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.

400 days to graduation…

Chris in Slovak Paradise

What feels like forever ago when I first started my diary I was counting up each day another day on my journey to becoming a vet. Now however I am counting down – that is either scary that I will be released onto poor unsuspecting animals, or amazing that I will finally be able to put my hard won skills to good use to make a difference.

I’ve come a long way since I’ve started not just in my knowledge but as a person. I never understood what I was letting myself in for when I got on the plane to come here – back when I started it was only accessible by Budapest and then a road transfer. I realised in Budapest that there were languages other than English – and that not everyone spoke English when trying to find my transfer company. It then got better when I was shouted at in the supermarket when I tried to buy ham – seems that I don’t understand here is mistaken for I cannot hear…

However I love Slovakia – and whilst I have just 400 days left here I am reflecting on what a great country it is. I’ve met some of the nicest people I’ve ever known, and seen some of the most beautiful places I’ve ever seen. The culture is amazing – I’ve never been anywhere where I can just walk down main street to find something going on – whether that is drums and folk dancing – or the Christmas market with hot wine in the snow. I’ve been up mountains in the snow – and at times thought I was going die – and then in summer laid by the outdoor swimming pools.

I’ve had opportunities here that I would never have got anywhere else. From anaesthetising a tiger, to working with dolphins, to chasing bulls around hills with a blowpipe. It is not always smooth, and its often crazy organisation – however that is just medicine – it depends on a lot of things and plans often go out the window. I’ve learnt loads, done loads, and seen even more.

So yes I am excited that I only have 400 days left, however I am sad that I only have 400 days left in this beautiful country. Each and every day I will learn a little bit more, both I hope in veterinary and as a person…

A little about dealing with wounds in animals…

Looking after wounds in animals - equine foal wound

Today’s Diary Entry is sponsored by Chart Stables

Recently I’ve been noticing a lot of pet owners posting online with a picture of an animal with a wound asking for advice. These have varied from a scratch through to a burn, however what all of these have in common is the massive list of comments with different treatments for it .

Now I’ve been fortunate to have attended lectures by wound management specialists such as Georgie Hollis (amazing speaker that if you get the chance you should see!). I’ve also been lucky enough to learn from some top surgeons about the surgical techniques that can complement the management of wounds. Along with my knowledge of the body and physiology and pharmacology I am often left shocked by the advice that I have seen given.

Now a wound is any breakage of skin, this can be from surgery or from trauma, yet the goal is for it to heal so the animal returns to normal functionality and with a satisfactory cosmetic outcome. In fact wound management is becoming pretty much a speciality within veterinary surgery with some amazing results for catastrophic wounds.

One of my textbooks describes wound healing to that of the performance of a symphony orchestra, when each instrument plays it part in conjunction with the other instruments at the appropriate time beautiful music is the result. The same is true of wound healing, when each component performs its function at the correct time uncomplicated wound healing occurs. Going back to the symphony however, if we got a conductor that only understood violin and drums then the music would suffer.

This is the same in wounds, to get the best result we need to know where in the process we are, and then we need to understand what is happening, and what will happen next. To look at wound healing in simple terms there are 4 stages, however these stages do overlap a lot so often it is not possible to define them completely:

During the inflammation stage the body attempts to stop the bleeding from the wound by constriction and clot formation, shuts down the lymphatic system to that area to keep the inflammation local and stop spread of bacteria. There is then microscopic widening of the spaces between tissue cells to allow the spread of cells involved in immunity and repair to reach the place they need to be (hence the swelling of the area). The start of a fibrin clot framework starts, and when exposed to the air this clot forms a scab under which the repair continues.

This is the arrival of cells such as neutrophils and macrophages into the wound which remove any dead tissue and kill bacteria. As the lymphatic system from the wound area is shut down, plasma and other fluids leave the area through the wound helping wash any nasty stuff away. Some of the same cells such as macrophages act as a bridge to the repair stage by sending signals causing the growth of new cells within the wound.

Repair (proliferation)
This is where the forming of granulation tissue occurs with the creation of new blood vessels and skin cells over the wound. This stage occurs around 3 – 6 days after the start of wound healing and creates a barrier against infection. It is also important as the granulation tissue here will contract the wound and bring the edges closer together as well as let other cells use it as a transport system.

Maturation & Remodelling
This is where the wound starts to regain its strength, under the right conditions this can start as early as 24 hours of injury, however the strength is not significant until around day 6 of this process. It continues to gain in strength between days 5 – 15, however the final stage is not reached until around day 21 with no disturbance.

Now this is a really simplified summary (there are textbooks on this!), however just with this it is possible to see how bad management can affect the outcome. Take for example some common antiseptic products; a lot of these are cytotoxic so they kill cells. Now by using these in the repair stage you are simply killing the new repair cells that the body is producing. The use of these in the inflammation and debridement stage however may be beneficial.

Bandaging during the debridement stage can be both good and bad, and a vet takes a lot into account in making a decision here. Bandaging can trap the bacteria next to the wound, however it also gives a way to remove the bacteria and moisture whilst stopping outside contaminants entering the wound. In the granulation stage however a bandage is less important as the granulation tissue provides a barrier against infection.

Something I’ve seen mentioned a lot online is honey. Sadly this is something where a little knowledge is a bad thing. There are certain types of honey that are good for healing (Manuka is one of them), however commercial honey brought in supermarket generally contains bacteria that whilst safe for us to eat in the quantities allowed is not good for wounds. When looking for Manuka honey you need to make sure to get medical grade which is specially produced with sterilisation to ensure that it is 100% pure with no bacteria.

Again another thing I’ve seen mentioned is sudocream, when used correctly it can be great, however using it at the wrong stage can increase the work to debride the wound for example – this is a foreign substance, and is water repellent which while it stops stuff getting in, will also impact bacteria being washed out. It also contains an alcohol, now alcohol used to be used loads for preparing surgery sites… However more recently it does have less use here.

I’ve barely touched the surface, however I hope that I have helped people realise that wound management is not as simple as looking at a picture and asking what cream to use. For those that would like to learn more (plus see some awesome case studies) I would refer you to Georgie Hollis and The Veterinary Wound Library.