“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.

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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.

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Eyeballs, ovaries, and anesthesia!

Its finally the start of our Easter break and its given me a chance to write another post. This has been a full on semester…the material is a lot more clinically relevant and interesting. I love that we get more hands on experience. This is the fun stuff, the stuff that counts, its what I’ve been looking forward to for years.

Recently I had a really good week of practical classes:

The first one was our Ophthalmology Practical class.  I’ve helped out with tons of eye examinations at work over the years, but only got to use the equipment myself a few times. I have never been overly interested in eye cases but this class was a lot of fun for me. We had our ophthalmology lectures a few days earlier which were full of different pictures and explanations of what to look for. Our lovely teaching greyhounds were present and we got to practice Schirmer Tear Tests (STT (measures tear production)), fluorescein eye stains (highlights wounds or ulcers in the eye), and examination of the eyeball with a focal light and an optivisor. I’m starting a clinical placement at a small animal clinic this week and I am really hoping to get a chance to practice my examination skills.

We had our second Bovine Reproduction Practical class where we practiced rectal palpation on female cattle. Our main objective was to attempt to find and palpate the cervix, bifurcation of the uterus, and both ovaries. I was able to find all the structures; one of our cows even had a cystic ovary. That ovary was a lot larger and easier to find than the normal healthy ovaries. The week before we had an Equine Reproductive Practical class where we felt for the same structures in horses. It was good practice to go between species and think about the differences in anatomy. Horse ovaries are bigger and you feel for them higher up than cow ovaries.

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We both found ovaries! Well on our way to diagnosing pregnancy…. 

Our Small Animal Reproductive Practical class finished off our clinical skills in our reproduction block. Unfortunately there was no dogs or cats present in our class so we mostly used microscopes to examine slides of swab samples. Cytology (the examination of cells) is one of the best ways to determine which stage of a cycle the bitch (female dog) is in. It is very important to know what stage she is in so that she can be bred on the right day and get pregnant with puppies. Looking through microscopes is definitely not my favorite part of vet med but after this class I understand a lot more what to look for in these cases.

My favorite practical class that week was our Equine Anesthesia class. We were split into 2 groups of students. Half of us were given a drug protocol and had to calculate drug doses and draw up our medications. The other half of the class had to complete a physical exam on our patient. My roommate and I were in the same group and we felt quite confident about how to start and complete a physical exam on a horse because of our time volunteering in the horse hospital. After we completed our exam we had to clean, prep, and insert a jugular catheter so we could administer the premedication drugs. Our group had a ‘Triple Drip’ drug protocol which is very common in horses. Then we proceeded to anesthetize our horse with our maintenance drugs. When the patient was asleep we were responsible for monitoring his vital signs and recording everything on the anesthetic record. We also practiced intubation. I’ve done intubations in cats and dogs before, horses are different because it is a ‘blind intubation’. That means that you cannot see exactly where you are placing the tube and instead have to rely fully on feel and knowledge of anatomy.

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I am holding the maintenance drugs we used for our TIVA (total intravenous anesthesia) Triple Drip protocol and equine intubation tubes. 

So vet school? Loving it!

After a full 9 weeks of class I’m ready for a 2 week break to catch up on lectures and complete some clinical placements…

 

Volunteering at the Equine Hospital

In the 3rd year of the DVM degree there is a volunteer program run at the equine hospital on campus for some students.  I wanted to volunteer to improve my clinical skills with horses and help solidify the concepts we learn in class. My housemate and I are partners and we’ve already had 3 shifts. The shifts usually start at 6pm after our classes end and most of the daytime staff at the hospital have gone home. During our shifts we work with the overnight nurse until about midnight.

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After our first shift! 

Our shift usually starts with physical exams on the horses staying in hospital. On our first shift we reviewed how to do it and then me and my housemate have been on our own. Same principles of examination apply for any animal–start at the nose and end at the tail. We assess the face for symmetry or any swelling, look for any discharge or other facial abnormalities. Moving on to mucus membrane color (looking at the color of a horse’s gums) and then taking out our stethoscopes for a listen. I really enjoy listening to horse hearts because I feel like I can understand and better hear the differences in sounds at different valves in the heart—> horses are easier than cats and dogs because their hearts are larger. Horses have a different gastrointestinal tract (GIT) than cats and dogs (and humans!) and it is usually quite noisy! We always listen to different areas of the gut to make sure normal sounds are heard. My favorite sound (yes, i have a favorite animal GIT sound….) is the ileo-cecal flush. Here is some horse gut sounds for those who are super interested. We also check for the presence of a pulse before eventually taking a rectal temperature. Counting respiratory rate in a horse is fairly easy–we just watch their flank (sides) move in and out with each breath.

Sometimes, certain horses need medications or treatments done. I have been lucky enough to be able to practice giving intravenous (IV) (into the vein) and intramuscular (IM) (into the muscle) injections. I have also practiced re bandaging legs and assessing surgery sites.

Later on in the night we complete ‘walk-bys’ which include walking infront of each horse’s stall and recording notes on what they are doing, how they look, if bandages have fallen off, etc. We also provide food and water.

On one of our shifts there was an extremely sick horse in the hospital. She was on fluids, but still very dehydrated. We took a blood sample to run and analyse.  It was quite exciting to listen to the vet and the nurse talk about what could be going on with this horse and her future treatment plan. We learned a lot about fluids in class this year so seeing it in practice was interesting.

We were also lucky enough to experience a euthanasia during our first shift. There was a couple of 4th year DVM students there who mentioned that they hadn’t seen an equine euthanasias during any of their shifts at the hospital or placements. We discussed how to appropriately check for signs of death in a horse and logistics of equine euthanasia compared to small animal or other livestock.

Another time I entered an isolation stall with the nurse to help treat a horse with a suspected case of Strangles. This was a great learning experience for me as we have talked about Strangles a lot in the last 2 years. As well, it was a great opportunity for me to practice appropriate use/application of personal protective gear (PPE) (safe clothing like gloves, gown, boot covers, etc) and attempting to minimize contamination.

On another shift my friend in 4th year was working on training one of the troublesome teaching horses. I do not have any experience training horses so I had a lot of fun chatting to him and watching his techniques.

I’m really starting to love equine medicine more and more. I can’t wait to see new cases and get a lot more practice on further shifts!

Beginning Clinical Skills Practice

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!