The last class…

Mom watching over my shoulder during treatment of the foal

It feels like forever ago that I was excited for my first day of vet school (you can read about it here) and what a feeling it was. I’m a little nostalgic as I read over my diary as I was so much younger and way more naïve back then.

It is the opposite today though, I am coming towards the end of my time as a vet student and that is scary. Today was my last ever class as a vet student so I am going finish as I started.

My last block of vet school is equine, and today was rescheduled from one of the earlier bank holidays this month. The class today was the examination of the distal limb of the horse.

We started with nerve blocks and the anatomical location of the nerves and where to inject the local anaesthetic to block the nerve. This can be used as a very useful tool to identify where a problem is in a horses leg as when you block the pain the lameness will decrease or vanish completely. This allows you to start with nerve blocks lower down moving higher up until you get rid of the lameness and tells you where to focus the rest of the exam whether that is radiography, ultrasound or arthroscopy.

After this we moved to dissection of the leg, looking at all of the important structures and how they connect together with the muscles tendons and ligaments. The equine leg is pretty impressive with how much strength it has and how fast it can move. This is largely due to the structure of the tendons which act almost as springs when they are loaded with a force.

The class finished with a live horse to do ultrasound of the tendons within the leg. This is one of the most common exams in horses and one of the easiest ways to look for problems with the tendons. It is possible to see many of the structures of the leg on the ultrasound machine and for any injury to the tendon is an extremely accurate way to determine the degree of damage.

It was a great last class, which combined theory with practice.

Comment when you see the problem…

dog-lateral-xray

Sometimes you see really cool things, this is one of those times. A dog presented to a vet clinic in America after trauma and the doctors there shared these scans in a private group – I think they are so cool I asked permission to share them with you… (answer at the bottom if you scroll down)

Comment when you spot the problem…

Lateral viewdog-lateral-xray

Dorsal view

dog-dv-xrayP.S. The dog is doing fine.

 

 

 

 

 

 

 

 

ANSWER

The is a part of the intestines in the area around the dogs knee. This is because there was a traumatic abdominal wall rupture with herniation of the intestines into the space under the skin around the leg. In surgery the rupture was found to be in the left abdominal gutter. The “doll” like bone between the back legs here is the penile bone as it is a male dog.

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

Baby duckling waking up after fishing hook removal

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!