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! 

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X-rays. Buffalo. Microscopes. Whale.

The diagnostics rotation is very different from everything else we’ve done this year. We were back to sitting in chairs and focusing on one topic all day long–it was a difficult transition for some of us. This was not my favorite rotation, but it was very good to practice reading blood smears, blood results, x-rays, and performing post mortem exams. The rotation was split into three components: clinical pathology, radiology & imaging, and anatomic pathology.

Clinical Pathology

This rotation was mostly self directed learning. We had a variety of cases to work through ourselves. We had several hematology and biochemistry cases to look at (blood work) and cytology cases (slides of cells).  We spent many hours looking down a microscope and compiling our answers all together.  One morning we all gathered in the lab and practiced doing packed cell volumes (PCVs) and blood smears. We also practiced doing urinalysis and looking at the sediments for the cells under the microscope.  The ‘sediment’ in a urine sample is all the cells and crystals and other things present in the urine; you can collect them on a microscope slide after you spin the sample in a centrifuge machine.

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Blood under the microscope

Radiology & Imaging

The second component of our diagnostics rotation was radiology and imaging. We started with the musculoskeletal system, and then thorax and abdomen. We were given multiple x-ray films from cats, dogs, and horses. We had normal x-rays to look at as well.  There were several radiology cases to work through and then we had to present a couple cases and our findings to the radiologist. When animals in the hospital needed a x-ray our group would go and assist with positioning the patient on the table and exposing the x-ray. We also looked at the images with the specialists in the radiology room. On the final day of the rotation we had a ‘positioning assessment’ where we had to position a stuffed dog model for different radiographic views.

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My group in the CT room practicing the positioning of ‘Emily’ for her x-rays

I have always enjoyed ultrasounds, so I thought it was very cool when we got some hands on ultrasound practice during this rotation. The first time we got to practice was on the ‘phantom’ which is a specially made box with spheres and wires hidden inside gel that we used the probe to detect. The phantom helps us learn how to manipulate the settings on the ultrasound to better find an image.  The next day we had a LIVE dog to practice on!  We started by finding the kidney in a longitudinal plane and then moving the ultrasound probe to image it in a different view, then moving the probe around the abdomen to look at the spleen, liver, intestines, and bladder. We were supposed to have a 3rd day to practice with the ultrasound and a live patient, but there was no dog available to us. We ended up ultrasounding each other—I am happy to report that I have a gall bladder but possibly only 1 kidney (jk I probably have two kidneys but we couldn’t find the other one).

Anatomic Pathology

Post mortems can be completed on animals as a diagnostic test to help determine the cause of death–especially if it was unable to be determined while the animal was still alive. The first post mortem we did was a congo buffalo from the free range zoo.  Before she died she was walking very weirdly; Her movements looked similar to a disease we see in horses called ‘Stringhalt’. She was immobilized with Etorphine prior to euthanasia. Etorphine is a drug that is very dangerous to humans and can be absorbed through skin and cause immediate cardiac arrest (depending on dose). Because of this we had to wear full PPE (personal protective equipment) and be briefed on what symptoms to watch out for in ourselves and our colleagues. We had someone on standby with a reversal drug. As well, we marked off the leg that the buffalo was darted in & removed that leg prior to starting our necropsy.

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A Congo Buffalo! (No, I also had no idea what they looked like before we saw her)

The second post mortem we performed was a dog that had died due to a dog attack. It was very interesting to see the full extent of the damage from the bite wounds that were not visible externally. The damage likely wouldn’t have been able to be identified with any imaging modalities either.  This experience will influence how I treat future trauma and dog attack cases because I am now better able to understand how many ‘hidden problems’ these patients have.

Our 3rd and most exciting post mortem was a whale! My group was very lucky to be involved in this post mortem.  The whale was stranded in shallow water and was unable to be resuscitated.  Our group and our pathology professors took a little field trip down to the zoo to perform the necropsy at their facilities. We wore full PPE again to protect ourselves against diseases that we might pick up from a marine mammal. Our team was organized—one person was in charge of measurements, ensuring all appropriate samples were collected & organized, others were in charge of examining different body systems. We discovered a massive gastric impaction with sea grass. When we opened one of the stomach compartments there was a large sheet of plastic as well. After doing some research for our post mortem report, we learned that this species of whale eats squid, not sea grass. We suspect that after eating the plastic she may been more inclined to eat an abnormal diet and started eating the sea grass because she had abdominal pain. Unfortunately, she was also pregnant.

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Hanging out in our PPE suits! 

My favourite part of this rotation was the post mortems, especially because we got to work with some very interesting species. However, I’m excited to move on to the next one and get more action in my day!

 

‘Cows Around’

If anyone caught that Corb Lund reference, thank you.

This placement was a blessing.  Last year I was trying to find placements to go to in Australia (we have to do a certain number of weeks in Australia). I was really struggling because I do not have many friends and no family in Australia. At home, it is easy for me to stay with someone I know or visit people in different areas where I might do a placement. It looked like I was going to have to spend a lot of cash to pay for transportation and accommodation to do placements in Victoria. I was chatting to some of the girls from church about this, and next thing I knew, my friend’s mum called me! She explained that her and her husband had a dairy farm in Gippsland and their vet was amazing, very busy, and took students all the time. She had already called someone and vouched for me and they had agreed to take me on as an extra student at Tarwin Vet Group.

The first day of this placement was what I had imagined real Gippsland weather to be like. It was windy and POURING rain and I started to mentally prepare myself for 3 more weeks of downpour. Our first call was to see some sick cows at a dairy. We wore our normal clothes in the truck and when we arrived at the farm we changed into our boots and rubber pants. Classic student… I didn’t realize the side panels on the vet box on the truck flipped up…so while the vet was hiding from the rain and changing in the dry area I proceeded to dance around and struggle to get my rubber pants on over my coveralls as I got progressively more soaked in the rain.  I am not meant for rain. The first cow we saw had very bloody diarrhea and very pale mucus membranes. The vet wanted to recommend an exploratory laparotomy (abdominal surgery)—in this case we didn’t think the cow would survive a surgery because of the expected amount of blood loss. We thought she had a condition called jejunal hemorrhage syndrome.  We also saw a cow with extremely bad photosensitization—so much worse than any terrible sunburn I’ve ever had, I really felt for that girl.  During my placement we had quite a few ‘sick cow calls’ which allowed me to get lots of practice doing physical exams–a few times we were able to give farmers definitive diagnoses, other times the cattle required tests to figure out what was truly going on.  I saw a lot of different cases including ill-thrift, lumpy jaw, woody tongue, coccidia scours, pneumonia, bilateral pyelonephritis, and polioencephalomalacia.

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I spent all 3 weeks on twisty roads, going up and down hills. At the tops of hills (on clear days) there was some amazing views 

We often got calls to see cows and calves with lumps on them! Our first ‘calf with lump’ call actually ended up being the most interesting.  Lumps in cattle are commonly abscesses and I couldn’t wait to lance it!  But this calf had a large, soft lump down his neck. As I palpated the lump it started getting softer and the calf would walk away and regurgitate up hairball like materials. We spent a while massaging his neck until the lump got much smaller.  We suspected that the calf was sucking hair off his pen-mates ears and ended up with a choke-like condition (more common in horses).

Lameness is another common reason a vet may be called to see a cow. We visited many lame dairy cows, and a few lame beef cattle during my placement. Depending on the vet I worked with I got to practice lifting up legs–either with pulleys (much easier) or just ropes (I need to get rid of my noodle arms). On one occasion we went to see a large Angus bull.  I learned that a lot of the vets will give a little bit of sedation to the lame beef cattle.  Sedation is given to the beef cattle because they are handled less than the dairy cattle and often more dangerous to work with, sedation can calm them down and allow us to safely complete a full lameness exam. I really liked this idea and think it is a smart option for me–especially as a new grad while I’m still developing clinical skills and figuring out my methods.  One of the best lameness cases I saw was a septic hock. I aspirated ~20ml of purulent exudate from the joint. It was very interesting to see the difference in treatment of septic hocks between the horses we saw at the referral hospital at the beginning of the year and this cow.

One of the vets that works at Tarwin is the ‘down cow guru’. One day we got an after hours call for a dairy cow with a dislocated hip. Two other students and I went with the vet to see the cow.  He showed us how to properly palpated the hip joint, the top of the femur (greater trochanter), and examine the abnormal appearance and movement of the of the leg in order to confirm that her hip had actually popped out of the  joint. He also showed me how to roll a cow over by myself (for when I’m working alone). We then put a metal bar under the cow’s leg and attached her up to a tractor to help put traction on the leg and pull it back into place —its hard to describe the procedure (but its so cool and I love it)! The sun went down as we worked and I drove back in the dark —they told me to watch out for wombats on the road…I imagine hitting a wombat is similar to hitting a boulder…

The next week we had another call for a cow with a luxated hip, I was excited because I felt like I had a better idea of what was going on and could be more involved in her treatment this time around. She ended up being a weird case–firstly, she was still walking around when we arrived on farm. We gave her enough sedation to drop a huge bull but she still wouldn’t lay down!  Then when we finally had her on the ground her knee felt swollen and we heard a loud pop when gently moving her leg. She may have had a partially luxated hip and also a knee problem.

During the last week we went to see a down cow and diagnosed her with compartment syndrome. We put hip clamps on her and used the tractor to pick her up and then completed a further exam. We tested reflexes, muscle tone, superficial, and deep pain. We diagnosed her with a radial nerve paralysis. The vet I was with then did some physiotherapy–>electrostimulation to assist her muscles in the healing process. While driving around with this vet I had some great discussions about acupuncture as a treatment for different conditions in animals.

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The machine we used for electrostimulation on the down cow

I enjoy reproductive work in cattle and horses. Unfortunately, we only had one calving call during my placement.  This was fun for me because the vet got me to stick my hand in first & diagnose the problem…. I felt 3 front legs…. and diagnosed her with twins! The vet untwisted and pulled the first one out and then left me to get the second twin out myself (which was pretty easy after she wasn’t entangled up with her sibling anymore)!  We treated quite a few cows with retained fetal membranes, did some metri-checks, and saw one cow with a mummified fetus.  Every day there was appointments booked for preg-checking. I actually quite enjoy this currently because preg-checking is something that is still quite difficult but I can see improvement in myself each time I practice. I received some great feedback from the vets on this placement about my preg-checking skills so that was encouraging!

Naturally, the call for a uterine prolapse came just after 5pm on a Friday evening. I’m sure I was much more excited about this than the vet (who probably just wanted to go home after a long week).  The cow was up and walking around when we arrived, she went down again about half way through replacing her uterus. The vet, me, and the other student had quite the time spinning her around out of the squeeze so the vet could continue…and then of course she wanted to stand up again after that!  We worked by the light of the quad and our phones until she was all put back together.  We went back to the same farm a week later to do some other work, I asked the herd manager how the cow was doing–fantastic!!

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The sun went down on us quite a few times. But I don’t mind–everyone needs more sunsets in their lives.

I also really like wounds and trauma cases. We were called to see a heifer with a torn vulva after dystocia (difficult calving) that the vet spent a while suturing back together so she could hopefully have another calf.

We did a couple of abdominal surgeries in dairy cattle during my placement. Left displaced abomasums are a relatively common problem in dairy cattle. This is a condition that is usually seen not too long after a cow has a calf, starts producing milk, and eating a really high energy diet—> part of her stomach (the abomasum) is displaced to the incorrect location in her abdomen and fills up with gas. This makes the cow feel sick and she begins to produce a lot less milk. To fix this condition you have to cut into the abdomen of the cow and deflate the abomasum before pulling it back into the correct position. It was very interesting to put my arm inside of the cow and feel the abnormal abomasum while it was full of air, and then to feel it again after we had removed the air and pulled it into a normal location. I’m concerned that I’ll get called to see a really large dairy cow with this problem and I wont be able to reach her abomasum because my arms are too short!!! One of the other surgeries we completed was an exploratory laparotomy— one of the vets had felt a large mass inside the cow’s abdomen during a rectal exam. Once we cut into her abdomen we discovered that she likely had a large abscess on her kidney!

I got to participate in an awesome new herd health management technique that Tarwin is performing—teat sealing heifers. A teat sealant is a substance put into the teats of dairy cows after they are finished milking to prevent them from getting mastitis.  The procedure is now being offered for heifers (cows who haven’t had a lactation yet) in herds who have a high percentage of mastitis in that group. I had no idea what I was in for when the vets and nurses were explaining the process to me but we donned our aprons and boots and hats and even duct taped our gloves on. They unloaded a specially made trailer and set up a whole table with ‘dirty hand wash’, ‘clean hand wash’, paper towel, and teat sealant. The farmer ran the heifers on to the trailer and then we loaded 6 or 7 of them on, cleaned the teats, put in the sealant, marked them with paint and then released them into the field. I loved how seamless the process was and would be interested in seeing results in regards to how much the mastitis rate decreased on farm.

Another day we went out and did some sedated calf de-hornings. I feel as though more and more people are moving towards this more welfare friendly option. We injected sedative into all the calves and waited until they fell asleep and then did cornual nerve blocks.  After they took effect we burnt off the horn buds,  gave each calf an anti-inflammatory/pain medication drug, and checked for supernumerary teats and removed those. This was really fun because I got to do some of the nerve blocks and removed the supernumerary teats! Also, seeing 40 sleeping calves all snoring at the same time is adorable.

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For the first week of the placement I would come back and study for my board exam (NAVLE) every night. I took one day off to write the exam in the city.  

I also really enjoy post mortem examinations–especially after my feedlot placement at the beginning of the year.  As the vet and I drove to the call we discussed reasons for sudden death of a calf a few months old. Our top differential was black leg (failure or absence of Clostridial vaccination). The calf actually died due to a failed/bad castration. We found a huge amount of hemorrhage in the lower abdomen and legs and an infection tracking up from the prepuce.

Pink eye is a common condition in cattle, especially in areas with a lot of flies because they can transmit the disease. In severe cases a 3rd eyelid flap can be performed to protect the eye and help it heal. After watching the vet do a couple of them I started helping out as well. We also injected antibiotics into the eyelids.

There was also a horse vet working at Tarwin. I spent some time shadowing him as well.  The first call we went out to was a very loved horse that had been fed bread and had choke (an obstructed esophagus). This seems like it would be a really emergent situation but its actually not that bad and horses can remain like this for a couple days while we treat them. You just have to nasogastric tube them and flush the obstruction a lot of times until it starts to break down and either goes forward into the stomach or backwards through the tube. We also went and did a gelding (male horse castration surgery) in the hot sun! No more of that pouring rain—I actually really lucked out with the weather for the rest of the week. The farmers probably wouldn’t agree, but I liked the sun.  We drove out to to a pre-purchase exam on an older horse. This was something we practiced on my equine external rotation.  We also had to put a foot cast on a couple different horses because of wounds they had.

I had an amazing time on this placement! With all the hands on practice, tutorials on abscesses, down cows, nursing strategies, calving management, and chats in the car–I learned so much! Staying at my friend’s parents’ house was also lovely; they had warm home cooked food for me each night and made me feel so at home.

Thank you to the Payettes and Tarwin Vet Group!

 

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!