Yay and neigh!

Not sure if that blog title makes sense… but its horse related!

I have always wanted to work with large animals after graduation, I have always had the hardest time finding equine experience. So one of my goals for final year was to gain more confidence working with horses so that after graduation I could be a mixed animal veterinarian who was willing to see horses and enjoyed the calls.  I had a 3 week placement at an equine clinic, there were boarded veterinarians on staff and they saw horses with many different kinds of problems.

For the first two weeks I was working with the surgery team. The mornings we spent in the surgical ward and then often the afternoons were filled with lameness exams.  My role often involved helping ‘drop’ (sedate) the horse in the padded recovery room and then move it onto the surgery table with the help of a winch. Here is a quick video showing how a horse is moved into surgery.  I could then help scrub the surgical site (for a really long time!!!) to make sure the area was clean before the surgeon made his incision. On the first day I scrubbed into a cryptorchid surgery and tried my hand at some suturing. I still haven’t been given the chance to do a gelding (castrating a male horse) myself and I cannot wait until I have the chance to do one. I watched a couple of arthroscopic surgeries; such as 3rd carpal bone fracture repairs on racehorses. One of the more interesting surgeries I got to watch (twice actually!) was a mandibular tooth retropulsion. The mandibular teeth are in the back of the jaw, on the bottom, so if they need to be extracted they are very hard to pull out the traditional way. It is much easier to drill a hole in the bottom of the jaw and then retropulse (basically hammer) the tooth out with a peg. This surgery required a lot of skull radiographs to ensure that the surgeon was drilling and hammering the peg in the right direction in order to remove the correct tooth. I was in charge of taking the radiographs and this is probably why these were my favourite surgeries to be involved with.

20180717_132423

Just in case you ever wondered how big a horse’s tooth is, here you go!

I also helped complete the treatments for all of the hospitalized horses. This meant giving injections, checking bandages, flushing intravenous catheters, taking horses for walks to graze, cold hosing wounds, etc.  In one part of the hospital there is a large model horse, we put it in front of the stall of any horses who are lonely or anxious without a friend –often it helps them calm down! One patient I helped with had gotten a large stick rammed up into his groin, another had extremely sore feet as he had a condition called laminitis.

20180722_201819

The lonely horse friend; conveniently on wheels!

During the first week there was an Ag Tour going on in the county; the tour group stopped by the practice on two different days. We had 3 stations in the hospital to explain to the people on the tour what actually goes on inside a big equine referral hospital. One of the tour groups actually got to watch through the windows of the surgical suite as we completed one of the mandibular tooth retropulsion surgeries.

On some afternoons we would load up the truck and go out to see horses at stables or farms. We often went to stables and looked at horses training for different competitions, we did lameness exams and joint injections. I often helped scrub the site prior to the injections. I did my first nerve block (abaxial) on this placement!  When owners are preparing to take their horses across the border into the United States they need to be checked by a veterinarian and have a recent blood test (Coggins) completed before they are allowed to enter the states. We did quite a few of these exams and blood tests. Often the paperwork for these horses can be monotonous but there is now a new app that allows vets to fill out information and take photo records on their phones! I also watched quite a few euthanasias and on a couple of horses we completed post mortems to find out why they had died. The intern and I got to practice finding our landmarks and performing joint injections.

20180721_161606

One of the lovely summer views we had while out on call. At this particular location we were dealing with a horse that refused to get onto the trailer!

I got to use some of the practice-owned horses to hone my lunging (an important skill for conducting lameness exams and just being a generally horse-competent person in general), reproductive rectal exam with the ultrasound, and placing a jugular IV catheter.  I also practiced putting in a nasogastric tube; it is an easy enough procedure to do when there is a calm situation.  NGT’ing is an important diagnostic for working up a colic case and I’m nervous for the first time I’ll have to get a NGT into a colicking horse (which can often be very stressful!).

On the third week I worked in the reproduction barn. It was the end of the season and appointments were slowing down–but this was good because it left me lots of time to ask questions. I spent a lot of time running out to mares in pens and giving them injections of hormones to help manage their reproductive cycles so that we could get them bred (so they could have a foal next year).  When we weren’t giving injections to mares we often had them inside the barn for a reproductive tract ultrasound exam; we would look at the body of the uterus, the horns, the ovaries and any follicles or corpus lutea that were present. If a horse had already been bred then we would monitor her for fluid build up (that could ruin a pregnancy) and preg-check her at 14 days to see if she had twins or not, and then assess the fetus’s heartbeat at 25 days. Later in gestation, the owners could bring their horse back if they wanted to know the foal’s gender (filly vs colt). I also got to watch a couple of stallion collections using an artificial vagina— if you wanna talk about dangerous jobs; collecting stallions is definitely one!

There was a cute little loft apartment on site that ended up being really handy–I stayed there when I did on call with the vet. Some of our emergency calls included: a miniature horse foaling, colicking horses, a broken skull, a horse who wouldn’t get on a trailer, and wounds. Other notably cool appointments included a horse enucleation, a horse with a bullet in his leg, a suspected Strangles case, and a suspected Potomac Horse Fever case!

I had a great time on this placement, I really enjoyed the chats with vets in the vehicle, bonding with the intern, the variety of appointments to see, and the friendly nature of everyone at the clinic! Thanks a million Delaney Veterinary Services 🙂

P.S: This was the only placement that gave ME a thank you card at the end of my time there, I was so blown away by this!!

 

Advertisements

Red dirt in the NT

 

The two weeks I spent in the Northern Territory of Australia were a once-in-a-lifetime opportunity. So many of these moments were new and fascinating.  I was pretty excited to get out of chilly chilly Victoria and get outside into some warm winter weather. As soon as our small plane touched down at Galuwin’ku airport we felt the heat!

20180616_163524

How could you not love this landscape?!

Three of us traveled to the remote Elcho island off the Northern coast of Aus for 2 weeks to be part of a council based Animal Management Program. There is a large amount of community dogs and cats that live in Galuwin’ku (the largest community on Elcho island). The majority of our work was spay and neuter surgeries and distribution of dewormer medication.

IMG_2916

This was one particularly friendly dog that met us on the beach one day and followed us home 🙂 

After we first landed we did a little tour of the community and drove past some of the main buildings.  After a few minutes we came across a group of people standing by a dog on the side of the road. He had been hit by a car and was not looking good. We asked if the people wanted us to ‘finish’ him (euthanasia).  In the evening we went to walk by the beach; you can’t go close to the water because it is full of crocodiles. The sunset was amazing. We heard a dog crying and found her laying in a stand of trees in the vines. She was old and riddled with ticks and mites. She belonged to a nearby family who I think moved the dog down to the beach because she had been sick and crying for days. I had never considered how difficult it might be for families to get rid of a dog or euthanize an animal who is sick if there are no vet services around.

20180618_094749

The ‘clinic’ and the ute that we used for all our veterinary work

No one on the island wakes up early; this means that we got to very casually wake up, eat breakfast, and leave the house around 9am… 9:30am…whenever. We often stopped in at the ‘clinic’ (a trailer) and picked up a few things we needed. Then we would drive slowly through the community and stop at family homes and ask them if there was any dogs or cats for ‘operation’ (the term for de-sexing surgery). We would sedate the dogs with their pre-medication drugs at their houses and allow them to get sleepy before loading them into the ute. Children would run and catch the cats for us to put into carriers. At the clinic there was two tables to do surgeries on; you either had to bend over or sit in a chair. One table required you to stack 2 chairs & a pillow on top of each other to be at the right height. There was a desk lamp for added light. We made a makeshift scavenger system for ourselves. The surgical instruments are kept in a saucepan and boiled on the stove each night. Gauze is baked in a canister in the oven. Instruments are scrubbed and sterilized in cold sterile between each surgery. We made swaged on needles as we needed them.  Anesthetic monitoring was done with an SPO2 monitor and our stethoscopes. Each wound was sprayed with Cetrigen purple spray after surgery and dogs received flea spray for a day of relief. All the spays are completed as flank spays: this is because they likely heal faster, if the wound breaks down there is less chance of evisceration, a lot of the patients are either pregnant or lactating and you do not want to disturb the mammary tissue, and its easier to recheck the surgery site from afar. A lot of the animals will remember you and not want to come near you afterwards. Us students got to do almost all of the surgeries by ourselves which was SUCH good experience, and really cool because I got a lot of practice doing the less common flank spays.

IMG_2806.JPG

A typical surgical morning.

Occasionally we would do other vet work. We did a couple of new puppy & kitten exams, checked out a lump on a dog, stitched up a dog who had been gorged by a pig, and checked a cat with tail injury.  But, by far, the most thrilling call was—Nigel. Nigel’s family thought he had broken his leg and our whole team was very distressed as we rushed over to his house! Luckily….he must have just stepped on a prickle  and he was totally fine & just as cool as ever.

20180620_143249

Nigel with his mum and his brand new collar!

In Aboriginal communities, especially in a climate like where we were, when someone passes away in the Wet (season) the body cannot be buried because of the humidity and the rain. The body is flown to Darwin where it is held in a morgue until the Dry (season) when it can be returned to the community for a funeral ceremony & burial. Dumbulah is an out station approximately 10 mins from where we were staying. We were invited to watch the funeral ceremony. Funerals can last for days to weeks; they happen for every person who passes away in the community—because of the associated health issues in aboriginal communities, funerals occur fairly often. As we walked closer to the community we could hear singing. When we arrived we saw a few hand painted cloth signs hanging up. The biggest sign was on white cloth, with bright green writing—’ Welcome Home’. Other signs said ‘rest in peace our loving father’, etc. The man’s name was painted.  There was 3 trees as flag poles for the territory flag, the Australian flag, and a third- they all flew at half mast. We sat on the dirt a little ways away and watched some of the singing and dancing. After a short time, a family invited us to come and sit on their mat with them. A lady on our mat explained to us that 2 different clans would sing/dance the next song (I think it was about a sunfish) one after each other. They had differently painted digeridoos.  This was such a valuable life experience for me; I sat there mesmerized for quite a long time.

We had a short meeting with some of the human medical team one morning to talk about a research project that is being run on the island. The medical team is swabbing mothers, children, and infants at certain households to look at skin infections (likely staph/strep). Our job was to take swabs from the dogs who lived at the house as well. The study required swabs from nose, mouth, and perineum.

Most nights we stopped at the beach on the way home to watch the sunset over the water. We would go for walks along the rocks close to the water or sit in a freshwater pool that was a safe distance from the ocean.

20180617_180504

Jess and I woke up early a few mornings to go for a walk on the beach or the road above the ocean to look for crocs or dugongs before breakfast. It was really lovely. We never saw a dugong, but we did see a crocodile!

CDR_0182

Our fantastic team, we got along swimmingly, and I think all of us grew a bigger spot in our hearts for Aboriginal culture and the NT. 

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! 

“To Cut is to Cure”

We had a 1 week surgery rotation at the university hospital. The university is a referral center with specialist surgeries being performed so we didn’t get to do much ourselves. We scrubbed into as many surgeries as possible and held tissues or passed instruments or operated the suction for the surgeon.  We worked long days; coming in early each day to check on surgery patients from the day before. We also called patients a couple days after their surgeries to check on them and see how they were doing post-op. We wrote discharge notes and surgical reports. Surgical reports are different than a normal medical history. We made sure to include all the instruments used, the type of scalpel and suture, the pattern of closures, exact dimensions of any incisions, and carefully explained each procedure. Each evening we had rounds where we talked about the surgical cases for the day and looked at the pre- and post-operative imaging (x-rays, or CT scans or MRIs).

One of my first patients this week was a beautiful dog who had a significantly sized mass removed from his soft palate (roof of his mouth). Once the surgeon took the mass out there was a very large fistula which needed to be repaired with a skin graft. I was reading some of the articles the surgeon had with him to assist the procedure. It was very complicated, and the anatomy went over my head…that’s the thing about the field of veterinary medicine & surgery… there is always so much more to learn and do and practice! He stayed in hospital for a few days and had to be stomach tubed his meals (who wants to eat when you have a skin graft in your mouth anyways?!). When we went out for walks I had to stop him from trying to pick up sticks with his mouth! Unfortunately, after a couple days one side of his skin graft had failed and he needed a repeat surgery to close the fistula in the roof of his mouth again. After freshening the edges and making another mini-graft the fistula was closed. As far as I know, this patient recovered really well after his revision surgery!

I watched a couple of other mass removal surgeries this week, they were not quite as cool as the soft palate resection + graft. One poor dog had a mass in her rectum that was very uncomfortable. Another dog was very prone to developing lumps all over her body and needed those removed!

One girl in my group watched four splenectomies or something crazy like that this week. I managed to watch one!  The university has this very cool surgical tool which makes splenectomies a lot easier; it basically cauterizes all the vessels and stops all the bleeding so the surgery is much faster and cleaner.

 

One day there was a cria (baby alpaca) that had come in for surgery. He was too big to stay in the small animal hospital so he stayed with his mum in the horse barn and then came to our small animal surgery team to have his bony sequestrum removed from his leg.  A sequestrum is basically a dead piece of bone sitting within the limb; they can be associated with infections and sometimes draining tracts will form. The CT scan of his leg was particularly impressive!

If any spays or neuters were scheduled my group members and I were meant to do them. I watched one of my friends do a spay and a couple of my other friends did castrations. I was very unlucky all week and my cases kept cancelling or no-showing on me! I didn’t get to do any surgeries this week.

 

Towards the end of the rotation I had a very complicated surgical case! The patient was in the ICU.  I completed my rotation in the ICU earlier this year. The ICU team determined that the patient had a septic abdomen. Which meant that he had a bacterial infection in his abdomen—this is really not ideal! We learned that this dog had previously been diagnosed with severe hydrocephalus and had previous brain surgery to put in a ventriculoperitoneal shunt (VP shunt). Very simply —this is a tube that goes from the brain (and tracks under the skin) to the abdomen where it drains the cerebrospinal fluid that builds up in the brain. The excess fluid cannot be in the brain and if it is drained to the abdomen it can be reabsorbed into the body there.

Image result for dog with hydrocephalus

Please enjoy this Google image of a puppy with hydrocephalus. His head is abnormally enlarged and domed. http://www.dogscatspets.org/hydrocephalus-in-dogs/hydrocephalus-dogs/

Unfortunately, the presence of this shunt complicated matters. We didn’t know if the bacterial infection in his abdomen had started in his brain or if it has started in his abdomen and then had tracked up to his brain. The surgery team spoke with the ICU team and then the surgery team liaised with the neurology team. Eventually we decided that it was in our patient’s best interests to complete his abdominal surgery first and then bring in the neurology team to remove his shunt. Then, if he recovered well in ICU he would require another brain surgery in a couple weeks to replace the VP shunt in his brain (this patient cannot live without the shunt). Both surgeries went really well! I helped put in the esophageal feeding tube at the end of surgery.  I’ve been trying to keep up on how this patient was doing by asking my friends who were on their ECC rotation in the ICU room.