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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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! 

Yay and neigh!

Not sure if that blog title makes sense… but its horse related!

I have always wanted to work with large animals after graduation, I have always had the hardest time finding equine experience. So one of my goals for final year was to gain more confidence working with horses so that after graduation I could be a mixed animal veterinarian who was willing to see horses and enjoyed the calls.  I had a 3 week placement at an equine clinic, there were boarded veterinarians on staff and they saw horses with many different kinds of problems.

For the first two weeks I was working with the surgery team. The mornings we spent in the surgical ward and then often the afternoons were filled with lameness exams.  My role often involved helping ‘drop’ (sedate) the horse in the padded recovery room and then move it onto the surgery table with the help of a winch. Here is a quick video showing how a horse is moved into surgery.  I could then help scrub the surgical site (for a really long time!!!) to make sure the area was clean before the surgeon made his incision. On the first day I scrubbed into a cryptorchid surgery and tried my hand at some suturing. I still haven’t been given the chance to do a gelding (castrating a male horse) myself and I cannot wait until I have the chance to do one. I watched a couple of arthroscopic surgeries; such as 3rd carpal bone fracture repairs on racehorses. One of the more interesting surgeries I got to watch (twice actually!) was a mandibular tooth retropulsion. The mandibular teeth are in the back of the jaw, on the bottom, so if they need to be extracted they are very hard to pull out the traditional way. It is much easier to drill a hole in the bottom of the jaw and then retropulse (basically hammer) the tooth out with a peg. This surgery required a lot of skull radiographs to ensure that the surgeon was drilling and hammering the peg in the right direction in order to remove the correct tooth. I was in charge of taking the radiographs and this is probably why these were my favourite surgeries to be involved with.

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Just in case you ever wondered how big a horse’s tooth is, here you go!

I also helped complete the treatments for all of the hospitalized horses. This meant giving injections, checking bandages, flushing intravenous catheters, taking horses for walks to graze, cold hosing wounds, etc.  In one part of the hospital there is a large model horse, we put it in front of the stall of any horses who are lonely or anxious without a friend –often it helps them calm down! One patient I helped with had gotten a large stick rammed up into his groin, another had extremely sore feet as he had a condition called laminitis.

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The lonely horse friend; conveniently on wheels!

During the first week there was an Ag Tour going on in the county; the tour group stopped by the practice on two different days. We had 3 stations in the hospital to explain to the people on the tour what actually goes on inside a big equine referral hospital. One of the tour groups actually got to watch through the windows of the surgical suite as we completed one of the mandibular tooth retropulsion surgeries.

On some afternoons we would load up the truck and go out to see horses at stables or farms. We often went to stables and looked at horses training for different competitions, we did lameness exams and joint injections. I often helped scrub the site prior to the injections. I did my first nerve block (abaxial) on this placement!  When owners are preparing to take their horses across the border into the United States they need to be checked by a veterinarian and have a recent blood test (Coggins) completed before they are allowed to enter the states. We did quite a few of these exams and blood tests. Often the paperwork for these horses can be monotonous but there is now a new app that allows vets to fill out information and take photo records on their phones! I also watched quite a few euthanasias and on a couple of horses we completed post mortems to find out why they had died. The intern and I got to practice finding our landmarks and performing joint injections.

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One of the lovely summer views we had while out on call. At this particular location we were dealing with a horse that refused to get onto the trailer!

I got to use some of the practice-owned horses to hone my lunging (an important skill for conducting lameness exams and just being a generally horse-competent person in general), reproductive rectal exam with the ultrasound, and placing a jugular IV catheter.  I also practiced putting in a nasogastric tube; it is an easy enough procedure to do when there is a calm situation.  NGT’ing is an important diagnostic for working up a colic case and I’m nervous for the first time I’ll have to get a NGT into a colicking horse (which can often be very stressful!).

On the third week I worked in the reproduction barn. It was the end of the season and appointments were slowing down–but this was good because it left me lots of time to ask questions. I spent a lot of time running out to mares in pens and giving them injections of hormones to help manage their reproductive cycles so that we could get them bred (so they could have a foal next year).  When we weren’t giving injections to mares we often had them inside the barn for a reproductive tract ultrasound exam; we would look at the body of the uterus, the horns, the ovaries and any follicles or corpus lutea that were present. If a horse had already been bred then we would monitor her for fluid build up (that could ruin a pregnancy) and preg-check her at 14 days to see if she had twins or not, and then assess the fetus’s heartbeat at 25 days. Later in gestation, the owners could bring their horse back if they wanted to know the foal’s gender (filly vs colt). I also got to watch a couple of stallion collections using an artificial vagina— if you wanna talk about dangerous jobs; collecting stallions is definitely one!

There was a cute little loft apartment on site that ended up being really handy–I stayed there when I did on call with the vet. Some of our emergency calls included: a miniature horse foaling, colicking horses, a broken skull, a horse who wouldn’t get on a trailer, and wounds. Other notably cool appointments included a horse enucleation, a horse with a bullet in his leg, a suspected Strangles case, and a suspected Potomac Horse Fever case!

I had a great time on this placement, I really enjoyed the chats with vets in the vehicle, bonding with the intern, the variety of appointments to see, and the friendly nature of everyone at the clinic! Thanks a million Delaney Veterinary Services 🙂

P.S: This was the only placement that gave ME a thank you card at the end of my time there, I was so blown away by this!!

 

Farm calls, farmyard surgery, …and chocolate!

I was really looking forward to my Production Animals Rotation and hoping that we would get lots of hands on opportunities with the large animal species that I love working with.

We started the week with a couple of days in the classroom talking through a mastitis case, a reproduction problem on farm, how to get a job in rural practice, etc.

One of the best days during this rotation was when we went to the cattle yards at uni and practiced doing tail vein blood draws, epidurals, inverted L blocks, and paravertebral blocks. The ‘blocks’ are a procedure that the vet usually does prior to surgery where an injection of anesthetic solution is put over nerves & tissues in order to block feeling to that area.  They are a very common procedure in cattle medicine so I am glad we had the opportunity to practice them. We were also able to practice rectal exams & pregnancy diagnosis again. None of the cattle were pregnant.

Wednesday is often everyone’s favourite day. In the morning we visit an abattoir and in the afternoon we go to a chocolate factory. I really enjoyed the abattoir visit; it was a sheep processing facility that produced halal meat. We started at the packing end of the plant where all the cuts of meat in boxes are stored in chilled rooms and packed for shipping. The Australian’s got to experience going into a -20C and -40C freezer. It was entertaining. Then we proceeded up the processing line to where the sheep were stunned and killed. Then we visited the yards outside where the sheep are held when they arrive at the abattoir prior to processing. I really enjoyed this experience because I am interested in food production and a vet’s role in how we are involved in the production of safe, efficient, tasty, humane food.  This is a sensitive topic for a lot of people and I like being educated and involved. In the afternoon we went to the Great Ocean Road Chocolate Factory. It was meant to be a visit to a food processing facility…. I think the university could have picked a better location like a feed mill, or a milk processing plant, but I got free chocolate–so I’m not complaining!  We got to wander around the show room and then went to the back for a special chocolate tasting and spoke with a chocolatier about his techniques and favourite things to create. Some of the chocolate we tried included Australian bush flavors which were really tasty!

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Any day at the chocolate factory is a good day!

We had a fantastic opportunity to do both vasectomies and castrations on rams at the university. In the real world you wouldn’t do both procedures on the same animal because they are required for different reasons. The sheep were anesthetized and resting in a shepherds chair. We worked in partners and were set off to calculate our own drug doses, complete an exam, and get the surgery going. There were other vets around to help us when we got stumped. It was a really fun experience, everything went well and we went back at the end of the day to check on our patients and make sure they were doing fine.

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Jess demonstrating how the shepherds chair works

On one of the days we hopped in a van and drove out a few minutes to a nearby farm to see some sick cows. The first cow had been lame a week ago but looked much better today.  Another heifer looked like she was either walking on her tip toes or dragging them along; after watching her walk around the yards & lifting her feet up we diagnosed her with contracted tendons. She was likely born with them & either they weren’t fixed when she was a calf or they got a lot more significant as she grew older. The third cow we saw was quite skinny & sickly looking. I could FEEL her heart murmur without even using my stethoscope, that’s how impressive it was! She had already been treated a week ago and was not improving, it was decided that she would likely go for post mortem next week if she continued going downhill.

Another day we drove out to a very large sheep farm on a gorgeous property! We stopped and watched someone who was a contracted sheep ultrasounder. He had his own little trailer that he sat in and pregnancy scanned sheep through their flank. His ultrasound probe was different than I have seen before–it had water that sprayed out of it constantly so they he wouldn’t have to waste time by reapplying ultrasound gel. It took him appx 1-2seconds per sheep to determine if she was pregnant and if she was having a single or twin! We all watched completely astonished for a short time. We walked through the woolshed from the 1800s and then spent the afternoon talking about epidemiology cases.

Alpaca farm day! Everyone was pretty excited about this too–because who doesn’t love an alpaca?! We got to practice catching alpacas (basically sneak-attack hugging them around the neck), ultrasounding them for a pregnancy diagnosis, and blood draws. We were also taught the traditional method of getting alpaca’s to sit down–I forget the proper word! You can tie their legs up underneath them and then they will sit calmly for you to perform a procedure or transport them. There was also a few males that needed to be castrated so we got to ‘share an alpaca’ and practiced our farmyard castrations.

This was a fun rotation and it makes me excited for some placements I have booked with large animal practices back home!

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On the last day we had to give presentations—This is my group mates who brought a model cow all the way from the shed into the seminar room just for a demonstration!