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!

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The Mane Event

The MANE event! Get it? ha! (It’s probably too late at night to be writing for the public eye…)

After a week “off” for research my group headed back to the equine hospital for our External Equine Rotation. This rotation was meant to be like a ‘general practice horse vet’ but we actually only spent one day driving around to farms to look at horses.

On the first day of the week we used a teaching horse from the university herd and did a practice ‘Pre-Purchase Exam’ on her. This is a special type of physical exam that veterinarians can do on an animal (typically horses or breeding animals) if someone is interested in buying it. There can be a lot of legal implications surrounding these exams– disclosure of medical information, high value of animals, suspected performance status. As a veterinarian you need to know the full extent of your role in this situation. During our exam of the teaching horse we detected some lameness so we took some radiographs of her leg. I have taken many x-rays on cats and dogs but never on horses. It is very difficult to know exactly how to position the horse for x-rays and where to position the machine in order to get the best pictures. This is something I will likely need a lot more practice with if I end up seeing some horses in practice.

Horses have this weird anatomical structure called ‘guttural pouches’ inside their heads. They are a common site of infection in horses so it is important to examine them.   I got a chance to practice driving the scope again. I really like this—its the only “video game” I enjoy.

On Wednesday, my wish came true! The main event! I finally got to see a colic surgery, and not just one, but two!! The horses went into surgery right after each other. I was able to stay on the “dirty side” of the surgery (I didn’t scrub in and work on the “sterile side”) and help out with an impaction colic.  This involves getting rid of all the excessive food material in the horse’s gut that is unable to move through. This was so cool! The second colic surgery was a different kind of colic—this horse had a twist in his intestines.  Can you imagine how painful it would be if your intestines twisted up on themselves? I am so glad that I finally got to see colic surgeries before I finished my equine rotations and be involved in helping these animals recover!

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This is just before the surgeons will open the gut to remove the impacted feed material

We worked with another teaching horse from the university herd and practiced placing bandages on his limbs. I much prefer practicing on live animals instead of models or cadaver legs–it is a much more real experience and there is a lot of factors that you learn to deal with i.e: windy day, muddy feet, how to pick up a foot on a horse that doesn’t like his feet being picked up, etc.

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I know this isn’t a limb, but can we all just take a moment to appreciate how great this vet wrap is?!

We also practiced nasogastric tubing (NGT)  horses. This is a really common procedure veterinarians can do to provide a horse with fluids, medications, or decompress a stomach during colic!  It is important to make sure that you put the tube in the stomach of the horse and not the lungs! Quite often we pour fluids down the NGT and we really don’t want to be pouring fluid into the horses lungs.  The way a horse’s larynx & pharynx is placed inside it’s head means that by flexing a horse’s neck downwards while we insert the tube (through the nose) the horse will swallow the tube into the esophagus (where we want it to go!).  You can smell stomach smells from the tube (surprisingly not as bad as you would think…) and hear the stomach bubbling away (a fancy medical version of the game ‘telephone’).

Everyone looks forward to the ambulatory day of this rotation. We drove out to meet one of our wackiest professors for a day of horse vetting in the field! It was a very relaxed day, seeing and chatting about a variety of patients. None of the patients were very sick and it was a pleasant day. We preformed a Caslick procedure, a mini-neurological exam on a mini horse, did some more guttural pouch scoping, and had a lot more fun! Our lunch on this day was legendary! An extremely lovely family made us a feast and I experienced the best date scones I’ve ever eaten…

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Me and two of my group mates with our horse vet professor! There was a huge sunflower field just outside one of our appointments.

On the last day of the week we gave a presentation that we had prepared and spoke about our ambulatory cases. Our last practical class this week was on a life-size model horse. We practiced rectal palpation–it is SO important to know the anatomy of a horse (or cow) so that you know what you are feeling (because you can’t see what you are feeling). You can make a lot of diagnoses this way, so the practice was appreciated!

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My group isn’t going to leave any rotation without some great baking!

 

Thanks again to the equine team for a wonderful week! We had a blast 🙂

‘Watch me snip snip, watch me neuter’

I’m on my way back to Australia right now; sitting in LAX (my least favorite airport) and killing 9 hours.

Yesterday I finished off a 2 week placement at Tri-Municipal and Meridian vet clinics. They are a mixed animal practice–with the majority being small animal work.

Throughout the week I followed doctors into dog and cat consults. Often I would just listen but sometimes I was involved in the discussion of the case. I  also did my own physical exams and administered vaccines and dewormer to the patient.

Early in the first week I got a chance to try my hand at a cat neuter.  This is a relatively ‘easy’ surgery in small animal medicine—you still have to go to school for a lot of years to get to do it though!  There is a few different techniques and I wanted to try them all.

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I made sure to practice on this string with a knot in the end… I probably castrated it about 18 times. #poorstring

We diagnosed a textbook case of demodicosis.   This is a skin disease caused by a little mite that lives in the skin and can cause a dog to be itchy and lose patches of hair. You can find the mite by looking at a sample under the microscope. This was interesting for me because it is not an overly common disease. As well, quite often you can diagnose a patient with the disease without ever finding the little bug! This particular case presented an interesting opportunity for research to determine if this animal was safe to breed. There is a concern that this could be passed on to future puppies.

My favourite calls this week were the cattle calls. The first one turned out to be a bit of an emergency— we were called to a farm who had a cow with an episiotomy. Unfortunately the cow was bleeding out and the vet had to rush in and suture her up! I hear she is doing great!

We also went to a couple of small hobby farms to do some preg-checking. Yes, this is one of the times where vets stick their arm up cow butts to see what they can feel. It was nice to be on a small farm for these appointments because it allowed us to go a bit slower.  I palpated each cow after the vet and gave my own diagnosis of pregnant vs open (not pregnant).  You can diagnose this based on what the uterus feels like. I need more practice before I can really start being specific about weeks of gestation.

We went to a dairy and examined 4 sick cows. Two of them likely had pneumonia. This was interesting for me to see after my last placement where we did lots of post mortems on cows that had died of pneumonia. This week I got the chance to examine and observe clinical signs of pneumonia in live cows.

Abscess are pretty common in cows. And if you are one of those people that love ‘Dr. Pimple Popper’ then you will love cattle abscesses. So when we got a call about a ‘cow with a lump on it’ that is what we suspected. But, that was not quite the case….

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This is not an abscess, not an abscess at all.

Instead we were presented with a really weird tumor hanging off the cow. It had appeared to have burst open then sealed and re-grown. We determined that it would be best to sedate the heifer for the removal procedure. We attempted IV sedation via the tail vein. Either we under-dosed or the heifer was just not having it—she got a bit loopy and angry but never sleepy enough for us to cast her. She paced at the end of her rope on the non-ideal side of the squeeze.  A bit of a rodeo ensued but eventually she was safely inside the squeeze again, and we infused the stalk of the tumor with a local anesthetic before removing it. The sun was going down and it felt like a bit of a race against time. When we finally had the tumor off I cut it open to see what it looked like inside (classic vet student… because this thing was gross!!).

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It was swollen and dark red inside. When you pressed on it a black liquid came off in my hand

The inside was really weird looking and my best guess is a hemangioma? Any other vet field friends have guesses as to what it could be?

 

I had been crossing my fingers and saying little prayers that we would get a calving call on one of my placements. It is a bit too early for lots of calving in Canada right now.  But we got a call for a c-section! Surgery was preformed in a fantastic and heated (yay) barn! with warm water and facilities—like a table! Everything went great and we had a live (large) calf at the end of it! We did a 2 layer closure on the uterus and a 3 muscle layer closure, then sub-cutaneous tissue, then skin. I definitely got my practice in with cattle sutures!

We had a few other interesting cases this week. One of them was a dog who could not pee. He is an adult dog but we suspect that he was born with an abnormality that prevents him from urinating. We took x-rays and he had a huge bladder! I catheterized it and drained a lot of urine for him! You could tell that he started feeling better by the minute. We hadn’t got to the bottom of the problem by the time my placement was over.

I also observed tail docking of some rottweiler puppies. This is quite the ethical/moral debate in the veterinary world.

Another interesting house call was to do puppy exams on German Shepherds (one of my favourite breeds!) at a breeder’s facility. This was a particularily cute….and wiggly exam day.

One morning we arrived to a severely sick scouring calf. We monitored vitals (heart rate, breathing rate, and temperature) and ran in warm IV fluids for a short while before heading off on a farm call. There was an older bull calf castration on the schedule that I wanted to watch.  The bull calf was a bilateral cryptorchid (inguinal crypts).  This means that his testicles were not fully descended and castrating him was not going to be as easy as we wanted it to be.  After putting in an epidural we got the job done on not 1, but 2 bull calves.

By the end of the second week I was lucky enough to have done a few feline spays, a couple of canine castrations, and a bunch of cat neuters on my own. I feel much more confident doing these surgeries by myself. I have yet to determine my own specific favorite method though—hopefully that will come during my de-sexing rotation in a few weeks time.

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So much focus and brain energy used. I also need to focus on not tensing up my shoulders during surgery.

 

 

After the last day of placement I said goodbye, and drove home in a beautiful snowfall to finish off my packing. Some of my friends stopped in to say goodbye which was lovely as well.

Thanks again to all the staff at Tri-Municipal and Meridian Vet Clinics! I had a great time!

 

Freezing Fingers & ‘Cutting Deads’

Its a balmy -10C outside today as I write this and think fondly back on my last week. I drove out to Calgary to work at Veterinary Agri-Health Services (VAHS), a practice that does a lot of feedlot work. They also service cow/calf operations. It was below -20C almost every day–what a way to kick off the year!

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It is not the best time for cattle work in Canada–a little too early for calving season which is usually in the early spring and can be quite busy. So my mornings at the practice were spent in the offices either helping with drug orders or studying. I sat in on a webinar about a new vaccine in Canada, attended a pathology presentation for feedlot workers, and listened to a presentation on Johnes disease in beef cattle from a previous summer student. I really enjoyed the discussion about that topic.

This practice is completely ‘ambulatory’ which means that farmers/producers will call the practice and the vet drives out to their farm (or feedlot) with all the equipment they need. All the exams, treatment, and surgery the vets do happen on the farm. So each afternoon I hopped in the truck with a vet and we headed out.

I worked with a couple of female vets this week. I really appreciated this experience as it allowed some conversation about how to survive as a female in the world of large animal vetting and agriculture. We discussed confidence, work/life balance, how to protect your body from breaking down, and how to pee when you haven’t seen a washroom in 100+km…

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I honestly have missed seeing that big Alberta sky, but that doesn’t leave a lot of spots for privacy…

Feedlot vets do a lot of post mortems (autopsies); while this might sound a bit morbid to some of you I actually quite enjoy them.  The colloquial term a lot of vets use is ‘cutting deads’. It is very exciting to be able to open up an animal and look at 1 or 2 organs and diagnose why the animal died. We did post mortems everyday– they aren’t easy work but it will keep you warm outside!  Its not the safest work either—when you can’t feel your hands and your standing on ice—it just takes a few tries to learn some of the tricks! At the beginning of the week I struggled with finding where to put my knife and remembering all my respiratory pathology from first year–by the end of the week I felt a lot more confident about what I was doing and what I was seeing. But I’m sure I’ll be getting a lot more practice with this.

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Twice this week we looked at some cattle for export. This means that they are being transported across the border from Canada to the United States before they are slaughtered. This involves walking the pens and looking at the animals– and holding back any animals that look sick or have sore feet/legs and who would not transport well.

We got asked to check out a cow on a feedlot that had been acting a bit weird–when we got there the cow had neurological signs. There is a lot of things that can cause a cow to have neurological problems. We often don’t investigate these problems in cattle the same way we would in small animals — with x-rays, CT scans, and diagnostics. Sometimes you can figure out what is going on in cattle but it is quite hard.

On the Thursday the vet and I went out to a large feedlot where they had two bloat surgeries for us to do. Depending on what cows are eating sometimes their stomachs can fill up with gas or bubbles and become really bloated! This can actually be lethal for a cow if the problem isn’t discovered and treated and prevented. If you are interested, this is a really good article from Alberta Agriculture about bloat. The vet did the first bloat surgery and then I did the second one. We were in a shed and there was a heat lamp but it was still so cold! Loosing feeling in your fingers, freezing suture, and frozen blood on the suture is a whole new level of difficulty. Very simply speaking, a bloat surgery puts a hole from the stomach of the cow to the outside world so they can safely release gas!

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This was a great placement! Despite it being cold and a little slow I felt that I gained a lot of knowledge (or topics to study up on) about the Canadian cattle industry and common diseases in feedlots. I appreciated a chat I had about being a practice owner and what that could look like–this is something I have always aspired to! Lastly, and not related to cattle…. I now know which little town to stop in and find the best peanut butter pie on the prairies!

Thanks again to all the wonderful vets and techs at VAHS!!

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