Small Animal Surgery

This was a 4 week rotation that was split into 2 weeks of soft tissue surgery and 2 weeks of orthopedic surgery.  The students that were on the rotation with me were Misty C. and Jacob N. (I forgot to get a group picture :( )I was on soft tissue first with Dr. Milovancev.  I had a total of 12 patients and 7 of them went to surgery and I was able to scrub in. The surgeries were really varied and I got to see many different procedures from pulling teeth associated with an oral tumor (epulis) to a septic abdomen. My favorite patient was a dog that had a huge spleen that took up 75% of his abdomen. He was a pretty good sized dog and when we took him to surgery to remove his spleen we were all surprised at the enormity of the splenic mass. We all tried to estimate just how much it would weigh during the surgery and afterward I weighed it and was shocked to find that it was 9 pounds! I had to adjust my patient's medications after his surgery because he was now 9 lbs lighter. He did well after we sent him home and the best news was that his splenic mass came back as a benign lesion.  We also had a lot of brachycephalic dogs come in for corrective surgery to help them breathe better. Brachycephalic means short head/face and example dog breeds include English Bulldogs, French Bulldogs, and Pugs. These dogs often have difficulty breathing and require surgery to make their nostrils bigger and shorten their soft palate to help them to breathe better.

The entrance to one of four small animal OR rooms.

Scrubbing in for surgery was fun. I was really nervous at first but I grew to enjoy and look forward to it. Scrubbing in entailed putting on a cap and mask, scrubbing your hands and arms for 5 minutes and then  putting on a sterile surgical gown and gloves. Most of the time I would just oserve the surgery and help retract things (legs/body wall etc.) for the surgeon. Occasionally Dr. Milovancev would let me try my hand at things like cauterizing blood vessels and he taught me how to use a ligasure device that cauterizes and cuts at the same time. This device was used to remove the spleen from the patient described above and it was pretty nifty. I would also use scissors to cut the suture tags for the surgeons, I got to lavage tissues with saline and a bulb syringe, and I was allowed to suture the skin on several of my patients. I tried to always be prepared and knowledgeable about the surgical procedure because I was sure to be quizzed about it during the surgery.

One of the owners sent me a thank you card with a picture of my patient and she expressed her appreciation for how I took good care of her dog while she was in the hospital. I didn't get this card until I had already moved on to the orthopedic surgery part of my rotation but it sure made my day to know that someone appreciated my hard work.

Thank you card from a client. :)

Orthopedic surgery was much different but was also a good experience. Dr. Warnock was the surgeon on clinics while I was doing the ortho rotation. I saw 20 patients on this rotation and scrubbed in for 3 surgeries. There was a lot more re-check appointments with follow up radiographs (x-rays) to assess bone healing. I felt like ortho was busier with less down time to work on paperwork. Often I would leave around 7pm to go home and eat while working on paperwork or studying up for procedures that would be going on the next day. The residents were great though and helped the students out where they could. I got to practice doing orthopedic and neurologic exams and I feel more comfortable doing them after finishing this rotation. 

Things that were in my pockets or on my person at all times during this rotation.

On ortho, I scrubbed in on two fracture repair surgeries and one TPLO. The TPLO procedure was really neat especially because I had never seen one before. This procedure is done to treat a ruptured cranial cruciate ligament in the knee joint to change the weight bearing surface of the tibia and make the leg functional. Dr. Warnock let me handle the arthroscope for a minute which was pretty neat. The scope is used to assess the integrity of the cruciate ligaments and the meniscus in the knee joint before starting the TPLO surgery. I got to drive the scope around the knee joint with her help and I got to take pictures of the inflamed joint. She also let me drill a hole in the bone and place a screw in the TPLO plate. It was so cool! The picture below shows an x-ray of a dog leg following a TPLO procedure. 

This image is from the web. X-rays after a TPLO. I was able to place the 2nd screw from the bottom in my patient.

My other surgical patients both had a fracture of bones in their front leg. One was an older dog with a fractured ulna and luxated radius (aka Monteggia fracture), the other was a young puppy with a fractured radius and ulna. I got really adept at applying modified Robert Jones bandages on both of these patients while they stayed at the hospital. I also learned the awesome healing properties of Manuka honey as we applied some to a few bite wounds and they started healing well. Both of these patients got their fractures fixed with a plate and screws and an omental graft. The omentum is an organ in the abdomen that is often used as a graft due to it's ability to provide good supply and therefore increase healing of the fracture. The older dog was not spayed and since we would be going into the abdomen anyway to retrieve the omentum the owner asked us to spay the dog at the same time that we repaired her fracture. I was able to do most of the spay and that was pretty neat and went well. 

My patient's spay incision. I closed the skin with a ford interlocking pattern.

My skin sutures in a little puppy leg after her surgery. A cruciate suture pattern.

One of the many bandages I applied while on the ortho rotation.

Overall, I enjoyed this rotation but I definitely was burned out by the end and was ready to return to a sense of normal life. The time I spent at the hospital was about 60 hrs per week. I had a total of 32 patients thought not all of them had surgery or were hospitalized. Most days I was eating and drinking on the go as I was walking to the pharmacy or in between seeing patients or while I worked on paperwork. Comfy shoes were a must as I was on my feet most of the day. Students were responsible for 7 am and 7 pm patient care for any hospitalized patients even on weekends so sleeping in on weekends was out of the question. I also discharged several patients on the weekends so I would go in later during the day to discharge them as well. I learned so much and enjoyed the variety of things that I got to see and do. I got better at communicating with clients about their animals and I grew to enjoy calling them with daily updates when their pet was staying in the hospital. Most of the people I talked to were so appreciative and it made me feel good to let them know that their pet was in good hands and doing well.

Magruder Hall @ 7 am

Magruder Hall @ 7 pm Same Day.

 While on this rotation I figured out what I will research for my Senior Paper. I had several patients on the ortho service that had orthotic braces. These braces help with mobility by providing support for injured limbs. They are sometimes used as an alternative to surgery or in conjunction with surgery. I find this topic in vet medicine very interesting and we didn't cover it in our school lectures so I decided to pursue a senior paper topic about orthotic braces and their uses in veterinary medicine with my mentor Dr. Warnock. I'm very excited about this topic and though my Senior Paper isn't until March my goal is to work on it now and get as much done as I can.

An Example of an orthotic brace stabilizing the knee joint. Image from the internet.

Other things of note: 

- It was surreal to see the new 1st years starting school and remembering when I was in their shoes four years ago! I can't believe I am a 4th year vet student and I graduate in June.

-  My date is set to take the NAVLE on Dec 5th. This is the national licensing exam that all vet students must pass in order to practice veterinary medicine in the U.S. It is a 7 hour computer based exam that covers everything learned in veterinary school. 

- My next rotation will be 2 weeks of overnight shifts. One week in the large animal hospital followed by a week in the small animal ICU. Wish me luck with staying up through the night and sleeping during the day.

Anesthesia

I've now completed my 3 week rotation in anesthesia. Also, I am now about 1/4 of the way done with my senior year! It's gone by pretty fast and I have learned a lot. I was very nervous a the beginning of the anesthesia rotation and by the end I was able to relax and enjoy it. 

Me getting ready to induce my patient for a surgical procedure

I was able to get more comfortable anesthetizing animals for surgery or other procedures like CT or MRI scans. I gained knowledge about when to use certain drugs and when to avoid them. I also got to see the differences between anesthesia in dogs and cats versus horses. I got to practice placing IV catheters in dogs and got more confident at it. I was able to do an epidural in a dog and I placed arterial catheters in horses.

A typical day would go as follows: We would arrive in the morning with an anesthetic protocol that we created for a particular case that was going to need anesthesia for a procedure that day. (Each student would typically have 1 case for the day) The anesthesiologist would listen to our plan and make changes to it as needed. Then we would make sure everything was set up in advance for the procedure like the anesthesia machines and other things like fluid lines, blood pressure cuffs, catheter supplies, endotrachial tubes, etc. At the appropriate time we would pre-medicate the patient to sedate them for IV catheter placement, then we would induce them with more meds,  place an endotracheal tube and hook them up to the inhalant anesthesia and a bunch of different monitoring equipment (ECG, blood pressure, ventilator, temperature, etc). 

The induction room where animals would be prepared for surgery.

If the patient was getting a surgical procedure done they would be prepared for surgery at this time (hair shaved, epidural, surgical site scrubbed, etc). Then the patient would be rolled into an OR and hooked up to the anesthesia machine and monitoring equipment in there and positioned for surgery. Then we would monitor the patient while the surgery took place making adjustments as needed and administering drugs as needed. For this part you would be basically on your own with the anesthesia techs or residents ready to respond to a call on the walkie talkie if you had any questions or needed help. They could also monitor your patient from other rooms and usually would show up before you even had a chance to call them if they noticed something off.

 When the procedure was over the patient would be disconnected from all the machinery and moved to its recovery destination. When they were awake enough we would remove their tracheal tube. We closely monitored body temperature and warm them up as needed.The whole thing would be documented with a computer program and when you were done you printed out a anesthetic record that a tech or resident would go over to make sure there were no errors. We would have rounds in the afternoon and talk about our individual cases and then get assigned a case for the next day.

Horse anesthesia was similar but different. The biggest difference was how we moved them. Moving anesthetized horses required a hoist system on a track in the ceiling to move them from the induction stall to the operating table and then to the recovery stall.

Inside one of the Large Animal ORs. Orange door = induction stall, Blue door = recovery stall. Part of the operating table is visible in the right of the image. 

Large animal anesthesia machine. Big animals require big tubes!

Overall I was the primary anesthesia student for 2 horses, 7 dogs, and 1 goat. One procedure I did was an after hours emergency procedure and I got to see how they do a blood transfusion in a dog. The dog did well under anesthesia and surgery. I really enjoyed helping other students with their cases when I didn't have anything going on. I would help input data in the computer, help them set IV catheters by restraining their patient, and help with set up/clean up. They all did the same for me. I'm glad that I was with a really great group of students :) 

Students on the rotation: Jacob, Katelyn, Me, and Steen

We are being goofs and wearing dog muzzles on our heads :) 

Next up... 4 weeks of Small Animal Surgery. Yikes!!

Clinical Pathology

Last week I completed a 1 week rotation in Clinical Pathology. I enjoyed the rotation a lot especially because it was a bit more laid back and also because it was fun. We practiced looking at cells under the microscope for abnormalities. We spent a lot of time at the ten-headed microscope which allowed our instructor to drive the microscope and point out things while we all simultaneously viewed . I meant to get a picture of my group at the microscope and totally forgot :( So here's a picture from the internet to illustrate what the microscope was like.

The microscope was like this but with 10 heads (viewing ports)

We looked at all kinds of cells. Cells that make up blood, cells from masses, cells in abdominal fluid, etc. Emphasis was mostly on telling normal from abnormal and cancer from regeneration. Below are just some cool pictures of cells that I found online that are similar to things we looked at under the microscope.

Red Blood Cells in rouleaux formation (coin stacking) - normal in Horses and Cats

What lymphoma looks like in a lymph node aspirate from a Dog

When we weren't looking at things under the microscope we were practicing interpreting blood work and test results and coming up with differential diagnoses for both large and small animals. We also practiced making blood smears and doing urinalysis practical skills. This rotation was very clinically applicable because everything that we practiced and learned will be used in a clinical setting every single day. 

We ended the week with a Food Friday. We each brought something that fit our chosen theme of Mexican food and had a yummy lunch. After lunch we had an open book practical exam and that ended the rotation. My next rotation will be a 3 week rotation in Anesthesiology.

Oncology Rotation

Friday was my last day of a 2 week rotation in oncology. Oncology refers to the study of cancer and on this rotation I saw patients that were being treated for various forms of cancer. It may sound like a sad rotation because there no cure for cancer and our main goal was to maintain a good quality of life for as long as possible. It was sad at times but it was also rewarding to get to know the patients and their owners and see how much these people cared about there pets.

 I was able to do more doctor-like things on this rotation like bringing animals into an exam room, doing a physical examination and take a thorough history from owners. After that I would leave the room and report my findings to one of the oncologists or residents and after discussing it we would go back in and they would ask more questions and do an exam themselves. After this they would talk about treatment options or changes to the current treatment regimen. Some animals received chemotherapy and it was neat to be a part of that and see all the extra safety precautions taken when administering those drugs.

It was a very busy rotation but that made it go by fast. I got better at drawing blood from the jugular vein in the neck of dog and cats. I got better at taking fine needle aspirates of skin masses and staining them to look at under a microscope. I also got better at feeling  all the lymph nodes although there were certainly a few that I missed and I was glad that I wasn't the only one checking for enlarged or firm lymph nodes. I got better at writing discharge papers for owners telling them what we did to their pet that day and providing information about their pet's particular form of cancer. I learned about a lot of chemotherapeutic agents, when to use them, and common side affects associated with them. I learned about different treatments for many types of cancer. Surgery, Chemo, and radiation are common treatment options for animals. Some of my patients needed x-rays, ultrasounds, or CT scans to determine the extent of the disease to help owners make treatment decisions.

Supplies needed for a fine needle aspirate (FNA) - Pic from the web.

I feel like I worked hard and tried to do my best on this rotation. There was a really steep learning curve at the beginning because I was not yet familiar with the computer system used in the hospital or the main protocols like submitting blood work or writing prescriptions. Each day started at 8 am and the time I left varied a lot. The earliest I ever left was 5 pm and the latest was 8 pm.

Overall, I'd say that I enjoyed this rotation but I'm also glad that it's over. I had a total of 24 patients and I saw 3 of them twice. It was nice to see a patient that I'd already seen previously because I already knew their history and what we were doing for them.The most common types of cancer that my patients had were lymphoma, mast cell tumors, and melanomas. The most common breed of dog that I saw was Golden Retriever (5).

I wish I had some great pictures from this rotation but unfortunately I do not because we are not allowed to post pictures of patients in the hospital. My next rotation will be 1 week in clinical pathology.