Today’s Diary Entry is sponsored by Best Pet Hair Remover
One of the things here that is a little strange is that a lot of the lecturers also have private clinics in the local area. Whilst this lowers the number of patients being seen at the university it does mean that it is possible to see several different styles of medicine being practiced.
This week has been pretty hectic for me and I managed to go all week(well since Monday) without seeing a single surgery. For me it’s almost like withdrawal, i start to get cravings as it just feels like real medicine and a reminder of why i am here. During andrology our doctor mentioned that he had a mammary gland tumor resection and i was like a fish on a hook.
Before we go there lets talk about todays andrology class, as I’ve said andrology is all about the male reproductive organs. So today was all about the collection and examination of semen from a bull. This is pretty interesting as when a bull mounts a cow they ejaculate pretty quickly. Our lesson actually started with us watching this happen; sometimes i am still amazed when walking into classrooms with massive animals in. For this class there are metal pillars set into the floor for us to stand behind, in the UK at least not many places keep bulls because they are so dangerous, and apparently as a young inexperienced bull even more so i really was glad of this little bit of protection.
After the collection of the sample (apparently enough to inseminate 100+ cows) we moved to the lab where we performed the examination which included staining to distinguish between the live and dead.
After class i then met with the doctor to go to his private clinic for his surgery. I was impressed as it looked pretty recently constructed, and though being a relatively small space still had a lot fitted in. Within the university a lot of relatively simple stuff takes a long time with so many students so it was a breath of fresh air to see so many patients so quickly and effectively. This continued with the surgery using a basic triple combo anesthetic, good monitoring, and the patient recovering uneventfully.
Today i finished my day by having food with some friends. Though it was not such a crazy day this was the first food I managed to have today so was very well recieved!
Today’s Diary Entry is sponsored by Chart Stables
So this morning at around 6am I got a sms for emergency surgery in the equine clinic, as always there was no indication of just what the surgery was going to be. Jumping out of bed I did an hours reading before then heading down to clinic so that I could be in on the pre-op. Heading into stables i found our equine surgeon talking with our ophthalmologist so realized it was eye related. I then found the patient, a foal that had sustained trauma to its right eye hiding in a stable behind mom.
Now i am not sure if i have written about foals before so I will include a few notes here. When working with foals you tend to also have to deal with mom, this can make it interesting as sometimes mom is not so keen on you touching her baby. Also adding another horse into a procedure just automatically doubles the danger. However to get the foal to go somewhere normally if you take mom the foal will follow, downside here though is that if mum gets nervous or scared then the foal will as well.
Because of this it is sometimes chosen to also sedate mom. So after mom leading the foal onto the scales to get the weight, and then the preparation of drugs it was time for the surgery. Now mom led the foal into the operating theatre, and the foal was positioned so that she would be able to have a controlled fall on the operating table. She was then given anesthetic drugs and carefully positioned onto the surgery table. Careful attention was given to mom during this time to ensure that mom did not freak out when her foal fell onto the table. Mom was then moved back to the stables whilst surgical prep started.
The area around the eye was cleaned and shaved whilst the anesthetic team monitored the foal and the ophthalmologist scrubbed and then prepared her instrument tray for the surgery. Something really important is balanced anesthetic and in this case it was also decided to use local nerve blocks around the eye to reduce the amount of general anesthetic needed. At this point it was uncertain whether the surgery would be to repair the eyeball or to remove it. The first thing the ophthalmologist did was to clean and examine the eye, unfortunately in this case the damaged was too severe and so the decision was taken to remove the eye.
Now this is a relatively simple procedure with several different techniques possible to achieve the goal of removing the eye. In this case because of the trauma what is called a transconjunctival approach was selected. This is where the conjunctive tissue (this is the tissue inside the eyelids) that surrounds the eyeball is cut to release the eyeball from the socket before the nerve and blood vessels are then cut. On this occasion the vessels were not ligated but compression used to achieve hemostasis by filling the empty socket with gauze to apply pressure until the bleeding stopped. A surgical drain was then placed to allow any fluid to drain from the wound. The eyelids were then trimmed to remove the eyelashes before these were sutured shut.
The foal was then taken to recovery. Now this is also different as we do not leave a foal to recover alone but support the recovery with the foal being restrained on the ground until the drugs wear off. Once the foal is reasonably awake we then help the foal to stand and support them until they can stand alone. After this mom is then brought back to be with the foal as this helps reduces stress in the foal.
Today we had our second Andrology and AI lesson; it was completely practical so turning out in the freezing cold to catch the bus at 7:45am was pretty difficult however it’s only going get colder now so best to get used to it.
So we headed first to the uni farm to collect overalls and wellies, before jumping back onto the bus to head out to another farm where there were some bulls. Now adult bulls are extremely dangerous animals, and are highly selected for positive breeding features so sadly there are a lot that do not make the cut. The animals we were allowed to work with today had all been identified for slaughter for one reason or another – however they were still extremely dangerous (I’ve met ex-dairy men walking with sticks because of being kicked by cows).
Getting ready to start we had a safety briefing and then an introduction into just what we were looking at and where (and how) we would find it. There are several different glands around the penis (including the prostate) that are very important medically and so we need to learn to find and check these. The only way to do this is via rectal exam and so we started firstly by sedating the bulls we were working with for safety (even then it was scary at times) and then started with the rectal exams.
After this we moved onto the penis itself, in bulls the only way to be able to examine and possibly treat any injuries sustained is to have it relax and “hang” itself. To encourage this we can use anaesthetic drugs to block the nerves that control it from working. Sounds simple right? Well not so much, the nerves we need to block are located within the pelvis so it involves a massive needle being inserted along the side of the rectum/colon and controlled into place through the wall of the rectum during a rectal exam. Once this was done it was then possible to exam and flush the penis.
So a few hours later, with the only warm part of my body being my right hand we had finished and headed back to uni.