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.

Ultrasound on the inside, what is intraoperative ultrasound? (Day -236)

Vet student intraoperative ultrasound

Many people know about ultrasound, its used all the time for pregnancy check-ups in women. However did you know it can also be used inside of an operating theatre during surgery when the body is open? So instead of looking through the skin you are directly looking at the organ.

Now when you first see an ultrasound like this it is a little bit strange – as you are so accustomed to seeing the skin and muscle in front of the organ of interest. So when we put the ultrasound probe directly onto a kidney it looks very different.

In this case I’d come into the operating room during a surgery on an exploratory laparotomy just as the surgery had stalled. You see the most important thing in surgery is information – and here there was a kidney that was enlarged with an enlarged ureter (tube from kidney to bladder) which contained a stone about halfway down its length.

Now here was where a decision that was going change the cats life needed to be taken. Was the correct action to remove the stone from the ureter and place a catheter from the bladder to kidney to keep the ureter working whilst it healed? Or was the correct course to remove the kidney?

A few months before this I had read an article on intraoperative ultrasound on sonopath (they give a free student membership!) which is the best ultrasound guide I’ve come across. This basically said that using ultrasound inside the body was even better than using it outside especially with surgery so that you could take samples from lesions identified by normal ultrasound before surgery. Even when you see a lesion on ultrasound, once you open the abdomen it can be very difficult to find the lesion to take a biopsy from it so using ultrasound during surgery helps with this.

The great thing about this that I remembered was that it did not need any specialised equipment; you can simply fill a sterile surgical glove with ultrasound gel and insert a ultrasound probe into it. Then you just use the probe through the glove in the area of interest (on sonopath is suggests using sterile saline between glove and viscera however I did not remember this at the time).

So randomly I just suggested that I bring an ultrasound machine in and we take a look at the structure of the kidney before we made the suggestion. After explaining that it could be done with a glove and some gel I was sent to get the machine and sonographer. I think the weirdest part of the entire experience was that as with normal ultrasound we turned the lights off in the operating theatre to see the picture on the screen better.

Now on ultrasound it was obvious that the kidney was no longer functional, and so the best option going forward was relatively obvious. The problem here however was that we did not know the status of the other kidney – kidneys only show clinical signs after around 75% of the functional part is destroyed – so the owner needed to decide which was a bigger risk leaving it or removing it and hoping the other kidney worked. The decision was made that the kidney was going come out (a nephrectomy), and after discussion with the owner this was what happened.

The patient was sitting up completely different (partially due to the good analgesia) and now 3 weeks after the surgery the patient is doing well and is at home.

Sheep scanning, and a lump…

Sheep pregnancy ultrasound scan of fetus

One of the reasons I love this university is how practical it is, and how you are pushed to think for yourself. We were left with a bull calf with a large lump on its neck and told to come up with a diagnosis in diseases of ruminants this morning.

This was a very large lump almost the size of a basketball hanging below the jaw on the right side. Now when dealing with lumps it is important to consider the location in relation to the structures that anatomically occur in that area. Then it is how the lump feels, and what it is attached to. Considering what diseases can affect that area of the body. Sometimes it is worth looking at a ultrasound scan of the lump, or taking a biopsy from it to examine in pathology.

The lump on this bull however is most likely from trauma and a massive haematoma which is like a bruise. All this blood had collected inside a capsule under the skin.

The afternoon we headed out to the farm for a reproduction practical – it is always interesting on these trips as we rarely know where we are going or what we are going to be doing. When we got there we found that we were ultrasounding sheep and goats for the diagnosis of pregnancy.

We ended up on a farm with a large number of sheep and goats, we set up the ultrasound machine and got started. Apparently once we are qualified we don’t get the time to play with ultrasounding fetuses and have to decide within seconds whether the animal is pregnant or not. Today however we had the time to look properly, and attempt to find the different parts of the fetus. It was actually even possible to find the heartbeat of the fetus on the ultrasound along with the different organs.

Normally though when ultrasounding for pregnancy we take any sign of pregnancy as a positive pregnancy – this can be the cotyledons (attachment of placenta to uterus), the amniotic sac, or part of the fetus. Once we see this we mark the animal as pregnant and move onto the next, usually this occurs at the same time as milking to reduce any stress to the animal.

Sheep pregnancy ultrasound scan of fetus

The image above is of the fetus of a goat inside its mother who is very pregnant.