Linnaeus GDP; Medical Musings

This week we headed to Wakefield, visiting Paragon Referrals with the Linnaeus Graduate Development Programme.

We were doing Medical Musings which meant seizures, dystocia, dyspnea, pruritis and some endocrinology.
Each lecture was given by the specialists and they were all really good and not just focused on gold-standard referral level which some specialists tend to get carried away with at conferences and things.

The hospital opened two years ago (this week) and the facilities are amazing. Reception is massive with their own separate dog and cat waiting areas...

...and a branded coffee machine!

I actually learnt and retained loads from the lectures and have been using things now I'm back at work this week!

RCVS Registration

Today we travelled down to London to the RCVS to register as Members of the Royal College of Veterinary Surgeons!

Torunn and I were up super early (we're still in Student Mode okay!) and left home at 7am, drove down to a friends flat in Ealing and got the tube to Westminster from there.

Registration was nice, Harriet from our tutor group was also registering and lots of other international students. The RCVS building is soo nice, we handed in our documents, read out an oath and met a few of the staff members.

The first thing we did once we were registered as vets was head to the Natural History Museum!

Then being #veganAF we went to Mildred's in Camden for burgers and did that rank touristy thing of taking photos with our food x


Dr Volden and Dr Wescott MRCVS

We're Going on a Job Hunt

I've been thinking about first job and where I'd like to work for a while, in that it's been in the back of my mind as I arrange EMS placements, speak to people and get a general impression of a practice. There are some locally that I know not to touch with a barge pole from the way they treat staff; you can generally tell as they have a high turnover and are always advertising for jobs. Others would be amazing to work at and rarely have vacancies as people never leave!
Cat and Bobby came out for the Vets4Pets Workshop a few weeks ago and I've been spurred on into applying for jobs.

I've been seeing practice regularly at the PDSA for three years which is a big charity hospital with a high caseload and lots of surgery, that's kind of become my normal so I'm looking for something similar.
PDSA have a graduate programme which I'd love to apply for but it's super competitive and speaking to a few grads we've had over the years the interview process is intense. The money isn't great but I figure I could live at home and it's more money than I'm on at the moment!

I know I want a busy practice within an hour of Birmingham where I can do lots of surgery, have decent support and seeing a few Exotics would be a bonus.
I'd also quite like a grad scheme as friends who have graduated in the last few years seem to be well supported so why not take the support if it's out there...

Vets4Pets Workshop

I got an email from Vets4Pets in September to say some Košice graduates on their grad scheme had nominated me to be a Student Ambassador.
As part of that I organised a workshop with Cat Curtis from Vets4Pets to come out with Bobby, a Joint Venture Partner, and Niamh, one of last years graduates, to come and speak to us about Setting Up for Success.

The workshop covered everything from writing a CV and cover letter to selecting practices, interview technique and how to make the job work for you - there has to be the right fit for both the practice and the candidate.
Feedback from my yeargroup was really positive in that they spoke generally and inclusively of mixed, farm and equine practice even though they all work in a small animal environment. They really didn't push the graduate programme at all and while the session was meant to finish at 4:30pm, people were still there asking questions at 6pm!

We went out for drinks on the evening and chatted more about jobs, recruitment and Vets4Pets. To be honest I'd never really thought about working for them before as I didn't know much about the group but speaking to Niamh and Bobby has changed that!

Another two weeks seeing practice

I landed at Heathrow from Mumbai last Friday and went straight to a friends wedding in London. We had a really good weekend, lots of their family are Irish so it was a proper family wedding with lots of dancing aided by an open bar!

Back home and I was back at the PDSA for two weeks. I'd hoped to be able to do some neuter surgeries but the whole two weeks I was there we only had one bitch spay and lots of cats so I didn't get to do any this time but I still got lots of surgical experience.

Following the August Bank Holiday we had 24 inpatients so were busy treating those on top of the planned surgical cases.
Depending on the vet I am working with I'll often induce and intubate patients for procedures and then take x-rays with nurses, mass removals and start dentals - a vet will come in to do extractions or to evaluate x-rays etc.

We had a kitten come in with a broken femur so we took x-rays and I scrubbed in for the fracture repair.

The vet opened, located and aligned the break then I helped to drill the intraosseous pin and then close up, after taking further x-rays to check alignment.

This week I've done a lot of closing abdomens and wound stitch up's as we're short staffed due to holidays and maternity leave so while I'm closing the vet can get on with other surgeries.
It's great for me as I can practice my intradermals which I'm pretty confident doing now ...though they are much harder in thin cat skin!

Today I was mainly an astronaut

Dental anaesthesia means astronaut gear...

Seeing Practice with PDSA

I've been Seeing Practice with PDSA Oldbury this week and loved every minute!
The PDSA are a national charity providing free veterinary care to pets of people in need since 1917, with 51 hospitals and 380 pet practices across the UK.

The Oldbury hospital opened in 2015 so the facilities and equipment are all great.

Within half an hour of walking in on Monday morning I had donned gloves and gown and assisting in surgery; a cystotomy to remove bladder stones. I was able to hold the bladder to stop it disappearing back into the abdomen and place catheters to flush saline and clear the calculi.

The vets were great at explaining things to me and nurses very patient explaining and restraining animals for procedures.
I did a few afternoons consulting, taking histories and doing clinical examinations - they have double consulting rooms split down the middle so I was able to grab a vet after they'd finished their consult to discuss my patients and what treatment was necessary.

The first few consults were general health checks either post-operative or new kittens, I had a diabetic dog come in which hadn't eaten breakfast but was still given insulin and went into a hypoglycemic state. The owner had given cake and glucose powder so I admitted the dog for blood glucose and monitoring. The nurses were great in letting me do the blood glucose throughout the day and on the discharge consult I was able to explain the importance of routine for diabetic patients; consistency of feeding and insulin routine and reasons why.

Throughout the week I scrubbed in and assisted on lots of other surgery including a caesarean section, dentals, pyometra and an ex-lap which unfortunately found a stomach tumor so I euthanised and closed up.

I have another week with the PDSA in September and will hopefully be back again next summer!

Week 2 of Mixed Practice at Straiton Veterinary Hospital

My second week at the EC Straitons Veterinary Hospital has been even better than the first.

Now that I've got to know all the staff and learnt where things are kept, how procedures are done, I've felt a lot more useful and learnt more from it.

On the other hand, now that they know me, I've been able to do more too.

Whilst I didn't get to do any surgery I learnt loads of practical skills, especially placing catheters to take blood and giving intra venous injections. While we are taught these skills in vet school and able to learn in practicals, you don't really get a feel for it until you have a go and regularly practice; even little things like which size catheters to use in different patients.

I saw several TTA (Tibial Tuberosity Advancement) and TCT (Tibial Crest Translocation) surgeries which are often done as referrals, I got to understand the procedure and equipment used so was sterile during the surgeries to pass the surgeon kit and suture material. I was also able to position for x-rays before and after the surgery so I could really see the difference.
As they do orthopedics on a regular basis there were several post-op check consults which meant I saw a whole range of cases, from pre-surgery to 6 weeks post-surgery.

Being a Mixed practice I had hoped to get out on some farm visits but due to the time of year and staff holidays the farm work has been quiet, apart from routine TB testing which is done all year.

I saw a few horses that came in to the hospital for lameness evaluation and radiographs.

They have a great wireless digital radiography system which they use for equine work which is portable and means x-rays can be taken and viewed immediately (1.9 seconds) on a HD tablet for diagnosis and taking of further views as required.

They provided me with a glowing reference and invited me to go back next year so I'd like to return in January or Easter time when there will be more going on with the farm animal side, especially lambing!

Mixed Practice at E C Straiton

I've just finished a two week placement at EC Straiton & Partners Veterinary Hospital in Penkridge and had a great time. They are about 40 mins from home but my nearest mixed (small animal, farm and equine) practice and have a great reputation so I booked the placement 18 months ago.

The hospital has 13 vets so a very busy practice, from new grads to vets who have been with the practice 37 years!
Everyone was great and made me feel really welcome. The vets would ask my opinion on cases and medicine, so whilst I wouldn't always know the answer they tried to get me to think logically and then explain why they'd use certain treatment. Of course the next time a similar patient presented, I was able to explain possible treatments, using pattern recognition.

The hospital is built around what used to be an old farm yard so it took a few days to get my bearings but the layout is great and works really well for the team.

It's been sweltering this week, pushing 33oC on Tuesday so unfortunately we had a dog come in with heat stroke which died; just goes to show the importance of not leaving dogs in hot cars, even 'just for 5 minutes'.

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.

Easter Placement

I'm back home in the UK for Easter and have been seeing practice with my local Small Animal hospital for just over a week.

I love going back there as I know the vets and get on really well with the team of nurses. 

I've felt a lot more useful this time around as I can help prep surgery kits and leave consults to collect drugs for the vet; I'm trying to learn Pharmacology of commonly used drugs so kept my Formulary close by.

Vets have asked a few questions in front of clients in consults but nothing too taxing so I survived... anything I didn't know, I made sure I knew next time and I won't forget!

Chris, one of the new grad vets I went to school with, has recently left and moved down South so they've had two locums in. It was great to ask questions and learn how things are done differently in other practices.

Now that I've been a few times it was nice to recognise a few patients and follow up on the cases. Particularly cats with Hyperthyroid and Diabetes which are in fairly regularly so I've seen them a few times. The owners recognised me and have been asking home I'm getting on - though lots of people forgot which country I study in! Usually get Hungary, Slovenia and even America!

On Thursday, just before the Bank Holiday weekend, we had a Border Terrier in for a Caesarian section. She had two big healthy boys and we speyed get at the same time as she'd had a c-section previously so the breeder took the decision to neuter her.

I'm flying back to uni today so I took in a few boxes of cakes to say thanks for having me!

New Small Animal Hospital at UVM Kosice Vet School

We were given a tour of the new Small Animal Hospital today and I'm amazed at how good it was!

Walking in the new entrance there is a massive reception and waiting room divided for dogs and cats, of which comes off the cosult rooms. Behind that is a suite of operating theatres all with automatic doors and pass-through cupboards behind to maintain sterility throughout.
To get into the sterile areas there are two automatic doors which act as a lock, in which you have to get changed into sterile clothing; the clean-side door won't open until the dirty-side door is shut behind you.

Downstairs there are purpose built rooms for MRI and CT scanners as well as massive operating theatres able to hold whole classes viewing surgery.

The theatre control panels are suspended on arms from the ceiling so that they can be moved around the room and have controls for lighting and video as well as gas, suction and trays for sterile instrument packs.

There is also a hydrotherapy room which is something I've not seen firsthand before, only read about and seen on TV shows like Supervet. Also a lameness suite with cameras to detect subtle changes in movement and gait; included in here is a treadmill with force place which animals are exercised on to see how much weight they are (or aren't) putting on each leg.

All the building works have now been completed and most of the large equipment is in, they are just finishing up fitting it out. It is due for completion this summer so I guess the surgery department will move in and then have a grand opening in September.

We're really lucky that as 4th years, we will be the first class (next year) to use the facilities and be in the new clinic for our staże, or rotations as we'd call them in the UK.

I didn't get any photos today so you'll have to do with old progress photos...
Before and after, taken from down at Falconry:

Few progress photos over the last year:

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!

Northern Goshawk necropsy; Aspergillosis and Trichomonas

I saw a necropsy of a juvenile wild Goshawk (Accipiter gentilis gentilis) today, which sadly died after being brought into the clinic last week.

He had anklets put on his legs so that he could be perched and fed on the glove but was found collapsed on Sunday afternoon.

The bird died from chronic Aspergillosis seen as spores and large granulomas in the air sacs.
They think the bird had been ill for several weeks as the granulomas were so big and that would coincide with his capture and being brought into the clinic.



He also had secondary Trichomonas gallinae parasites seen in the mouth which were probably elevated due to immunosuppression.

Sri Lanka; Government Veterinary Hospital

We arrived in Kandy last night on day 8 of our tour of Sri Lanka.

My parents and brother went to the Botanical Gardens but I spotted the Government Veterinary Hospital while we were driving, so walked back to have a look.

 As I was walking up I asked a man if I could take photos, he asked where I was from so I explained I was a vet student from the UK. He introduced me to the Chief Vet Surgeon who gave me a guided tour of the clinic, surgery rooms, pharmacy, dispensary and kennels!

They have four surgery tables which were all in closed rooms behind glass, I couldn't see any gas anaesthetic machines but it all looked very clean and well organised. Surgery instruments looked like they were kept in glass cabinets and autoclaved as needed.

 Consult tables were on the patio around the outside of the building under cover, I guess it's cooler and less stressful for the animals to keep them outside.

There was a price list above the door; Farm animals are free, Small Animal consult 20-30 rupees (10-15 pence) and a Rabies vaccination costs 50 rupees (24p).

The clinician said they see a lot of skin conditions and parasites through the clinic which they manage quite well and mange, which I've seen a lot of when travelling the island.

 I stayed to see a few consults which were Parvo, Distemper and Rabies vaccinations in young puppies, foreign body removal from a puppies ear and some really bad mange.

A big German Shepherd type dog came in on the back of a Tuk Tuk collapsed which they had to immediately put on IV fluids, I didn't get chance to ask what was going on in the rush but it looked like heat stroke which I'm sure they just see a fair few patients for.

They had kennels out the back for monitoring post-op animals, dealing with skin conditions and separate area for Rabies monitoring.

Love their cones of shame which looked like a small plastic laundry basket.

I got some videos on my GoPro so will compile and upload those when I can!

Peregrine Falcon with Bumblefoot

Brigid and I picked up a new bird from the clinic on Monday, a female Peregrine Falcon.
We don't know much about her history, just that she was bought to the clinic from Austria for treatment.

We could see both feet were swollen and hot to the touch, when we picked her up onto the glove she was very unbalanced and shaking slightly so obviously they were painful to stand on.
We thought it was Bumblefoot (which I've seen a few times before in chickens) which reading online can happen in many ways, namely when a talon pierces the skin on the bottom of the foot which heals enclosing bacteria and causes infection, from trauma or from improper perching.

This morning we took her to the clinic and Dr Major one of the vets had a look at her.
He anaesthetised her with gas and had a good look at her feet, confirming it was Bumblefoot in both feet. Using a little scoopy instrument (technical term) he got out the infection, thoroughly cleaned it with Betadine and applied an antibiotic Bumblefoot Cream to dry it all up; the girls bandaged both feet and woke her up.

The clinic made up a solution for us to apply to the bandaged each day to keep it clean and dry it out and we'll take her back to have them re-dressed on Monday.
They used yellow vet wrap but if you look closely you can just see them bandaged up...

I fed her on the glove this afternoon and she seemed much comfier on them already, still using her wings to balance herself a few times but was using her talons to hold food while she ate.

Back to The Oaks

While I was home I thought it would be a good idea to see some practice, my first EMS as a vet student, just to remind me why I was at vet school and keep me motivated for the final half of this semester before the dreaded Finals!

I texted a friend who's a small animal vet at The Oaks, the first place I ever saw practice at, asking what days they were open over Easter and if it would be possible to spend a day with them - the reply came quickly that I could go the day after I got home, Thursday.

I arrived at 8am ready for consults to start at 8:30am where we had post-op checks, vaccinations and a dog who had just gone off his feet who Andy admitted for a neurological examination.

I then went out back to once prep and theatre started; the board was pretty full and Brian was doing most of the operations today.

We started off with two Fine Needle Aspirates (FNA's) on dogs, both which appeared to be fatty lumps rather than anything sinister but were sent off to the lab which can help make a diagnosis or rule out more sinister things like cancer.

Brian stressed the importance of taking true representations of the lumps, swap needles between each biopsy and importance of labelling slides correctly!

Next up we had neuters for a local cat charity - two castrates, one of which came in as a possibly pregnant feral cat but turned out to be a quite friendly little man, followed by a spay on a young female who once turned out to be pregnant once we'd opened her up. 

I've seen pregnant cats spayed before so when Brian asked what I thought about the ethics I was ready with an answer; the procedure is being done for birth control purposes so leaving her to have the kittens on the street would only make this situation worse as not only would she have more kittens in the future but so would her kittens continue the cycle as there's no guarantee that she would be trapped again in order to be speyed in the future.

Before he started the spey Brian the vet asked if I'd like him to talk me through the op, I said I'd seen loads before so he was ok, he double checked I was sure, yep... and so said I had to talk him through what he was doing!
Luckily we did the female urogenital tract in Anatomy last week so it was fresh in my mind and I remembered the abdominal muscles as he was cutting through those. He pointed out that I was naming everything in Latin rather than English and I think (hope!) he was impressed that I could name all the structures.
Andy asked me later on about the endocrine system and although I've done it all before it was years ago and I didn't have a clue! Once he explained it came straight back to me and made sense but I wouldn't have been able to come up with the answers by myself...

It looked like they were getting through the ops board just fine when a cat was admitted in a diabetic or hypoglycemic crisis. He looked a lot better than he had at home where he was circling around the living room, but we took a blood glucose and got a reading of 3.2; it should be between 5 and 15.
He was really cold so put in a cat kennel with a heat pad, some warmed smelly cat food to tempt him and we would repeat blood glucose an hour later.

The last op of the day was a dental on an English Bull Terrier with Cushings disease which is an endocrine disorder usually caused by a tumor on the pituitary gland which causes an excess of cortisone in the blood, affecting metabolism. Because of this they wanted to closely monitor her throughout the anesthesia and keep her on a drip to support the kidneys. 

They really struggled to place a catheter to get the drip in, tried both legs, took a break and then tried again - it said in her notes from 2 years ago that they really struggled back then too.

I monitored her heart and respiratory rates throughout the scale and polish and although they were lower or slower than expected, she was stable throughout and recovered just fine.

The diabetic cats blood glucose stabilised and as he was on insulin they adjusted his medication and timing and were going to monitor it closely for a while.

I really enjoyed the day and felt like I was able to help out and be useful rather than getting in the way, holding animals while they were injected or sedated, wiping down consult tables, helping to pre-med animals with the nurses before surgery and cleaning theatre ready for the next op.

Vaccination time for Gizmo

We got up early and went to the vets at 8:40 this morning.

Gizmo had a full health check and then his first vaccinations; the vet said he was perfect and really well behaved!

4 of us went, all with our charity foster cats, and the others were wriggly but Giz sat on my shoulder throughout just watching the world around him...

Puppies and Poultry!

Crazy busy day at Pype Hayes today!

Chris was operating today so I watched a couple of dog castrates and a dental then at 11am a French bulldog came in for a caesarean. Everyone was ready to help the puppies and it was Chris' first caesarean so Stacey one of the other vets was there to guide him through it, meaning there were 8 people in theatre.

It was getting a bit too busy so we came out for 2 minutes to wait for the vets to hand over puppies for us to rub and get then breathing.

They came our one by one and we vigorously rubbed them in towels to stimulate their breathing, a bit like we do with lambs - a couple had drops put under their tongues and had an oxygen mask ready to support them.

She had 7 puppies, 5 girls and 2 boys, of which 6 were healthy but one was born with it's eyes open and developmental problems who didn't get breathing.

6 healthy puppies is great though! 

Her uterus looked like it was about to rupture so the owner was rang and as it was her second caesarean the decision was made to spay her at the same time.

This afternoon I was in consults with Stacey one of the Locum vets - she was really nice and explained what she was doing as she went. 

Two Ayredale puppies came in with colitis so she checked them all over, weighed them to see if they'd grown since they were last in 2 weeks ago. They seemed ok so have been put on a low fat diet to see how they go and sent home with a faeces sample pot should they get any worse.

We had a cat in with suspected flea allergy or lice so I helped Stacey do a skin scrape and hair pluck to have a look at under the microscope.

Last thing we had someone bring in a limping duck with a bubbly eye. It didn't look like Mycoplasma and no other respiratory problems so not sure what the eye was about but the leg was warm and inflamed and because it had been a few days they took the decision to have her PTS.

It was quite nice talking to the owner about her other chickens and ducks, that they could live together happily and I told her how to sex her ducks. Apparently they get chickens in but rarely see ducks, especially domestics and not wild mallards so was nice to see that!