear scintigraphy is


used for diagnostics because of its sensitivity and noninvasive nature. A 99mTc labeled radiopharma- ceutical is injected intravenously into the horse and images are acquired immediately post-injection and several hours later. Staff members are often in the room with the horse during the acquisition process. If you must be involved, avoid additional radiation exposure in a clinic with this diagnostic modality by wearing all recommended protective gear, and min- imizing contact with the patient and patient’s waste for 48 hours after the procedure.


Waste Anesthetic Gases


Waste anesthetic gas (WAG) exposure concerns many pregnant health care workers in human as well as veterinary medicine. Although a recent meta-analysis concluded that occupational exposure to WAG is associated with increased risk of sponta- neous abortion, most of the studies included in the meta-analysis were conducted before WAG scaveng- ing had become a legal requirement, and none of the studies attempted to establish a relationship be- tween amount of exposure and magnitude of risk of spontaneous abortion. The meta-analysis included 19 studies of various designs with anesthetists, op- erating room physicians and nurses, dental assis- tants, operating-room workers, hospital workers, health workers, and veterinarians and veterinary assistants as subjects.2 More recent studies have demonstrated that “rates of spontaneous abortion and low birth weight infants were statistically sim- ilar among female veterinarians and lawyers,”2 leading one to conclude that WAG is being effec- tively scavenged in most settings. However, if you can smell anesthetic gas, the level


is entirely too high for safe exposure, whether you are pregnant or not. Appropriate operating proce- dures for safe anesthesia include always checking the machine for leaks before use, ensuring the scav- enging system is connected and operational, and using a cuffed and properly inflated endotracheal tube. The most dangerous times for exposure are during induction and recovery. In order to allow time for the system to be flushed through the scav- enging system, once the procedure is complete, the anesthetic gas should be turned off and the patient maintained on high oxygen flow. This will help to minimize exhaled WAG after the patient is discon- nected from the anesthesia machine. Vapor respi- rators can also be purchased and worn as an extra barrier. If possible, swapping with a coworker dur-


AAEP PROCEEDINGS  Vol. 66  2020 365


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