KEEP CALM OR I WILL BOLUS THE PROPOFOL

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Propofol is a very commonly used drug in the veterinary world. We use it to help patients fall asleep before surgery.

My last rotation of the year was spent in the anesthesia department at the university hospital. This was a rotation that my whole group wished had been scheduled earlier in the year. We were taught lots of valuable information about drugs that would have been very helpful during our placements–but better late than never!

The anesthesia department at the hospital runs almost all of the anesthetic protocols for any procedure going on in the hospital–so this means cats, dogs, horses, and occasionally other fun animals!  An anesthetic protocol is required for any patient that needs to be asleep for a procedure– like taking an x-ray or having a surgery done.

Each student was required to be ‘primary’ on a case for the day and read their patient’s file and then develop an anesthetic plan that would appropriately match the patient’s diseases and procedure. This is complicated. Especially when your patient has multiple diseases and you can’t give them certain drugs.

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Jessica reading up on her patient’s medical history. There is a TV in our student lounge connected to one of the surgical suites. On this day, I sat & ate my lunch and watched a thoracotomy. 

After doing a physical exam on our patients, creating an anesthetic protocol, and preparing all our equipment and machines we would draw up our drugs into syringes. The first step is then administering a pre-medication drug to the patient to make them a little sleepy. After that we would collect our patient from the wards, bring them to the prep room and place an IV catheter in their vein. We also placed an endotracheal tube (so we can control their breathing), and finished prepping them for their surgery or procedure. During surgery we monitor the patient’s vital signs to make sure their heart is beating properly, they are breathing correctly, and other important things. Once the surgery is finished we are in charge of making sure the patient wakes up smoothly and safely.

One day I monitored an anesthetic for 7 hours, one of my wonderful group mates brought me food from home and the rest of the team tagged me out for a break 🙂

During some of the afternoons we had tutorials where we learned about different stages of the anesthetic protocols and could ask any questions we needed to.

We all had to take complete charge of a patient (with no help from supervisors and nurses) and we were assessed to make sure we could do everything appropriately and safely. My patient was in hospital for a toe amputation. Everything went smoothly!

Some of the patients that I created anesthetic protocols and monitored for were getting CT scans, MRIs, spays, foreign body removal surgeries, etc.

Unfortunately, this post can’t be too much longer without talking about a lot of fancy drug names and anesthetic equipment. I found it helpful to practice using new drugs and talk about protocols with the experts!  At the end of the 2 weeks…we were done! But actually, DONE! No more rotations 🙂 next step…. graduation!

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Last day of DVM4! We are in the prep-room in front of some of the anesthetic machines we had been using during our rotation. 

 

 

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Cat: “I’m getting fixed?” … “Am I broken?”

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“Fixing” = De-sexing

We had a week of de-sexing rotation during the beginning of the year and a second week at the end of the year.  De-sexing means spaying & castrating (neutering) cats and dogs.  We completed this at a massive animal shelter in the city! This means we had to commute in on the train each day… which we somehow always struggled with. We seemed to end up with endless delayed trains, massive traffic jams, and absent parking spots.

On the Monday we had an induction in the upstairs tea room and talked about the layout of the days. Then we spent some time practicing different suture patterns and knots on the suture boards.

In the morning two of us would be the surgeons and two of us would be the anesthetists. The other two students were ‘floaters’ and stayed outside the surgical suite and were involved with patient care and recovery monitoring.  We switched roles in the afternoon. When we first got allocated our cases we had to go find the dogs and cats in different wards in the shelter. We would bring them to the veterinary room where we would do our physical exams, place IV catheters, and give them premedication drugs so they would start to get sleepy before their surgeries. The anesthetists would be calculating their drug doses for the patients and preparing the anesthetic machines. We also checked our patients from the day before and looked at their surgical incisions to make sure everything was healing alright!

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Our group standing outside the surgical suite which contained 2 surgery tables and 2 anesthetic machines for us to do simultaneous surgeries at. 

Being the surgeon was fun because I was often the only person scrubbed into the surgery—this meant I did everything by myself! Last year, when we did our first surgeries at the university hospital there was at least one other person scrubbed into the surgery and we had to share all different parts of it with each other. It was difficult to learn that way. One of my favorite things that we learned how to do on this rotation was pedicle ties on the ovaries of cat spays.  They are done on most cat spays at the shelter. I liked this technique because it is faster than a more traditional method and leaves less suture material inside the patient. I have now taught multiple vets on placements I’ve been to about how to do pedicle ties.

As the anesthetist it was good to practice our drug calculations and give intramuscular injections. It felt like a lot of my patients had issues with blood pressure during their surgeries so I learned a bit more about how to manage this issue.

On the Wednesday of the first week we received personalized feedback from the vet. This was really nice to actually speak to someone DURING a rotation about things we were doing well and other things we could improve on.

When I got the chance to do a dog spay I enjoyed performing Millers knots in a live patient instead of on a suture board. Practicing on suture boards is great, but its nothing like the real thing.

During our first week of de-sexing we took advantage of being in the city close to things to do–we had dinner one night at a fav location (Laksa King… I may have mentioned it before…) and then went to a comedy club.

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Please enjoy this very in focus and amazing photo of our group at Laksa King.

On the last day of the week we organized a group lunch with us and the surgeon and the nurse. On the first week we made rice paper rolls (second week was TACOS) and gave some quick presentations regarding shelter medicine. Jessica and I presented on olfactory enrichment for shelter animals.

On another day we braved the pouring rain and really windy conditions to walk to Mork chocolate for a snack before starting the long journey home on the delayed trains.  How dedicated are we?- we even stood outside in the rain until there was an empty table!

As an update, this is my second last rotation. Which means there is only 1 rotation left. AND THEN WHAT?! (plot twist: its graduation)

The classics.

General practice is where a large portion of vets will work after graduation. GP vets are capable of many things, but some of the most common appointments include health exams, vaccines, ear infections, skin problems, etc. We had 1 week of general practice rotation at the beginning of our 4th year and just finished a second week now, at the end of our year.

We spent one day each week at the university hospital with a specialist dermatologist who only saw skin patients. Skin issues can be so complicated! I am glad we got to spend 2 full days with the dermatologist only looking at this one body system (yes, the skin is a whole body system!). Skin issues can be complex and involve infections and allergies or other diseases. Often it can take lots of time and searching to find an answer to your pet’s problem! Most of the skin patients we saw ended up having allergies to things in the environment (like grasses, dust mites, etc) or food.

One patient we saw was presented to us because his toenails kept falling off. The dog was diagnosed with symmetric lupus onchodystrophy, which is a disease I have read about in my notes many times… however, the dermatologist said this is quite rare and he has only seen one case in his whole career!

We had quite a few vaccine appointments where we got to practice our physical exams, vaccine injections, history taking, and medical note writing.

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Not a picture from rotation. But I did just get to meet my friend’s new puppy on the weekend and gave him quick little exam! 

In my second week of GP I happened to be rostered on with the exotics vet for a couple days! This was pretty cool because instead of cats and dogs I saw lots of different kinds of patients like: rabbits, chickens, blue tongued skinks, bearded dragons, turtles, eclectus parrots, and cockatoos!  These are all animals that may need a vet at some point in their lives but we don’t get to see them very commonly.  We have some lectures on exotic animals but often, most of our learning is done day to day when the problems arise!

Some highlights included doing first health exams for nine (NINE) baby bunnies! They were all very cute… I mean, healthy. And fluffy… I mean, eating well…

I also enjoyed an appointment with a blue tongued skink with who had a suspected broken back! After a full exam I got to take x-rays of him to look at his spine. In the end, he was diagnosed with metabolic bone disease. We talked about changes his owner could make in his tank, diet, and gave him some pain medication!

Another very cool thing was having a patient (cockatoo) who was older than me! That hasn’t happened since I first started working in veterinary clinics when I was 17.

One day of the week we are rostered on to help with minor procedures. I helped monitor the anesthetic for Jess to do a cat castration. Then we had an aural hematoma repair (one of my favorite small animal appointments to do!). This is a condition in dogs where the skin of the ear fills up with blood. It can be very uncomfortable and swollen. At previous clinics I have worked at you can release the pressure and then suture something on to the ear so the area cannot fill up with blood again. I think it looks cutest when you suture buttons onto the ear. At uni however, I got to suture on little pieces of tubing.

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Buttons on the ear of a dog who has had an aural hematoma repair. https://www.belfastlive.co.uk/news/belfast-news/pet-dog-buttons-sewn-onto-14030456

General practice rotation flew by. Next up is our second week of desexing rotation at an animal shelter in the city.

 

 

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!