Toxicology – end of week 1 of year 2 of vet school… (Day 375)

Veterinary Toxicology

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

Well today is my last day of my second first week of vet school here in Slovakia, I honestly do now know where the time has gone and am pretty exhausted. I think I am going have to slow down over the next few weeks as if I continue like this I will not make it to Christmas without getting sick. I just want to be the most amazing vet I can so am doing the same as everyone else plus extra stuff outside of the set curriculum.

Today we have only one (long) subject starting the morning with a lecture then a 3 hour in veterinary Toxicology. To start off with the most basic thing, anything can be a poison in excess so in addition to looking at the common poisons we also look at the effect of medications and so on taken in excess. The lecture this morning was really interesting as we started looking at the history of toxicology which actually seems to be pretty much developed by assassins in the old ages before it became a science in the past 100 or so years.

The practical today was another introductory lecture, and was focused on lab safety – I get the feeling that this time they were serious when telling us that we could die if we did not follow their rules. They reinforced these multiple times with different videos on how to behave in the lab, and then started talking a bit about arsenic and cyanide so I am a little nervous now especially as the morning lecture was about how arsenic is not detectable by taste, colour or smell.

The rest of the practical was looking at to collect different samples and get them to a lab. This was interesting as the curve ball of how do you sample for fish poisons in water supplies and the logistical side of things.

Veterinary Toxicology

Now for a weekend of reading and writing up notes! Until next week people 🙂

Anatomy, Parasites, and a bit of Radiography… (Day 374)

Today’s Diary Entry is sponsored by Supreme Pet Foods

Well today is probably my most practical day of the week, I have my Anatomy, Parasitology and Radiology & Diagnostic Imaging practicals back to back. Whilst interesting it does mean that I have a block of classes from 8am to 3pm without any break. So this semester we are covering Angiology (the heart and blood vessels), neurology (the brain and nerves) and also everything from last semester as well.

Today was focused on the heart which whilst on paper is suprising simple turns into a nightmare when it is out of the body by itself. This is mainly because you have to orient yourself with the left and right views of it which until you understand what you are looking at is pretty complex. Basically we have to know all the different muscles that operate all the different valves in addition to the parts and vessels. On top of this we have to know the interspecies differences which include for example that cows have a bone inside the heart the ossa cordis.

After Anatomy it was then time for Parasitology, this week as an introduction lecture basically was another recap of lab safety and a quick overview of what the different egg types look like.

To finish the day we started our Radiology & Diagnostic Imaging practicals which was cool as it was with one of the doctors I had worked with over the summer. This week was very dry for me however as I have done Radiology within my previous in a lot more detail than we went into here, I am just hoping it improves over the next few weeks when we start looking at specific regions of the body… I am especially looking forward to the last few lectures which are on ultrasonography – a skill I am getting better at but still struggle with!

Radiology, Pharmacy and some equine castration… (Day 373)

Today’s Diary Entry is sponsored by Supreme Pet Foods

Well today is my second day with an early lecture, my first lecture this morning is at 7:15 and is Radiology and Imaging Diagnostics. This basically means ways to look inside patients using x-ray, ultrasound, CT, MRI and so forth. After this I was straight into the Pharmacy and Therapeutics practical, as I said yesterday this is not the most practical subject however covers things we are required to know (at least for Slovakia). Today we looked at how the pharmacoapea works, and how to interpret the information within it.

I had been invited into surgery this morning so went from pharmacy to this, basically I am pretty interested in anaesthetic and with my practice from the summer can be slightly useful. During this week and next the final year Slovak student’s have an intense equine practical session which is why today’s surgery which is a castration was brought into clinic instead of being performed in the field. This also meant the entire session was being conducted in Slovak so also gave me a chance to work on my understanding some more.

I know I’ve mentioned it previously however equine surgery tends to be a team effort, there generally needs to be at least 2 vets one for the surgery and the second just for anaesthesia. Something I am especially interested in is the recovery process, I believe it’s really important that I understand the normal so that when something is out I can recognise that its wrong and at least attempt to do something about it.

Following this there was still the reproductive case in clinic that was still being checked daily. So from my 6am start this morning, I got home from uni for the final time today around 11 pm ready to be back at 8am tommorow morning for anatomy. This week so far is exhausting me, and I think it is going be a case of reducing just how much I am trying to do so that I am still alive at the end of semester!

Starting Clinical Diagnostics, and a little nutrition… (Day 372)

Vet School Clinical Diagnostics

Today’s Diary Entry is sponsored by Pets Bureau

Well second day of my second year, yesterday though long absolutely flew by, I’m also spending some time with one of the doctors this week doing some reproductive practice. Basically with animals it is now more common to use artificial insemination to breed selectively for optimal results, part of this looking for ovulation when the ovary releases the follicle(egg)  into the uterus (womb). This means that at the moment I am basically with the doctor every 7 hours to check the status of the ovary – this is a pretty big (and interesting) topic so I will write more about it separately soon!

Anyways back to my official programme… Today I started the Clinical Diagnostics module which is kind of interesting as these are the essential skills of being a vet, and one of the topics where I’ve not found a single textbook covering it all. I’ve done a little bit in the past, and have gained a lot more skills here during my study and practice in the summer as well so today kind of was a recap of stuff I already knew, however I was looking forward to the practice session which was later this evening.

Between this though I had a large gap before my Pharmacy and Therapeutics which I used to check the horse ovaries again. Making it into Pharmacy 7 Therapeutics now I realise that though it is essential to understand some stuff, a lot of it is specific to Slovakia, and hence once I graduate will not be of use to me. However the interesting part of it is that available drugs are controlled on a country basis with each country having an official pharmacopoeia which is a big manual of drugs. Basically drugs are even further restricted within the UK with something known as the cascade which is managed by the Veterinary Medicines Directorate. This means that every option has to be exhausted before a drug that is not approved for the species can be used (including for the use of drugs developed for humans). It really is something I will be having to read up myself before coming back to the UK to practice.

Now following this we started Nutrition, as I said yesterday we are looking at applied nutrition so how to calculate what and how much to feed to specific animals. We’ve started with dairy cows (which I luckily happen to know a little bit about) where the goal with nutrition is to get the best milk production possible. If you remember last year I studied Milk Hygiene where milk quality is based on the amount of milk fat and protein content within the milk. In addition to the owner the quantity of milk is also important. Now nothing appears from nowhere so these are both affected by what the cow eats so we need to ensure that the protein in the milk is replaced in the cow through the protein in the feed (otherwise we will get a very malnourished cow pretty quickly).

To start this process we need to determine how much protein, energy and nutrients (milk has a lot of calcium and phosphate) that the cow actually needs to produce the milk whilst maintaining its body condition. This is easier than it sounds as we have very good guidelines produced by the National Research Council which are compiled from large research surveys. So once we have this we then have to look at the types of feed, balancing this however is a different matter and definitely something I will also cover separately later as well.

This evening my last practice starting at 5:25 and finishing at 7pm was clinical diagnostics, this was interesting as walking into the room we were greeted by two cows, a sheep, a goat, and two dogs. The practical today was working with the animals, how to restrain them for exam and then percussion and auscultation. These are something that I will try and cover later as well as I am pretty much over my word count today with my rambling!

Vet School Clinical Diagnostics

My second first day… (Day 371)

Today’s Diary Entry is sponsored by Pet Hair Remover

Well today was my second first day, that is my first day of my second year as a vet student. I left dorms around 6:30am this morning as I wanted to check in on the horses before I started lectures today (there’s been rumours over the past few weeks that there will be a umbilical hernia arriving in a foal yet its not arrived…).

So we started today with a Pharmacology lecture, this was interesting as it appears that the university has a “new” pharmacology and toxicology building round the corner outside of campus which has bigger lecture theatres (which are definitely needed). The lecture was pretty basic covering the different classes of drugs (Mass Produced vs. Magistral and officinal preparations) however did look into history a bit which was slightly interesting (I might write some of this up as a separate post)!

We then headed back to campus to start our second semester of Nutrition and Dietetics, this semester will we be looking more at the requirements of animals and how to formulate diets to the match their needs. Last semester we looked at the different properties of various foodstuffs to give us the understanding required to do this.

Next up was Pathological Physiology (or as I will be calling it from now on Pathophysiology) which is the study of disease processes and dysfunction within the body. This is rumoured to be probably the hardest exam of the year when I have to do it next summer however is also one of the most interesting subjects. After the introduction we started looking at the effect of fever on the body which is pretty interesting as whilst I know the basics I had not got anywhere near this much understanding. The practical then continued this, however was done in a question and answer session which really made us realise just how little we remembered from physiology last year.

Pharmacology practical was a little bit of a let down as instead of anything drug related we went straight back into Latin (which I hate!). Here in Slovakia at least all prescriptions have to be written in Latin. This is a double edged sword as whilst I can already write English, it opens up every other country where English is not used for (so vets leaving England may struggle).

For now I will leave it there! Here is to tomorrow which looks to be another packed day!

Second year registration for vet school in Kosice (Day 367)

Becoming a second year vet student photo

Today’s Diary Entry is sponsored by Vet School Success

It’s hard for me to believe that I have been here over a year (1 Year and 2 days to be exact) and now like I registered for my first year last year, today I have registered for my second year as a vet student here at the University of Veterinary Medicine and Pharmacy in Kosice. I’m older, definitely wiser, yet still full of energy (well flu at least) and excited to start. Registration was a lot simpler this year as it was basically entering the modules we want to take into our study records and then submitting this for approval.

Last year I started with no expectations and very little idea of what to expect, this year I’ve calculated that over the next semester I should have a total of 49 hours a week of classes and practical scheduled. I’ve not even got some of them in my timetable yet! Rumours from older years is that this is “hell year”, the part of the course that either makes you or breaks you. Next year is easier as instead of trying to cram loads of information into you, the focus is on the state examinations required to become a veterinary surgeon. In the meantime here is a look at just what I have coming up next semester…

Monday is a jam packed day, I start at 7:15am with Pharmacology which is the study of the effect of drugs on the body. Then at 8:55am I have Nutrition and dietetics which this year is looking at how diet is managed to help with clinical diseases such as diabetes. Moving on at 10:45am I have Pathological Physiology which is the study of disease processes on the body. These are followed at 12:25 by the pharmacology practical (I dunno what we do here yet…) and then at 14:05 by the Pathological physiology practical which again I am not sure what it’s about.

Tuesday is a slightly later start at 8am with Clinical Diagnostics, I am generally expecting a lecture on different exam techniques and this is followed by a gap (which I am sure will be filled shortly) until 12:15 when I have Pharmacy and therapeutics – which I have absolutely no clue about. I have a feeling it could be more focused on legislation and laws then anything animal related… Next up is a Nutrition and dietetics practical at 14:05 and then a clinical diagnostics practical at 17:25 finishing the day at 7pm.

Wednesday looks slightly better with a 7:15am start for Radiology and Imaging Diagnostics, then a Pharmacy and therapeutics practical at 9:45 followed by Parasitology at 12:25. At the moment (though am also sure it will be filled) I am free to revise from 14:04 for my anatomy credits on Thursday.

Now Thursday has always been a hard day with a weekly test for the past year, we’ve only got 1 semester of anatomy to go now and start at 8:05 with the lecture with the practical starting at 8:55. This semester we should be looking at angiology (blood vessels and the heart) and neurology (brain and nerves), though the exam is combined with everything we covered in splanchology (organs) from last semester so is going be very difficult. My anatomy practical is followed straight after by Parasitology practical at 11:35. My day then finishes at 15:45 with a practical for Radiology and Imaging diagnostics.

Friday has over the past year had subjects I struggled with, however this semester is filled with Toxicology with the lecture at 8am and then the practical at 12:25. This is something I find especially interesting because as well as poisons, this subject covers the metabolism of drugs, and the effects of overdosing and underdosing (along with how to treat other poisons).

In addition to this I’ve also elected to take two optional subjects this semester: Breeding and diseases of reptiles and terrarial animals, and diseases of small mammals. Both this subjects fall into my special area of interest which is exotic animals so I feel are essential for my learning and time well spent.

Here is to starting the next year on my journey to becoming the greatest vet I can be!

Becoming a second year vet student photo

A vet students (non)summer (part 2) wound healing and foals…

Mom watching over my shoulder during treatment of the foal

Today’s Diary Entry is sponsored by Pet Hooligans

Well after writing part 1 I’ve taken a few days R&R before the start of next semester (which is next Monday!) as its supposed to be the most intense year in the entire course with at my count around 48 hours a week of classes and practical. Now if you’ve not read part 1 you can read it here, if you have then welcome to part 2.

During my time in equine clinics I also got to see some wound healing, now this is something that I have covered in theory through a online webinar however I’d no practical experience at this point in time. Now the body is really good at healing itself (though sometimes incorrectly) if given time, however the changes are so slight that if you see it every day then its difficult to see any progress. To combat this it’s very useful to take photo’s as you go along so that you can compare the difference to a fixed point in time which can sometimes be very dramatic.

Generally with wounds it’s important to consider whether there is any damage to underlying structures which can change the prognosis considerably, and to consider and mitigate the risk of infection. The first wounds I saw were to the back of the hoofs and pastern regions (feet) and one case in particular had concern whether there was involvement of the underlying structures (cartilage etc). These wounds looked very bad initially, however over the next few weeks with regular bandage changes, debridement and treatment these healed very nicely. The bandage used here was pretty complicated yet provided great support to the injury both underneath and around – those these horses were completely confined to stables to prevent further injury!

We then had a new patient arrive in which though I did realise it at the start was going become an amazing learning experience for me. This patient was a 3 week old foal that had got a leg caught (possibly in a barbed wire fence) causing severe injuries. Though primary closure (aka suturing) was attempted this failed due to the tension in the wound and so we moved on to supportive care for healing by second intention (nature). Whilst this in itself was new to me, it got worse with the patient going septic (systemic infection with very high temperature) and so it went from general care to intensive 24 hour care with me at times actually staying overnight. This meant that I had a big learning curve on the different medications that were being used (I will never give a medication to an animal without understand its effects and potential side-effects). This worked for a while however the condition was getting worse so we started to question things, I spent a morning with textbooks working out the actually nutritional requirements including fluid (in a foal this young its a shocking 15 litres a day!) and proposed that we change our treatment quite dramatically which after discussion was accepted. During my time at BSAVA Congress I’ve met some good exhibitors (and equally some bad ones) that have been willing to talk through equipment with me even though I was not planning to spend money with them. One of the things I had been taught was about the fluid pump – no one else around knew anything about this – so I decided to bring this into play meaning that instead of just 100-200ml/hour I could get a rate of 999ml/hour of fluid into the patient instead.

So with a great improvement in the first day with this new fluid protocol (and me actually breathing a sigh of relief that I had not killed the patient with it) we could focus on the other problems. During the time in the stable the patient had developed septic arthritis (inflammation of a joint), and joint lavage had been performed twice to try to clean the infection out. One of the PhD students had done some research so we spent some time reading up on different journal articles with one of the techniques that we both noticed being that of regional limb perfusion. Now basically the theory is that drugs have side effects and the antibiotic we were using was bad for the kidney yet to get the concentration in the joint area we needed a high dose through the body which was bad (medicine really is a balancing act). Now with the regional limb perfusion technique what we did was simply create our own local area by restricting blood flow to the leg, and then delivering the drug directly to the leg meaning that instead of affecting all the body the main concentration was in the area we wanted.

Obviously this had risks as cutting of blood to any area is dangerous, and extremely painful. We used regional nerve blocks along with careful timing for this procedure with the patient sedated and after this procedure the inflammation subsided greatly. During this time we were still treating the original wounds which were healing nicely and we were supporting with a wound medication specifically to reduce the granulation tissue and so promote the contraction of the wound edges. I guess that this case will really be remembered as it’s the first time I’ve worked with a foal, and the first time that a single patient has meant looking after two animals. It really was at times quite unsettling being “watched” by mom…

Mom watching over my shoulder during treatment of the foal
Mom watching over my shoulder during treatment of the foal

A vet students (non)summer – Part 1

My first day in the Small Animal Clinic

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

Now this really is a post that I don’t know where exactly to start, I’ll apologise in advance if some details are vague however I do have to protect client confidentially for some patients. So over here in Slovakia, when it comes to summer exams you can schedule your own timetable within 2 periods (15th May-15th July and 15th August-31st August) and its your responsibility to ensure that you pass everything to be allowed to progress to the next year of study. With the fundraising I have been doing for tuition last year I’d let some of my revision slip, and did very few exams at Christmas so was left with nearly a years worth of exams to do within this period.

Now at the same time I also wanted to get as much practical experience as possible, so I decided to attempt to do an exam a week along with as many clinics as I could get into. Knowing nothing about equine I decided this would be a good start if I was ever to get over my fear of horses (they have a reputation of dying very easily) so started with equine. I was told to get some dark scrubs and then come – apparently white coats freak the poor animals out – this wasn’t easy though as nowhere in Kosice sells scrubs (I even tried the hospital) and I had to order from the UK in the end. It is about working your way up here, and for the first couple of weeks I was solely watching and handing things over. This suited me fine as I was trying to pass Anatomy at the time so gave me time to study as well.

So fast forward a couple of weeks, we had a horse arrive for some dental treatment. Basically within the horses mouth you have a large gap between the front teeth (incisors) and the (pre)molars at the side which are used for chewing. Sometimes a horse may have a small tooth in front of the molars in the top row known as the wolf tooth. Now this extra tooth which does not really have a purpose now can get in the way of the bit when riding so is usually removed. To be honest I was pretty surprised that the roots of these teeth were so small as I know the other teeth have very large roots (the entire tooth was around the size of a 5p!). The next stage of a equine dental is to make sure all the surfaces used for chewing and grinding line up properly, and that there are no sharp edges which can cause damage to the tongue and cheek – this is where the rasp comes into play! It’s really important to remember that horse teeth keep growing, and that if the surfaces wear down unevenly then the tooth will also grow unevenly. And finally once finished with the molars(cheek) teeth it is time to look at the incisors which are the teeth at the front.

Incisor overbite in equine dental examAs you can see with this horse the upper teeth protrude in front of the lower teeth which is known as a overbite which is where the incisive bone is slightly longer than the mandible (jaw bone). This causes uneven wear on the upper teeth which increases the bite and so these have to be ground down by a equine dentist or vet on average every year. The opposite which is a underbite is where the mandible is in front of the incisive bone and is most common in brachycephalic dog breeds! I was lucky to see a few dental cases over the summer, including one which had a retained part of the root after a previous fracture which made its way to surface a few months later.

During this time I was also popping in and out of small animal clinic as equine only operates during the morning unless it’s a emergency. I got thrown in the deep end here as well with a crash course in the common procedures over the first few weeks such as managing IV’s, canula’s, giving meds, doing clinical exams and more. This was where I learnt one of my three biggest lessons from the summer, never make any assumptions. Just because a patient has a history or is being treated for one problem does not mean that there is not a more immediate life threatening problem that is still undiagnosed. Definitely is a lesson that I will remember for ever, and I am taking every chance I get to examine every animal as thoroughly as I know how. Animals cannot tell us what the problem is, or where the pain is, so even when presented with a case that I have seen already I will do a complete clinical exam.

My first day in the Small Animal ClinicNow that I’ve covered my first major lesson this summer I think I will leave this diary entry here for now. Obviously trying to write about everything at once is difficult and is enough to fill a book, however in my next post I will introduce you to my first experience with a foal, some experience with artificial insemination, and some of my surgical patients!

Small Animal Soft Tissue Surgery Book Review

Small Animal Soft Tissue Surgery Book Review

As a vet student learning surgery is one of the biggest challenges that lies ahead, and is something that is exciting, yet bears a weight of great responsibility. Most of the surgery textbooks that I have seen are either very specific, or are absolutely massive so I was slightly surprised at the size (and weight) of this book. Flicking through quickly it is possible to see that for the size it has a lot of good solid information without the “fluff” that some books add starting with principles and techniques of aseptic technique, instrument use, and suturing. The book then moves on to discuss the different organ systems, and soft tissue surgical procedures that are used with these.

What I especially love is that the basics are covered in a high level of detail, with the different approaches to the same task considered and contrasted. For example looking at haemostasis the options of direct pressure, crushing haemostasis, ligation, vessel clips, vasoconstriction, diathermy (monopolar and bipolar), topical haemostatic agents are all considered before finishing with a discussion of the complications of bleeding disorders. The two chapters on suturing cover the different materials, and then the different patterns that are used with step by step photographs of each pattern. Pain management, post-operative nutrition, wound management and reconstruction with amputation is covered with an entire chapter on oncological surgery and skin tumours.

When looking at abdominal surgery it starts with a chapter on the principles of abdominal surgery looking at the different approaches, prevention of adhesions, exploring the abdomen and limiting complications. The rest of the section covers the procedures for separate organ systems within the abdomen with each chapter covering the principles behind the system, before going into the clinical indications, diagnostic imaging and different techniques for each procedure. Off note here is the chapter on gastrointestinal surgery which covers the different approaches for diagnosis, special principles and techniques including suture patterns and performing a leak test. The chapter then looks at gastric obstruction and GDV covering from initial stabilisation through to selecting a site for gastropexy. One of my favourite (and as a student most useful) chapters is the one of peritonitis management and the acute management which covers the stabilisation, oxygen & fluid therapy, right through investigation, imaging, diagnosis and treatment.

I’ve already had the pleasure of seeing some small animal surgical clinics here, and this book with its concise indications for, differentials and description of the procedure has been a golden resource for me to quickly get up to speed on the procedures being performed. This is especially useful as I am studying in Slovakia and my understanding of the language still needs improving so prevents me getting completely lost.

One of the first things that got me was that the images are not in colour and are instead printed in high contrast black and white. To be honest I personally like this as I find that they have a higher contrast between tissues which makes them easier to see as colour images rarely match up to what you see in surgery with the difference in lighting and perfusion etc.

For a vet student starting surgery this is a book I would thoroughly recommend, it has the answers to all the “stupid questions”, as well as covering the basic skills that once mastered will make you a better surgeon. I for one will be keeping this book on hand throughout the next 3 years of my training!

This is a book I’d recommend to go into any veterinary collection for a quick reference of the different surgical options available for a client, or as a cheat guide to avoiding the common pitfalls of different procedures.

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