KEEP CALM OR I WILL BOLUS THE PROPOFOL

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Propofol is a very commonly used drug in the veterinary world. We use it to help patients fall asleep before surgery.

My last rotation of the year was spent in the anesthesia department at the university hospital. This was a rotation that my whole group wished had been scheduled earlier in the year. We were taught lots of valuable information about drugs that would have been very helpful during our placements–but better late than never!

The anesthesia department at the hospital runs almost all of the anesthetic protocols for any procedure going on in the hospital–so this means cats, dogs, horses, and occasionally other fun animals!  An anesthetic protocol is required for any patient that needs to be asleep for a procedure– like taking an x-ray or having a surgery done.

Each student was required to be ‘primary’ on a case for the day and read their patient’s file and then develop an anesthetic plan that would appropriately match the patient’s diseases and procedure. This is complicated. Especially when your patient has multiple diseases and you can’t give them certain drugs.

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Jessica reading up on her patient’s medical history. There is a TV in our student lounge connected to one of the surgical suites. On this day, I sat & ate my lunch and watched a thoracotomy. 

After doing a physical exam on our patients, creating an anesthetic protocol, and preparing all our equipment and machines we would draw up our drugs into syringes. The first step is then administering a pre-medication drug to the patient to make them a little sleepy. After that we would collect our patient from the wards, bring them to the prep room and place an IV catheter in their vein. We also placed an endotracheal tube (so we can control their breathing), and finished prepping them for their surgery or procedure. During surgery we monitor the patient’s vital signs to make sure their heart is beating properly, they are breathing correctly, and other important things. Once the surgery is finished we are in charge of making sure the patient wakes up smoothly and safely.

One day I monitored an anesthetic for 7 hours, one of my wonderful group mates brought me food from home and the rest of the team tagged me out for a break 🙂

During some of the afternoons we had tutorials where we learned about different stages of the anesthetic protocols and could ask any questions we needed to.

We all had to take complete charge of a patient (with no help from supervisors and nurses) and we were assessed to make sure we could do everything appropriately and safely. My patient was in hospital for a toe amputation. Everything went smoothly!

Some of the patients that I created anesthetic protocols and monitored for were getting CT scans, MRIs, spays, foreign body removal surgeries, etc.

Unfortunately, this post can’t be too much longer without talking about a lot of fancy drug names and anesthetic equipment. I found it helpful to practice using new drugs and talk about protocols with the experts!  At the end of the 2 weeks…we were done! But actually, DONE! No more rotations 🙂 next step…. graduation!

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Last day of DVM4! We are in the prep-room in front of some of the anesthetic machines we had been using during our rotation. 

 

 

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Cat: “I’m getting fixed?” … “Am I broken?”

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“Fixing” = De-sexing

We had a week of de-sexing rotation during the beginning of the year and a second week at the end of the year.  De-sexing means spaying & castrating (neutering) cats and dogs.  We completed this at a massive animal shelter in the city! This means we had to commute in on the train each day… which we somehow always struggled with. We seemed to end up with endless delayed trains, massive traffic jams, and absent parking spots.

On the Monday we had an induction in the upstairs tea room and talked about the layout of the days. Then we spent some time practicing different suture patterns and knots on the suture boards.

In the morning two of us would be the surgeons and two of us would be the anesthetists. The other two students were ‘floaters’ and stayed outside the surgical suite and were involved with patient care and recovery monitoring.  We switched roles in the afternoon. When we first got allocated our cases we had to go find the dogs and cats in different wards in the shelter. We would bring them to the veterinary room where we would do our physical exams, place IV catheters, and give them premedication drugs so they would start to get sleepy before their surgeries. The anesthetists would be calculating their drug doses for the patients and preparing the anesthetic machines. We also checked our patients from the day before and looked at their surgical incisions to make sure everything was healing alright!

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Our group standing outside the surgical suite which contained 2 surgery tables and 2 anesthetic machines for us to do simultaneous surgeries at. 

Being the surgeon was fun because I was often the only person scrubbed into the surgery—this meant I did everything by myself! Last year, when we did our first surgeries at the university hospital there was at least one other person scrubbed into the surgery and we had to share all different parts of it with each other. It was difficult to learn that way. One of my favorite things that we learned how to do on this rotation was pedicle ties on the ovaries of cat spays.  They are done on most cat spays at the shelter. I liked this technique because it is faster than a more traditional method and leaves less suture material inside the patient. I have now taught multiple vets on placements I’ve been to about how to do pedicle ties.

As the anesthetist it was good to practice our drug calculations and give intramuscular injections. It felt like a lot of my patients had issues with blood pressure during their surgeries so I learned a bit more about how to manage this issue.

On the Wednesday of the first week we received personalized feedback from the vet. This was really nice to actually speak to someone DURING a rotation about things we were doing well and other things we could improve on.

When I got the chance to do a dog spay I enjoyed performing Millers knots in a live patient instead of on a suture board. Practicing on suture boards is great, but its nothing like the real thing.

During our first week of de-sexing we took advantage of being in the city close to things to do–we had dinner one night at a fav location (Laksa King… I may have mentioned it before…) and then went to a comedy club.

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Please enjoy this very in focus and amazing photo of our group at Laksa King.

On the last day of the week we organized a group lunch with us and the surgeon and the nurse. On the first week we made rice paper rolls (second week was TACOS) and gave some quick presentations regarding shelter medicine. Jessica and I presented on olfactory enrichment for shelter animals.

On another day we braved the pouring rain and really windy conditions to walk to Mork chocolate for a snack before starting the long journey home on the delayed trains.  How dedicated are we?- we even stood outside in the rain until there was an empty table!

As an update, this is my second last rotation. Which means there is only 1 rotation left. AND THEN WHAT?! (plot twist: its graduation)

The classics.

General practice is where a large portion of vets will work after graduation. GP vets are capable of many things, but some of the most common appointments include health exams, vaccines, ear infections, skin problems, etc. We had 1 week of general practice rotation at the beginning of our 4th year and just finished a second week now, at the end of our year.

We spent one day each week at the university hospital with a specialist dermatologist who only saw skin patients. Skin issues can be so complicated! I am glad we got to spend 2 full days with the dermatologist only looking at this one body system (yes, the skin is a whole body system!). Skin issues can be complex and involve infections and allergies or other diseases. Often it can take lots of time and searching to find an answer to your pet’s problem! Most of the skin patients we saw ended up having allergies to things in the environment (like grasses, dust mites, etc) or food.

One patient we saw was presented to us because his toenails kept falling off. The dog was diagnosed with symmetric lupus onchodystrophy, which is a disease I have read about in my notes many times… however, the dermatologist said this is quite rare and he has only seen one case in his whole career!

We had quite a few vaccine appointments where we got to practice our physical exams, vaccine injections, history taking, and medical note writing.

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Not a picture from rotation. But I did just get to meet my friend’s new puppy on the weekend and gave him quick little exam! 

In my second week of GP I happened to be rostered on with the exotics vet for a couple days! This was pretty cool because instead of cats and dogs I saw lots of different kinds of patients like: rabbits, chickens, blue tongued skinks, bearded dragons, turtles, eclectus parrots, and cockatoos!  These are all animals that may need a vet at some point in their lives but we don’t get to see them very commonly.  We have some lectures on exotic animals but often, most of our learning is done day to day when the problems arise!

Some highlights included doing first health exams for nine (NINE) baby bunnies! They were all very cute… I mean, healthy. And fluffy… I mean, eating well…

I also enjoyed an appointment with a blue tongued skink with who had a suspected broken back! After a full exam I got to take x-rays of him to look at his spine. In the end, he was diagnosed with metabolic bone disease. We talked about changes his owner could make in his tank, diet, and gave him some pain medication!

Another very cool thing was having a patient (cockatoo) who was older than me! That hasn’t happened since I first started working in veterinary clinics when I was 17.

One day of the week we are rostered on to help with minor procedures. I helped monitor the anesthetic for Jess to do a cat castration. Then we had an aural hematoma repair (one of my favorite small animal appointments to do!). This is a condition in dogs where the skin of the ear fills up with blood. It can be very uncomfortable and swollen. At previous clinics I have worked at you can release the pressure and then suture something on to the ear so the area cannot fill up with blood again. I think it looks cutest when you suture buttons onto the ear. At uni however, I got to suture on little pieces of tubing.

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Buttons on the ear of a dog who has had an aural hematoma repair. https://www.belfastlive.co.uk/news/belfast-news/pet-dog-buttons-sewn-onto-14030456

General practice rotation flew by. Next up is our second week of desexing rotation at an animal shelter in the city.

 

 

Push up Girls! Push up!

No, not a push up bra. Just a really common saying as we get cows lined up in a race before their examinations. “Push-up girls!” We want them to push up into a nice tight, straight line so both the cows and us will be safe.

Jess and I flew down to Tasmania for 2 weeks to complete our Dairy Rotation. Obviously, the days were filled with cows… and cow poop! But we kept the weekends open and ready for lots of exploring.

Something new that I did in Tasmania was induce cows to calve. This is not commonly done in the rest of Australia. Farmers in Tassie use induction to help maintain tight calving intervals of their herd (having all their cows calve at the same time) so that it matches up nicely with the pasture growth (so there is food for the hungry momma cow’s to eat!). It is a simple procedure–just an injection! But the methodology and the conversations behind it were what I found most interesting.

Another new thing I did on this rotation was something called “visvaging”.  Yes, as in “visualizing the vagina”. This is done with a speculum and a light. Every cow in the milking herd needs to be examined in order to identify the presence of infection coming from the uterus. The sick cows need to be treated so that they can heal and become pregnant again. This is an older technique, as many veterinarians use a ‘Metricheck’ now. The older technique is still preferred on some farms and I think it is important to know how to do it.

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The only cow I was allowed to take pictures of on this rotation. Also, who wants to see pictures of visvaging anyways?!

Although this was our dairy rotation we spent some time semen testing bulls; which is more common in beef bulls. Semen testing is done to make sure that a bull is healthy and fertile before the breeding season. It is important that they can do their job (which is getting cows pregnant!). One afternoon, Jess and I both drove out to one of the vet’s house to semen test his bulls. Firstly, he had an absolutely fantastic property on top of a hill with almost 360 degree ocean views! Secondly, I found it hilarious that I tested one bull and came out relatively unscathed (ie: clean) and Jessica tested the next bull and came out absolutely covered in “dirt”…. don’t ask me how she did that!

I went to a lot of preg-checking calls. For many of them, the farm set up was not conducive to having a student manually palpate cows after the vet so I ended up watching the ultrasound screen a lot. This was okay because it gave me a decent amount of practice ageing pregnancies based on their size. At one of the first preg-checking calls (at a dairy) the vet told me she’d let me guess the breed when we arrived. Thinking that I had a decent handle on dairy breeds (there is not a lot of common ones), I thought this wouldn’t be that bad…. when we drove up I saw a bunch of red cows (some with blue eyes!) staring back at me. I responded with “not dairy cows”. Fun fact! Apparently Australia has their own breed called: Aussie Reds. For the super hardcore; here is the breed website. For everyone else, here’s a great picture!

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Please enjoy this Google image of an Aussie red cow. 

Another one of my favourite calls was to a Wagyu beef farm. They were one of the only farms in the area doing embryo transfer. The recipient cows were black Angus which were these huge beautiful CRAZY cows that were such a pain to get through the race and into the crush. Looking to the paddock beside us were all the relatively small wimpy (comparatively) looking Wagyu animals that are just so expensive and produce the most amazing steak! As well, this farm is located close by to an island and they do a yearly run of their cattle across at low tide. We went in for a cuppa after the job was done and had a nice chat and watched some amazing drone footage of the crossing!

Some of my favorite calls are for calvings. This whole year I have been hoping to get more experience with them. Luckily I got to go to 3 calving calls on this rotation. The first was a cow that had gone down (like literally laid down and couldn’t stand back up) because she was exhausted from trying to calve.  We met the farmer at their house and hopped on a “bike” (actually a quad…) and drove up and down some whopping hills and  through a creek before we found the cow at the bottom of a steep embankment. She had gone down in some thick mud beside a stream. Besides getting my boots stuck in the mud and flailing around wildly to try and stay on my feet, I managed to get the calving chains on the calf’s already exposed feet & pull him free! The benefit of being right beside the stream was being able to walk 2 feet and stand in the fresh water and wash all of our gear (and our arms!).

The second cow was WILD. By that, I mean a beef cow that was NOT happy to see us. Luckily she was already in the crush when we arrived, but that did not stop her from trying to kill us as we walked by. I’m not going to lie, I was pretty proud of myself for getting her epidural in (on the first try!) and not getting kicked! What ensued was an amazing rodeo of calf manipulation, attachment of calving chains, having the cow go down in the crush (and then up again…. x3), putting on a halter and then letting her out of the crush to go down. Folks, this is when the real fun started; we had the halter wrapped around a metal pole and being held by the farmer. In about 2 mins I would be silently praying that this was the strongest rope halter created by mankind… The vet snuck up and got the calving jack into position. For those of you who do not know what a calving jack is, here is a picture:

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The calving jack is the metal piece of equipment. It is placed under the cow’s tail. Chains are safely wrapped around the calf’s feet & attached to the handle on the long pole. You can then pump the handle up the pole which will pull the calf out of the birthing canal. https://www.pbsanimalhealth.com/products/vink-calf-puller

At this point the cow decided to get up again and start swinging back and forth at the end of her rope. Which meant we had an angry cow with a 10ft metal weapon swinging around in front of us. I attempted not to get knocked out cold while marveling at the determination and calm mindset of the vet who continued to dodge the jack, replace the chains, and eventually pull the calf out!

The third calving call was a lovely calm cow who’s calf was breech. This was fun for me because the vet let me do a lot of the call. He helped move one of the calf’s legs into position and I moved the second leg into position, I need a few hints and tips on where to pull and in what direction. Side note: apparently some vets think its cheating if you can fit both your arm’s inside the birth canal to manipulate the calf 😛 (sorry non-vet people for that mental image!) Then we attached the calving jack and I pulled the calf out!

Okay, okay, enough cow stories! On our weekends we tried to squeeze in as much exploring as we could. Neither Jess or I had been to Tassie before and we doubted we would be back again. On our first weekend we drove down to Cradle Mountain and did a few awesome walks around there. This drive was when we realized how beautiful Tassie really is! The wattle trees were in bloom–brilliant yellow everywhere!

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We had everything from horizontal rain, snow, and sun during our few hours of hiking in the Cradle Valley! One minute we would have great visibility, and the next we could barely see a few meters ahead.

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Jess, just reaching the top of Marion’s Lookout in Cradle Valley. Luckily the snow had cleared! 

The next weekend we had big plans! We drove from Smithon down to Hobart, over to Wineglass Bay, Launceston, and then back to Smithon! The best part was probably the hike we did at Wineglass Bay. It involved a short hike up to the lookout and then about 1000 steps down onto the beach—which was gorgeous! And when ocean is that beautiful, how can you resist jumping in it?!

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It was as beautiful as it looks 🙂

So the classic Canadian in me… I changed in the bushes and then ran straight into that water. It was….fresh! Even with all my experience swimming in glacial lakes growing up, I still got the wind knocked out of me when I hit the water. haha!

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The view from the top of Wineglass Bay

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Proof that I actually did go in the water. This is me probably struggling to breathe. 

We stopped a bunch of times along the way and ate some nice food, did a few short walks, and had a lot of fun urging our tiny rental car up and over the hills!

It was a short flight back to Melbourne and a day of rest before starting our second week of General Practice rotation at the University Hospital.