Large Animal Rotation

Today for clinics I had the large animal rotation, where we get a case, are given the presenting symptoms, and then we are supposed to come up with a list of differentials, a diagnosis, and a treatment plan. Basically, the point is to start training your brain to actually think like a vet, which isn't as easy as I thought it would be. It's so easy to jump ahead and skip steps and make assumptions that can cause you to miss a lot of important clues in what is actually wrong. Anyway, so we got this case and we were left alone to discuss as a group what we thought was going wrong. And even though it pains me to say this, this large animal case was so much better than the equine one.

Our case was about a 2 month old mixed breed beef calf. He was admitted for having a bilaterally distended abdomen and for appearing depressed. He had previously been admitted for calf diphtheria (I just had my exam on that one- yay for knowing Fusobacterium necrophorum!) and had been on antibiotics for a while. Now the thing about cows is their rumen is a pain in the butt. Anything wrong with the rumen is no good. Anything wrong with all the little microbes inside the rumen is no good. And what do antibiotics do? Wipe out all the little microbes in the rumen. So as we were discussing the case that was like a red flag to be aware of.

The attending clinician gave us the vitals from this calf (high heart rate and weak pulse), there was some pinging and splashing in the abdomen (a sign of gas, possibly bloat), absolutely no motility (ruminants should have a least a couple of gut sounds every 2 minutes), and told us that he was dehydrated as well as having some diarrhea. Then we were left to discuss our problem list, differentials, diagnostic procedures, diagnosis, and treatment.

Now, I don't pretend to know anything about cows. I really don't know anything. Mama cow was in the next pen over with a ridiculously fuzzy winter coat that made her look like a teddy bear, and I didn't even know cows grew winter coats. I don't know why they wouldn't, but it never occurred to me that they would, either. So that pretty much sums up my experience with cows.

So while the group is sitting around discussing, one of the first things said is a displaced abomasum. This is one of the only diseases that I actually know about it cattle, besides bloat. The abomasum is the "true stomach" of the cow's 4 chambered stomach, meaning it's the chamber that's like our own stomach. And normally it sits more on the right side of the abdomen, and it being displaced just means it's not sitting where it should be. I think we also came up with decreased vagal innervation (the vagus innervated the GI tract) as well as just all the little rumen bugs being wiped out. I was happy about this, because it meant I actually knew what was going on. I didn't really think it was a displaced abomasum though, because beef cattle almost never get them. That's apparently a dairy cow thing. I was told this by someone who knows a lot more about cows than I ever will (aka Jenn).

Eventually our clinician comes back and tells us that it actually IS a left displaced abomasum. And all the clinicians were so excited and told us we were the luckiest vet students in the entire world that we got to see this. I will take their word for it. But we did get to watch the clinicians ultrasound the calf, which was cool. usually when you ultrasound the rumen you can't see anything, because gas blocks the ultrasound waves and thanks to the rumen bugs the rumen is full of gas. But because all of the microbes in this calf had died we could see into the rumen, and we could also see the abomasum right where it shouldn't be, next to the rumen. Then we got to watch (and help) rock the calf. That's what they call it when you essentially flip the calf onto its back, grab it's feet and rock it from side to side. The idea is that reversing the orientation of the calf would move the gas in the stomach, and then by rocking the gas would kind of carry the abomasum back to where it should be. Unfortunately, probably because this calf had no gas on it's stomach, ultrasound confirmed that 2 attempts at rocking didn't work. That means the poor little guy is probably going to need surgery to fix it.

But I'm feeling pretty good about getting to witness something so rare (because apparently a left displaced abomasum in beef cattle are completely unheard of) and to see how to rock a calf. I'd say this is in the top 3 as far as productive clinic days go. =]

Fundraising Attempt Number 1

I recently tested my hand at a bake sale, which was my first fundraising attempt to go to South Africa. It was our school's homecoming game (which I found out about 2 days before the game), so I decided I was going to make cupcakes with our school's colors on them and attempt to sell them. I've never done a bake sale before. I had no idea how many cupcakes to make or how to go about selling them, but that wasn't going to stop me.

I spent about 4 and a half hours baking and decorating cupcakes, both regular sized ones and minis, because they're so cute! Jenn made me some kick-ass homemade icing, and I picked up a Halloween decorating kit, since the colors so nicely match our school colors. And for the record, the homemade icing was waaaay better than the Betty Crocker icing I picked up. It started out looking nice and then completely melted off the cupcakes before I even got outside, and yes, the cupcakes were cool when I decorated them. It left me with an unfortunate number of cupcakes that looked too bad to sell, but my husband was more than happy to eat them so I wouldn't have to be reminded of my icing blunder.


It was harder than I thought. It was harder baking and decorating then I thought, and harder to sell them than I thought. By the end I was tired, thirsty, hungry, sweaty, and ready to go home. But it was also easier, because a lot of people were much more generous than I was expecting. My trooper of a husband walked around the school campus with me for nearly 3 hours to sell these cupcakes. We had a mobile bake sale, which people seemed to really like. There were a lot of supportive people out there who were willing to by my cupcakes that were melting in the Oklahoma heat, and there were a surprising number of people who didn't want a cupcake but were willing to donate to me anyway. And that really, honestly touched me. I think that's one of the main things I like about Oklahoma. You don't really see that in Philly too much.

We managed to sell every cupcake that was presentable, as well as a couple that weren't (in my opinion, at least). I would call that a success. Granted, it wasn't really a huge amount of money considering they were just cupcakes for 50 cents or a dollar and taking into account the money I had to spend to make them, but I was really proud of myself for pulling it off. And I learned an important lesson, which was yes, people will help you out and buy your cupcakes. So now we're going to be doing bake sales at our other fundraisers, the next of which is a pet photoshoot on November 17. Wish us luck, and if you're in the Norman area, bring your pets out and help support us!

Up Close and Personal with the GI Tract

I think my last anatomy lab was one of the more interesting ones, at least for parts of it. This time the themes was gastrointestinal tracts. The lab was split into three parts- equine, large animal and small animal, and then each of those sections was split up as well. So for the equine rotation we got to observe endoscopy and ultrasound, which was really cool. Now I fully admit I am no good at reading an ultrasound yet. I couldn’t do it for therio when trying to find follicles on the ovaries, and if I hadn’t been told what I was looking at I wouldn’t have been able to tell you if I was looking at spleen, intestine, or artifact. But it’s clinical application, and I love learning that. Since I’m hoping to become an equine practitioner I’m going to have to learn someday, so I might as well start now, right? We traced over the entire gastrointestinal tract, starting at the edge between the thorax and abdomen, where we could see some lung too, over the stomach, spleen, liver, intestines, kidneys, cecum, and colon. I won’t promise this, but I feel slightly confident now that if I saw an ultrasound I could at least tell you the difference between the spleen and the liver on an ultrasound. Especially if I knew which side of the body the image was from. Ultrasound is such a useful diagnostic technique, but I think they need an entire class on how to read it. No more radiographs, I’ve had enough of them. We need some more ultrasonography. 

Then we got to watch one of the vets scope a horse, and he did get the endoscope all the way into the stomach. I am a little worried about being able to perform endoscopy myself, since apparently if you play a lot of video games you’ll be really good at it. I do not play a lot of video games, and I definitely wasn’t picking up on the whole everything is reversed aspect of it very quickly. But I’ve only ever seen inside the stomach of a dead horse, and that’s a lot different, so it was really interesting. And we some some bot flies in the horse we scoped. I did feel bad for the horse though. It doesn’t hurt, but it’s not really fun having a tube shoved up your nose and down your esophagus all afternoon.

The final equine station was about putting a stomach tube down a horse’s esophagus. This is important because when a horse has colic one of the things you might do is give it some mineral oil to try and break up whatever obstruction is causing it. So we did give a horse about 2 gallons of mineral oil and then refluxed it all back up. This part was mostly learning about positioning, how to make sure you’re in the esophagus and not the trachea, and then we all gathered around to listen for gut sounds. My favorite part of the lab, for obvious reasons. I feel like I’ve been horse deprived while in school, so I always love being able to just be around them, even if it is during lab. At least vet school is probably the only place you can get away with not paying attention to the teacher so you can pet an animal and you won’t get in trouble for it.

Next was the large animal section, aka cows. I am not a cow person. They’re cute when they’re little, then they’re just big. They have pretty eyes, but that’s about it. But in this lab we did pretty much the same things- we ultrasounded the GI tract and put in a stomach tube, and we also got a little lecture on teeth. You might not know it, but cows only have teeth on the bottom of their mouth. On the top they have what’s called a dental pad. Just a little fun fact. 

The best part of the cow lab was getting to stick my hand into Rupert, the school’s fistulated cow. Rupert essentially has a plug in his side that goes straight into his rumen, so you can’t stick your arm in and get all up in the hay inside his stomach. And you can really smell the fermentation. And don’t worry, it doesn’t bother him at all, he’s happy as can be. So we all got to have a feel around his rumen and then we all took a look at a slide that had rumen microbes on it. And those little bugs were zooming around all over the place like my husband after multiple Monsters, or my Sydney going after a roach. I could have watched them for a while, they were very entertaining.

The small animal section was not as much fun, so I’m not going to talk about it much. We did get to look at some pictures from various endoscope procedures in dogs, and we did a “physical exam” on two dogs, meaning we pet them and tried to look busy. This can be a good lab, but it’s on a Friday afternoon, and by the end of the week if you stick a dog in my lap I’m a lot more likely to scratch it’s ears than palpate it’s lymph nodes. But over all, I’d say it was a pretty good lab. 

Passing mineral oil down a nasogastric tube

Me and Jenn

Listening to gut sounds

A brave classmate inserting the hallow tube that we pass the stomach tube through, which prevents the cow from being able to bite down on and destroy the actual stomach tube

ultrasounding a cow

Dr. Streeter ultrasounding a cow

a cow's stomach- the rumen is the giant sac, the reticulum has the honeycomb appearance, and somewhere in there is the omasum and abomasum

Rupert!

Oh Salmonella...

My lab assignment for this week is to attempt to culture Salmonella from a fecal sample. I don't know whether or not their actually is Salmonella in the sample, and I probably won't until about Thursday, because apparently Salmonella is very difficult to culture.

Now, you may be asking why I would care about culturing Salmonella. And besides the obvious that I am getting graded on this and it will most likely be a large part of my next lab exam, there is also the fact that everyone reading this has heard of Salmonella. If I decided to talk about culturing Actinobacillus pleuropneumoniae you really wouldn't know what I was talking about. But Salmonella is a very important zoonotic disease; it's why we're told never to eat raw eggs, because chickens can pass Salmonella through their eggs. Salmonella is a common cause of enteritis in humans, which is essentially disease in your intestines, and it is actually the most common food borne zoonosis that causes mortality.

So I guess you could say that Salmonella is a pretty big deal in the infectious diseases world.

Salmonella is a pain to culture because of a couple reasons. One, just because you might have the disease doesn't mean you're actively shedding it. Salmonella sheds intermittently, so a negative culture doesn't guarantee that you're actually negative for Salmonella. You have to have at least 5 negative cultures, each one 48 hours apart, before you can say with 95% certainty that you might be negative for Salmonella. Of course, if it's positive, then you're positive.

Salmonella also takes a really long time to grow. We try to help it out by using a special medium called a Selenite broth, which is a type of enrichment broth. Basically it increases your chances of finding Salmonella present in small numbers by suppressing the growth of other bacteria (Gram+) and enhancing the growth of Salmonella. And then even after you do all this culturing, you only have Salmonella suspects. You have to do additional testing to confirm that what you are seeing is actually Salmonella and not just another Enterobacteriaceae, like E. coli. We do this using slant mediums to test for color changes in the medium to see if it is a fermenting or non-fermenting colony (Salmonella is non-fermenting). Each step of the incubation process takes at least a day, since the plates all need to incubate overnight. And that is why if your vet thinks your animal has Salmonella and wants to culture it, you probably won't hear back for about a week.

These are some positive Salmonella cultures.

Notice how the Salmonella turned black in the one culture? And on the right side it is a pink color on an agar that started out more yellowish-green.

Color change in a slant tube test

Castrations at Dawn

This morning I had a wet lab that I have been looking forward to for a long time, since the first email went out looking for horses at the end of last year. I dragged myself out of bed at 6:00, somehow managed to get dressed and find my stethoscope, and headed out to the vet med ranch. When I pulled up the driveway the sun was just starting to come up, but our first horses were already waiting in the chute by the barn. Today was castration day.

I'm not going to go into all the dirty details, in case some people are like my husband, who started to feel physically sick while trying to listen to me talk about it. But we did have some ranch colts and some clients colts who needed to be castrated, and we were the ones getting to do it.

The groups were broken down into one person from each year, with fourth years and DVMs and residents floating around to help. The first years were responsible for performing the physical exam on the horses before they were even allowed off the trailer. We don't need any strangles outbreaks. They did temperature, respiration, all that fun stuff, and the most important was checking to see if the colts actually had two testicles. If they didn't, we can't cut them, and there was one cryptorchid in the ranch horse bunch.

Once the physical exam was completed and the horses found to be healthy, they were moved inside the barn. Inside, it was our job as second years to place the catheter into the jugular vein, so we could give them their ketamine and knock them out for the procedure. It's always fun trying to stick a needle in a horse who hasn't been handled much, but aside from a little rearing here and there there wasn't anything too bad. We also calculated out all the doses for the different medications the horses would be receiving.

After the catheters were in we moved into another part of the room and waited for their pre-op drugs to kick in and make them look drunk, then it was time to lay them down and inject the ketamine into the catheter. From here on the third years were in charge of the actual surgery, with a vet watching everything they did. I won't go into detail on the surgery, but I think it's pretty cool to watch. And while the third years perform the surgery it was our job to monitor the anesthesia, and to get some more meds if it looked like the horse was waking up. We check the heart rate every couple of minutes, along with the palpebral response, which is done by tapping on the inner and outer corners of the eyes. Then once everything was done the horses were given some penicillin and a tetanus booster if they needed it, and the rest was just waiting for them to wake up.

This is what I mean when I say the wet labs are where you get the most experience. I've seen multiple field castrations done over my years working with equine vets, but other than drawing up medications I was never really involved in one before. I think the lab ran pretty smoothly, so I'm hoping they do it again next year. Then I can be the one holding the scalpel and really feeling like a vet. =]

The Eye Beholds...

This is not for the faint of heart, but today we got to dissect a cow's eye in anatomy! I'm not going to lie, it was pretty cool. And as a quick disclaimer, the eye did come from a cow that was already dead and was donated by the owner to the teaching hospital.

The full globe of the eye

Our eye dissected. You can see the tapetum, which is the iridescent part on the inner part of the globe. This is what makes animals' eyes appear to glow in the dark. Primates do not have a tapetum. You can also see the lens on the right, which is ringed in black and stuck on the vitreous humor, the gel that gives the eyeball its shape. On the left is the choroid body, which change the shape of the lens and allow it to adjust. On the other side of the choroid body is the iris and cornea.

The lens.

Jenn holding our dissected eye =]

Phase 1- Planning

The planning has begun! Jenn and I have begun our fundraising plans, and we have a lot of ideas that we are super excited about. You can follow our updates here on Tumblr or visit our fundraising page GoFundMe. Any and all support is appreciated!

               
 Today we sat down with the head veterinarian in the zoo, exotics and wildlife ward, who helps sponsor this learning experience. We are hoping to have several events set up by Christmas, including pet Christmas photos, a professional night mixer, and a bake sale including homemade baked goods for owners and their pets. We are hoping that by getting as early a start as possible we will have better luck raising the funds we need.

Me and Jenn with some of the ZEW wards!

Visiting Simba

I am ridiculously excited for this. I am beyond excited. I have been dreaming of this chance since I first saw the Lion King in theaters. That was a long time ago.

Of course, I'm talking about the chance to go to Africa. Specifically, the chance to visit the Shamwari Game Reserve in South Africa. Every summer Shamwari hosts a program for vet students and pre-vet students to get them some hands on experience with the African wildlife. And as a vet student, I've been assured that if any sick animal comes in I will get first dibs. On everything. So I'm going to get college credits to go somewhere I've always wanted to go and take care of elephants and lions. It doesn't get better than that.

The program is a mixture of lecture and practical experience. Lectures topics are along the lines of wildlife restraint, pharmacology, wildlife diseases, and wildlife rehabilitation. Then we get some practical lessons too, like in darting (shooting a tranquilizer dart to be able to safely approach and work on an animal), monitoring elephants, ear notching rhinos (for identification), large carnivore immobilization, performing post-mortems, and then a day where we get to act as the vet in charge. The course lasts less than 2 weeks but you walk away with more knowledge then you would get from certain semester-long classes.

So of course I really want to go. The catch? The price tag. Isn't it always.

The airfare out to Port Elizabeth is more expensive than the actual program. And the program gives me housing and three meals a day. Good thing I have 8 months to come up with the money! And that one of my best friends is going to go and fundraise with me. Together I think we can pull this off.

We will be hosting a ton of fundraising events over the next several months in an effort to raise money for my trip. Check out all of my gigs on Fiverr.com under soleilfleur21- it doesn't cost you much, and every little bit helps me! Plus you can get some pretty awesome stuff in return. Who doesn't want a picture of my lizards dressed like a bride and groom?

We are also hoping to host some pet Christmas photo sessions with some santa and elf hats. Jenn is an amazing amazing photographer, and as you will see on my Fiverr I am good at dressing animals up in cute clothes =] I can do more than just lizards, I promise! And if you are in the Stillwater/OK area, keep your eyes and ears open for some nights at Ibiza bar and lounge!

I am so excited to have this amazing opportunity, it really would be fulfilling a childhood dream to be out on the safari. I just need to get myself there! And if I could get myself to vet school with everyone telling me the odds were most definitely not in my favor, then there isn't a single reason I can't get myself to Africa. With your help, too, of course. =]

My Fiverr Gigs