Hay gurl

My trip home over Christmas break was so refreshing. It was just what I needed before heading back to Australia for the final year of my degree. The day I landed back in Melbourne it was 39C. It was a bit of a shock to the system…and naturally being me–I couldn’t wait to get to the beach.

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How is this only 20 mins from my house?

The next morning we started our Equine Internal Rotation at the horse hospital on campus.  This was the rotation that everyone said was difficult, you just have to get through it, and people cry every year. I’m not sure if I took the same rotation or not… but my group had the best time! The whole class is divided up into groups and we spend the  year with those same people as we go through our university rotations.

Whenever a new patient would be admitted to the hospital or come in for a day procedure one of us students had to claim the patient and we would work with that case for the duration of the hospital stay. This also meant that we had to know all the diagnostic tests, findings, and treatments that were run on the patient–we presented everything at the morning and afternoon rounds.

My first case was very interesting. The foal had been admitted to the hospital the day previously with difficulty breathing. It had a tracheostomy tube put in his trachea so he could breath. When I first came in the foal started showing some neurological signs so we decided to investigate further. X-rays showed us that the foal had actually broken it’s neck. This foal needed to be euthanized. I did it; I place very high value on these experiences during vet school.

We call something a ‘textbook case’ when it presents with all the exact signs and symptoms of a disease that you would read about in a textbook. We had a textbook ‘Recurrent Airway Obstruction’ (RAO) case.  It basically means the horse has allergies. It is an important and fairly common equine disease and something that I should likely know well for my board exam! I was pleased that this case came in during my rotation so I could see it in real life and not just read about it. We did a test called a bronchoalveolar lavage (BAL) on the horse which includes putting fluid into the horse’s lungs and then sucking it back up to get a sample of the cells present. Depending on what cells we find this can tell us information about the disease the horse has.

Last year I volunteered in the equine hospital as a 3rd year student. One of the patients that was very memorable came back in for a bit of a check up. This horse is a particularly interesting case because he has a collapsed trachea. This is typically something we see more commonly in dogs and definitely not in horses! His collapsed trachea has already been repaired and he is living comfortably with 2 stents in it to make sure it stays open and he can breathe!

Over the course of the 2 weeks we had a couple of very sick patients–one of them was in isolation. This means we had to start super early, put on all our protective wear and go into his isolation stall to check on him.

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Luckily there is a cafe in town that opens at 5am. We head there for some real caffeine. 

One of the things I really wanted to see during this rotation was surgery. I specifically was interested in seeing a colic surgery–unfortunately that didn’t happen. But I did get to watch an extremely beautiful Clydesdale undergo an impressive surgical procedure. She had bilateral hock arthroscopy procedures and an ocular cyst removal done. Horse surgery to me is so much more impressive than surgery on cats and dogs. Horses need to be anesthetized and then picked up on a huge winch/crane system so that they can be placed on the surgical table. It can be dangerous to anesthetize horses because of their large size—it causes problems with their lungs! When we first knocked this horse out there was about 13 people running around who all had jobs to prepare the horse for surgery—putting in a urinary catheter, preparing, and scrubbing the surgical sites, applying monitoring equipment, hooking up anesthesia tubes and drugs, positioning the horse, etc etc. Usually I love jumping in and getting involved but this was one time I was happy to be a fly on the wall and just observe all the action around me! It felt like a dream!

Orthopedic work is a big deal in horse medicine. We saw a lot of lame horses during this rotation.  No, a ‘lame horse’ is not a horse we don’t like, it means a horse that is painful in its legs or feet and is not walking normally. This means we watch the horse walk, trot, canter, etc. We check to see if the horse is more lame on a hard surface or a soft surface or while turning or at different speeds. Using a variety of techniques and tests we try to figure out exactly where in the leg the horse is painful! Nerve blocks are a common test we do; we inject a little bit of anesthetic into specific nerves in the leg. This means the horse loses sensation to the area of the leg that that nerve goes to. If we ask the horse to trot and the lameness is gone–then we have a better idea of the location in the leg that the horse is painful!  We can also use x-ray, ultrasound, nuclear scintigraphy, and MRI to help.

Horses are great at injuring themselves! They are impressive and beautiful animals but they are amazing at getting into tricky situations. My next patient was a horse who had been kicked. The wound on his leg went right into the joint space. This can be very dangerous if bacteria are able to grow and then spread around the body. Using a small needle you can stick it directly into the joint and take a sample of his joint fluid. We also flushed out the joint with saline and then left some liquid antibiotics in there before bandaging it all up! We monitored him closely to make sure the infection was healing and not spreading.

 

A couple of my group’s favorite patients were there for almost the whole 2 weeks of our rotation. One of them was an older teaching horse with a medley of problems but the sweetest personality! We made sure to spend a few extra minutes with her every day. The other horse we loved was a very small stallion who presented with only one eye!  He was very sweet. During his physical exam every day he let me hug him while my partner did the exam.

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A very scientific sample of the discharge taken from the eyeless horse’s socket. We needed to make sure it wasn’t infected. 

Most days we were working 11 or 12 hour days. One day we managed to actually get out of the horse hospital at a decent time and went to the beach right afterwards because it was a nice day. Just as we were getting ready for bed my cell phone rang and we were out the door and back to the hospital for a colicking horse!  Colic is a confusing term–it basically means anything that can give a horse abdominal pain.  An initial colic work up is providing pain medication, rectal palpation (to feel the abdominal organs), checking vital signs, nasogastric tubing, and abdominal ultrasound.  We did all of these tests because we were trying to figure out if the horse needed to go to surgery or if we could treat him medically.  The horse was quite sick but his clinical signs weren’t making sense with any of the more common causes of colic. We decided it was probably best to monitor the horse over night and reassess him the next morning.  During our exam the next day we noticed that he hadn’t urinated since arriving at the hospital and being on IV fluids over night.  I passed a urinary catheter as far as I could up his urethra–until I hit a blockage. Then we put a scope (which is a tiny camera) up his urethra until we saw a stone!! That’s why he couldn’t pee. We did something called a ‘belly tap’ which where we insert a needle into the horse’s abdomen to get a sample of fluid—we discovered that it was urine! This horse had a very rare condition. A stone (we call them uroliths) had formed in his urine and traveled down his urethra until it got stuck and could not move. The horse could not pee and this kept going on until his bladder burst and his abdomen filled up with urine (uroabdomen). Unfortunately, this is very unusual in an adult horse and this horse likely needed at least 2 surgeries to have a chance of recovering—his owner elected to euthanize him. We did the post mortem the next day and the pathology we found definitely confirmed that that was the right decision for this horse.

The next evening we got a referral for a very sick pregnant mare coming in. My whole group decided to stay after hours even though we weren’t all on call.  This horse had hepatic lipidosis –which is a liver disease and was very sick. We were concerned that she was going to abort her foal or go into labor much too early. We decided that she needed to be induced to foal. We prepared all our equipment and debriefed for CPR on the foal.  We were all so tired from being on call and working long days–none of us had food for dinner. We made a call to a kebab shop for sustenance.

We spent a lot of time with that mare and didn’t leave until close to midnight. We had case presentations to give the next day—and we weren’t finished preparing yet! Me and my partner picked the uroabdomen horse to present on because it is such an interesting case! We got home, and finished our presentation and made cupcakes for our last day as a thank you to the equine hospital team! And yes, we modeled them after our patients….

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The cupcakes were modeled after our favourite teaching horse!

Extra big thank you to all the vets, residents, and nurses who put in an effort to teach us, answer our questions, and help us along these past two weeks!

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Road Trips and Lameness Exams on my Racetrack Veterinary Placement

My second week of my Easter break was another clinical placement. This week I worked with a racetrack vet.  Horse racing is something I have never been involved with so a lot of the cases we saw this week were new for me. Almost every horse we saw was to investigate a gait issue, do a lameness exam, inject joints with medications, change a bandage, etc. These are a few of the calls that stood out to me…

Each day started with trot up exams at the Flemington Racecourse (the same place they hold the Melbourne Cup!) We also did trot ups at other stables around the area. A trot up exam is where someone ‘trots’ with the horse up and back a path while the vet examines the horse’s gait and how they are moving. They are looking for abnormalities, swelling, pain– anything indicating lameness.

The first farm call we drove to was a horse who had chronic swelling over his fetlock. We had to do an x-ray to try and figure out what was causing the swelling. This was one of the first times I had assisted with a portable x-ray machine (as opposed to large ones that are permanent installments in hospitals).

We investigated another horse with an interesting skin issue and discussed different possibilities–infection, allergy, multiple conditions, atypical presentation of a sarcoid tumor.

During the week we also did a few nasal scope exams. Scoping is where a special camera is inserted into the nose of the horse to check for any abnormalities of the respiratory tract if trainers or owners or potential buyers would like to investigate the larynx and pharynx. Some of the horses we scoped were done before they were sent to the yearling sale and a few we scoped because there was some concern for disease.

Each evening I was reviewing lectures for an upcoming midterm. A lot of the lectures were on eye conditions. So it was particularly interesting for me when we drove out to see a horse that had a healing corneal ulcer. The horse had a lavage system sutured into its eye—to make it easy for his owner to give him his eye drugs

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This tube sits just inside the eyelid of this horse so that the owner can stand back and  put medications into the other end of the tube. The meds will then drain onto the eyeball.  

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My favorite call during the week was to a lovely farm with a colt who was suspected of being a cryptorchid. The vet I was working with was unable to palpate both testicles while the horse was standing. Apparently it is sometimes easier to find the other testicle (that has not descended) when the horse is sedated and rolled onto his back. After sedating horses in class a few weeks ago I was excited to see this in practice again. We  safely ‘dropped the horse’ and rolled him over. The vet immediately found the missing testicle so then we quickly gathered his instruments and he performed the castration surgery. This was also great because it allowed a discussion of open vs closed castration (different surgical methods that we have been learning about in class lately).

On Friday I had planned to wake up early and go observe a dynamic scope. Unfortunately it was cancelled and instead I spent a day at the Oaklands Junction Sale Yards with an internal medicine specialist. We were at the sales in case any of the clients wanted pre-sale scopes, microchipping, or any other assistance.

I appreciated listening in on a lot of the client interactions and observing how to generate important relationships with clients. The vet would call and talk to another vet or a specialist if there was something he was unsure about. I enjoyed my week learning about racehorse medicine and driving around the Yarra Valley, Cranbourne, Pakenham, Mornington Peninsula and other places. I’m already thinking about future equine placements I could organize.

20170421_103847 Special thank you to Flemington Equine Clinic who had me tag along for the week!

Eyeballs, ovaries, and anesthesia!

Its finally the start of our Easter break and its given me a chance to write another post. This has been a full on semester…the material is a lot more clinically relevant and interesting. I love that we get more hands on experience. This is the fun stuff, the stuff that counts, its what I’ve been looking forward to for years.

Recently I had a really good week of practical classes:

The first one was our Ophthalmology Practical class.  I’ve helped out with tons of eye examinations at work over the years, but only got to use the equipment myself a few times. I have never been overly interested in eye cases but this class was a lot of fun for me. We had our ophthalmology lectures a few days earlier which were full of different pictures and explanations of what to look for. Our lovely teaching greyhounds were present and we got to practice Schirmer Tear Tests (STT (measures tear production)), fluorescein eye stains (highlights wounds or ulcers in the eye), and examination of the eyeball with a focal light and an optivisor. I’m starting a clinical placement at a small animal clinic this week and I am really hoping to get a chance to practice my examination skills.

We had our second Bovine Reproduction Practical class where we practiced rectal palpation on female cattle. Our main objective was to attempt to find and palpate the cervix, bifurcation of the uterus, and both ovaries. I was able to find all the structures; one of our cows even had a cystic ovary. That ovary was a lot larger and easier to find than the normal healthy ovaries. The week before we had an Equine Reproductive Practical class where we felt for the same structures in horses. It was good practice to go between species and think about the differences in anatomy. Horse ovaries are bigger and you feel for them higher up than cow ovaries.

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We both found ovaries! Well on our way to diagnosing pregnancy…. 

Our Small Animal Reproductive Practical class finished off our clinical skills in our reproduction block. Unfortunately there was no dogs or cats present in our class so we mostly used microscopes to examine slides of swab samples. Cytology (the examination of cells) is one of the best ways to determine which stage of a cycle the bitch (female dog) is in. It is very important to know what stage she is in so that she can be bred on the right day and get pregnant with puppies. Looking through microscopes is definitely not my favorite part of vet med but after this class I understand a lot more what to look for in these cases.

My favorite practical class that week was our Equine Anesthesia class. We were split into 2 groups of students. Half of us were given a drug protocol and had to calculate drug doses and draw up our medications. The other half of the class had to complete a physical exam on our patient. My roommate and I were in the same group and we felt quite confident about how to start and complete a physical exam on a horse because of our time volunteering in the horse hospital. After we completed our exam we had to clean, prep, and insert a jugular catheter so we could administer the premedication drugs. Our group had a ‘Triple Drip’ drug protocol which is very common in horses. Then we proceeded to anesthetize our horse with our maintenance drugs. When the patient was asleep we were responsible for monitoring his vital signs and recording everything on the anesthetic record. We also practiced intubation. I’ve done intubations in cats and dogs before, horses are different because it is a ‘blind intubation’. That means that you cannot see exactly where you are placing the tube and instead have to rely fully on feel and knowledge of anatomy.

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I am holding the maintenance drugs we used for our TIVA (total intravenous anesthesia) Triple Drip protocol and equine intubation tubes. 

So vet school? Loving it!

After a full 9 weeks of class I’m ready for a 2 week break to catch up on lectures and complete some clinical placements…

 

Volunteering at the Equine Hospital

In the 3rd year of the DVM degree there is a volunteer program run at the equine hospital on campus for some students.  I wanted to volunteer to improve my clinical skills with horses and help solidify the concepts we learn in class. My housemate and I are partners and we’ve already had 3 shifts. The shifts usually start at 6pm after our classes end and most of the daytime staff at the hospital have gone home. During our shifts we work with the overnight nurse until about midnight.

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After our first shift! 

Our shift usually starts with physical exams on the horses staying in hospital. On our first shift we reviewed how to do it and then me and my housemate have been on our own. Same principles of examination apply for any animal–start at the nose and end at the tail. We assess the face for symmetry or any swelling, look for any discharge or other facial abnormalities. Moving on to mucus membrane color (looking at the color of a horse’s gums) and then taking out our stethoscopes for a listen. I really enjoy listening to horse hearts because I feel like I can understand and better hear the differences in sounds at different valves in the heart—> horses are easier than cats and dogs because their hearts are larger. Horses have a different gastrointestinal tract (GIT) than cats and dogs (and humans!) and it is usually quite noisy! We always listen to different areas of the gut to make sure normal sounds are heard. My favorite sound (yes, i have a favorite animal GIT sound….) is the ileo-cecal flush. Here is some horse gut sounds for those who are super interested. We also check for the presence of a pulse before eventually taking a rectal temperature. Counting respiratory rate in a horse is fairly easy–we just watch their flank (sides) move in and out with each breath.

Sometimes, certain horses need medications or treatments done. I have been lucky enough to be able to practice giving intravenous (IV) (into the vein) and intramuscular (IM) (into the muscle) injections. I have also practiced re bandaging legs and assessing surgery sites.

Later on in the night we complete ‘walk-bys’ which include walking infront of each horse’s stall and recording notes on what they are doing, how they look, if bandages have fallen off, etc. We also provide food and water.

On one of our shifts there was an extremely sick horse in the hospital. She was on fluids, but still very dehydrated. We took a blood sample to run and analyse.  It was quite exciting to listen to the vet and the nurse talk about what could be going on with this horse and her future treatment plan. We learned a lot about fluids in class this year so seeing it in practice was interesting.

We were also lucky enough to experience a euthanasia during our first shift. There was a couple of 4th year DVM students there who mentioned that they hadn’t seen an equine euthanasias during any of their shifts at the hospital or placements. We discussed how to appropriately check for signs of death in a horse and logistics of equine euthanasia compared to small animal or other livestock.

Another time I entered an isolation stall with the nurse to help treat a horse with a suspected case of Strangles. This was a great learning experience for me as we have talked about Strangles a lot in the last 2 years. As well, it was a great opportunity for me to practice appropriate use/application of personal protective gear (PPE) (safe clothing like gloves, gown, boot covers, etc) and attempting to minimize contamination.

On another shift my friend in 4th year was working on training one of the troublesome teaching horses. I do not have any experience training horses so I had a lot of fun chatting to him and watching his techniques.

I’m really starting to love equine medicine more and more. I can’t wait to see new cases and get a lot more practice on further shifts!