Week 8: Anesthesia Shadowing, Physical Exams and Inflammation!
This week started off with an engaging nervous tissue lab! This lab was a way to supplement our previous lectures on the autonomic nervous system and make sure that we had the ability to identify different aspects of the nervous system on a histological level. The information learned during that lab was a perfect preview for the lunch talk on “Brain Basics and localization for Intracranial Issues and Seizure Management in the ER”. This talk was case-based and a local neurologist, Dr. Alex Tun, walked us through different situation and explained how he would go about treating the patients. We worked through differentiating which cranial nerves were affected and if the issue was likely bilateral or localized to only one side based on the way that the patient's presentation. The remainder of the afternoon was spent in another lab focused on the principles of different imaging modalities in veterinary medicine. There were a plethora of stations set up around the room with different images generated via CT, MRI, X-ray, and an ultrasound machine with a fluid-filled model to practice our scanning techniques. The evening concluded with a question-and-answer panel with our school’s surgery clinicians and residents. It was interesting to hear their experiences regarding the program and learn about the different paths they took to get to where they currently are. It is a huge commitment to specialize in any of the veterinary specialties and this talk emphasized the importance of making sure that you know exactly what you want to do before you specialize because it is a tremendous sacrifice (with a big payoff). Regardless of what you choose to focus on as a specialist, you will be “in school” for another 3-4 years with rigorous hours and limited control over your schedule so it has to be something that truly lights your soul on fire or else it is not worth it.
Tuesday started off with an awesome lab on neoplasia. I then participated in a gloving and gowning lab so that I have the ability to shadow and scrub-in on different surgeries throughout the year. The day wrapped up with Morgan and I giving our presentation on dialated cardiomyopathy in our Spanish class! If you are interested in learning about Miocardiopatía Dilatada, you can access that presentation here.
Wednesday was a day chocked full of lectures on inflammation and by the end of the four-part series I could confidentially say my brain felt inflamed...
Thursday started off bright and early with anesthesia rounds at 7:00. Diego and I were shadowing the anesthesia team (clinician and residents) for the morning and when you are invited to join the team for their morning briefing before starting on cases, you go regardless of how early it is. The rounds presentation involved going over the capnograph and different capnograms that you may expect to see while an animal is under anesthesia and what each one may represent. You can access those notes here. After rounds concluded we went into the veterinary teaching hospital (VMTH) and met our the patient for the day. Our little friend had unfortunately jumped off of a two-story building and needed a carpal arthrodesis. This procedure involves surgical fusion of the joints in the dog’s carpus (wrist). After meeting the patient, we shadowed the residents as they prepped everything for surgery. It was then time sedate our friend and get them ready for anesthesia. After the initial sedation was given (acepromazine and midazolam) the dog was then given alfaxalone as an induction agent and was then intubated. After everything was prepped the pup was rolled into surgery and it was go-time! Shadowing anesthesia was an awesome experience and I learned a lot about the “why” behind certain things instead of just doing them to do them since "that’s how it’s always been done". The afternoon continued with an officer meeting for the Canine Medicine Club and then we had an equine physical exam lab followed by a bovine physical exam lab. These were both great refreshers on how to perform a thorough physical exam and what key things we should be checking for as we look over the animal.
Friday started off with another awesome lab on inflammation! It is exciting to see case-based scenarios and be able to identify different things that are happening based on the way they present histologically. It is definitely challenging at times and sometimes it seems like everything looks the same but once you take the time to slow down and break things apart it starts to make sense! The afternoon concluded with an ethics lecture on the “Concerns in Farm Animal Practice”. We were given a dilemma regarding sow husbandry and were asked to come up with different solutions as the veterinarian. The main issue being addressed was rooted with a producer wanting a veterinarian to euthanize a handful of his sows that had become “social misfits” they were not putting on as much weight as the others and seemed to be easy targets for the other, more dominant sows. There were no apparent health concerns associated with this request for euthanasia so at the core of this issue, the veterinarian was being asked to end the life of perfectly fine animals. This discussion brought up some key points:
In all aspects of veterinary medicine, large and small alike there can be a conflict of interest between the owner and veterinarian. However, this can be more prevalent in large animal practice because these animals are sometimes viewed solely as property and are a person’s main source of income. Instead of looking at these animals as pets, they are considered for their economic value. In this situation the farmer is looking at the time and money being spent to care for the pigs that are repeatedly picked on and the cost does not seem to outweigh the potential benefits. This puts the veterinarian in a difficult position because they have to decide if they are morally ok euthanizing these healthy animals to comply with the producer’s request. This may seem like an obvious choice, but when you are in the middle of this situation, it becomes much more complex. This veterinarian may be servicing other clients in the area and if word gets out that they are not providing the services that these producers are requesting, they may be out of a job.
Large animal veterinarians that specifically target the livestock population are presented with the challenge of balancing their personal ethics with the law and client compliance. It is also hard speaking up during veterinary conventions because these events are often hosted by the production industry which supply these veterinarians with a lot of their jobs. There have been some improvements regarding the welfare practices around livestock and enrichment is now required in the EU for breeding sows. It is not yet a requirement in the United States, but it may be in the near future. It is also important to understand the natural behavior of these animals. Most livestock live in a social hierarchy so if you just remove the “aggressors” or “misfits” these positions will soon be filled by the animals that are “next in line”.
To wrap it up, a key takeaway is that livestock medicine is inherently challenging due to a multitude of external conditions and cultural history. It takes time to implement change and it is important to understand that in certain situations, the quality over quantity of life for these animals is something that needs to be considered.
Saturday consisted of a nice long run in the morning followed by a pumpkin patch adventure with my housemates and Naomi. We then had lunch at a fun rustic restaurant to cap off the afternoon. The rest of the weekend was spent hanging out with Churro and reviewing for our upcoming exam!
Quote of the week: "It's Fat Bear Week... vote early, vote often." -Dr. Woolard
*If you wish to follow the request of Dr. Woolard, you can vote here.
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