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.

When pigeons need surgery too…

Pigeon intramedullary pin fracture fixation surgery

Being a vet student brings great diversity in my daily patients which is one of the reasons I love it so much, today I assisted in surgery on a pigeon. Now this is one of those things that is not always taught in vet school – there simply is not enough time with everything else that we must learn.

A lot of my knowledge on the less common animals come from a lot of self study (if you are interested in pigeons check out the BSAVA Pigeon Manual here) when really I should probably be learning about the common things on dogs and cats… However sometimes like today the extra study pays off.

Now birds are different to other animals because they need to extremely light to be able to fly. One of the main weight savings is made by the bones being pneumatised – this means that they are hollow and join the lungs in the respiratory system in helping the bird breathe. This also helps the birds respiratory system be more efficient than in other animals – it is one of the reasons they can fly at such heights where other animals would suffer from a lack of oxygen.

Another important difference for when we consider surgery is that bird bones are a lot more mineralised than in other animals. This means that they are more likely to splinter than to “break” – an important thing to remember.

Before we started the surgery we did radiography, one of the goals is to return function and this allows us to check that the important ligaments of the wing are intact. It also allows us to see the damage and plan the surgery – in this case because the fracture was near the end of the bone where there was muscle attachment we needed to fix this into the proper position before we could then insert a intramedullary pin into the bone to fix it.

I am extremely lucky here that I have some very talented vets to learn from, and I was allowed to assist in this procedure. For me it was the most delicate orthopaedic surgery that I have assisted on so far, and in this case I was amazed at just how we could work with bones barely wider than a matchstick. However the surgery went very well, we fixed the end of the bone into the correct position and then inserted a long pin through the middle cavity of the bone to fix the two pieces together. Now something important to remember is that this long pin would act like a hinge for the two pieces of bone to rotate around so we inserted a second pin into the bone and the other end so we could fix them together to prevent rotation.

Hopefully this pigeon will make a full recovery, and be the first of many different species that I will be able to help when I finally qualify!

Why negative tests at the vet suck…

Babesia blood smear - typical two tear drops

Today’s Diary Entry is sponsored by Spikes World

I am not quite sure how I got to this subject today, however it is something that I thought I would share my thoughts on from the past couple of months. After all as vets we will use tests to work out what is wrong, yet just what are we looking for?

Now diagnostics has played a big part in my life over the past 50 or so days, I’ve seen many physical exams, listened to tons of hearts, and watched countless breathes. I’ve looked at hundreds of radiographs, seen quite a few ultrasounds, and looked at blood and parasite slides.

I believe there are two ways that tests can be used. You can either confirm or eliminate a diagnosis. Personally when I look at a radiograph I am hoping to see something wrong. If we can see something wrong then can attempt to fix it.

So we look at a radiograph, and we see nothing abnormal. Is this really good? Personally I am on the fence here, not seeing anything means that I still don’t know what is wrong. Then there is the other problem, not everything will show up on a radiograph, so sometimes we use special foods or liquids to increase the contrast so we can certain things more clearly. Because we’ve not seen anything on the normal radiograph, does that mean we need to do a contrast radiograph? Or does it mean there really is nothing there?

Same with looking a blood slide under a microscope. If I see something is there it means I know what should be treated… If I see nothing is it because there is nothing? Or just nothing in that drop of blood? Or because it will not show up on the stain I used? Or worse, did I miss the 1 single abnormal cell within the 1000 cells that were on the slide?

Or how about the skin scraping looking for parasites causing the patient to have itchy skin… If I didn’t find anything does it mean that it is not there? Or did I not scrape deep enough? Or scrape in the wrong place?

The worse is the patient where all the diagnostic tests are normal, but the patient’s clinical signs show that they are sick… We can do test after test and they all come back negative…

Sometimes I think diagnostic tests are a dangerous thing, if not used properly they can be a time consuming and very expensive stab in the dark. However what are we supposed to do when they are negative and we are forced into the elimination route of diagnosis?

Is it because the test didn’t work? Or because it really is a negative?

Diagnostics are improving, yet it really is down to the skill of the clinician that uses them that determines just how useful they are….

P.S. For anyone wondering about the picture today, it is babesia, it is the third blood slide that was made for this patient as the first two were negative…