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!

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.

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.