As I previously mentioned I attended the Vetsim course held at Nottingham university this Summer and I found the experience both inspiring and informative.
Day 1
Having dropped off all my luggage I headed for an afternoon of lectures; firstly James Ridgeway (author of SURF – The Liquid Universe Book) gave an extremely motivational talk about four simple steps to improve the chances of a successful university application. For those who are required to sit the BMAT examination he suggested using the brain gym on the Med-link site not only to keep your brain working over the Summer but to improve your chances of scoring highly in the real examination. Secondly he suggested blogging as well as staying up to date with current veterinary news. Furthermore, he advised receiving expert guidance with regards to your personal statement as well as ensuring it conveys both your commitment and passion. Lastly he encouraged us to discover as much information as possible about all the prospective universities in order to give the best chance of a successful application.
Following this we were given a lecture to briefly describe the procedure and apparatus involved in both ultrasound imaging and laparoscopic surgery in preparation for the practicals. We were informed about the different types of probes used for ultrasound imaging that emit different frequencies of sound waves to explore different depths. Frame rate is also an important factor, particularly for dynamic structures such as the heart, and the contrast can be altered to allow the shades of grey to bring out different structures. The key to understanding ultrasound imaging is to use pattern recognition and notice unique structures such as valves within the heart.
The first animal to undergo laparoscopic surgery was a Red Setter in order to correct a heart defect. Laparoscopic surgery is defined by the size of the incision, not to be confused with microsurgery which involves optical enhancement and a large incision, despite the term ‘micro’. We also considered the various advantages and disadvantages of laparoscopic technique in a cardiac surgery over the conventional bypass surgery. Firstly not only is the incision size significantly reduced (around 5-8cm compared with 30-38cm) but far less trauma is caused to the patient, with keyhole surgery only cartilage needs to be removed whereas bypass surgery would make it necessary for the sternum to be sawed open. Therefore, obviously the hospitalisation and recovery times are far longer with conventional surgery; which is clearly negative from both an economic and sentimental point of view for the owner, as well as causing more stress and discomfort to the animal. However, in spite of the clear benefits of laparoscopic surgery the surgery time is largely increased, in fact to about double the length; this causes further complications in surgery as not only is the expense of the operation increased, but surgical staff must remain focused for a longer period of time. Additionally more anaesthetic must be administered therefore increasing the risks of complications. As the surgery is carried out using a small camera and a screen, the visual perception is in 2D compared to the 3D spacial awareness associated with conventional surgery making the procedure much more complex. Overall, in my opinion I feel the benefits of laparoscopic surgery far outweigh the few disadvantages, such as longer surgery times, as the treatment is far more effective for the animal and can improve their quality of life far quicker.
The first animal to undergo laparoscopic surgery was a Red Setter in order to correct a heart defect. Laparoscopic surgery is defined by the size of the incision, not to be confused with microsurgery which involves optical enhancement and a large incision, despite the term ‘micro’. We also considered the various advantages and disadvantages of laparoscopic technique in a cardiac surgery over the conventional bypass surgery. Firstly not only is the incision size significantly reduced (around 5-8cm compared with 30-38cm) but far less trauma is caused to the patient, with keyhole surgery only cartilage needs to be removed whereas bypass surgery would make it necessary for the sternum to be sawed open. Therefore, obviously the hospitalisation and recovery times are far longer with conventional surgery; which is clearly negative from both an economic and sentimental point of view for the owner, as well as causing more stress and discomfort to the animal. However, in spite of the clear benefits of laparoscopic surgery the surgery time is largely increased, in fact to about double the length; this causes further complications in surgery as not only is the expense of the operation increased, but surgical staff must remain focused for a longer period of time. Additionally more anaesthetic must be administered therefore increasing the risks of complications. As the surgery is carried out using a small camera and a screen, the visual perception is in 2D compared to the 3D spacial awareness associated with conventional surgery making the procedure much more complex. Overall, in my opinion I feel the benefits of laparoscopic surgery far outweigh the few disadvantages, such as longer surgery times, as the treatment is far more effective for the animal and can improve their quality of life far quicker.
Subsequently we were able to question a panel of veterinary students about their own experiences; interviews, university life, the application process and previous work experience to name a few of the topics covered. I found this to be extremely worthwhile as it gave a first hand insight into life as a veterinary student.
Then we were given a talk regarding ethics, something that is likely to be discussed in interviews, we focused on many highly debatable topics such as whether animals have rights. The lecturer argued that yes animals do have rights, however, they are conceivably different to human rights and that humans can be seen as a higher species due to their implementation of free will and understanding of morality. These animal rights include the right for us as humans to ensure animal welfare, it is a veterinarian’s responsibility to stop malnourishment and to establish an environment in which normal behaviour can be expressed. Additionally these rights require that there must be a justifiable reason for the killing of an animal. Moreover, he argued that the dignity of a human (who is a moral being) must come first at all times and that animal welfare should be ensured as long as human dignity is maintained. The lecturer had extensive experience in working with veterinarians suffering from depression and depression related disorders and explained that when a veterinarian loses sight that they themselves are a higher being, they consider themselves equal to any animal that is suffering and perceive that the kindest thing to do is to ease their own pain, thus giving the explanation for the extremely high suicide rate observed within this profession. Therefore this is the reason that veterinarians must indeed separate themselves from the animals they see and treat every day.
Lastly we were given a lecture on auscultation and advised to download normal heart sounds to become accustomed to them. The frequencies that can be heard by a human ear are between 20-20,000 cycles per sec and the heart sounds between 30-250. The intensity (volume), duration and the quality (distinguishes sounds of equal frequency and intensity) must also be considered.
The typical mammalian heart creates two sounds as the AV and semilunar valves close respectively, known as S1 and S2, which are short and high frequency sounds. Heart murmurs can be detected as they create longer lasting sounds. The human ear can only distinguish sounds that are >0.02 seconds apart; usually the two valves close less than 0.02 seconds apart from each other therefore creating one sound. However, if the difference is above that 0.02 second threshold then two sounds, known as a split sound, can be heard and it must be determined whether this is a murmur or just a split sound. Murmurs are extra noises made by the heart that often indicate pathological change to the heart valves. For example a valve that doesn’t close correctly can lead to blood flowing backwards, causing turbulence between the meeting volumes of blood and a low frequency. The diaphragm must be pressed firmly to listen to high frequency sounds (such as those created by the typical mammalian heart) and the bell must be pressed lightly to listen for low frequency sounds.
Auscultation sites must not be over valves as the sound waves would interfere with each other (much like stones dropped in a pond creating concentric circles). The ideal positioning is the furthest point from the valve whilst still being able to hear it.
Day 2
Day two was the beginning of the practical sessions, which for my group began with anatomy, running through the basic anatomical features of a canine, such as organs and bones. Next was the turtles and tortoises, we were informed about a few of the different common problems that can arise as a result of mistreatment such as pyramiding (from a high protein diet or lacking sufficient calcium) and metabolic bone disease (also a result of insufficient calcium). We were given the opportunity to handle all of the animals.
Next we were given a talk about the Pet Blood Bank; “a charity which provides a national canine blood bank open to all UK veterinary practitioners”. Firstly the dog must adhere to certain criteria such as being over 25kg and between 1-8 years of age. If it’s a dog’s first time giving blood they take an extra sample to test their packed cell volume (to see the proportion of blood volume occupied by red blood cells) and the total solids to check for dehydration, as well as sending some to the lab to check liver and kidney function, whilst the donated sample waits in quarantine until all abnormalities can be ruled out. They won’t restrain a dog and the sample is weighed constantly to ensure they don’t extract too much. One unit of donated blood has the potential to save up to four other dogs as the blood cells and the plasma are both split into two in a centrifuge. The plasma is frozen for around 12 months whilst the red blood cells are stored in a fridge at around 2-6°C.
Prior to lunch we were also given a small display and a talk about birds of prey, such as owls, hawks, eagles and kestrels. We were lucky enough to be given a session on meerkats and even more fortunate to be able to handle them. Meerkats are becoming increasingly popular in society and are viewed as great pets because they are ‘cute and fluffy’, however, far too many are ignorant of the huge responsibility that comes with owning such an exotic animal. They require the correct habitat as well as being accustomed to living within a gang/mob of meerkats and in many cases this leads to neglect of the animal and ultimately the need for it to be rescued. To finish the day we were given three more ‘hands-on’ sessions allowing us to handle and learn more about parrots, macaws, skunks, hedgehogs, porcupines and even a coatimundi.
Day 3 began with a session about arachnids from the publisher of www.giantspiders.com. We learnt about the urticating hairs that new world species posses for defence, as well as the four spinnerets that produce silk (that remains in liquid form in the abdomen before oxygen solidifies it). When an arachnid sheds its exoskeleton through the process of ecdysis it not only loses its appetite but becomes swollen, spreads its urticating hairs and turns black; this is an extremely vulnerable time for the spider. Female spiders have a spermathecae for storing sperm following mating, whilst males posses tibial spurs or hooks to grip onto the female. Arachnids are prone to mites and parasites as well as dehydration and nematode worms which can spread very easily.
The next session, on small animals, informed us of the routine checks that are performed when a dog comes into a veterinary surgery. The vet will check the pulse rate (60-150bpm), CRT (capillary refill time – should be <2 seconds), weight, eyes & ears, lymph nodes, teeth (for tartar and plaque), flea dirt and hair loss. Vaccinations in puppies begin between the ages of 6 and 12 weeks followed up two weeks later with a booster. We also had a short talk on guinea pigs and learnt that it is a common concern of owners that they eat their own faeces, however this is normal and necessary in order to reabsorb minerals they were unable to digest initially.
We were given a presentation about an elephant conservation programme in Sri Lanka at the Pinnawala elephant sanctuary which i found to be extremely absorbing and is something that I would love to have the opportunity to do.
Then we were given a talk about alpaca, a pack animal solely found in captivity and bred for their coats which must be sheared at least three times a year. They are mostly treated with medication for livestock although they are not under the same transport restrictions. Alpaca are ruminants however only have three stomachs, unlike sheep and cattle for example that have four stomachs. Additionally they have a cleft lip and pallet instead of top teeth. Their gestation period is 10 and a half to twelve months and the mating process induces ovulation.
We were given a demonstration and a chance to attempt an examination on two police horses that were brought in. Firstly we were told to check the CRT and mouth and eyes for discharge. Next we were directed to obstruct the jugular veins to check they were both refilling. We also listened to their heart beat (which is clearer on the left hand side), lungs and felt their wave like pulse in the vein behind their eyes and in one of the horses in a cluster of arteries near the hooves.
The final talk before lunch was about reptiles, firstly specifically about the anatomy of snakes. Snakes have an elongated stomach and intestines as well as having no diaphragm or stomach muscles. Not only does their heart consist of three chambers but I found it fascinating that they can in fact transport it around their body. They also have what’s known as the Vemeronasal or Jacobson’s organ containing sensory neurones that detect chemical stimuli, in particular pheromones. Additionally if the tank that a snake is kept in is too big then it can become stressed and stop eating, ideally it should be the length of the snake itself and around 25-30°C. Furthermore they are prone to tumours and respiratory problems, it is difficult to treat them as antibiotics designed for mammals work at an optimum temperature of 37°C which is out of their ideal temperature range.
Lizards, much like the tortoises I described previously can contract metabolic bone disease which has similar effects to those of rickets in humans. They also require UV light in order to synthesise vitamin D to break down calcium. We were also given the opportunity to handle bearded dragons and a skink.
Lizards, much like the tortoises I described previously can contract metabolic bone disease which has similar effects to those of rickets in humans. They also require UV light in order to synthesise vitamin D to break down calcium. We were also given the opportunity to handle bearded dragons and a skink.
The last half of day three was filled with clinical sessions, the first of which was CPR using the ABC technique – airways, breathing, circulatory. Firstly we were advised to assess the surroundings ensuring it is safe to approach, and compress any bleeding wounds. Next you should assess the consciousness of the animal by either tapping the corner of the eye (for the blink reflex) or pinching the skin between their toes or pads. Next check the colour of the gums and the CRT and make sure the airways are not obstructed by keeping the head and neck as straight as possible and pulling the tongue out of the mouth. You can also use a couple of resting breaths in the nostrils and if the lungs don’t inflate this indicates an obstruction. Similarly to humans the heimlich manoeuvre can be performed by holding the animal upside down against your chest with its head to the floor and its back towards you and compressing the lower abdomen with a fist and a flat hand. In order to check their circulation you can either check the digital or femoral pulses.
Following this we had the X-ray session, we were shown several examples and asked to identify various problems such as hypertrophic cardiomyopathy (something I was previously familiar with as I chose this subject to work upon for my AS biology coursework). Additionally we learnt key terms such as radio opaque (appears solid white), radio translucent (appears faded grey), ventral (to the belly), dorsal (to the spine), medial (to the body), lateral (away from the body), distal (to the extremities) and proximal (to the body). I also learnt that a key way to distinguish between dogs and cats via an x-ray is not only the size, but dogs do not have clavicles whereas cats have the remnants of them, also dogs have square vertebral bodies whereas cats have rectangular ones. Also in order to tell apart the radius and ulna on an x-ray the radius is thicker, shorter and medial, whereas the ulna is longer and lateral with an extra process.
During the Ultrasound practical we were able to use the equipment to view our heart, tendons and kidneys. Ultrasound is used for soft tissue imaging as the high frequency waves pass through and reflect off of soft tissue, the machine measures the time and strength of the returning waves, producing a darker image if the wave takes longer to return. A gel is needed to carry out ultrasound as it provides a constant medium for the waves to pass through.
I was also given the opportunity to carry out a simulated laparoscopic surgery using the real instruments and camera, we were allowed to practice first by peeling grapes! Our final practical session was suturing; we were given a block of fake skin with a cut to suture and we were shown the correct way to tie off interrupted sutures.
Amy
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