S2 Week 3: Trivia, Decontamination Drugs, and Avain Radiology!
This week we jumped right into a radiology case discussion to practice pattern recognition and continue to learn how to identify normal vs abnormal. We then had a lecture on calcium homeostasis followed by a discussion on the same topic with some clinical application. In short, calcium is tightly regulated within the body and there are numerous systems in place to make sure we stay within that narrow optimal range. Our bodies will also sacrifice our own skeletal structure to make sure that we have enough calcium!
During lunch we had an awesome presentation from Dr. Marie Holowaychuk, a boarded emergency doc that has a passion for helping people in the veterinary profession just as much as her furry patients. Dr. Holowaychuk spoke about the variety of mental health challenges that veterinary professionals face and then gave us some tips for reducing stress and also emphasized the importance of seeking professional help if needed.
Some of her recommendations involved the typical exercise, nutrition, sleep etc. but she made sure to make these suggestions accessible to busy professionals and students. A lot of the time people do not have time for a full hour workout but even 15 minutes of high intensity can help get the blood flowing and relieve some external stress. She emphasized the importance of mental wellness and made sure that we understood that a person’s mental health incorporates multiple complex layers. There is not a simple one-size-fits-all manual that can help us all feel our best so it is up to the individual to find out what works best for them and then incorporate that into their daily or weekly routine.
She recommended finding ways to decompress such as yoga or breath work and highlighted the importance of social connections. Humans are innately social beings and thrive off of being in
community. This is something to remember in
a profession that is extremely hectic at times.
Spending time in community is a way to ground
yourself and form meaningful connections.
Monday afternoon wrapped up with a lab focused on trauma, development pathology, and radiology. There were roughly 10 stations that we got to explore and work through different cases. It was a great way to connect the topics from the prior week and fill in any knowledge gaps.
Tuesday started off with a discussion on clinical pathology of calcium and phosphorous. During this lecture we learned the importance of having the appropriate balance of calcium to phosphorous (should be roughly 2:1 or 1.5:1) and what the potential underlying disease could be when these are out of whack. That discussion was followed up with a lecture on the pathology of metabolic bone disease. This lecture highlighted the four categories of metabolic bone disease and how they are diagnosed and treated.
That afternoon we had an injection lab where we were able to practice injections on canine and feline cadavers. We practiced subcutaneous and intramuscular injections and were able to understand exactly where we were administering the solution since there were dissected canine and feline prosections for our reference. We then transitioned into a blood collection lab where we were able to practice cephalic, jugular, and medial saphenous blood draws. The day finished up with some quality time with our cadaver dog dissecting the muscles of the antebrachial region.
Wednesday started off with a review session and then went straight into the anatomy of the brachial plexus which is basically a bundle of nerves in the shoulder that carries movement and sensory signals from the spinal cord to the forelimb and foot of the animal. The next lecture focused on topographic anatomy of blood vessels and then we had an hour blocked off to review and study for our upcoming exam and practical.
During lunch we got to listen to a great talk from Dr. Blamire on decontamination procedures.
When animals eat things they are not supposed to we often try to “decontaminate” them by inducing emesis (vomiting). This can be done in a multitude of ways but the most common are administering hydrogen peroxide (slightly old school and definitely not a first choice), apomorphine which is a human drug and has to be acquired through a compounding pharmacy, and a new drug named Clevor . The active ingredient in this new drug, Clevor, is ropinirole and it is a full dopamine agonist with selectivity for the dopamine D2-like receptor family1. Ropinirole induces vomiting by activating the D2-like receptors in the chemoreceptor trigger zone which transmits the information to the vomiting center to facilitate vomiting1.
This is different than apomorphine which is a dopamine receptor agonist that is not specific to D2 receptors2. Since apomorphine has a broader action in the body there are more potential side effects which is why more veterinarians are reaching for Clevor. Clevor is also FDA approved to use in dogs which makes it easier to acquire1.
Both apomorphine and Clevor work by administering the medication into the eye and shortly after, vomiting should begin. Both are still considered good options, but it is exciting to see new drugs with less side effects emerge!
It is important to note that apomorphine, and Clevor are not to be used in cats to induce vomiting. There is still research being done on this topic but as of now, there is evidence to suggest that cats have a different receptor composition in their chemoreceptor trigger zone which makes dopamine receptor agonists ineffective2. Alpha-2-Adrenergic receptor agonists such as xylazine and dexmedetomidine are more potent emetics in cats and should be the drug of choice when trying to induce vomiting2.
The afternoon wrapped up with the second part of our problem-based learning session on the little pup with a gnarly fracture. After discussing the learning objectives from our last session, we were presented with a surgery report and post-op radiographs. Our job was to discuss the radiographs and assess the healing of the patient. This was a fun way to explore different aspects from lecture in more depth!
The afternoon finished up with a nice long walk with Churro and some vet trivia with friends at Woodstock’s. This was sponsored by Alliance Animal Health and they provided dinner for everyone along with some information about their summer externships.
Thursday started off with a hot yoga session followed by a nice swim. It was a “mentor” day meaning we got to meet with our mentor, Dr. Keller, for a few hours and the rest of the day was free. Dr. Keller organized a cool session focusing on avian radiography. This tied in perfectly to our current block since we have already been working on reading radiographs. We started off the session by reviewing basic bird anatomy and then we began to identify the structures on radiographs. After we got accustomed to the positioning, we looked through some abnormal radiographs and discussed our findings. We do not get a lot of exotic experience, unless you do the zoo track during third year, so this was a fun way to get a taste of some exotic animal medicine! The rest of the day was spent studying and hanging with Churro.
Friday started off with an anatomy lab that focused on identifying the major nerves and vessels. We have an exam and lab practical on Monday so the rest of the day was blocked off for self-directed study. The anatomy professors hosted an optional review in the afternoon that went over all of the major muscles we should be able to identify, as well as gave us some free time with the cadavers so that we could ask them any remaining questions. The rest of the afternoon was spent playing with Churro and I finished the day off with a swim. While I was swimming, I shared the lane with a veterinarian that had just moved here from Colombia. She is currently a first-year PhD student studying diseases in calves!
Saturday started off with a run around the arboretum with Churro followed by a hot yoga session. The rest of the day was spent studying and getting some things done around the house. Sunday was also spent doing some final review for the exam tomorrow and then decompressing with Churro.
Quote of the week: “Welcome to the squirrely world of veterinary medicine, I know you don’t embrace it and want binary black and white but that’s not the way medicine is.” -Dr. Murphy
References:
1." Clevor®.” U.S. National Library of Medicine, National Institutes of Health, dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=b8cfb2c3-18a7-4e35-a807-2b9b13aa10c2. Accessed 27 Jan. 2024.
2. Dowling, Patricia M. “Drugs Used to Control or Stimulate Vomiting in Monogastric Animals - Pharmacology.” Merck Veterinary Manual, Merck Veterinary Manual, 24 Jan. 2024, www.merckvetmanual.com/pharmacology/systemic-pharmacotherapeutics-of-the-digestive-system/drugs-used-to-control-or-stimulate-vomiting-in-monogastric-animals?autoredirectid=21581.
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