The end of anatomy, and an extra special wildlife patient! (Day 670)

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

This morning I sat my anatomy final, I am emotionally and mentally exhausted and last night asked my twitter followers to help me through. This they did wonderfully and I drew enough strength from it to get my through my exam today with a D. When you consider how much is needed to be memorised and for so many species you can understand why I am happy with that. Also I have decided that I would rather have practical skills and understanding than straight A’s with just book learning.

After this I popped my head into clinic to see what was happening, surprisingly it was busy with two guinea pig castrations booked in. I ran anesthesia for the first castration surgery and then assisted in the second surgery which was pretty cool.

After this as I was about to leave a member of the public dropped in a duckling with fishing line coming out of it’s mouth. Now this is the first time I have seen it here and so I decided to stick around.

Duckling with fishing line from mouth

We quickly anaesthetised to inspect the mouth and see if we could find the hook, we could not see it in the mouth cavity, and taking a quick look with the endoscope I could not see it in the upper part of the esophagus. Because of the way the esophagus is a elastic tube you normally also need to also introduce air to see further which we do not really have the facilities to do. So it was decided that our next step would be to get xrays to see exactly where the hook was, it was lunchtime so xray was closed which meant we had to wait an hour for this.

When doing xrays it is really important to do both a ventrodorsal (laying on back) and a lateral (laying on side) image as this will let you use your imagination to put them together to get a 3D image. The one on the left below is the lateral image taking from the side, and the one on the right (which also has my measurements for planning the procedure) is the one with the ducking on it’s back (you can click it to see a bigger version).

Ducking with fishing hook in crop lateral and ventrodorsal radiograph viewsFrom the xray you can see that the hook is inside the thoracic cavity (the space between the start of the ribs and the diaphragm) – and if you look at the xray on the right you can see the ribs visible on top of the hook. Now during surgery on the thoracic cavity is very challenging at the best of time so we wanted to avoid this. The easiest way to go and get the hook was through the mouth, so one of the doctors here attempted to slide a tube along the fishing line to see if he could dislodge it whilst I prepared the endoscope.

Chris preparing endoscope to remove fishing hook from ducklingNow I do not know where they came from as I had never seen them before, but I found a pair of grasping forceps (well biopsy forceps originally…) on a rigid attachment for the endoscope so I decided to give this new toy a try. The doctor had failed to get the hook out using the tube so it was time for my performance.

We used isoflurane (a gas anaesthetic) with the duckling so we had to remove the mask to do anything which meant we had a limited time we could do anything before the duckling started waking up and the mask had to be put back. Because of the previous attempt to get the hook out using the tube there was some air trapped inside the esophagus which made visibility better for me and I followed the fishing line down to the hook. Now on the xray it didn’t look it had a very big barb so I made the decision to try and remove it from the lining of the crop which was successful with no bleeding observed. I then caught the point and started to bring it back up the esophagus, near the mouth the hook slipped from my instrument however I was able to grab it again and remove it completely as below with fishing line attached.

Fishing hook after removal from ducklingAll of this took me under 90 seconds to do, and as I brought the hook out the duckling started to wake up. I was a little bit surprised at how quickly I had managed to do something I’ve never done or seen before. We do have a recording system for the endoscope but I was so focused on getting the hook out of the duckling that I totally forgot about this until now though I really wish I had a video of this to share. Instead here is a picture of the duckling with the hook and my new favourite instrument!

Baby duckling waking up after fishing hook removalSo with this I’ll leave you with a request that I am sure has been said a thousand times before…

The great outdoors is great fun, but please make sure the only thing you leave behind is footprints!

All about bananas, orangutans and ultrasound… (Day 667)

Today’s Diary Entry is sponsored by Eickemeyer

One of the things that I miss in life is surprises, its usually extremely rarely that I am surprised and today I got an amazing surprise. I’ve been out working with a zoo vet again today (I know I’ve not finished yesterday’s diary yet but I am so thrilled by this I must write it now), we had several patients today including a camel, a pair of sea lions, a rhea, a Mara, a Lama, loads of birds, and the continuation of medical training for the orangutans!

So to give a little bit of a background as medical training is a term you may not be familiar with, usually with zoo (or wild animals) it is extremely dangerous to work with them unless you sedate or anaesthetise them. This is stressful for the animal (and the vet!) and so alternative ways of managing common procedures have been developed. The leading method here is through medical training – this is all reward based and can be teaching a elephant to place their foot on a special stool to trim the toe nails through to getting a sea-lion to open their mouth. In all its normally a win-win situation both for animals, the vets and their keepers.

Now a few months back it was noticed that some orangutans may have been up to some naughtiness and be pregnant. A urine test – a human test is actually used here as they are so similar to humans – came back positive. So over the past 4 weeks the zoo vets have been trying to train a orangutan for ultrasound to allow them to check on the status of the baby. This was going well with the orangutan coming to the bars and staying still. Then the orangutan allowed the ultrasound probe to be placed and moved on their abdomen.

Then there was a problem, now ultrasound doesn’t work through air, this is why a ultrasound gel is used to conduct the sound waves from the probe into (and back from) the body. However the orangutan does not like the ultrasound gel, the minute that it touched her she sprinted away to clean it off! This had been going on for a week or so…

Last night I did some reading, there was very little in scientific documentation available – though I did learn about the Great Ape Heart Project which is really cool – and the only potential solution I found was actually in a newspaper report from 4 years ago.

Apparently the solution was bananas… No not to feed to the orangutan… But to use instead of the ultrasound gel. To me this seemed pretty stupid, and so this morning when we were discussing patients for the day I was a little hesitant to mention it however did so to some strange looks.

When we arrived at the orangutan house there were more strange looks from the keepers, however they found us a banana… And then I got asked just what was supposed to be done with it, now the newspaper didn’t really go into much detail so I kinda improvised here and the next thing I know the zoo vet was trying to ultrasound themselves using a slightly mushed up banana. I was pretty surprised to see it working with a grainy black and white image appearing on the ultrasound machine.

So with it working on humans, the next stage was to start the training session. Now I was expecting it to take quite a few sessions to get the orangutan used to having the banana on their belly. This was going well so the vet tried a little on the probe, letting the orangutan taste it before moving to their belly. When using banana you don’t need to use that much on the probe (no where near like loading it up with gel). I was holding the ultrasound machine at this point, and when the first ultrasound images from the orangutans at this zoo started to appear using banana conducting gel I was shocked.

Then I was amazed as the vet continued and then the baby orangutan appeared (It looked like a head to me). Continuing we looked at more – the fetus was too large at this point to fit on the ultrasound machine so we saw loads of bits rather than an entire fetal orangutan however it was still really really cool! My arms were aching from holding the ultrasound yet I didn’t want to move in case it scared her.

It was like a magic spell, I was not expecting to even see the ultrasound working when I started this morning, yet here I was one of the first people in the world to see this first ultrasound of this (hopefully) soon to be baby orangutan! I was even one of the first people in the zoo to see medical training for orangutan ultrasound working, and was even more lucky to be part of the team effort that made it happen!

Some days are just priceless, this is one of them!!!

Why price shopping for a vet is so dangerous!

Todays diary entry is sponsored by Pet Hair Remover

Recently I have seen a lot of posts on social media comparing the prices for things like spays and castrations for different animals. Sometimes it is really easy to fall into the trap of looking just at the procedure, for example lets talk about castration of a rabbit (I had an interesting conversation on surgical techniques here the other day)…

So prices ranged from around £40 right up to £120, whilst there is some influence on the area that the person lives and the size of practice lets look at possible reasons why there is such a big difference.

Getting new clients through the door
Some vets will use castration and spay surgeries as what is known as a loss-leader, basically they lose money as a way to attract new clients. Afterall if you have a great first experience you will likely use them regularly in future.

A package deal
It depends what else is included in the castration “package”. Some vets will include the followup appointments and any aftercare medications. Others may also include microchipping, free insurance and more to get your pet of to a great start!

Surgical Protocols
Now there is considerable variation in the type of surgery protocol between vet practices. There are different ways to anaesthetise an animal so the cost of the drugs used may vary. Sometimes a inhalation anaesthetic may be used as well which may require intubation, here in cats and rabbits there are options as to how this is done either using a endotracheal tube or a special device called a V-Gel. Then there is whether a cannula (a injection port into a blood vessel for drug and fluid administration) is placed, and if IV fluids are given. Also the way the animal is monitored may vary, it may be done manually, or the vet practice may have invested in special monitors which give more advanced notice when something is going wrong!

The Surgical Technique
There is then the surgical technique employed which is dictated by the vet performing the surgery. As I said the other day it was a interesting discussion as there are many different approaches. Sometimes there may be one or two incisions, the sac containing the testicles may or may not be opened, the incisions may be sutured, glued or even left open. Suture material is rather surprisingly expensive (especially if it is absorbable) so the surgical technique can in turn affect the pricing.

Follow up careResearch has shown that many animals can feel pain, so its important to consider surgery to be painful to animals as well. Especially with small mammals this can lead to stress and then onto major complications like gut stasis and so forth. I personally believe that any animal should be given adequate pain relief after surgery. It is also important that patients are monitored properly after the surgery as well!

There are loads of different ways to do things and no one way is the best, however it is important to dig deeper than the title next to a price in a list. Vets will be happy to explain things to you, and if you have questions you should never be scared to ask. Question how things are cheaper, and more importantly question how your pet will be looked after during the procedure!