Tag Archives: surgery

“To Cut is to Cure”

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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.

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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.

Freezing Fingers & ‘Cutting Deads’

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

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

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

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

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

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

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

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

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

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

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

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Poutine, Emus, and Study Days

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I very much admire the vet students who have managed to create regular blog posts throughout their semesters. I thought my second year was busy but my third year must have been busier because here I am writing my first blog post in over 6 months.

We have just finished our third year of classes and this only further confirmed how fast time can fly. Here is a quick run down of some of the most exciting/important things from the last few months:

I spent Canada day in Melbourne this year. Sometimes the weather in July here really makes ‘Christmas in July’ feel possible. Its often very rainy and windy. So I donned my Canada toque, met up with my cousin and one of my closest friends ( who thinks he is Canadian, but he’s not), and we ventured off for a day of fun. Its not my ideal Canada day–usually I look forward to some sunshine, a bit of dirt on my feet, and an escape from the city. This year we started the day off at a nearby pub. We had a maple imperial stout which was actually amazing…. but had a scarily high percentage! We may have also had two different kinds of poutine. Once we found out that not everyone was sure what a zamboni was we headed to the very busy skating rink in town to see if we had retained any skating skills. The next bar had ceasers…. disappointing…very disappointing. Federation Square was set up with red and white lights, Canadian flags, and a few spots of fake snow! We ended the night at the last bar which was a huge party with Tim Horton’s espresso martinis, life size cut outs of Justin Bieber, fooseball, plaid, and non-stop Canadian tracts. Oh… and more poutine.

Never thought I could ever be snow deprived. But it happened, I got very excited about some of the worst snow I have ever seen!
Did you know you can’t actually buy cheese curds in Melbourne? The bar manager had to make his own!!!

We had a very exciting week in August.  We had our White Coat Ceremony at which we were all presented with our doctors coats. I was very blessed to have a family member— my cousin (who is currently living in AUS) at the ceremony. This day signaled our official transition from pre-clinical study (lectures and textbooks and exams) to clinical studies (working in hospitals, hands-on, practical assessments).

Then a few days later I got to wear that shiny new coat to complete one of my first surgeries. My roommate and I worked together to spay a lovely greyhound–who happened to be my other roommate’s dog! The surgery went very well and we still see the dog often which is so nice! I was much less nervous for this surgery than my last one which was very refreshing! We had multiple papers to read, videos to watch, and a tutorial on medical models the week beforehand.

On my spring break I planned a quick camping trip out to the Grampians for 2 nights!  I’ve been wanting to camp in this park since my first year in Australia. Other than an annoying detour  the trip was fantastic. We went hiking both days, wandered the town, stopped for ice cream, hid from the rain, and saw kangaroos, an echidna, and even emus! How crazy is it that I am seeing WILD EMUS. I would love to come back to the Grampians for a week in the summer and do more hikes and hopefully find a couple of swimming holes.

Another very cool thing I did this past semester was participate in a 1 day large animal emergency rescue course. We mostly talked about horses but the techniques are applicable to cattle and other large livestock animals. The day was a mix of lectures and hands on. We learned how to make our own darts for medication, how to organize and run an emergency incident site, and practiced safely restraining horses from a variety of difficult situations.  They day concluded by rescuing a (model) horse from a dam.

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‘Bruce’ the model horse, just moments after our team coordinated his recovery from the dam

And finally, my last exam period. We had 6 finals this time. These are my classes:

  1. Cats & Dogs
  2. Principles of Professional Practice
  3. Horses
  4. Cattle
  5. Small Ruminants (mostly sheep and goats… with a few llamas and deer thrown in)
  6. Birds

(How cool is that!?)

At the University of Melbourne we have 1 week off before the exams begin. My alarm went off at 7am every morning and I used a timer to keep myself focused during the long hours and days. Finals were just as enjoyable as usual…..but with that I’m done my 7th year of university and am looking forward to the final year in my vet school journey.

Next year will be all placements and rotations. I get to book some of them myself–at practices that I am interested in working at or curious about the cases. The other rotations are administered by the university. I have a lot of high expectations for next year. I expect it to be challenging, exciting, and quite a growing experience.

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I have a new study buddy. She showed up most mornings at about 7:30am to sleep on my bed until she headed downstairs for dinner around 5pm.

Beginning Clinical Skills Practice

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Lets get back to the real reason I started this website… I won’t be doing any more traveling for a while as I have just started my 3rd year of vet school! The first 2 weeks were an intensive block on the ‘Principles of Professional Practice.’ The mornings consist of lectures and then most afternoons we have very interesting practical classes:

In our fluids practical class we worked through some case studies. We had to decide if a patient needed intravenous (IV) fluids, how dehydrated they were, and what kind of fluids to give them. Then we had to calculate how fast we were going to give fluids to the animal. Another part of the class was practicing how to put IV catheters into canine forelimbs. The university provides us with fake ‘skin’ and realistic dog arms with ‘blood filled’ veins to practice on!

I really liked our first surgery class! Initially we looked at all the different types of surgical instruments you could use, and talked about how to properly hold them, clean them, and what kinds of surgery you might use them for. Then we had some time to practice a few different suturing patterns and knots on fake skin! The other half of the class we learned how to properly do a ‘surgical prep’ —> shaving the hair and washing the skin of a dog prior to abdominal surgery. We learned the basics of maintaining a sterile surgical field and how to properly drape a patient. Then I was volun-told to scrub in for surgery, put on a surgical gown, and close glove (this means I need to safely wash my hands/arms, put on my surgical clothing/gear without contaminating myself by touching anything).

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All of the things we got to take home to practice our clinical skills with–masks, surgical gown, cap, gloves, hand brush, catheters, suture, and surgical instruments.

Radiology (x-rays) practical class could have been very boring, but thanks to great professors it was engaging. The first half of the class we talked about different radiology equipment and machines that we might use in practice. We discussed how they worked and why we might want a certain set up. Then we went into the teaching hospital and exposed some x-rays of single bones. We also got to explore and play with the university’s rad viewing software.

The communications practical class was something I was both very excited to do and very nervous about. In this class we had to go into the teaching hospital and read the history on a case. Then we went into the waiting room and called our client and patient into our consult room. Our job was to establish a good first impression, understand the client, and get a sufficient history. We were to conduct the consult up until the point where we began a physical exam of the animal–we will practice that part later in the year. The case I got was about a dog with itchy ears and eyes. Once I called my client into the room I became a lot less nervous and my questions and conversation flowed more naturally.

Equine Clinical Examination: this class was a bit of a review from DVM1 I think. We had to work in groups and do a clinical exam on a horse–this includes looking at the horse from head to tail and assessing all the body systems for abnormalities. We also used our stethoscopes to listen to the different heart, lung, and gut sounds. Then we practiced intra-muscular (IM) and IV injections (into the jugular/neck vein) using saline.

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Listening to the heart of a horse after it finished competing. This picture was taken in my first year of vet school. I was assisting with vet checks at an eventing day. 

So even though we have well over 30 lectures to study within the first 14 days of class –I love vet school. Third year is going to be a good time, I can feel it!