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!

20180530_154049

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.

20180531_104153

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!

20180607_153209

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! 

Advertisements

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.

20180524_100712

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.

20180525_134757

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.

congo buffalo

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.

32512068_10155161941376394_6060239459276816384_n

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!

 

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.

WhatsApp Image 2018-04-22 at 10.06.35 PM

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.

20180313_114208

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!

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!

29340143_10155930484875306_1177722582804201472_o

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.

20180222_115135

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…

29258448_10155930482990306_7082194423047520256_o

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!

20180222_084652.jpg

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 🙂