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

 

 

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Rhino poaching – a battle!

I finished my last day here in South Africa treating a rhino for an abscess on her hindquarters. She was darted from a helicopter, when running with 2 other grown rhinos and a calf about 8 months old. I was on the ground leading the “buckie” (truck) to where the helicopter instructed me to go when the animal was darted, and saw the rhinos running over the open grass field. I can’t explain the feeling of awe that went over me looking at these magnificent creatures. They got as close as just 20m away from me; full grown rhinos with horns! Unfortunately, it’s not often you see them with horns anymore. The reason for this is poaching.

Facts about rhinos killed in southern Africa is shocking. In 2009, 122 were killed; in 2010, 333 were killed; in 2011 448 were killed, including 19 critically endangered black rhinos. 200 were shot by pseudo hunters, 28 poached in Zimbabwe, 27 poached in Kenya and two poached in Swaziland reaching a shocking 705. In 2012, 281 had been killed by the end of July and it’s expected that this number will reach 595 by the end of this year. Numbers are increasing almost daily (facts from Getaway Sept 2012).

There has not been any medical proof found by traditional medicine that the popular myth that rhino horns (ground to powder) is an aphrodisiac is true. A politician in Vietnam ran a television campaign about how rhino horn cured his cancer, which caused an increase in demand. Other than that it’s believed that it reduced inflammation, fever and hangovers. In Yemen, the horns are used as a handle for daggers that men own. The fact that rhino horn is illegal and so rare causes the black market prices to rocket. A 2 kg rhino horn can go for 2 million South African rand. Seeing as minimum wage is so low in South Africa, poaching is therefore an alternative some choose to supplement their income. If successful they can earn a lot. A grown rhino can have horns up to 6 kg. Another problem is speculators who hedging against rhino extinction.

There are a lot of corrupt people in the anti rhino poaching industry as well. At the moment there is a trial going where a game farmer and two vets are charged with killing more than 39 rhinos and selling their horns on the black market. The cost of a rhino is a fraction of what you can get for its horn, so some game farmers might be tempted to hunt their own rhinos for their horns. I asked a farmer who said that the cost of a rhino could be around 240 000 R, whilst its horn several million. I find it horrible that vets, who are there to look out for the welfare of such animals, could be in on this. It doesn’t help the public’s trust in the vets that actually do good.

Poachers don’t always know how to properly kill the rhinos when they shoot them. They therefore often leave them hurt to the point that they die a slow death. The poachers won’t hesitate to start dehorning the animal whilst it’s still alive. I heard that poachers will shot the calf as well if there is one. The calves do not have horns, but because they often stay with their mums, the poachers are often afraid of them. Therefore rangers can end up finding both the female and calf rhino dead. I was told that the vet I worked with was called out once when the female rhino had been poached. The calf was found next to her alive, but soon after the calf got really sick. When the vet came, he found
that the calf had been shot too, but at a place that wasn’t very visible. The shot had penetrated the chest cavity right next to the right front shoulder, which penetrated the lung and diaphragm on the right side. This unfortunately caused the calf to die a few days later.

So I’ll try and write about some of the good the vets do to prevent poaching, from my experience the past weeks. Some farmers choose to dehorn their rhinos to prevent the animals being killed by poachers. If they don’t have any horns, there won’t be a reason for them to shoot the rhinos. The vet would dart the animal from a helicopter, then monitor its anesthetics safely, whilst using a chain saw to cut off the two horns. Care has to be taken not to cut too deeply, because this can cause blood loss. The process is documented with photos and a person from the government wildlife conservative has to be present. The vet also has to apply for a permit to do the procedure, which last
a month at the time. After the horn is cut, diesel is poured on the horns and they are burned to ash, which is documented again. A problem with the application to get a permit is that this process is very slow and by the time the vet gets his licensed for the needed rhino, it might have been poached in the meantime. Another problem with dehorning the rhino is that the female rhino uses its horn to defend her calf from the male rhinos, which can cause the calf to die if the mother can’t protect it.

Another approach is to microchip the horns. Another farmer we visited didn’t want his rhinos to live without their horns. They lose their pride and beauty if you take away their horn. So in this case the rhinos are darted. Then a small hole is drilled in each of the two horns and a micro chip is inserted into the horn. The drilled out bit is placed in jars, along with blood samples and some pieces of hair. This is all sent to a lab to be DNA profiled. If a rhino poacher is caught and some form of DNA is found with the poacher it can be traced back to that killed rhino and the person can be trialed. The problem with this again is that it won’t prevent the poacher from killing the rhinos in the first place. A person who has a permit to keep a rhino horn, will have to have a microchip in the horn, there are then people who come and check yearly that the person has not sold that horn on the black marked.

It is horrifying to think that these magnificent animals might become extinct in my lifetime!

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Glasgow 150 years of excellent veterinary teaching

This year 2012 is the 150^th anniversary of the Glasgow University School of veterinary Medicine was founded by James McCall in 1862.

The 5to 7^th of October we had a “New Horizons Research Symposium” providing both history and current perspectives on veterinary research at Glasgow. It was amazing to see how big a contribution Glasgow vet school is making to the research in its field and made as all very proud to be a Glasgow vet student. The final James McCall Memorial lecture was delivered by out former dean Professor Stuart Reid, who is not the principal of the Royal Veterinary College in London.  All the student came for the Friday lectures. But all in all there were over 400 alumni that came from all over the world for the weekend events.

I also bought a book that has been published: The Glasgow veterinary school 1862-2012). If anyone else wants to buy it. I can be bough online www.universityofglasgowshops.com or at amazon.

James Herriot books has always been a great pride of the Glasgow vets. Alf Wight – pen name James Herriot graduated from Glasgow. For the 150year anniversary his son Jim Wight came and had a talk to all the student: very inspirational as a vet student.  His also given an interview you can watch here:

Jim Wight Interview

James McCall founded the Glasgow Veterinary College in 1862, one hundred years after the establishment of the first Veterinary School in Europe. The first class had 10 students enrolled and lectures lasted three hours a day. The fees at the time for the three year veterinary course were 16 pounds for the first year, 18 pounds for the second and 20 pounds for the third. The student numbers continued to increase and one hundred and forty-three student had enrolled by 1894.

Glasgow Vet 150 years

Today the university of Glasgow veterinary school is pre- eminent in teaching, research and clinical provision. They have researchers, clinicians and students from around the world providing an expert referral institution for Small animals at the Small Animal Hospital, Horses at the Weipers centre for Equine Welfar and Farm animals at the Scottish  centre for production animal health and welfare.  Glasgow also keeps getting awards for its research not only in Scotland but around the UK as well.  The school is also accredited with the American Veterinary Medical Association (AVMA). The north American veterinary licensing education (NAVLE) pass rate is up to 87% for 2011. We also became associated with SCAVMA(Student Chapter of the American Veterinary Medical Association ) last year as the first UK vet school, in addition to our Accreditation with, RCVS (Royal collage of veterinary Surgons), BVA (British veterinary Association) and BSAVA (British Small animal Veterinary association) plus a few more =)

Glasgow school of veterinary medicine is located on 80 hectare on the northwest boundary of Glasgow city, about 30 minutes from the main university at Gilmorehill. The school has 190 hectars commercial farm and research centre at Cochno, 15 minutes from the Garscube campus. There is about 179 staff: academic, research and support with additional 65 postgraduate research students and 30 post graduate clinical scholars and 500 undergraduate students here.

The university of Glasgow is constantly pushing their students to the limit academically and clinically. They emphasise that being a student is not only in the classroom but in the veterinary community as a whole. Being a good veterinarian isn’t just about small animals or large animals, it’s about incorporating veterinary medicine into our lives and giving back to the community, wether that’s is here in Scotland, Africa, India, Scandinavia or America. They focus on producing well rounded veterinarians that have the ability to flourish once they graduate and enter the great big world.

Me and Professor Stuart Reid

Me and our old Anatomy Professor Jack Boyd

All in all I can say that I’m proud to be a 4^th year vet student here at Glasgow. I’m lucky to have the chance to be a part of their family. Cos that’s that we are here at Glasgow- one big Family

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The last of second year

The last blog I wrote in February ended with my mum coming to visit, we had a lovely weekend where she stocked up on some homemade food for me to have in the freezer. She made Norwegian Kjøttkaker and Labskaus..mmmmm.

A couple of weekends later Ivan came to visit. At this time id been asked to photograph the 5^th years for this years naked calendar. They aren’t actually naked, they do wear underwear and then place animals or instruments to hide the underwear. The money for the calendars are given to charity. It was a lot of work trying to organize the 5^th years and get them to meet at the sites that we were photographing in the end, but everyone seemed happy with the outcome. I’ve always been a landscape photographer so I got a crash course by Scott McGinley (http://www.scottmcginlay.tk/)  who is a graduated vet from Glasgow. He had been doing the calendar before and gave me some really good pointers. He also helped me edit the calendar=)

Anyways Ivan came to visit. Spring was coming to Glasgow compared to Norway which still had now. I went hacking with Ivan on horse, which was quite funny seeing he hadn’t been riding since he was 8 years old. I must say he did very well, but he was walking a bit funny on the next day! We also went reading at Garscube state park and went to the lock 27 with the other vets one of the nights which was very nice.
I decided to do something fun and educational one day and went to Strathblane Falconry, which works with birds of prey. For two hours, north of Glasgow in the country, we worked with Graeme and his birds, learning about the different popular breeds, seeing them fly, basic first aid, how to handle them when the come into the clinic, and common diseases we might see with them. At the end, we even got to have one land on us. It was truly amazing to see these birds and I really would like to spend some more times with these amazing creatures. Graeme knew everything there was to know about these birds and I think we all walked away a little bit more interested in Birds of prey.

After the dramatics and the hospital during easter break I came back ready to kick some butt and get the may exams done. As I said in my last blog I had convinced the doctors to let my try and take my exams even though id missed all the reading during easter break, but its better to have a few resits in may than all of them. We had 1 month to read all that we could to pass our exams. Me and Brianna paired up like last year. We worked out from 7-8 then showered and started reading at 10 everyday until 10 at night. It was hard days so when the annual Glasgow Rodeo came we decided to read in the morning for then to give our self a treat. The committee for this year’s rodeo was from our own 2 year (the 51th annual Rodeo) and I must say they had done an amazing job getting everything in tip top order for the day. There were dog shows, duck herding, birds of prey, agility, stands from all the animal charities and some breeds, ferret races, exotic and small animal tents, face painting, amusement parks, farm animal etc. Me and Brianne got our faces painted with flowers.

In the evening of the rodeo me and Brianna had got tickets to the Scottish Ballet who were played Alice in wonderland. They are amazing dancers, but they had changed the piece, so I wouldn’t say I liked that Alice in wonderland as much as others I’ve seen before.

 

 

 

 

My mum came over for a weekend and cooked for me and Brianna. She also helped us made a plan for the remaining days until our exams so that we would get an idea to get through it all. Even though she was there, we still ran or did Tracy Anderson every other day and read from 10am to 10pm. There was as you see underneath  quite a lot of material to get through and the picture of all the labelled noted under was only in anatomy.

 

 

Time flew, It was warm and sunny in Glasgow so we really just wanted to go outside rather than sit inside all day reading for professional. One day Brianna got flowers on the door from here boyfriend Ryan in the US. I told Ivan about it at night when skyping him. A couple of days later I got a huge package outside my door when I got home at night. Inside was an apple tree. There was a card. This is the tree of knowledge, love Ivan. I laughed so hard, I’ve never been given a tree before and he assured me that a tree lasted much longer than flowers:P
The professional exams came and we started off with biochemistry. The following day we had physiology. Physiology was cumulative meaning they would test you on material from both year 1 and 2. It was a double test, where you first had 3hours in the morning, then a break and 2 hours in the afternoon. Even with all this time, I felt like there wasn’t enough time in the test. We had a day break and then Husbandry for 3 hours. We were lucky and had the weekend off before anatomy written was on Monday and practical was on Tuesday. This year was different than all other years because you no longer have the opportunity to have an oral if you are between 45-50%. In phys I was unfortunate and had about 47% and therefore had a retake. But because of my situation with the gallbladder I kind of expected a resit. Just happy it wasn’t four, but only 2. I’ll catch you up on the summer break another day.

 

 

Love

 

Annette

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Winter has reached Glasgow

After the pep Rally and Women football karaoke fun  at Shanghai Shuffle, Dick day was finally here! We had all worked so hard, with extra practices like fitness or keeper practice. Dick day is the day Glasgow vets play the Edinburgh (dick) vets in Hockey, Rugby, Football & netball. The Women teams of Glasgow beat the Edinburgh women but the Edinburgh men won over Glasgow men, but all in all Glasgow Won the day, which was great seeing it was at home ground this year.

Yesterday it started snowing, I ran outside at midnight to be snowed down. Really reminds me of home and how much I wish these exams were over. They have given us Christmas exams 6,7,8,9 & 10^th of December this year. I leave for home on the 10^th in the evening. Can’t wait! There is so much reading for exams this year because we have gone through almost half of what we are meant to learn this entire year already. Hope my brain can cope with all this information. I also moved into a two bedroom flat at Killermont view after Stuart informed me that his brother was going to live at the flat permanently. Seeing his brother was an arrogant, rude, unliveable guy + his girlfriend, I immediately started looking for a new place. This flat is great and just behind the vet school. Its got wooden floors and IKEA design so kind of reminds me of home. All I need now is to find a flat mate, which can be tricky around this time of year. When I woke up today, everything was white and I walked over to the vet school seeing dogs playing in the snow. It really made me Miss Theodor and think of getting a dog here. Anyways back to exam reading, I’m at the James Herriot library now. Miss you all, wish me luck

~Annette

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