Intralipid uses

Intralipid is a very cheap addition to your toxbox in your clinic. It has a shelf life of over 2 years and can be a life saving substance to give your patient with the right toxins.

Intra lipid emulsions can be used in veterinary medicine for some toxicities with fat-soluble compounds (e.g. Beta blockers, calcium channel blockers, anti epileptics, cocaine, pyrethrins, permethrin, ivermectin, ionophores, marijuana).

Use of ILE has been advocated by animal poison control centres, such as the Veterinary Poisons information Service (VPIS). Intralipid has been showed to give a faster recovery time, reducing the time the pet need to spend in the veterinary clinic. However, the use of ILE is considered off licence and therefore the use will need extra informed consent from the owners.

A VPIS position statement indicates “ILE is not suitable for lipophilic compounds, such as vitamin D compounds and anticoagulant rodenticides”. Contraindications to ILE include renal insufficiency and liver damage which can cause fat matabolism disorders.

Side effects seen in practice include fat overload syndrome, where the elevation of triglycerides in the serum can cause dyspnoea, fever, respiratory distress, reduced hepatic function and coagulation disturbances, seizures and coma. when prolonged doses of ILE are given pancreatitis can be seen. Acute blindness in cats due to fat deposits in the cornea can occur, but this can resolve after 4-10 days. Phlebitis, hypersensitivity reactions, fat emboli, lipaemia are other more common adverse reactions.

The mechanism of action MOA isn’t clear yet, but there are two theories. One is that intralipids work as a “lipid sink” for lipophilic substances and therefore enhance the elimination by binding to these substances. Intralipid administration act as an extra high fat content organ, and increase the volume of distribution of lipophilic drugs in the body. this then reduce the amount within the body tissues and potentially reducing the dose of the toxic treshold. This enhanced volume may allow normal clearance mechanisms time to reduce the amount of toxin in the body.

The 2nd theory believes that the myocardium and brain work as a fatty energy substrate. Therefore enchancing myocardial contractility or intracellular calcium levels by enhancing the availability of free fatty acids.

The effectivity of intralipid can be predicted by looking at LogP of the toxin. Substances with LogP>2 appear to be most effectively treated by the use of lipid emulsion, although as it is a relatively benign treatment, some authorities would recommend its use for any neuro- or cardio-toxins.

Dose: The dose recommendations for the veterinary patient are adapted from human literature. ILE20% are started with a bolous for 5-10 minute of 1.5ml/kg IV. This is followed by a CRI of 0.25-0.5ml/kg/min for 30 to 120 minutes. Where entrohepatic circulating drugs as the toxin a longer CRI with a smaller dose might be considered. ILE20% is an isotonic solution and can be given in peripheral veins or in central line with an aseptic technique to prevent bacterial contamination

If you have further Interest this article is a good read: https://onlinelibrary.wiley.com/doi/abs/10.1111/vec.12322

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Two working theories of mechanisms of action exist. One is that intralipids work as a “lipid sink” for lipophilic
substances and therefore enhance the elimination by binding to these substances, another one points out their
ability to work as a fatty acid energy substrate for the myocardium and brain (this may be direct, by enhancing the
availability of free fatty acids, or by increasing intracellular calcium levels).
In terms of the lipid sink theory, administration of a lipid emulsion, such as Intralipid®, appears to act as an extra
high fat content organ effectively increasing the volume of distribution of lipophilic drugs in the body: this has the
effect of reducing the amount within body tissues and therefore potentially reducing the ‘dose’ below the toxic
threshold; whilst unlikely to alter clearance rates in itself, this greater volume of distribution may allow normal
clearance mechanisms time to reduce the total amount in the body and has perhaps been better described as a
‘lipid shuttle mechanism’ The effectiveness of lipid emulsion in this regard can be somewhat predicted by looking
up the LogP (octane solubility) of the toxin on the internet: substances with LogP>2 appear to be most effectively
treated by the use of lipid emulsion, although as it is a re

Kennel cough – should you vaccinate?

Kennel is a highly contagious upper respiratory infection that can be caused by inhalation of a bacterial or viral particles into the respiratory tract.  The disease is usually transmitted between dogs in close contact by aerosolized respiratory secretion, often during coughing or sneezing. It can even transmit to your dog by exposure to surgaces that have been tainted by a sick dog. There is typically a harsh honking type of cough, but sometimes the coughing can seem more like gagging or vomiting slime/frothy material. Some dogs develop a fever and anorexia for a few days.

Kennel cough is very common among young dogs and puppies, but older dogs get it too. In many cases, it will clear up on its own in 3-4 days. Many dogs with kennel cough will not act sick and are active, eating and drinking, but coughing as well.  Therefore is the dog is coughing and acting ill, have a fever etc- you should take your dog to the veterinarian.

To prevent your dog getting Kennel cough there is a vaccine. Many kennels wont keep your dog unless you have proof of the vaccine, but you need to plan ahead, because it can take up to 2 weeks for the vaccine to kick in. therefore ideally you should vaccinate your dog 2 weeks before planning to place them in a kennel.  The vaccine is inhaled through he nose. Side effects of the vaccine include: vomiting, hives, lethargy, breathing difficulties. If accidentally injected instead of inhaled the animal can be sore at the injection site and potentially feel lethargic and develop an abscess at the site.

The kennel cough vaccine is still not 100% effective. There is still a change that your dog develops kennel cough, but the vaccine will reduce the severity and the length of the illness. The vaccine will not be of any help to your dog if its already got Kennel cough. Normally if they get kennel cough, the veterinarian will treat with an antibiotic against the opportunistic bacteria Bordetella bronchiseptica etc. the antibiotics will however to affect the viral components of the condition but they should prevent the dog developing secondary pneumonia from the opportunistic bacteria. First choice antibiotic is doxycycline, but other alternatives include oxytetracycline, potentiated sulphonamides or amoxicillin/clavulanic acid. A 7-10 day course should be sufficient, but some cases will require a longer course.

If you don’t feel comfortable vaccinate your dog with this vaccine, Kennel cough is a self limiting illness, meaning it can go away on its own. However if your dog is coughing, not himself, fever etc- please bring your pet to your veterinarian.

Veterinarians

We feel that animals have as much right to Planet Earth as we have, that companion animals bring joy, hope and unconditional love to us each and every day, and that it continues to be our moral responsibility to look after them and to love them back to the very best of our ability.

Starting work as a Dentist Veterinarian ?

“I`ve always felt that animals are the purest spirits in the world. They don’t fake or hide their feelings, and they are the most loyal creatures on earth. “ Pink

This is my 2^nd week as a working veterinarian. Yesterday I got my name badge and my name on the consulting door with “veterinary surgeon” underneath. Such a surreal feeling. I made it, I made my dream since a little girl come true! I feel so privileged to have made it.

I started my first day with my favourite subject: surgery. I did a couple of dog and cat castrations.  The rest of my first day I was asked to consult. I jumped right into the deep end and started consulting on my own on my first day. The reception was nice and scheduled in 20 minute consultations (instead of the normal 10min per patient) and also scheduled in fairly ok patients for me. I had a lot of vaccinations; booster vaccination, primary vaccinations of puppies, microchips and puppy litter checks.  I`ve seen a lot of ear infections- showing clients how to clean dog ears and dogs needing dentals. I know dental scale and polish can be expensive, but when your dog is 3-5 years and has a lot of dental tartar- you should as an owner prioritise this treatment for your pet. Postponing it will only make it worse! Your pet can get periodontal disease: which is both unpleasant and can result in your pet having to have its teeth out at a younger age than needed. When it gets to this stage it really is too late to brush its teeth. Brushing teeth is really a preventative measure which needs to be done preferably every night or every other night for it to have any affect. Both royal canine and Hills pet food supply a dental food diet, but again only part of the treatment for your dogs dental tartar. Recent studies have demonstrated that there is an association between oral health issues and systemic general health issues affecting the kidneys, heart and metabolic system.  Have you ever wondered why your dog`s breath smells? Bad breath in  pets can be cause by many health or behavioural reasons, but more likely due to lack of oral hygiene.

Plaque is a clear white film that forms on the outside of the teeth. It is formed by bacteria naturally found in the mouth. Tarter or calculus is formed when plaque is allowed to sit and mix with chemicals found in the dogs saliva. This quickly form a coating (made of bacteria) developing on the teeth and also under the gumline. Once tartar is formed, it is too hard to be removed by a toothbrush and require a dental scale and polish. Gingivitis is another big concern. The inflammation of the gums is the immune systems attempt to get rid of the infection from the tartar buildup. Which is the beginning stage of peridonal disease, if this is left uyntreated it can recess into the gumline, periodontal pockets and cause oral abscessed and tooth loss. Because the bacteria from the mouth can become blood born, it can also affect other organs of the body and therefore contribute to heart disease etc and therefore shorten the pets life.

Oral health is key to a long healthy life for our furry friends, not just dogs but cats as well. Think if you had tooth ace and didn’t go to the dentist? It would only get worse, well it’s the same with your pet. Instead of giving stuffed toys and treats for Christmas, why not give your pet a dental scale and polish if its breath smells?

This week I had to trim the tooth of a hamster. Most pet rats and pet hamsters will not have a problem with their teeth during their lifetime. If your small pet is happily chewing on toys and food during the day, he will keep his teeth healthy and you will not need to trim them. However, if your furry friend hurts a tooth or becomes sick, it’s possible that tooth overgrowth or another problem will arise that will necessitate a tooth clipping.

That’s me for now, write soon.

Love,

Annette

Qualified Veterinarian

“Your profession is not what brings home your paycheck. Your profession is what you were put on earth to do with such passion and such intensity that it becomes spiritual in calling” Van Gogh

Ever since I was a little girl I was always interested in animals. In school the teachers taught us about human history and I would ask questions about the animals. I always wanted to be a veterinarian – the student advice councillor at my school said I should pick something easier. To me it wasn’t a choice. It was my passion. I didn’t want to become anything else.

With dyslexia and learning difficulties I could have picked a profession that would have been easier to achieve. Would I then be happy for the rest of my working professional life?

I recently qualified as veterinarian from Glasgow University after 5 hard working years. It has been a much tougher road then I though it would be starting this career path. I first completed a bachelor in Animal Science at Aberystwyth university studying in english my 2^nd language. Great to do to get into the terminology, but the veterinary title was always my goal. Then I got accepted at Glasgow university were I have been the past 5 years. I have watched close friends repeat years, I have had resit exams and sacrifices along the way. I feel very fortunate I didn’t have to repeat a year- especially when I was hospitalised with gal bladder stones in 3^rd year, but did my exams anyways and passed them. Some girls in my year had even repeated 3 extra years – so 8 years in total- but they got through. Having had resit exams made me doubt my knowledge- but my councillor pointed out that resitting an exam isn’t always so bad. Some people need longer to go through the material- so you might even know it better now that you have had to repeat it again. I have suffered from exam anxiety trough veterinary school. This is quite common in higher education- and I think its because the pressure of making it becomes so huge. Because Norway (the country I’m from) isn’t part of the EU, I had to pay full fees of 18,750 pounds a year. If you times this with 5 plus an undergrad degree, you’ve accumulated a lot of dept over the years- so the option of repeating a year or not making it wasn’t there. Every time I had an exam- the thunderclouds that was my finances was sat over my head making the anxiety worse. For my final exams we had a power cut in the middle of the exam- although this was beneficial for most students- because they got extra time then to think things over, it worked differently for me. I didn’t spend the time thinking about the answers to the exam, but rather about what would happen if I didn’t pass this exam. I worked myself up to the point that when we were allowed to continue the exam (an hour later), I couldn’t even read the questions on the paper. I couldn’t understand what it said anymore, which stressed me out even further. I ended up failing that exam with 1%. It was devastating. I wouldn’t get to graduate with my class, the class I had been with the past 5 years. I had the resit exam 2 months later after reading all summer. I actually had one of my final exam on my birthday, fun ey. I felt I knew the material well enough for the first exam, but then going over it again all through the summer I knew it even better. I will be graduating with some of my other class mates on the 5^th of December- but until then I managed to land my first job as a veterinarian.

It was my first interview with a great organisation including a new graduate scheme with a mentoring system- rotations through their branches and potential for further surgical certifications on the 2^nd year. I will be the best veterinarian I can be, and I really feel this job will give me a great stepping stone into the working life.

“The greatest oak was once a little nut, who held his ground”.

You work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you enjoy doing.

The veterinarians Prayer:

Oh lord, maker of all living things, I ask that you guide me everyday, with compassion, as I attend to the animals that are in need of my care. Guide me in all decisions and keep me focused. Grant me the ability to console those in need, comfort those that are saddened, and to rejoice in all of your miracles, and please lord, give me courage, to make the tough decisions and the knowledge to help heal in a gentle loving manner.

Love Annette

Paphiakos & CCP Animal welfare spay and neutering

Cyprus cat protection and animal welfare in paphiakos was founded in 1982. It provides shelter for stray cats and dogs and has grown in existence since then. It now provides many services including information, veterinary clinic to the public, free rescue and 24 hours emergency service, shelter, boarding, re homing, pet travel, education programs for school and the general public, a coffee shop and four charity shops. Phaphiakos also provide shelter for old/ injured donkeys. Paphiakos has  many local fundraisers to raise money for the charity and the neutering program. It really is a great organisation

3 Glasgow students: Heather, Victoria and me went to Cyprus and worked for the spay and neuter program at Phaphiakos.  We were welcomed by their vet team: Dr George Sergio, Dr Nefelli , Dr Filipos, Dr George Shikkis.
Generally we did medications for in patients in the morning followed by surgery the rest of the day. We were supervised by the vets and nurses at phaphiakos, but given the responsibility to spay and neuter cats as well as some spays and castrations of stray dogs with the vets scrubbed in. This really was a great placement. I went for 2,5 weeks in may, and I would really recommend other 4^th/final year looking for spay practice to take the trip.

 

You also get days off to explore Cyprus. We joined a gym about 15 min walk from paphiakos and got to borrow their pool. Accommodation is free at Paphiakos.

Dental vets

In final year we have rotations in different aspect of veterinary, but they had removed any practical rotations with dentistry. I think that dentistry is going to be a large part of veterinary practice when we qualify so booked myself a week with Norman Johnston which was the lecturer who taught us dentistry forth year.

Norman Johnston had over the years created a specialist referral hospital for Dentistry up in North Berwick, Scotland. It was about a 2 hour drive from Glasgow and I was very lucky to come across Brenda & Frank at the Richmont cottage, who let me stay with them for my week for a very good price.

Norman had seen dentistry with a lot of different species including, polar bears, sun bears, Asiatic black (moon) Bears, Chengu du, Lions, tigers, jaguars, leopards, cheetah, African wild dogs, gorilla, chimpanzees and may smaller monkeys such as L´hoest, squirrel monkey and lemur.  He’s also treated pygme hippo, red panda and babirusa so you can say hes seem quite the variety of patients. Norman used to teach the dentistry final years at Glasgow, so I think I was very lucky to find him.

My first day I was thought the importance of the Dental chart, which is a chart that vets can use to systematically look at each tooth and grade how much gingivitis or calculus there is on a tooth. This could allow the vet to compare the mouth hygiene of a dog/cat from one polish to the next, and can also show the owners the importance of tooth brushing in animals. Norman used this in some dogs where they located where the owner were missing to brush on the teeth so that the owner could correct this for the next time.

I saw a lot of different things, but the major difference I noticed with a referral dental clinic is that they have 2-3 patients a day, so everything is a lot less stressful and Norman also has the time to properly explain everything to the owners. He takes before and after pictures to make reports both to the vets and to the owner to better explain things, which I thought was an excellent idea.  There was a dog which had fractures its canine down to the pulp, which then had to be toot canaled. There was a cat which had been in a car accident that they had previously placed a wire to connect the mandible symphysis, the wire was removed and its fractures upper canines was removed.

One little dog had mandibular disoclusion (overshot bite 2mm) and lingual displacement of the lower canines occluding into the hard palate. This created wounds in the hard palate. This is an inheritable condition.

I also experienced removal of an epulis over upper incisors that had proliferated from the peridonal ligament (fibrous amilioblastoma) & incisor tumour growth.

Dental vets also showed me how to position dental xrays to cover the tooth & root of the tooth you are investigating as well as developmental settings for the radiographic equipment.

My dog Tasha had fractured here decidious canine whilst playing with here brother and under further examination I concluded that the pulp was exposed. Norman was kind enough to let me fit Tasha in between the other clients on the last day. Because here canines were lingually displaced as well, we concluded to remove both here decidious whilst she was under anesthesia anyways to allow the permanent canines to have the full potential to develop naturally. The operation went fine, and she recovered great without pawing at here stitches too much.

It was a great week, so hope to come back to see north berwick again. Its really a shame we don’t see dentistry practically at the vet school, but I at least feel a bit more equipped to deal with it when Im a new graduate now!

Warren house Equine fertility practice

This week I’m located down in the west Midlands doing Equine fertility work with John Newcombe and Gary Kelly. John Newcombe is one of Britain’s most prominent equine stud vets and is an expert in his field. He works with Embryo Transfer all over the world and Mare Fertility/ pregnancy diagnosis. John also does a lot of research within equine reproduction. Gary is also an equine fertility vet, but he also works with Equine dentistry.

The problem with being a new vet is that it’s expected that you know so much when you graduate even though your not allowed to do much before your qualified when seeing practice. Therefore I decided to travel to Brownhills in West midlands, just outside of Birmingham to gain some experience in equine reproduction with the famous John Newcombe. I flew in from Glasgow on Sunday and already on Sunday evening John was having me rectal examine his mares to locate the uterus and ovaries. He would then ultrasound these structures to identify what stage of the cycle they were to potentially cover them with a stallion.

Rectal examination of horses is quite a tricky thing to do in the beginning, because you might know the theory bind what your meant to feel, but you don’t know how it feels or where to located what your meant to feel. All mares are different as well, which makes it hard to standardise the learning. The only way to learn this method is to practice it, but then again many clinics won’t let you practice this as student, because of the danger that the mare will have a rectal tear, in which case she might have to be put down. John has over 50 horses at his yard, which are all used to him examining them. So I was allowed to examine them when brought in. In the beginning I had problems locating the uterus, especially in the older mares because the uterus was often located much further in and I’m not a very tall person.

I’ve now been here a week and with being allowed to rectal examine horses 3 times a day, I’ve notices a huge improvement. I can now locate the uterus in all the mares that come in as well as locate most of the ovaries. I’ve also started to be able to assess the tone of the uterus body and horns as well as the size of the ovaries. This is important because the uterus and horns will change in tone depending on where in the cycle the mare is. The ovaries will also change in tone right before ovulation as well as some mares being more tender at this point. Its therefore important to assess all of the mares behaviour, not just oestrus behaviour.

Several of the mares were covered/mated when I was here as well. John is doing research where he flushes the Mare after a certain amount of hours after she has been covered to compare how many inflammatory cells there are in the uterus after natural service (stallion) compared to frozen or chilled semen inseminated. Therefore 4-6 hours after the mare was covered, we flushed here, often at midnight.

Warren house if one of the few veterinary clinics in Britain that y regularly and successfully carry out Embryo transfer.  This procedure is when you take a 7 day old embryo from one mare (“donor”) and place it into the uterus of another mare (“recipient”).  The recipient mare will then carry the pregnancy to term and mother the foal until weaning. The donor mare is then free to be mated again to achieve more pregnancies in the same year or continue her competitive career.

Next week I’m of to do Veterinary dentistry at a referral clinic in North Berwich.
Talk soon
Annette

Final Years starts..

Glasgow University has changed the structure of final year to now be a 52 week year- so that everyone has the most practical experience they can, before graduating as veterinarians.

I started my final year on Small animal core rotation, starting with the Dogs trust in Glasgow. This is a surgery rotation meant to let us spay/ castrate dogs. Because I got so much experience In Cyprus when I went do see EMS there, I was pretty confident. Each rotation we have to pass something called a DOPS, which is based of “day one competent” tasks we are meant to be able to do. I was DOPSed on a bitch spay the first day and passed  =). 

The next week I was on Dermatology, ophthalmology and rabbits. The week started with ophthalmology at the Glasgow small animal hospital with George Peplinski. We spent the day sitting in on all his consultations- getting to assess the animals that came in. I was a bit sad that we only had one day on ophthalmology because I enjoyed it so much at Willows referral hospital, aspecially that we didn’t get to see any surgeries. Tuesday and Thursday we were on Dermatology on a practice outside of Glasgow in Paisley, working with Pete Forsynthe in Derm referrals. He was a great teacher and made sure we knew how to do dermatological clinical exam on the patients that came in, along with dermatological sampling, cytology and allergy testing. I had a DOPS on dermatological exam of a hyper springer spaniel, but passed this one as well. Wednesday we were doing rabbit spay/castrations with miss Livia Benato. We weren’t that lucky with the rabbit spays for this day. Two rabbit were schedules for a spay, but one had complications during induction which lead to the surgery being pushed on week, and the next rabbit had a scar on its linea albae. When we opened up, it was discovered that the rabbit was already spayed previously. Therefore most of the day went to rabbit husbandry and handling instead. 

In the weekend I was asked to Guide the buss for the International society of Glasgow to Alnwick castle, which is also known as Hogwarts, where a lot of the harry potter films were filmed. It was a beautiful castle and a really fun day out with Broomstick flying & Medieval fancy dress. Too bad the weather wasn’t too great down in England. The weather in Glasgow had really been amazing the past weeks with temperatures up to 30’c. 

This past week I was consulting for the PDSA aid hospital in Glasgow. I got to consult some of the clients that came in, then the vet had a look and I had to tell him what was wrong, formulate a plan and then talk to the owner and do what was needed. I really enjoyed this form of teaching. It made me feel like a vet, as well as I had the backup from the vet to be sure I wasn’t diagnosing the animal wrong. We had everything from dogs, cats, puppies, kittens, budgies, rabbits etc. It was a lively clinic with a variety of different clinical presentations. PDSA is a veterinary practice for people on housing benefits who can afford the ordinary vets. I really like that there is a place, so that these animals are seen to, even when their owners can’t afford the vet. Although most of what we did was free to the clients, there were a few health/ welfare issues where the owners had left things too long before bringing the animals in. we didn’t have to put any animals down, but severe/ long term treatment was needed on some of the cases. 

Next week i’m in the PDSA as well, but this time on the surgery rotation, so I’m looking forward to that =) 

Also I’d like you all too meet a new individual in my life. Below picture is my new dog Tasha. She’s an 11 week old labradoodle girl. I got here yesterday and she’s very well so far. 

 

 

 

Willows veterinary centre and referral service EMS placement

These two weeks I’m placed at Willows referral hospital, which is located in Solihull, West Midlands near Birmingham. Willows offer EMS to final year students, and seeing I passed all my exams my first stop before starting rotations started here.

Willows is a first class hospital for animals that offers: orthopaedics, ophthalmology, anaesthesia & analgesia, internal medicine, soft tissue surgery, neurology and diagnostic imaging as well as having a first opinion small animal clinic. During the 2 week placement I get to follow different cases in all the different disciplines to get a taster of what the specialist field is like. Each patient often receives care from several different teams. I honestly think that these animal hospitals are set up better than many of the human hospitals. I would join the vet of a certain discipline for consults in the morning until around midday. If the patient required surgery, it would be scheduled to undergo diagnostic imaging and then surgery the same day and under the same anaesthetic and either be sent home the same evening or the next day, depending on if the patient had recovered properly.

Treatment room

If a patient required special attention the hospital had an ICU ward, where the patients received one to one nursing and checks. The nurses that work at willows knew a lot. There were specific nurses for the different allocated areas, weather it was the dog ward/ cat ward, pharmacy, MRI/ CT nurses, prep room nurses or operating nurses, just like for human hospitals. These nurses had all undergone special training. It seemed to make the hospital run more smoothly.

CT

If a patient came from consultations and was now scheduled for a surgery, the patient would get a willows collar with its name written on it (kind of like a hospital wrist band), if the veterinary surgeon was ready to see it in the operating theatre at that point, he would be clipped, the nurse would place an IV Catheter, there would be an anaesthetist vet to write up the drugs it was to get, in the case that it had any special considerations for the anaesthesia e.g: heart murmur, airway problems, geriatric, obese, kidney problems etc. If the animal required x rays for the surgery, the nurses would then take it to the radiography room where they positioned the animals and took the x rays for the vet to have a look at right before surgery. The animal would already be induced by this point, and they had anaesthetic trolleys that they transported the patient to the prep room for the operation.

Prep Room

Having these trolleys would prevent the animal being carried, each of the trolleys had isoflurane anaesthesia attached, a breathing system and oxygen so that the patient could be transported sleeping.  Once in the prep room all the nursing staff had to wear blue coloured scrubs (vs green for the rest of the hospital) and head caps. The animal was then either induced (if it hadn’t had images taken beforehand) or just prepared, where the surgical site would be cleaned. Once the animal was in the operating theatre the surgical site would be cleaned by a trained nurse again before the site would be draped. All the veterinary surgeons would have to scrub in and put on gowns before operating to ensure that this was as sterile an environment as possible. A nurse would sit and monitor the anaesthesia for the patient throughout the operation and keep records of heart rate, respiratory rate, blood pressure, oxygen etc.

Treatment room

Once the operation was done the animal would be taken out to the treatment room where they would be closely monitored before waking up, given their pain relief and any other medications given before being placed in the kennels. There was a kennel staff who would take patients out for walks as well as making sure the kennels were clean at all times.

My first two days I got to work with Orthopaedics. I was lucky to work with Toby Gemmill and Stephen Kalff consulting on initial referrals or post operative care patients. In the afternoon each day they did TPLO’s which is the abbreviation for tibial plateau levelling osteotomy which is a surgical procedure used to treat cranial crucuate ligament rupture in the knee joints of (often large) dogs. This involved changing the angle of the top of the shin bone (the tibial plateau) by cutting the bone, rotating it, and stabilising it in a new position with a plate and screws. Cranial cruciate ligament rupture is one of the most common causes of hind limb lameness in dogs so these surgeons did a lot of this type of surgery.

Wednesday I moved onto Ophthalmology with Mike Rhodes and Carolin Chiwitt. Here I got to see Cataract surgery, keratectomy and cherry eye surgery. Cataracts are an opacity or clouding in the lens in the eye. The lens is normally crystal clear but looks black because the darkness inside the eye. The lens is there to focus light on the sensitive tissue at the back of the eye (retina). Cataracts often form in both eyes and often get worse. It’s more common in older dogs and can be inherited.

phacoemulsification

The only treatment is surgery (but some cataracts are not operable). The surgery is under full general anaesthetic and with a muscle relaxant and then preformed under an operating microscope with tiny instruments. Two small cuts are made in the window of the eye (cornea) and the iris. The eye is filled with a viscoelastic gel to inflate the eye and protect the structures inside.  The cataract is then removed though the hole in the capsule using phacoemulsification which is an ultrasound procedure which is also used on human cataracts. After the surgery a special artificial lens is placed where the old lens was, permanent buried deep inside the eye. The surgery wounds are closed with tiny dissolving stitches. Most dogs will actually see on the day after surgery.

Cherry eye is a condition where the third eyelid gland has prolapsed. Dogs have a third eyelid which sweeps back and forth across the surface of the eye protecting and spreading tear film (also called nictitating membrane) which produced 60% of the tear production of the eye. When it prolapses it becomes visible as a pink mass (lump) near the inner corner of the eye. This condition often affects dogs than cats and young animals between 6 to 12mo.

Cherry eye & Pocket technique

Some dogs are predisposed as well: bulldogs, Shih Tzu, Lhasa Apso, Cocker Spaniels, Great Danes and Mastiffs. It can be quite painful and make the eye dry so surgery is recommended, but not to remove it. Pocket technique was carried out at willows where a little pocket is made and the gland is put into it and stitched closed. It sounds like simple thing to do, but this is also done under a microscope with tiny instruments. Ophthalmology is definatly something for the steady handed surgeons.

Friday was Anaesthesia and Analgesia day where I worked with Alessandra Mathis & Anna Bryla. Most of the procedures at Willows will need some kind of sedation, even X rays, Ultrasound scanning or surgery. There are many different types of anaesthetic drugs and many different conditions which require precautions or use of other drugs. Its therefore important to have a good knowledge about patients with often several problems at once, can and cannot get, to prevent drug interactions and other complications.

New week started and I was placed with Soft Tissue surgery with Chris Shales and Stephen Baines. Here I saw surgeries like Tie backs with Laryngeal Paralysis, Porto systemic (liver) shunt surgery and Linear Foreign body removal. Laryngeal paralysis is when there if a functional failure of the larynx opening the vocal cords during inspiration (breathing in). Most cases are older larger breeds like Labrador Retrievers, Golden Retrievers, Weimeraners, Bernese Mountain Dogs, Great Danes etc. Dogs will typically present with a noise when breathing in, coughing, weight loss, reduced exercise tolerance, collapse, reduced tolerance for temperatures, altered phonation (Bark), problems swallowing food/ water, and sudden respiratory distress. A patient doesn’t have to show all of these symptoms. The condition is caused by a dysfunction of one or both the recurrent laryngeal nerves which supply the muscles holding the vocal cords open during breathing. Treatment which is most effective is surgery “Tieback” also called Unilateral Arythenoid Lateralisation (UAL). Which is basically permanently fixing one of the patient’s vocal cords in an open position. 90-95% who have this procedure will improve significantly, but there are some minor complications which can occur as well.

A portal systemic shunt is a blood vessel anomaly that results in the blood from the abdominal organs (small bowel, large bowel, stomach etc) being diverted to the heart or bypassing the liver. This can be a birth defect (congenital port systemic shunt) or acquired if there is a chronic disease. The problem with having a shunt is that nutrients and toxins that should be cleared from the circulation now bypasses the normal portal blood flow to the liver and results in a small liver and build up toxins in the bloodstream which can cause nervous symptoms. The patients often lack necessary substances to give a good supply of energy and therefore have a stunted growth. The surgery I saw was a puppy only 5 mo old. The patients can present with poor muscle development, behavioural abnormalities (walking in circles, disoriented, unresponsive, quiet, staring into space, pressing head into surfaces) and seizures. A portovenogram was done during surgery which is an x ray examination which allows the liver shunt to be accurately visualised during surgery. A vein draining the small bowel is injected with dye which contrasts on the x ray showing the abnormal liver shunt. Surgery is very complex and dangerous for the animal, which involved locating the shunting vessel and closing it to re direct blood through the liver. This might have to be done gradually by placing a cellophane band around the vessel which causes gradual closure over 4 to 6 weeks, giving the liver time to develop without producing an excessively high blood pressure.

Wednesday and Thursday I was on Internal Medicine with Kirsty Roe, Isuru Gajanayake and Amy Lam. Cases with pancreatitis, hypoglycaemic puppies and thrombocytopenia was seen.  Pancreatitis occurs when the pancreas becomes inflamed (tender and swollen). It occurs mostly in middle ages to older dogs, breeds like Cocker Spaniels and Terrier breeds. Symptoms ranged from mild signs (reduced appetite) to very severe illness (multiple organ failure). Most commonly it causes lethargy, loss of appetite, vomiting, abdominal pain and diarrhoea. It’s diagnosed with the history along with abdominal pain on examination, but because so much else can cause these symptoms a blood test and ultrasound scan of the abdomen is needed to rule out other conditions.

MRI

Today was unfortunately my last day here at Willows. I was placed with Neurology and Raquel Trevail who had done here residence in Glasgow when I started vet school. We had some follow up cases and also had a patient with Traumatic disc extrusion – slip disc which is when a small fragment of material from the centre of the disc suddenly breaks free and travel through the outer ring of the disc and collides with the delicate spinal cord. Diagnosing this was done with an MRI scan of the animal which I find quite amazing. Willows had a special Diagnostic team who works with Ultrasound, CT and MRI for all the cases that need imaging. Paul Mahoney, Andrew Parry, Lizza Baines and Andrew Tanner are all specialist in Diagnostic imaging to make the best diagnosis and make each sequencing required specially for that animal and that current problem. These two weeks have gone very quickly and I feel very fortunate to have had the opportunity to work with so many great vets & not to forget the nurses. I hope I’ll come back here sometime in the future.

All the best
Annette

Ps: Pictures are from Willows facebook or their website www.willows.uk.net