Orthopaedic Surgery classes

Today we started our surgery practical classes which is pretty exciting as it’s one of my favourite subjects.

We started off with a lecture where they describe a procedure and then we practice performing the procedure on cadavers. We got to do fracture repairs with normograde and retrograde IM pinning, cerclage wires and plates.

All the best orthopaedic surgeons get their gloves stuck drilling IM pins 👨🏻‍⚕️🤦🏻‍♂️

This little piggy...

...got castrated.

This morning we headed to a private pig farm to do some pigs work and it was actually really fun!
We had to don these sexy disposable overalls which are one size fits all, so a little snug.
My group started with castrations which I've never seen done in piglets before, the best age to do them is younger than 7 days old but the ones we had were just over a week so that we could practice giving intra-testicular anaesthetic blocks and being bigger I think they were a bit easier.

It was the usual "no no you do first" with people nervous to do it so I went first and it was pretty straight forward - kind of like a cat (scrotal incision and exteriorise) and a calf (using emasculators).
Afterwards we applied a topical antibiotic powder, injected iron, vitamins E, D, K and vaccinated them.

We didn't take our phones in to the pigs because of biosecurity with African Swine Fever and zoonotic Salmonella etc so no photos of piglets!

Canine Blood Transfusion for Lino

Lino came into the ITC having been inappetent for several weeks, we found he had a severe chronic anemia with his Red Blood Cell count being a fifth of what it should be.

His owners had another dog, who was used as a whole blood donor alongside supportive therapy thanks to donated transfusion sets from the USA.

Dogs can be given a first time transfusion safely without being blood typed, but second transfusions must be matched for reactions

Emergency Exploratory Laparotomy

After a quiet day we went down to dinner at 8:30 and as we were walking past we noticed there was a case in the clinic so stopped to see what was going on. A young Rottweiler presented collapsed with acute abdomen screaming in pain; the owners said it started today...

We placed an IV to put him on fluids and do a clinical exam while the vets took a history in Tamil language. He is regularly fed chicken bones, was straining to pass feces and had vomited so due to the acute nature we suspected he had a foreign body or GDV.

X-rays were taken which didn’t really show anything (but useful as it ruled out a GDV) and an abdominal ultrasound was also unremarkable except for a small spleen. After strong IV pain relief he was still screaming in pain so the decision was to take him to surgery for an exploratory laparotomy.

The team rushed to get everything ready including kits and warm fluids but the ex lap showed he pathology on liver and spleen; both were pale and discoloured.

Vinay scrubbed out to speak to the owners and advice of a poor prognosis, especially given the limitations of being a low resource charity. The owners elected to close the abdomen and try medication but saw how much pain he was in after recovering from surgery, despite strong pain relief, and sadly he was euthanised.

First ever cat spay

I've been lucky enough to do lots of surgery so far including lots of cat castrates and many neuter surgeries on dogs, but never done a cat spay so this seemed like a bit of a milestone.

Unfortunately an Indian politician died yesterday so the roads are closed and the boys were unable to go and catch or release dogs, so we were given owned cats to neuter.

As with all other surgeries, the cats are given a premedication, an intravenous catheter placed for induction of anaesthetic and perioperative fluids. Here she is after being clipped and just waiting for a surgery table so she can be scrubbed.
It gets pretty cold in Ooty so you can see the hot water bottle which has the iv line running under it to to keep her warm, and the hair drier which can be used in recovery to warm them up.

I took a midline approach and opened the abdomed, searched for a couple of minutes and couldn't find her uterine horns or ovaries. We checked, twice, to make sure she wasn't a male so the supervising vet stepped in to find the uterine horns, which he was unable to do.
Another vet scrubbed in to check, and another, who were all unable to find them! Eventually we found a cervical stump which would indicate she had been spayed before but as there was no midline incision scar and her eartip was not clipped, she must have been done flank and by someone else.

All very odd but I closed the abdomen which was good practice and will wait for another opportunity for my first proper cat spay!

WVS Surgical Training Course

I've just completed the WVS Surgical Training Course at the ITC Ooty in India and can honestly say it's been one of the best experiences of my veterinary career so far.

The course was well structured, including everything I'd hoped to cover and more. By the end of the two weeks I'd done 8 dog castrates, 8 bitch spays and a scrotal ablation.

The ITC work under 'limited resources' in that they don't have access to a huge range of drugs and equipment we do in the UK. They have had anaesthesia available but only at one operative table so it's used for longer surgeries but neuters are done with Total Intra-Venous Anaesthesia. We have a protocol using 10 injectable drugs for anaesthesia and analgesia (pain relief).

At first it sounded daunting and we have to monitor patients much more closely under anaesthesia but the protocol was explained well and the lecture we had was great so I understand the drugs we use and why we used them. It also meant that we could use the protocol in individual animals should they need more pain relief or anaesthesia.

Even though they're under limited resources the staff they have are amazing, particularly Dr Vinay and "the boys". The boys are a bit like our nurses and technicians/VCA's in one. They catch the dogs for us to sedate then prep and scrub them for surgery as well as monitoring anaesthesia and prepping all our kits, surgery and much much more.

The care each and every dog receives is second to none, with constant monitoring throughout anaesthesia and recovery, we even had pulse oxymetry which some clinics I've been to back home don't have.

I've done a fair bit of work experience and assisting in surgery back in the UK but have always had a vet scrubbed in explaining the procedure, checking my ligatures and any bleeding.

At the start of the course we had vets scrubbed in to supervise but I'm now confidently doing dog castrates and bitch spays all by myself with no assistance, complete with intradermals.

Intradermal suturing is something I've never done before but as we are operating on free roaming dogs we want them recovered and returned back to where they came from as quickly as we can. Intradermals mean we don't need to take stitches out after a week.

During rounds the following morning we checked every dog giving them a wound score and pain score followed by pain relief and a rabies vaccination.

That also gave you the opportunity to check your tissue handling and intradermal technique and we could see how our wound scored improved over a few days.

During our first week the ITC neutered their 20,000th dog which is a huge achievement and shows the expertise and experience the staff have. We celebrated with a giant chocolate cake and dog 20,000 was given extra treats that evening.

Accommodation was in single sex dorms which were clean and better than I anticipated in that we had wifi and a flushing toilet! The food provided three times a day was amazing, all vegetarian and not too spicy as that could be added individually.

The cook definitely ramped up the spice slowly over the two weeks which we loved.

I would recommend the course to every vet student and new graduate wanting to gain confidence in soft tissue surgery.

I spent a further two weeks after the course travelling around India and found myself comparing everything to Ooty. While I fell in love with India, the cooler climate and calmer pace of life in Ooty suited me perfectly and I would love to return to the ITC in the future as a volunteer vet.

Waking up to a text...

"Do you want to come and spay a quail and amputate a Harris' Hawks wing?"
...and of course, I did!

One of the vets in the Exotics clinic and a friend were doing a salpingectomy or hysterectomy on a quail; something they'd not done before so I just went down to help out monitoring anaesthesia and flicking through the surgery textbook.
Initially we started with a left ventral incision but found it hard to identify the ovaries so then we went midline, which gave much better visualisation and the procedure went smoothly. Ideally the textbook says it would be done endoscopically using surgical clips but I think it's better to walk before you can run!

The great thing about the Exotics clinic is that you don't know what's going to come in next so while we were there a Rosella (small parrot) came in with a leg ring which was far too tight and needed removing as it had caused the foot below the ring to swell up. He was more difficult to anaesthatise than the quail as they can bite so we caught him in a towel and gave Isoflo with a mask. The ring came off with a dremel and needed bandaging to reduce the haematoma and stop him biting at the wound. As he was under we also coped (filed down) his beak and nails.

Finally we amputated the Harris' Hawks wing. He was bred by a friend of ours and sold to a falconer for hunting but had an accident whilst out in the field and was electrocuted. The whole of the carpometacarpus and second digit were necrotic and had to be removed back to the bone and sutured up. He recovered quickly so will be fed up in the clinic and eventually come to us in Falconry Club as he can no longer be flown to hunt.

General Surgery

I've just sat my General Surgery exam and really pleased with how it went.

I thought the subject was really interesting so took the time to study it properly, bought the BSAVA Surgical Principles textbook and read the whole thing then watched lots of videos about the practical parts of the exam; suturing, catheterisation, endotracheal tube placement, bandaging.

The first part of the exam was practical where we had to demonstrate different suture techniques and then talk through preparing an animal and ourselves for surgery; clipping, scrubbing, gowning, gloving etc.

Next we went into the theory part where we choose two questions from an envelope, write answers and then explain them to the professor. As they're oral it means we hear the students ahead of us speaking and the two people before me failed so I was nervous going in...

I picked Suture material selection and characteristics, knots and techniques and then Perioperative patient monitoring. Both questions I'd studied well and was able to talk about things I'd regularly seen in practice. Professor stopped me mid way through my second question and gave me an A!

I came home after the exam and wrote my Haematology final report, handed it in this afternoon and got an A in that too.

If you've read other posts you'll know I'm not a Straight-A student so I'm delighted with that!
All the weeks spent seeing practice back home paid off. It's given me a boost to study hard for the next few exams and get home for summer.

Eastern Imperial Eagle in Exotics Clinic

I was in the Exotics Clinic this week when a professor asked me to help him take something upstairs. I followed him and soon realised it was a bird, an Eastern Imperial Eagle which had been brought in by a member of the public.

Unfortunately the bird was completely blind in one eye and had been hit by a car while it was feeding at the roadside, resulting in a compound fracture of the tibiotarsus. The wound was very dirty with dead tissue so the bird was given inhalation anaesthesia while we cleaned the leg and placed a thermoplastic cast and bandaged him up.

The Eastern Imperial Eagle is a breed threatened with extension in Europe so as he is blind and no injured it is hoped that he will recover and be placed in a captive breeding programme to help the future population.

Small Animal Practice

I've spent a week seeming practice with a local Small Animal Hospital.

It's a practice I've been to before so I know the vets and nurses who are all really nice and also means I can be a bit more useful as I'm learning where things are kept and how each vet works.

I watched surgeries for the first couple days and then was able to learn and have a go myself.

Chris one of the vets, who was in the year above me at school, got me to scrub in and he explained how he does a cat castrate so I had a go at that. The following day I was able to do all the local cat charity castrate operations which went really well.

Two of them were little brothers which were much more fiddly, Chris was there to explain and jump in if I needed help but luckily they were fine!

They have a new vet who studied in Portugal who I was with in consults and theatre, she was saying when she started she had no surgical experience but seemed really confident now and her consults were great. Was encouraging to hear a graduate who also studied abroad was getting on well and settled into the job nicely.

It was really nice to get back into the vets and feel more useful for a bit of motivation before the next month of exams!

First Rat Castration Surgery

Yesterday I successfully completed my first surgery, a rat castration!

Granted it isn't a surgery done every day in clinics but it's great practice for rabbits and cats with similar principles being applied.

We learnt how to administer and monitor anaesthetics, about the procedure and then suturing afterwards.

We did seven rats between us which all went well and the rats have all been adopted by vet students.