This Week

[Sailorwolf 0]

Looks like you had a fun week. The bandage prac looks awesome. We Watched a video on bandaging a little while back and the Robert Jones bandage gets huge. Almost like those plasters they put on thumbs in the old cartoons. lol.

Isn't the twitch used also as a distraction so that the horse thinks about that rather than what's going up its nose?

 

How do you get round posting pictures? Our uni sent out an email saying that we can't post pictures on the internet of people, their animals, uni staff and students without their (the people and animals in the picture's) permission.

[Zebra 0]

Hi Zebra, I asked that myself when I was first taught to use it.

Used properly it should not produce any pain at all. If it does it is very brief. The upper lip is very sensitive. The twitch is designed to stimulate the natural response to strong pressure (almost 'pain') by releasing a powerful wave of endorphins (opioids) from the brain, which stimulates euphoria and inhibits the sensation of pain. They might feel a bit sore afterwards but the theory is that by the time the feeling in their lip returns there is no sharp pain sensation.

Of course that doesn't mean that twitches are always used properly.

Here is its wikipedia entry http://en.wikipedia.org/wiki/Twitch_%28device%29

 

Thanks , when I was like 13 years old I went to a riding school and we were using it there sometimes, I hope we were using it the right way , they didn't really explained it to us :hap:

[Chrysocome 0]

Yeah Sailorwolf, the Robert-Jones is pretty incredible. It's almost comical seeing the thing. We've been shown one on horses too. I do have a picture of one of those when the demonstrator was using a client's dog that needed it, but as you picked up I'm not allowed to show it. You are right, the uni did recently send around a very strict email telling us we weren't even allowed to talk about clients, their patients, or post pictures of them (this is especially important in second semester when we are in the hospital for real). In this thread I hope I managed to avoid mentioning real patients, and stopped it when the email was sent. The posts from way back (not in this thread) I probably talked about them a bit but I can't edit those anymore. You might notice I don't post as many photos as I used to, and they are of my friends, and teaching animals not patients. But thank you for reminding me, I do slip up sometimes and forget how much detail I am getting into. I guess it's true of any photo being placed on the internet, you must get permission from all the people in the photo before you post it.

[Sailorwolf 0]

It kinda makes it less fun doesn't it. Well at least you know you can take pictures of the wall, the floor and the ceiling with out getting in trouble. Not quite so interesting though.

[Chrysocome 0]

Week 12, Friday morning

Canine Surgery 4: Thoracotomy

This very long post is an important moment in my career and it is here in its entirety. It is something I will never forget. This terminal surgery I had to be anaesthetist and the prac was thoracotomy. As such, I had the hardest job of all. This was also the last of the 3 terminal surgery pracs that I will ever do. In these pracs, the animals will not wake up from the anaesthetic and are euthanased while unconscious.

 

Our dog was almost certainly the result of a breeder’s cull, as there appeared to be quite a few of the same. I did the pre-anaesthetic exam and then set up the pre-medication – a heavy dose of sedative (Acepromazine for you SW, if you’re interested). I then put on a hairnet and mask, grabbed an anaesthetic machine and set it up (as the dog was over 10kg, I used an adult rebreathing circuit). I had made sure the night before that I was super-organised so I knew everything that needed to be done and it all went smoothly – machines all set up and checked for leaks, all gasses, fluids and drugs checked and made up, etc.

 

My fellow surgical team members then entered the operating theatre. They placed the dog on the table. As they did so our ‘assistant surgeon’ exclaimed. She could feel the buzz of the heartbeat through the chest wall. I listened – sure enough, a Grade 4 heart murmur. The heart was incredibly loud, especially now in the quiet of the theatre. Each pulse of the heart could be felt, physically, as a gurgling gush when I placed my hand on her chest.

 

I had to begin the dog’s anaesthesia as well as control fluids. I shaved her foreleg, cleaned it, then placed a catheter into the vein. So then we were ready – a series of events I’m sure will become second nature to me someday, one after the other. I injected the induction agent (Thiopental) and watched the dog go unconscious. That dose is limited so I had to move fast, drawing the dog’s tongue out and using a laryngoscope to help me see, I placed an endotracheal tube into the trachea. I squeezed on the rebreathing bag, inflating the ETT’s cuff until I was sure there were no leaks. I then connected the ET tube to the anaesthetic machine, turned on the oxygen, turned on the anaesthetic vaporiser (Isoflurane) and watched the dog, making sure she was staying deeply unconscious. I connected fluids to the catheter. I then inserted a probe into the oesophagus, connecting it to stethoscope earpieces, so I could hear loud and clear the sound of her heart. I kept those in my ears for the entire prac.

 

Maintaining her on the anaesthetic, the surgeons got to work preparing her for surgery including shaving and scrubbing. My job was to look after the patient (yes, that is how we all thought of her, even though this was a terminal situation). There are different indicators of anaesthetic depth that must be checked constantly – including eye position, jaw tone, palpebral reflexes (blinking) and withdrawal reflexes (reacting to a painful stimulus), as well as cardinal signs such as heart rate, pulse strength and respiratory rate. I had to do that check every 5 minutes. The gush of her defective heart was in my ears, a constant buzz in the back of my mind.

 

The surgeons were then ready. The head surgeon had scrubbed and gowned, and now draped the dog. I kept my eyes on the signs, listening and checking for any hint of a change as the surgeons began their thoracotomy. A thoracotomy means opening the chest to observe the heart and lungs. It can be done as an exploratory tool when ultrasound and x-rays have not told us anything, or to do surgery on the heart or lungs such as remove cancer.

 

I then had a difficult task to do. Breathing relies on the pressure difference between chest and lungs. When the chest cavity is exposed, that pressure difference disappears and breathing cannot occur. My job was to press on the rebreathing bag, pushing air into the lungs and acting as a ventilator. In essence, I had to be her lungs. There is a certain pattern to breathing – inhale, exhale, pause, repeat. I had to do this constantly for about, oh, half an hour. I had to inflate it at a certain pressure too – too much and I would damage the lungs, not enough and she wouldn’t get enough oxygen. At the same time, I had to listen to and record the heart and respiratory rate (which meant I had to count my own rhythm of squeeze, pause, pause, pause, squeeze…). Getting a heart rate (ie counting how many beats within a certain time then multiplying it to get beats per minute), numbers floating around in your head while trying to maintain a steady rhythm, it is not easy! In addition, I had to keep checking anaesthetic depth by looking at the eyes, eyelids and jaw tone. And of course watch the surgery too as that was part of my learning experience. Another factor is that the rebreathing bag fills at a certain rate so I had to keep opening/closing valves to make sure the thing didn’t fill too much (but it still had to be filled adequately). Finally, what made it really hard was that I had to stop inflating the lungs whenever the head surgeon wanted me to, because she was using the scalpel or needle and didn’t want to have inflated lungs in her way.

 

Between the constant checking, counting and all those other factors I was completely overawed. Right there, I saw her heart pulsing away. A living, beating heart, I was staring at it. I cannot get over that fact and indeed it was all the talk for weeks to come. I think we were all affected in the same way by the experience. The surgeons were actually holding it in their hands, and I got to feel the gush of turbulence through it. As I stared at the pulsing heart, and the salmon-pink lungs bulged with each squeeze of my hand, it dawned on me. I was the one keeping the dog alive. With the power of my hand, I was keeping this beautiful living creature breathing and functioning. With that realisation came a powerful knowledge of the fragility of life. It just really hit me, the responsibility I had right then, and for the rest of my life: to be responsible for lives, to save and to take them.

 

As for this dog, she had a massive pulmonic stenosis. The major blood vessel was constricted at the point where the blood was supposed to be flowing to the lungs. When blood did get past that point it shot out, causing turbulence and what we had heard and felt externally as that gurgling buzz. The part of the pulmonic artery after the constriction was massively dilated. The heart itself was abnormally large.

 

The surgeons closed the chest, tied a drain in place and finished the surgery. The dog resumed her own breathing and all was done well within the allocated time. We had each performed our roles well, and we had all learnt a lot from it – more than just how to perform surgery.

 

The real surgeons came around with a tube of green (Lethibarb) to end these animals’ lives. They made sure I was still wearing the stethoscope as the agent was injected. I listened as the heart stopped, instantly, and that gentle throb in my ears was no more.

Edited July 9, 2008 by Chrysocome

[Elly 0]

what an experience but in the end so very sad for the dog in the end

[Sailorwolf 0]

Thank you for sharing that experience Chryso. It was very insightful.

 

Being the anaesthetist is very time consuming. By the time you have finished all your checks the next 5 minutes has come round and you have to check again.

Being a vet can be very taxing at times, especially when dealing with life and death. You want to cry at the time, but you know you have to hold it together in order to function properly and be strong for clients, so you have to forget about emotions for a bit. I usually think to myself "I'll think about it later".

[birdluv 0]

what you do is so interesting and difficult, l do not know if l could do what you do.

[Chrysocome 0]

Thank you all.

I have now officially put two animals to sleep, a stray cat very sick with flu and an aggressive dog (it bit the owner's child). My first in what I suspect will be a very long list. But the worst is when animals die on their own and it takes days and days, as I witnessed very recently, it takes all the strength out of you, and you just have to keep it together for the owners who will sit with their animal for days, in silence, just being there for their pet. It is heart warming and it heart breaking at the same time.

 

I'm going to fly through the remainder of Semester 1 as the next semester is about to begin!

 

Week 13

Not the most interesting week.

 

Monday – morning was gross pathology, looking at the urinary system. Afternoon was ‘hospital orientation’ which was a basic tour behind the scenes of the Werribee Animal Emergency Centre, which is on campus. In second semester we will be doing rotations in WAEC, working on (gulp!) real patients.

 

Tuesday – Radiology 4: Musculoskeletal system. We looked at X-rays of normal and abnormal anatomy. I can’t wait for the day when I can recognise all the carpal and tarsal bones of a horse. They had lots of models for us to look at (and put together into anatomical parts - sometimes it felt like a difficult 3D puzzle) which made things heaps easier to understand.

 

 

Wednesday – Afternoon off

 

Thursday – Clinical Pathology 7: Tying together all the different blood results, biochemistries, urinalysis etc. More problem solving using numbers and patterns. This time we weren’t told what the theme was so we had to work off what we had learnt before.

 

Friday

Morning – Small Animals 3: Dermatology

I really liked this prac. The first part was looking at fixed histological slides from the museum at uni. We learnt what different organisms affecting the hair and skin looked like under the microscope. The second part of the prac was working with live animals. Students brought any of their animals that had a skin condition. We learnt different diagnostic and clinical techniques such as tape preps, wet smears, skin scrapes and biopsies.

 

Afternoon – Canine Surgical Anatomy 3: Thorax and lungs

This was done on cadavers. We repeated what we had done surgically in the terminal surgery (good for me, as the anaesthetist, I hadn’t concentrated much on the procedure) and then different procedures such as lung lobectomy and placing drains. These cadavers were from the morning’s terminal surgery, which was another group’s ‘thoracotomy’ (I had done it last week). I mention it because one animal goes a long way for us. They are used when alive to teach behaviour and clinical medicine, even have blood taken for the blood bank. Some are then placed in the terminal surgeries to teach anaesthesia and surgery. After they are euthanased, they are used for surgical anatomy, letting us look at different parts so we know what is important to avoid in a live animal. Finally, that animal may be separated into pieces to teach many groups of first and second year students general anatomy. It may sound gross at first but I believe it is a good way to teach students while using as few animals as possible. A single animal goes to teach dozens of students, helping all of us in our careers.

 

Week 14

This was the week of prac exams, and the last week of semester.

 

Monday

Morning – gross pathology, urinary system 2

Lunch – the 2nd pathology quiz! Eep! I really flailed in this one. Then I had to run (literally) for...

Afternoon – Equine practical exam. I was one of the first ones rostered. I had a very friendly lecturer that everyone likes so it wasn’t too stressful. A lot of other people were very nervous though, some near tears (apparently one of the other lecturers was really tough). I was examined on lots of different clinical, identification and handling techniques. We’re given a list at the outset that we absolutely must be able to do. I think I aced this one. He let me go on a unique identification mark because I wasn’t tall enough to see the top of the horse’s back! Hehe.

 

Tuesday – Small Animals 3: Urinary system

More clinical techniques and medicine – looking at the body system, different clinical presentations, blood and urinalysis, diagnostic techniques like X-rays, and techniques such as catheterising and getting sterile urine samples via needles. We then worked through full case studies.

 

Wednesday – AHM: Pasture budgeting

Every year this has been the worst concept for me, and possibly a lot of other students. It’s a lot of dull number work and I never really understood it because each lecturer used different systems. But this time we had a lecturer who taught it really well in class and did it really well in prac too. So I walked out actually feeling like I knew something important about grass!

 

Thursday – Bovine practical exam

This was even simpler than the horse one. A lot of people were worried because there was no set list given as to exactly what you needed to know. I got another really great lecturer. We acted out a scenario where I was the vet and he was a client, and I had to work out what was wrong with the cow and how to treat it (mine apparently had heart problems). He decided to use the last couple of minutes to give me career advice then we finished early. It was great.

 

Friday – Day off

 

Another mock up poster for the 'vet show'.

Edited July 19, 2008 by Chrysocome

[Neat 0]

I love it when you do those pics

Mate, bust week again :hap:

[Elly 0]

Our Brandy, stroked out and he had a very strong heart at 18y I couldn't imagine letting him lay like that. It is very hard decision but watching them suffer is horrible. Very interesting week you had and I also enjoy the pics.

[Sailorwolf 0]

Today we had an awesome lecture about Raptors and falconry. It was very fun and most interesting. We have a paper that is basically just about wildlife and mostly birds so it is very fun.

[Elly 0]

SW that is interesting, I love learning about birds they are just amazing.

[Sailorwolf 0]

I'm sad because Falconry is illegal in NZ and Aus. I so wanted to do it when I was younger.

[Chrysocome 0]

Ah, dang, I was just about to move to NZ because it sounded like you were learning about it for a local type thing.

I always wanted to do it too :sad:

Birds of prey are just amazing.

 

I've had a killer of a week and it's only Wednesday. We've had three days and going to have a fourth day of full lectures, ie seven lectures spanning over 8am to 5pm. I lose concentration by about 10am. 80% of it has been on pigs and I just can't focus on one topic for that long. It's torture, I tell you!

[Elly 0]

OH BOY.

[Chrysocome 0]

Well, Semester 6 (Semester 2 of Third Year) has begun. I can't tell you how excited I am (nor how utterly, utterly terrified!)

It started with our White Coat Ceremony on Sunday, where there was a big ceremony with all our families present. Each of us got a brand new labcoat. It is an occasion that marks the transition from vet student to trainee vet, taking us out of the lecture halls and placing us in the hospital with real clients and patients.

 

This is how the rest of the semester works for me. From now on each student group goes into rotations between the different parts of the hospital. (After the nightmare of picking groups in first semester, it turns out that groups C and D are sister groups so I ended up with all my friends anyway).

This is my schedule:

1: No rotations

2: Small animal surgery

3: Paraclinical sciences 1 (post mortems, microbiology, clinical pathology)

4: Paraclinical sciences 2 (post mortems, microbiology, clinical pathology)

5: Equine medicine and surgery

6: Agricultural animals

7: Special topics (dermatology, cardiology, exotic pets)

8: Emergencies and critical care

9: Radiology

10: Small animal medicine

11: Small animal referrals

12: Anaesthesiology

 

Week 1: Pig Week

This was quite a week - 8am to 5pm, solid lectures basically. I was going insane by the end of it. Most of it was on pigs. I like the feeling of the lectures now, I feel like they apply more to what I'm going to do and they make heaps more sense that way.

The only prac was on Friday, a pig autopsy, which was actually very interesting - ours had extremely severe changes. (Too bad I fell asleep during the introduction lecture!)

To make matters worse our group Veterinary Public Health assignment was due (as some of you know) so I was just exhausted by the end of it.

I slept and slept on the weekend!

 

Impending exhaustion and stress, here I come!

Edited July 28, 2008 by Chrysocome

[Chrysocome 0]

Week 2: Surgery

 

Well, what a week it has been!

To start with, let me explain the rotations. Each student is placed in a rotation group, and each week we move to a new rotation. There are three days of official prac days (Tuesday to Thursday) but in some rotations our responsibilities carry on through to the next Tuesday including the weekend.

 

Surgical rotation takes place in the hospital. We’re in with our sister group (group C), who are doing Anaesthesiology. We start every morning in rounds at 8:30. We go through each patient in the hospital requiring surgery, so we are kept updated by surgeons, clinicians and sometimes students taking care of a case: the history of the patient, what’s happened so far and the plan for the day. Any new cases get divided between the student surgical and anaesthetist teams. So each student has an animal to look after while it’s in hospital. Every morning before rounds (and lectures) and every evening we have to do a TPR (temperature, pulse/heart, respiration), walk, feed and assess our case, and also give any meds required. Let me add that these are real cases, so the pressure is really on! There are of course clinicians, surgeons and nurses looking over your shoulder but they ask you questions constantly and you get marked on initiative, knowledge, communication and decision making.

 

We follow our case from the consult, through the surgery, into recovery and finally discharge. When surgery is on you might be lucky enough to get to do some of it; usually you get to scrub in and be right there helping the surgeon out. (‘Scrub in’ means to do a total sterile scrub of your arms/hands, then put on a sterile gown, gloves, cap and mask). I scrubbed in on one of my main cases, who had his spleen totally removed. I just had to hold things for that. But it’s awesome enough just being allowed to scrub in; the other students have to stand back at least 1m from the surgical table so everything stays sterile (you can barely see anything if you're not scrubbed in). I was also lucky enough to perform a spay, which I did almost entirely by myself (the supervising surgeon had to close the skin because I ran out of time and my patient was getting dangerously cold). It was a great feeling, I really love surgery and am looking at doing some more of it in my extramural work.

 

My last case was a dog that tore its cranial cruciate ligament (in the knee) and was getting a procedure where they cut out a piece of bone, rotate it and plate it back on, to redistribute the forces from the torn ligament and decrease pain. It was so cool. I’ve been looking after him for four days (which means I had no weekend!). I had forgotten just how amazing surgery is. We’ve been somewhat desensitised for years and I only just realised again how incredible it all is.

 

I also got to go and watch other cases and surgeries, and freak out over how much the anaesthetist students had to know. Watching other surgeries was great, particularly when it’s your good friend doing the surgery! But there are some incredible procedures that go on in our hospital.

 

I stayed after hours most nights just because the surgery was so cool. There was one case where they did surgery entirely through tiny holes in the body wall – one for the camera, two for instruments. One of the dogs had an undescended testis in his abdomen. They removed it entirely with one instrument that held onto things, the other instrument was an electrocautery device. That means it ran a current between two points and literally cooked the tissue, so it acted as a scalpel but there was no bleeding at all. Endoscopy is always amazing, I feel like I’m swimming through giant organs XD

 

So that was my week, I really enjoyed it and think I will pursue surgery further in my work experience.

 

Now I have to write up a case report for one of my cases... I am SO sleepy!

[Neat 0]

Wow, sounds like surgery is a passion for you !!!

I don't think that i have the stomach for it though - I hate seening blood LOl

[Chrysocome 0]

I certainly think it is; although the surgery report is so tedious that it's dissuading me somewhat.

 

You know, I totally thought the same thing in high school, blood scared me a lot and I thought I wouldn't be cut out (no pun intended) for vet type stuff. But I've been totally desensitsed over three years to the kinds of things we do - I imagine it'd be the same for doctors. That said, nothing quite prepared me for the first time I cut into a living thing (it was anaesthetised of course). After three years of dissecting cadavers, I was totally fazed by the fact that I'd caused something to bleed. (Dead things are cold, don't bleed and if they do it's very dark and thick), it was so obvious but it was just a little shock that first time. The other thing is that living things move; arteries dance as blood moves through them, and even the gut moves all on its own, it's really creepy and no one prepares you for that kind of thing!

So I eventually learnt not to let things like that bother me anymore. It's an odd feeling, becoming distanced from the gross things you see, and totally forgetting that other people are 'normal' and don't want to hear about that thing over dinner! Lol!

[Sailorwolf 0]

What weirded me out the first time I saw a sheep killed (on a farm), was that the intestines and stomachs continue to move even after they are removed from the body. Even the whole fact that the body itself continues to move for ages even though the animal is actually dead. Their reflexes are still intact, but not controlled for awhile afterwards as well. I have been kicked by a dead/killed cow. I had poked it and it's reflexes caused it to kick me back.

[Denise 0]

What weirded me out the first time I saw a sheep killed (on a farm), was that the intestines and stomachs continue to move even after they are removed from the body. Even the whole fact that the body itself continues to move for ages even though the animal is actually dead. Their reflexes are still intact, but not controlled for awhile afterwards as well. I have been kicked by a dead/killed cow. I had poked it and it's reflexes caused it to kick me back.

 

 

Eww.....that reminds me of when my grandfather used to cut the chooks heads off and is they escaped from his hold they would be running around the yard with no heads until they dropped....gross

[Chrysocome 0]

Eww.....that reminds me of when my grandfather used to cut the chooks heads off and is they escaped from his hold they would be running around the yard with no heads until they dropped....gross

Ew... and what's even more gross is that birds have their vocal cords in their chest so they can keep squawking too.

They always tell us to go nowhere near the legs of a newly killed large animal - horses especially. Their nerves can keep firing even if they are actually dead, so they can reflex kick and still kill you.

 

Feeling morbid and... thoughtful... today - Groups D and C visited a prime lamb abattoir and witnessed the process from the moment the sheep were unloaded on the property, to when their bits were packaged and frozen (and everything in between). Very much an eye opener. I think that people should face what they are causing to happen instead of masking the brutality and sheer... number... of it.

 

I know i'm behind on my updates, I will do Paraclinical 1 and 2 (weeks 3 and 4) together at the end of the week.

Edited August 13, 2008 by Chrysocome

[Denise 0]

Eww.....that reminds me of when my grandfather used to cut the chooks heads off and is they escaped from his hold they would be running around the yard with no heads until they dropped....gross

Ew... and what's even more gross is that birds have their vocal cords in their chest so they can keep squawking too.

They always tell us to go nowhere near the legs of a newly killed large animal - horses especially. Their nerves can keep firing even if they are actually dead, so they can reflex kick and still kill you.

 

Feeling morbid and... thoughtful... today - Groups D and C visited a prime lamb abattoir and witnessed the process from the moment the sheep were unloaded on the property, to when their bits were packaged and frozen (and everything in between). Very much an eye opener. I think that people should face what they are causing to happen instead of masking the brutality and sheer... number... of it.

 

I know i'm behind on my updates, I will do Paraclinical 1 and 2 (weeks 3 and 4) together at the end of the week.

 

Sounds like you had an eye opening day...yuk

[Chrysocome 0]

Quick comment because it made me laugh so much.

 

 

(If you're wondering what's up with Linka and Wheeler, it's because someone had to "switch outfits with a member of the opposite gender for the whole night" - no one got a picture before they switched but we looked so awesome together)

 

We're a studious lot, we vet students.

 

 

Um... I'll explain when I update on the weekend

Edited August 15, 2008 by Chrysocome