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!

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.

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!

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!

Summer EMS Placements

I've been busy updating my CV this weekend to make it all veterinary focused and condensing it from 3 and a half to two pages in order to try and sort some EMS (Extra-Mural Studies) placements this summer.

Information I found online says UK vet students roughly have to do:
- Preclinical EMS Phase (Years 1 & 2) minimum of 12 weeks:
      2 weeks Lambing
      2 weeks Dairy
      2 weeks Pig or Poultry
      2 weeks Equine
      2 weeks Veterinary Hospital/Vet Nursing
      2 weeks free choice
- "Preparatory" Clinical EMS Phase (Year 3) around 6 weeks.
- Clinical EMS Phase (Years 4 & 5) minimum 20 weeks.

Ideally I'd like to follow that but we're limited out here in that I'd do mojority of my placements in the UK and we don't have an Easter holiday to go Lambing.
Though saying that, I've done 8 years of Lambing and quite a bit with Poultry so it would probably be more beneficial for me to get equine and large animal placements.

I've sent a few emails to vets asking for placements over summer and so far I have arranged a week in a small animal clinic, another small animal and then a week in an equine veterinary centre which will be really good as I've not really done much equine.
I'm struggling to find a Large Animal practice near home because we don't really have the demand for it in Birmingham, there are a few in Staffordshire I can email and I've love to go back to Ystwyth in Aber, would just need to find accomodation.

I've also emailed Twycross Zoo about a placement for summer 2016 and they've fully booked until February next year - that would be a three week placement, hopefully spent in the Veterinary Centre as by then I'd be approaching my 5th-post BSc year.

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.

Reflection...

It's A Level results week so I've seen lots of anxious, upset and elated posts on Twitter and Facebook with people heading off to Uni in September or some who didn't get the results they expected, wanted or thought they deserved and it got me thinking about where I was 5 years ago.

My friend George asked earlier in the week if doing these work experience placements before I head off have helped confirm I still want to be a vet and I guess they have. Obviously its something I've always wanted to do and I wouldn't have come this far if I wasn't sure, but I could have decided after seeing practice to become a Vet Nurse, Practice Manager, RSPCA Inspector etc.
I know I can do the physical job, its just the exams which might hold me back!

I've always loved the practical side of working with animals and started this blog 7 years ago, when I was 15, but have never been a high achiever academically so think I'm going to have to put some work in once I get to Kosice to make it work for the 4 years...

At school I cruised along putting the minimal amount of work in and got decent GCSE's with not much work but then A Levels came along and not putting the work in really showed!
Looking back at it I chose completely the wrong subjects - Biology, Chemistry, Physics, Maths and General Studies - because I wanted to get into Vet School, or uni, and not the subjects I liked or wanted to do.
Consequently I ended up failing most of my AS Levels and finished Lower Sixth/Year 12 with BEDUU.

At the time it felt like everyone was against me telling me to drop down a year, drop out of school completely and go to college but I'm a stubborn character and made my own choices; I got myself into the mess so had to sort myself out!

I didn't get on with my Business Studies teacher for GCSE but I liked the subject and was actually good at it, thought it would be useful afterwards and so picked it up for AS alongside my other A2 subjects.
I ended up really liking it and got an A without doing too much work - it has actually been really useful since and has helped with getting a job too.

I started working hard over Christmas of Year 12 because I really wanted to go to Uni and but then I got a Merit Award for Aberystwyth, which basically meant I had two Unconditional offers to study Animal Science or Zoology - I didn't have to finish my A Levels and they'd give me £1,000 for going to Uni; so I did just that!

I finished Year 13 with CCA, so I like to say that over my two years I finished with EDUCA - half an education ;)

Looking back it was a stupid thing to do and I wish I hadn't have found out until after I'd sat my exams but at the time I thought it was great.

The only reason I got those offers was on the back of my work experience placements because I wrote two essays in my entrance exam about the changing face of agriculture in the UK and another on Orf, a disease in sheep - all what I'd picked up on placement, not from textbooks, and it got me into Uni.

Again, when I was in Aberystwyth doing my Animal Science degree I didn't put enough work in and got an average grade. In third year when I should have been doing my Dissertation, I was stupidly busy working 24/7 lambing a research flock on the Uni farm.


All the vets, nurses and clients have asked which uni I'm going to and even though Slovakia is far from the answer they expected to come out of my mouth, everyone has been really positive about it.
Nowadays more and more students are going abroad to study so I don't think I'll have a problem finding a job in a few years time.

I guess the point of my random waffling is even though I haven't got in to Vet School the most conventional way straight after A Levels I'm still going but now I have a degree behind me that I can always fall back on, I guess I have some life experience and I've had a pretty good journey getting this far!
There are always other options or routes to take it might just take a bit longer than you first expected!

First week at Pype Hayes

I've had a great week seeing practice at Pype Hayes.

After a week at Willows the referral centre I was amazed at all the work they did, the fantastic modern facilities they had and the costs involved with all the work but it was also really daunting to think that it would be me doing some of that work in 4 years time.
This week has been really good to see a some more 'normal' small animal surgery rather than specialist Osteo and Neuro operations. The vets and nurses have all explained what they've been doing and answered loads of questions.

Someone bought a Seagull in with a broken wing and as the nurses knew I'm into birds they pulled me out of a consult to have a look and hold it whole Stephen had a look. It had to be PTS as he's broken a wing and lost lots of blood but was interesting to see either way.

I think because I'm 22 and not a 16 year old school student on work experience people take me more seriously but also assume I know more, which sometimes isn't the case... I've never had a dog or a cat so while I'm fine with them, one of the nurses showed me how properly restrain a cat while the vet placed a cannula.
I've started learning where things are kept in the practice so could be a bit more useful towards the end of the week, grabbing things as and when needed rather than just standing around feeling like I'm getting in the way. They've had brand new IDEXX blood machines this week so they've all been learning how to run samples through them - I'll never need to know how but they still took the time to show me how to run the tests, explain what the machine does and what results we can get from them.
They usually do pre-general anaesthetic bloods, especially on older animals, so they can keep a closer eye on them and put them on fluids during surgery if necessary.

Chris the newly qualified vet started this week so its also good to see how well he did in his first week and how Uni does prepare you, not just throw you in the deep end!

I made brownies to say thanks and Stephen the Practice Partner came in to theatre to say were the nicest brownies he'd ever had and that I'd be welcome back! haha
I have a month before I head off to vet school so I've booked another week with them mid-August and really looking forward to it!

Vet Selfie!

Willows Veterinary Centre & Referral Service

I've been on placement at Willows Referral vets this week in Solihull and it's been a great placement so far.

The centre was built in 2009 so everything is purpose built and brand new, designed with the animals and staff in mind. They have 15 consult rooms, 100 kennels and cat wards and the facilities are unreal.

(We're not allowed to take pictures of clients so I stole these off their website) 

Yesterday I sat and watched several MRI and CT scans on dogs which gave amazing diagnostic results and Paul the vet operating them had such an amazing knowledge he could see exactly what the problem was and diagnose in real time as the scans were taking place.

I've been mainly with the Primary team doing consults - things like puppy vaccinations, first opinion consults, operations follow ups etc which has been really good so I can learn the basics again.
4 years ago before I went to Uni I knew exactly what vaccines kittens and puppies have, what age they have them and what they cover but at the start of this week I'd forgotten it all.

Today I was in surgery for most of the day; there are 5 operating theatres and 4 theatre prep tables so always lots going on down there!

First thing I saw a dog come in for a primary consult who cut his front paw pad on something in the park yesterday and it was still bleeding. We admitted him and I followed him down to theatre to see the pad get sutured back together.

Next we had a dog with migratory foreign bodies, presenting as swellings under the skin.

They did ultrasound to find the object (as it was migratory) and marked it with a needle and he was then taken to theatre to have the object taken out, which turned out to be a 2-3cm grass seed! They did the same with the other lump which when opened up and investigated was another 2 grass seeds!

I then watched an Osteo operation on a cat with a completely fractured femur which they reset into the correct position and fixed with metal plates.
Another Neuro/Osteo operation I saw was on a dog with a slipped disk which was impinging on the spinal cord and so obviously massively specialised surgery. It was a really long operation and so not very exciting to watch but James the vet was really nice and explained what he was doing as he went through the operation and would pause at each step so I could see what he was doing, he explained the anatomical features as he went thorough so it was amazing to be able to see!

The staff were all really nice and treat the animals as if they were their own pets which was really nice considering how big the centre is.
I've never had a cat or a dog and not got much Small Animal experience so when they were asking me to hold dogs and cats to place a cannula for injections and things I was a bit out of my comfort zone so it was good to see how to deal with them really.
I'd love to go back in 4 years time once I've (hopefully!) qualified and experience it all again.