‘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!

 

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‘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!

 

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.  

http://westernveterinaryhospitalpllc.com/wvh-stories/corneal-ulcer–glass-s-story.html

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!

Cats and Dogs at My First Clinical Placement!

First week of clinical placement done and dusted! The small animal clinic was a bit smaller and slower than the places I’ve worked in; but you can always learn no matter where you are. This pace of appointments was perfect for asking lots of questions. I took the time to try and have some interesting discussions with the vets including their rationale behind drug protocols, unusual points they’ve learned from specialists or conferences, and how to deal with colorful clients as a new grad.

The clinic had 2 senior vets and 1 new grad vet. I loved this because the new grad vet chatted to me about lots of practical advice on how to navigate (instead of struggle) through my first year in practice. Speaking to the senior vets was fantastic for further expertise on cases and discussion of more complicated surgeries and techniques. This was helpful because after discussing multiple techniques on how to repair ruptured cranial cruciate ligaments we saw a couple of patients with the disease —one dog with a suspected tear, and another dog for a post-op assessment.

One of my favorite parts of this placement was the opportunity to see a flank spay. We’ve been taught that they are generally an older surgery and it is more typical to do abdominal spays now. However, this particular patient was contraindicated for an abdominal incision. I also enjoyed one morning when I spent some time monitoring a critically ill patient who had been brought into the clinic with an acute onset of heart disease and pulmonary edema (fluid in her lungs).

We also performed an enema and an ear clean under general anesthetic and admitted a patient with a fractured pelvis. I enjoyed listening in on consults regarding a seizing patient and a patient with behavioral issues.

Once the vets learned that I knew how to put in intravenous catheters I was allowed to put them in on all the patients that needed one. Practicing my hands on skills was the best part of this week.

A huge thank you goes out to the vets and staff at Greenvale Animal Hospital who are now part of my journey to becoming a veterinarian!

 

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