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)

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Adventures of a Mixed Practice Vet (Student)

I’ve just completed my very last placement of final year! I still have rotations to do (they are organized by the university not myself) before I’m totally finished. I booked my placement at this mixed animal vet clinic to be 1 month long. I wanted more time to get to know the vets, the area, and follow up on patients—which are features that you do not get when your placements are shorter.

I started at 9am on Monday, by 9:30am the first patient was in the hydraulic squeeze in the bovine exam room and I was in charge of replacing his rectal prolapse. Luckily the prolapse was quite small and I really only needed to put in a couple stitches.  As for other cattle work —I tried to jump on all these calls because this was the hands on experience that I wanted.  I went to a lot of herd health appointments– usually the first appointments of the day.  This is usually an appointment that occurs every 2 weeks at a dairy farm to assess the health & pregnancy status of the herd.  I preferred to get my practice with rectal palpation and trying to diagnose cows as ‘pregnant’ or ‘open’.  Some cool things other than pregnancies that I felt included cystic ovaries and a mummified fetus from an aborted pregnancy. Sometimes I watched the ultrasound screen while the vet checked the cows. You can tell how far along the pregnancy is by looking at the size of the embryo on the screen.

One particularly memorable call was helping out a heifer who having difficulty calving. She had already been going several hours and the farmer said her calf was dead. By the time we got out to the farm the rain was bucketing down from the dark clouds. We pulled up to an uncovered head gate with the heifer waiting for us.  With thunder and lightening rolling in we got to work. Calving calls usually requires a lot of lube…. and I mean a lot. I dumped a 1L bucket of lube into a pail and used a stomach pump and a hose to pump all the lube into the birthing canal (sorry for that mental image all you non-vet people). We also slathered both our arms in lube and got to work.  The dead calf came out piece by piece. I felt like we really helped that heifer; and bonus: we didn’t get struck by lightening!

We did a left displaced abomasum (LDA) surgery in clinic. I explained what this was in one of my previous blog posts about a cattle placement. Working on our large animal calls in clinic is often much nicer than on farm because all of our equipment is right there, we are in a controlled (& heated!) environment and we can often be a lot cleaner/more sterile than in the field. The LDA surgery was performed similar to others I have seen except this time we were able to wear gowns, gloves, and perform a proper scrub in the sink before starting.

We saw quite a few cattle with joint infections. Often all this takes is a small cut or wound over the incision that allows bacteria to come in and colonize. Sometimes these patients can be treated and sometimes they cannot. Close to the end of my placement a calf with a very badly infected joint came in. The situation looked grim but the farmer was game to try and save the calf.  We sedated the calf until it was laying on the ground. I was in charge of clipping the hair and scrubbing the foot (imagine how long it takes to clean a cow’s leg that has never been bathed ever in its life!) before we tapped the joint (stuck a needle into the joint space). We ended up draining a lot of the STINKY infected joint fluid before we flushed out the joint space and injected some antibiotics directly into the space. I applied a big bandage to the cows leg and was chatting to the farmer—it was almost 10 minutes later I realized I had chunks of joint material & dirt hanging off my face. #classy.

We drove out one day to an extremely nice property to see 3 highlander calves ((the fluffy ones!) who are apparently famous on instagram?!) that were coughing.  We suspect that they had lungworm because they seemed healthy otherwise and started coughing whenever they had to run around. On our way back to the clinic one of the tires on the truck blew off… so that was quite the adventure!

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I went for a sunset swim in the river with friends after work

Seeing ‘bull with broken penis’ on the appointment scheduler is always interesting. I think we saw about 3 of these cases while I was at this practice. One of them just had a bad infection and the other bull had a massive abscess all surrounding his sheath. I drained out & cleaned the abscess. Both the bulls went on antibiotics and they will be out for the rest of the breeding season this year.

Someone brought in a much older cow and an unrelated calf who both had walking issues. On rectal exam of the older cow you could feel spondylosis (extra bone growth) between all her vertebrae.  This is an age related change and was probably the bone just trying to stabilize itself. We didn’t think she could be safely bred any longer.

We also saw lots of sick cows which allowed me to practice my physical exams. We even had a few conversations about dart guns, treating wild cattle, and which drugs were the best to use because of amount, effectiveness, and depth of penetration of the dart (subcutaneous administration vs intramuscular). And yes, then I went and checked out a dart gun & some of the 10ml darts that are being used.

There was always something going on with the cats and dogs in the clinic. I placed drains in a couple of different patients with wounds. The drains go into ‘dead space’ beneath the skin of the animal and assist in draining out fluid that would delay or prevent healing. The first drain I placed was in a dog who had a lumpectomy surgery and his incision had dehisced. He came back in a week or so later for a suture check and then for his sutures to be removed; the wound had healed up great! On my last day of placement a large breed dog who had been attacked by another had a head & neck FULL of wounds. I placed 2 drains in his neck. A few days after I finished my placement one of the vets texted me pictures of his healing wounds!

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I had only been at the practice 4 days… and I already had clients leaving messages for me 🙂 

Speaking of wounds, because of the rural area there was a lot more appointments of pets that had been fighting, were attacked, etc. I looked at many wound patients, or hit-by-car patients, watched enucleation surgeries, and pulled porcupine quills out of dogs (one of my favorite appointment types)! I even saw my first cat with quills stuck in her face — cats usually run away so this was interesting.

During my first week there was a young puppy who refused to walk. The x-rays showed a broken leg. I got to see this puppy several times over the next 4 weeks as he came back in for bandage changes.

There was one dog who was diagnosed with bladder cancer, this is typically a fast moving and impossible to cure cancer. We were trying to manage this patient to be as comfortable as possible. She was having issues urinating so I helped to pass an indwelling urinary catheter that would sit in her bladder and allow her to pee. I also helped pass a urinary catheter in a male cat who was blocked (usually a stone stuck in his urethra preventing him from urinating).

One day a dog came in for ‘excessive slobbering’. This problem actually turned out to be a lot more interesting when we discovered the dog was unable to close his mouth and likely had a nerve paralysis!

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We had to do an emergency surgery on a dog who we thought swallowed a sock or a rope. It turned out that this dog was just obsessively eating grass until he packed his stomach solid with it. 

I was able to perform castration and spay surgeries by myself. As well, I taught the veterinarians & techs about a new surgical technique we learned (the Millers knot) that is really good for crushing tissue. The vets loved it and are going to use it themselves now! I scrubbed in and helped in a very large breed dog spay & a pregnant spay and even a c-section on a Frenchie! The vet let me deliver the last puppy myself— slipperier than expected!  I had a super interesting conversation with a vet one day because we had several puppy vasectomies and hysterectomies booked in. These are not common de-sexing procedures because they leave the testicles & ovaries behind in the patient which can continue to produce hormones. There are some breeders in the area that were requesting these surgeries. Speaking of puppies & breeders…. we did several first puppy exams. This means that I stood in a room of 5-10 puppies and got to cuddle them all!… I mean… examine… and then give them needles (vaccines). I’m talking white Labs, chocolate Labs, Beagle crosses, German shepherds….

We saw a young mastiff dog was was limping heavily, after some x-rays we discovered a severly diseased elbow with a condition called Ununited Anconeal Process (UAP) which requires a specialist surgery.

We did a couple of post mortems on rabbits! Not your typical case….

I started all of the small animal consults by myself, did my own exam, took samples, etc. before chatting to the vet about my suspected diagnosis. Then we went back in and finished the appointments together. I saw a puppy who was only a few weeks old that was dripping fluid from his nose & sneezing everywhere. We suspected pneumonia, although neither me or the vet had ever seen this condition in an animal so young.  We saw an old Caviler King Charles Spaniel with an extremely impressive display of decompensated heart disease with a murmur that likely could have been heard in the next room. We sedated a dog who’s owner thought he had porcupine quills stuck in his ears. Once I examined his ear canals I found a grass awn and managed to pull it out for him! Imagine just how irritating that would be?!

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Feelin’ good! 

THEN, there was all the horse calls! We did a couple of pregnancy checks on mares which was good to do in a different environment because I did a lot of this at my last placement. One of the vets at this practice had also done another course on chiropractic & acupuncture treatment for animals so she had several appointments (horses & dogs) come in for this.

I got to try my hand at floating teeth with a power float… harder than it looks… and I still haven’t mastered the ability to see all the teeth at the back of the horse’s mouth without climbing inside…

On another day we were on our way to see a horse that was acting neurological, by the time we arrived the horse had died. We spoke with some people on the farm and then took a blood sample for testing; we suspected West Nile Virus. When the results came back a week or so later that was not the case but a different disease that could have been prevented by vaccination was found instead!

We went to another farm to euthanize a very old horse. And another farm to check on a couple of horses with wounds. One horse had a wound high up in his armpit, another had a wound on the back of his leg with his tendons exposed! Back at the clinic we saw some miniature horses that had been attacked by dogs and had significant wounds. It was an after-hours call that took us almost 2 hours to clean up & stitch back together. I heard that they are doing well.

The smoke had been so bad in the area (from forest fires in the next province) for almost 2 weeks that I wasn’t surprised when we went and did an exam on 2 horses with respiratory issues from the terrible air quality.

There was a horse with a really bad case of mastitis. Usually this is a problem that we see more commonly in cattle & if you see it in a horse it is easily treated. That was not the case for this horse. When we saw her her udder was very swollen, firm, and quite painful. We checked on her almost daily & prescribed her a whole slew of medications.  I also put in a couple of intra-mammary antibiotic treatments & an IV jugular catheter. Treating her with intra-mammaries reminded me that a horse udder has a different anatomy than a cow’s udder. One day we got a call that now her udder was looking better but she was 3-legged lame & couldn’t walk! Confused, we drove out to the farm again. The horse was hungry but didn’t want to move to the grass. Her legs and tendon sheaths were all swollen. We suspected she may have had a drug reaction & pulled her off all her medication. The next day she seemed to be on the up & up!

So that’s a lot of fun stories! And I didn’t even mention all the fun I got to have in the evenings & weekends being home with my friends/fam…. coffee dates, farm visits & parties, dinner with my grandmas, learning to ride a motorbike & pull a trailer, markets & fairs, swimming, campfires, drinks….

I really enjoyed myself at this practice. The vets treated me like a doctor, like a colleague, and I felt my opinion was valued and appreciated. Thanks a million to BarrNorth Veterinary Services and I wish you a fantastic fall and winter season ahead!

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The clinic had a taco-in-a-bag customer appreciation day so my mom and a family friend came for a tour of the practice! 

“To Cut is to Cure”

We had a 1 week surgery rotation at the university hospital. The university is a referral center with specialist surgeries being performed so we didn’t get to do much ourselves. We scrubbed into as many surgeries as possible and held tissues or passed instruments or operated the suction for the surgeon.  We worked long days; coming in early each day to check on surgery patients from the day before. We also called patients a couple days after their surgeries to check on them and see how they were doing post-op. We wrote discharge notes and surgical reports. Surgical reports are different than a normal medical history. We made sure to include all the instruments used, the type of scalpel and suture, the pattern of closures, exact dimensions of any incisions, and carefully explained each procedure. Each evening we had rounds where we talked about the surgical cases for the day and looked at the pre- and post-operative imaging (x-rays, or CT scans or MRIs).

One of my first patients this week was a beautiful dog who had a significantly sized mass removed from his soft palate (roof of his mouth). Once the surgeon took the mass out there was a very large fistula which needed to be repaired with a skin graft. I was reading some of the articles the surgeon had with him to assist the procedure. It was very complicated, and the anatomy went over my head…that’s the thing about the field of veterinary medicine & surgery… there is always so much more to learn and do and practice! He stayed in hospital for a few days and had to be stomach tubed his meals (who wants to eat when you have a skin graft in your mouth anyways?!). When we went out for walks I had to stop him from trying to pick up sticks with his mouth! Unfortunately, after a couple days one side of his skin graft had failed and he needed a repeat surgery to close the fistula in the roof of his mouth again. After freshening the edges and making another mini-graft the fistula was closed. As far as I know, this patient recovered really well after his revision surgery!

I watched a couple of other mass removal surgeries this week, they were not quite as cool as the soft palate resection + graft. One poor dog had a mass in her rectum that was very uncomfortable. Another dog was very prone to developing lumps all over her body and needed those removed!

One girl in my group watched four splenectomies or something crazy like that this week. I managed to watch one!  The university has this very cool surgical tool which makes splenectomies a lot easier; it basically cauterizes all the vessels and stops all the bleeding so the surgery is much faster and cleaner.

 

One day there was a cria (baby alpaca) that had come in for surgery. He was too big to stay in the small animal hospital so he stayed with his mum in the horse barn and then came to our small animal surgery team to have his bony sequestrum removed from his leg.  A sequestrum is basically a dead piece of bone sitting within the limb; they can be associated with infections and sometimes draining tracts will form. The CT scan of his leg was particularly impressive!

If any spays or neuters were scheduled my group members and I were meant to do them. I watched one of my friends do a spay and a couple of my other friends did castrations. I was very unlucky all week and my cases kept cancelling or no-showing on me! I didn’t get to do any surgeries this week.

 

Towards the end of the rotation I had a very complicated surgical case! The patient was in the ICU.  I completed my rotation in the ICU earlier this year. The ICU team determined that the patient had a septic abdomen. Which meant that he had a bacterial infection in his abdomen—this is really not ideal! We learned that this dog had previously been diagnosed with severe hydrocephalus and had previous brain surgery to put in a ventriculoperitoneal shunt (VP shunt). Very simply —this is a tube that goes from the brain (and tracks under the skin) to the abdomen where it drains the cerebrospinal fluid that builds up in the brain. The excess fluid cannot be in the brain and if it is drained to the abdomen it can be reabsorbed into the body there.

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Please enjoy this Google image of a puppy with hydrocephalus. His head is abnormally enlarged and domed. http://www.dogscatspets.org/hydrocephalus-in-dogs/hydrocephalus-dogs/

Unfortunately, the presence of this shunt complicated matters. We didn’t know if the bacterial infection in his abdomen had started in his brain or if it has started in his abdomen and then had tracked up to his brain. The surgery team spoke with the ICU team and then the surgery team liaised with the neurology team. Eventually we decided that it was in our patient’s best interests to complete his abdominal surgery first and then bring in the neurology team to remove his shunt. Then, if he recovered well in ICU he would require another brain surgery in a couple weeks to replace the VP shunt in his brain (this patient cannot live without the shunt). Both surgeries went really well! I helped put in the esophageal feeding tube at the end of surgery.  I’ve been trying to keep up on how this patient was doing by asking my friends who were on their ECC rotation in the ICU room.

The First Cat and Dog Rotation!

I feel like there is a significant lack of cat and dog jokes around to make into a quirky title for this blog…

After my group finished our equine rotations we needed to switch our brains into ‘smallies’ mode because we had 3 weeks of Emergency and Critical Care (ECC) and Small Animal Medicine rotation ahead of us.

The Intensive Care Unit (ICU) room is located in the middle of the university hospital and all the most sick or critical patients get transferred there. Often the team is so busy they don’t leave the room and have no idea whats going on in the other departments!  We either worked day shifts or evening shifts–which were the ones I preferred.  This meant that after normal day time hours most of the other hospital departments had gone home–so if a patient needed a special procedure or diagnostic test we did it ourselves instead of transferring to another department.

Again, as a student we were meant to take a case and be “in-charge” of the treatment and monitoring of that animal while it was in hospital. If an animal presented to the hospital it was called over the loudspeaker and we went to the reception area to triage the patient and consult with the owners.

The first patient I saw ended up being the most complicated case we had all week! The cat was initially suspected to have hepatopathy (a fancy way of saying liver disease) and renal (kidney) disease. After further treatment and diagnostics we discovered both an intussusception and a gastric foreign body with bi-cavitary effusions, hypothermia, hypovolemia, and hypotension…which is a real fancy way of saying that this cat was very very sick!  Each day we had rounds where we could sit outside in the gardens and discuss emergency topics. This patient was a great patient to initiate discussions on identification of shock and management of critically ill patients.

On our next shift we had a blocked cat, which is something I had seen a lot of at my previous job! It is not an un-common problem in male cats.  My housemate went to a conference last year and listened to a lecture about sacroiliac blocks (epidurals) for cats during this procedure. We use epidurals quite commonly in cattle but less so in our small animal patients. One night we were lucky enough to have a cadaver cat to practice epidurals on as well as other emergency skills like jugular catheters, tracheotomies, thoracocentesis, and urethral catheterization.

Another evening, there must have been something in the water in Werribee because we had multiple patients present after they feasted on the laundry room products!! One dog ate everything in site—detergent, soap, wine, bleach, smashed glass, etc. One cat ate lily laundry detergent and lilies are particularity toxic to cats!!

In Australia it is quite common to see snake bite cases! The university is currently working on SnakeMap which is this cool project that collects GPS coordinates of where snake bites occur which will help veterinarians manage the cases more efficiently. We had a few patients present to us in different stages of the course of the disease. It was fun being involved in these cases and I will miss them when I practice in Canada one day.

In the true spirit of emergency we had a couple cases which were rushed directly to the ICU room.  My group stood back in awe and watched the well-oiled ECC team perform CPR on a ferret who was involved in a dog attack.  Within minutes we had experts from the anesthesia team and the exotic specialist vet at the ICU room to assist with the uncommon patient.  Another patient in the ICU needed a pericardiocentesis preformed.   This is a procedure where the vet will stick a special needle through the body wall into the sac surrounding the heart (without poking the heart) to remove fluid—often blood–which is preventing the patient from breathing and pumping blood around their body properly.  This is a really cool technique because it is both diagnostic & therapeutic. This means that by performing a pericardiocentesis we can often get a diagnosis of the disease we are dealing with and we can also TREAT that condition at the same time.

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Practicing CPR on stuffed animals during our tutorial. But with that hair-do…. I’m not sure if its CPR or headbanging 😛

My group then transitioned into the Small Animal Medicine Department for a slower paced and more detailed rotation. We had tutorials on nutrition for cats and dogs and discussed diets required for different medical conditions and how to best formulate that into a treatment management plan. We also talked about antibiotics and prudent use.  Lastly, we had a CPR tutorial where we practiced our technique on life-sized stuffed animal patients.  We had a ton of fun practicing because we searched up YouTube and played “Stayin’ Alive” on loud to help us keep on time (compressions should be done at a tempo of 120 beats/min)!

I was in charge of another critically ill patient this week that was transferred back and forth from Medicine, ECC, and Surgery. This cat initially presented with blood in his urine. However, he was very anemic as well. Over the course of the week he ended up needing at least 2 blood transfusions. At one point we were considering giving him dog blood (xenotransfusion) because we didn’t have any feline donors.  Personally, I didn’t know that you could even do that without an animal dying and was completely mind blown! The cat continued to get sicker during the week as we tried to figure out an explanation for his many problems. We performed x-rays, ultrasounds, multiple blood tests, and even an exploratory laparotomy (surgery).  This cat had a very guarded prognosis and I was amazed and delighted at the end of the week when he was pacing around the ward and meowing at me for more food in his bowl (and not through his stomach tube!).

Wednesday was cardiology day! We shadowed the specialist cardiologist that comes to the university. My group sat in on all his morning appointments to watch echocardiograms (an ultrasound of the heart) and ECGs. I had a patient that had come in earlier in the week for something unrelated and when I did my physical exam I heard an abnormally low heart rate, a few tests later and an appointment booked in with the cardiologist and we had diagnosed her with a serious heart condition requiring surgical implantation of a pacemaker.

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Sometimes you need several ECG pages to read in order to diagnose the heart condition your patient has…

And on Thursday we had extra training with the specialist oncologist. She was really lovely and spent some time helping us to better feel lymph nodes in dogs and cats. This is something that I have always struggled to find in normal patients who do not have enlarged nodes.  Several of the patients I saw this week were cancer patients in various stages of diagnosis, staging, and treatment.  I now have a better understanding of chemotherapy drugs, what to do when you think you may have found cancer in a patient, how to treat and diagnose cancer.

These 3 weeks provided tons of opportunities for reviewing multiple different diseases and we had a lovely time in the hospital!