Foals, fences, legs, and equine surgery….

Preparing the equine operating theatre for emergency foal surgery

Today’s Diary Entry is sponsored by Vet School Success

Rather late finishing this diary entry as it has been a hectic week with studying and preparing for my Anatomy exam next Monday but lets hope it was worth the wait. Today I wanted to talk about foals, those baby horses that look extremely cute…

Now when I started here back in September I had very very limited experience with horses, this past semester I have done what is on our timetable as “Horse Riding” (on the other timetable it is down as Intro to horse rehab). So I’ve learnt a bit, ridden a bit, and altogether got a lot more confident with horses, however though I’ve read a little, until today my only experience with foals has been being trapped in a field with two a few years back when walking… This morning we’ve had a 3 week old foal in after getting one of her back legs stuck in a fence and tearing the skin rather badly in a few places whilst trying to get it free.

When dealing with “baby” animals a very important factor to consider is the mother, whose natural instinct will be to protect their young. This is especially so when the mother weighs 10 times as much as you, stands taller than you, and has an extremely powerful kick. Sometimes animal “moms” are so protective that you cannot even get near their young even if you are their best friend. So in this case where urgent treatment is needed, there are two options: a) Separate mom from foal or b) Keep the foal with mom and sedate her too. As the first option can cause a lot of stress for the mother and the foal we went with option b!

So in this case it was unusual as we had two horses in the operating theatre at the same time, mom who was sedated first, and our patient the foal who was placed under anaesthesia and moved onto the operating table. I somehow ended up getting the task of holding up the leg whilst it was cleaned, shaved and surgery started. Whilst this was going guarantee massive arm ache later, it did mean that I had a perfect view of the surgical field. Now I know a little of the theory behind the different suturing (stitching) techniques and when and why they are used so it was very interesting for me to see this in practice in such a large way. Also a few drains were placed, and also a catheter to allow the wound to be flushed later on to clean it. The initial part of the surgery took around 90 minutes to close 3 different wounds along the leg, and once this was complete another student took the leg from a different position for the major wound which circumvented around 60% of the leg behind the knee and involved muscles.

Us students had a debate on what technique would be used with here with the suggestion of a skin graft being used because of the amount of tension. This however is where experience beats book and the surgeon chose to close it directly suturing each layer back together. There are special suture techniques that can be used to relieve the tension across a tissue which are especially useful in cases like this with skin over joints.

Preparing the equine operating theatre for emergency foal surgeryThe surgery took a total of 2 and a half hours which is a lot for such a young animal to handle, and so I was curious as to how she would wake up. We moved both the foal and the mother to a recovery stall in the stables to come to with the foal being monitored and restrained on the ground. At this point I was giving the mare (mom) to look after as an out of control horse wouldn’t have been a good thing. It took around an hour for the foal to come partially around and though they tried she was still unable to stand alone so they set to massaging her limbs to increase the blood flow before trying again 30 minutes later where she stood and suckled a little.

We then had the pleasure of trying to get a bandage onto the leg to protect the wounds, and more importantly to stop mom trying to remove the drains. All in all, from start to finish it took around 5 and a half hours, and it was probably the most exhausting 5 hours of my week!

The reality of canine CPR… (and equine wound healing)

Marie - Was adopted today yay!

Today’s Diary Entry is sponsored by Best Pet Hair Remover

Well today was another 8am start with the Equine service with wound checks for the hoof injuries and bandage changes. This has been fascinating for me as I have attended some very interesting lectures on equine wound management with The Webinar Vet which talked about the different treatment options. This has given me the theory, however experience is very important here, and so being able to see the healing progress is very interesting.

Equine wounds can look extremely nasty especially when covering large areas, and as owners seeing a wound each day the differences are miniscule so it is hard to believe that it is in fact getting better. Something that we as vets are recommended to do with the advent of camera technology is to take photo’s to compare the wound to – personally I think this should be extended to owners as well so you can remind yourself just how much better it is with each week. Now wound healing comprises different stages, however one of the most important factors is contraction which is where the wound gets smaller as it heals. This means that a large wound may eventually (months or even years later) leave a little tiny scar.

After this I then ended up in the Small Animal Clinic again, this time was going to be different however I discovered that Marie (aka Monkeycat) was being adopted today which I think is really cool as she is such a cutie (really struggled not to adopt her myself!)!

Marie - Was adopted today yay!Anyways there was routine stuff happening until I am about to leave at around 5:30pm when I get asked to help bring a emergency in. Now this is a neuro case and I was working with one of my favourite doctors who really can explain things so that they are understood. I cannot say anymore about the case however monitoring the patient during stabilisation the heart stopped. Luckily I had both the the doctor and a senior student in the room with me when this happened who both swung into action immediately. Whilst I started chest compressions a ET tube was placed into the trachea to keep the airway open and emergency drugs were administered. Sadly the patient didn’t make it despite our best efforts – it’s the first time that I’ve been involved in a patient dying this way so was a new experience. The thing that got me the most was that the owner had stepped outside just before it happened, and returned halfway in… Though I couldn’t understand the words I could understand what they were feeling, yet because of my lack of Slovak couldn’t say anything to her.

I’ve learnt several lessons from this, including some of the more important words in Slovak that are used within a veterinary clinic!

The end of my first week of clinics….

Endoscopy Gutteral Pouch Empyema in Horses

Today’s Diary Entry is sponsored by Supreme Pet Foods

What a week! I am actually starting to feel like a vet student now and not only have started to apply knowledge that I have learnt over the past year but also from my previous degree! In addition to this I have also managed to pass two exams this week (Veterinary Physiology on Wednesday and Animal Hygiene this morning)!!!

So this morning started with an exam, it still feels weird to me having to dress formal for exams however dressing smart also gives me a boost of confidence so I do like it. I now have a week to prepare for my Anatomy exam on the 24th June – this will be my second attempt as I failed my first one back in January as I had no clue what to expect on the question paper. Basically you are expected to just list the different parts of the bone instead of trying to write a description of how it looks 🙂 Hopefully I will do better this time!

Now this week has been pretty cool, I’ve got through a lot of Equine stuff, seen a castration, endoscopy, and wound management. Today I was slightly gutted as I arrived late after this mornings exam to find that they had done emergency surgery on a corneal ulcer (a ulcer of the eye) in a sports horse. I arrived just in time to see the movement of the horse from the operating table to the recovery box. This was interesting as when animals wake up from anaesthetic they are unsteady on their feet (same in humans but we have the ability to know what is going on and that we should lay there) and usually struggle to stand. On Tuesday for example the horse was held on the ground until he had recovered enough to stand, and then was supported with people at the head and tail vertebra. The rest of today’s surgery went to the wound management of the hoof injuries, and endoscopy lavage for the guttural pouch empyema (the bump in the image below is a large swollen abscess).

Endoscopy Gutteral Pouch Empyema in HorsesStandard treatment for corneal ulcers is applying a graft which helps healing whilst also preventing the eye from rupturing, and whilst I missed this I got to watch something else pretty cool. Now administering eye drops to a big horse is not something I had ever considered before, thinking about touching a painful area and the legs flying towards me I realise that it does require careful thought. In this case a supraorbital (above the eye) lavage system is used. Basically a small incision is made into the upper eyelid and a tube passed through this which is then fixed in place along the head. This allows a syringe to be connected and drugs to be applied directly to the eye which I think is pretty cool and makes it easier.

My first day in the Small Animal Clinic…

First Day In the Small Animal Clinic

Today’s Diary Entry is sponsored by Pet Hooligans

Well today I ventured into the Small Animal Clinic here on campus for the first time with no expectations and was pleasantly surprised (the small animal surgical unit is separate to the clinic which is a medical unit). I was lucky to be paired with a friend who is close to graduating and can understand Slovak whilst speaking English so can fill me in on what is going on. Most of the doctors here can speak at least some English however a lot of the clients cannot so again this is a motivator for me to learn Slovak faster (I’m picking up a few words now).

So I cannot say much on individual patients for the obvious reasons, however in terms of skills I picked up I can say much! 😀 So this morning started at 8am getting permission from the Dr’s to be in the clinic, I then started with observing vaccinations (and how the records are managed here in the vaccine book). An interesting case of canine otitis with a bacteria known as Malassezia dermatitis which is a yeast which is usually commensal (aka lives in harmony with the host on the skin). This means that the small amount present is usually not able to cause disease, however when there is a disease or the animal is stressed this microorganism can take advantage of the weakened immune system and grow.

I also got to observe an euthanasia and was asked to help restrain a particularly fractious cat on another. Many vets say that when you do not feel any more with euthanasia’s it is time to leave the profession, and though many times a brave face is put on in front of clients it is hard every time. Personally for me I feel that being able to relieve suffering is a great gift, however its also important to use it at the right time which is a great responsibility. I do however agree that if I couldn’t feel then I definitely shouldn’t be here!

Some of my time went to cleaning, something that is never ending! I lost count of how many times I washed my hands today! We have had a few cats in for rehoming including two little kittens who are very cute with their circus act. The rest of my time went to checking IV’s, giving a dog water by syringe and learning how to look after a recombinant patient.

I guess today’s highlight was actually being shown how to do sub cutaneous injections during a quite period, and actually injecting my first patient this evening. I finally managed to leave the clinic at 8:30pm… Not bad for my first day!

First Day In the Small Animal Clinic

Equine Castration and a James Herriot morning….

Veterinary Equine Castration Emasculators

Today’s Diary Entry is Sponsored by Pets Bureau

Well following on from yesterday this morning I was also with the Equine service and we had a castration scheduled for a young stallion followed by a visit to look at some hoofs. Now I know a few of you have read/watched the James Herriot series (if you’ve not you should!) and seen the way he speeds around the dales in his car. I know I’ve said about Slovakia being beautiful before however this morning has been amazing…

Now last night it was a big storm so I wasn’t sure what it’d be like this morning so had wellies, overalls and also waterproof overalls with me today. However meeting with the doctor on campus it started to get sunny, and with four of us in the car we went driving off along a road I’d never been down before. Hills and tree’s on either side, over rivers and along streams trying to miss all the pot holes in the road. The sun really started coming through now and a little while later we arrived on the farm with the young horse for castration.

Now there’s always a little confusion over just what castration is, in horses it is the removal of the testicle along with the epididymis. A common misconception is that just the testes are removed. This is because some people believe when males make sperm in the testes (testicles) it then comes straight out, however when sperm leaves the testes it is immobile and immature and instead spends around 10-15 days travelling through the epididymis where it matures and becomes motile. Whilst most people link the teste and epididymis together they can actually occur in separately within the body development.

I’m pretty new to equine practice (well horses full stop) which is why I am trying to see as much as I can at the moment as it all helps (and helps me with my studying as well as I will remember something I see or do more than something I am told or read!). At the farm we met up with the rest of the veterinary team who were going be responsible for the anaesthesia, and prep started with all the drugs being prepared along with all the instruments and equipment that was going be used. I remembered an episode of All Creatures Great and Small where James Herriot is called to castrate a horse, loads of ropes are used and no monitoring is carried out. This was the complete opposite and it was impressive to watch, a pre-med was used to sedate the horse before the anaesthetic was administered and the horse’s fall was controlled. Pre-meds are useful because it allows drugs to be used in combinations so less of each drug is needed which means that the side-effect risks of each drug are minimised.

Here everyone swung into action, rolling the horse onto his back and position him using sacks, because he was unconscious there is no muscle tone so the legs simply folded up against the body with gravity. The anaesthesia team started to place a catheter in the jugular vein to allow administration of drugs and fluids along with attaching a pulse oximeter (to measure the pulse & amount of oxygen in the blood) to the nasal septum. In addition they looked after the eyes keeping them moist as with anaesthetic the eyes remain open (ever wonder why eyes have tape on them in tv medical drama’s?). Whilst this was happening the surgical team cut into the scrotum and through the tunica vaginalis (the inner sack) to get to the teste.

Veterinary Equine Castration Emasculators

A pair of emasculators were then used to crush and cut the spermatic cord at the same time, after this was done forceps were used to control the bleeding whilst the testicular vein and artery along with the nerves and tunic were cut with a scalpel. This was then ligated (suture material is used to tie the ends of all these vessels closed and then the clamps slowly removed to make sure it was completed ligated. Now whilst it looks like both the testes are simply in the scrotal sack the scrotum has a division in the middle meaning that the testes are actually in separate compartments so each teste has to be removed seperately through its own incision into the body wall.

Once the testes were out the scrotum was stitched closed with antibiotics injected into the muscle and the anaesthesia team prepared for the horse to wake up removing the catheter. Now when coming around from anaesthetic there is a lack of body coordination and unsteadiness on the feet so the horse was held down simply by the owner sitting on the shoulders. The basic test for when an animal is ready to be allowed to stand is whether it can hold it’s head up by itself, and it took a while for this to happen. During this time as it was a really hot day the anaesthetic team monitored the horses temperature to ensure it did not exceed 38.1 (it stayed around 37.5 degrees celsius which is in the normal range for horses).

Now the horse finally regained its muscle control and was helped to stand where we then left in the car for our next visit which was the trimming of some hoofs. Now hoofs are like human nails in that they keep on growing, now in the wild these were worn down by the distance the horses travelled, however when a horse is kept in a soft field with rubber mats in the stable these are not worn down and so need to be trimmed either by a vet or farrier. This is done in part with a hoof knife, and in part with some clippers with both the shape and foot structures considered in the process.

It was then back in the car along the mountain roads, and across the bridges back to uni and to return to the real world of physiology revision for tomorrow’s exam….

Seeing some Equine Practice…

Inside the Equine Operating Theatre

Today’s Diary Entry is sponsored by Spikes World Wildlife Foods

I know I am being really bad at keeping my daily diary post at the moment, I’ve got a ton that I’ve started and not finished, and some weeks I’ve just been too busy with work and study that I’ve simply not had time to start. I am now realising why vet school is so tough and though I’ve started my exams I still have a fair few to go. I have however also managed to get onto a couple of clinics to get a chance to turn my theoretical knowledge into something more practical. At the moment it is the equine service and so far I’ve used what I know about wound healing, and today anatomy came into play in a big way in the equine operating room.

Inside the Equine Operating TheatreNow this morning started with a wound check for a thoroughbred patient that had kicked something with a back foot taking a lot of the skin off. This was a primary closure (closed with surgical stitches) and some nice granulation tissue has started to form here. So after cleaning and rebandaging this we moved onto the next patient…

Now this case came in over the weekend sometime and proved to be very interesting for me as I got to see how a farrier works with the hoofs to tidy them up. The main presenting problem however was nasal discharge and a endoscopic examination had been scheduled for the nasal and respiratory passages. I found this fascinating as its ok seeing something in anatomy class, however when its actually inside an animal where it belongs things start to fall into place and I managed to keep up on where inside the head the scope was!

In this case it was a early stage infection within the guttural pouch, and a sample of purulent fluid was collected for microbiological sensitivity testing to determine the best antibiotics to use to treat it. Then a lavage (wash)  was carried out with the infected area being washed with an antiseptic solution and then this being suctioned out for both sides.

Final case today was another foot injury which needed a flap of the skin cutting away to give a flat surface. I think the big lesson to learn is to make sure that horses have as little as possible to kick at! Equine wounds like this can take months to heal, and often are extremely painful for the horse as well.

Can the British Nutrition Foundation count? Possible error in survey results….

Error in British Nutrition Foundation survey! Fail!

Well today I couldn’t help but notice all the hype from a press release from the British Nutrition Foundation claiming that 29% of children thought cheese came from plants, and nearly 10% believe fish fingers to be made from chicken… So I was going write an article and share my insights with you so started my due diligence into the accuracy of this (as I do with every post) to ensure that my information was up to date and correct.

Now with a little searching (and waiting for their extremely slow website to load) I came across the original press release here: http://www.nutrition.org.uk/nutritioninthenews/pressreleases/healthyeatingweek

So in the article (and on all the 100’s of websites that have syndicated it) the claim is that 27,500 children were surveyed for these results… The original release includes the geographic breakdown by country and Primary or Secondary school as follows:

1. The research was conducted among 27,500 children of primary and secondary school age across the UK. Samples from each participating country were as follows:

• England: Primary – 9,575; Secondary – 10,742

• Scotland: Primary – 1,794; Secondary – 3,763

• Wales: Primary – 323; Secondary – 449

• Northern Ireland: Secondary – 1,458

So obviously you’d expect these demographics to add up to 27,500….

Error in British Nutrition Foundation survey! Fail!I was pretty shocked when I added these up to get the portion of primary school children to allow me to work out the numbers behind the percentages to get 28,104. Believing I had made an error typing it in I did the simple addition again and got the same result…

I got a total of 11692 primary school children, with a total of 16412 secondary school children giving a total of 28,104 participants.

I’ve always been wary of statistics when used to promote a cause and in this case with such a simple error here, and doubt as to the actual number of participants the survey is called into question. As the introduction to the article says 29% of primary school children, and adding up the numbers of primary and secondary school children doesn’t give the quoted 27,500 its impossible to work out just how many children this 29% actually is…

Sorry British Nutrition Foundation, in this case I think you have some explaining to do….