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Archive for the ‘Final Year’ Category

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

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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 4th/final year looking for spay practice to take the trip.

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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.

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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.

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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.
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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.

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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.

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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.

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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.

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

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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.

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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!

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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.

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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.

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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.

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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.

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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.

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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.

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

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Willows veterinary centre

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.

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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

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.

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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

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

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. IToby Gemmill and Stephen Kalff, 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 TPLOstabilising 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.opth 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

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

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.

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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.

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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.

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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

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

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

 

 

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