New Beginnings

Hello, long time no see because I've not had internet for the past week or two! :). Been a bit hectic with all the clinical skills. Been learning some knot tying stuff, and the board above is an example of what we use, and its free from the ethicon people. The deeper suture knot is intra-abdominal, and we've been told that the two handed tie is the most commonly examined in my practical exams (rather than the deep hook abdominal tie. 

Need to sort a few things out over the next few days. I'm having driving refresher lessons as I've quite forgotten how to drive over the last year and a half of not driving, hopefully I can still remember how to do roundabouts and motorways for when I start my first clinical placements two weeks tomorrow- scary. 

Going to practice my knot tying and suture skills if I can over the next few weeks- using some basic needle holders and shoelaces. You don't need any fancy material to practice clinical skills at all. I've also got to sort out my house accommodation for next year and unpack everything- I have too much stuff -.-. I also get exam results tomorrow. Feeling okay about it. Dog has her vaccinations on Friday- trying to just go onto the three year schedule rather than every year like my old vets used to do. Its been proven to be much better as a vaccination schedule. 

Will write more interesting things as I go on. I'm also trying to refresh all my old anatomy- I've fogotten limbs so much. 

Clinical School- Week 2 :)

So far this week my lectures have varied quite a bit. The main themes so far have been animal toxicology and therapeutics (when to use the right antimicrobial which is a human made antibacterial drug or antibiotic which is a naturally synthesised drug) with varied interest levels from me! 

Therapeutics are of extreme importance with the growing concern of antibiotic resistance. There are a lot of rules concerning drugs, certification and the 'cascade rules' of drug use, of which I need to go through again to truly understand it. One of the main things I gleaned from these lectures- don't use fluroquinolone to treat E.Coli mastitis- either use sulphonamides or leave the case to resolve on its own. The antibiotic use in the UK needs to be a bit more regulated- especially with the farm animal side of the industry. I also learnt a bit about human generics of drugs, and prescriptions.

 Not sure how I feel about the extra charges that I see levied on some drugs when the human alternatives are a lot cheaper. Not to say that human doses of a drug are advocated for any animal- a vet should be consulted first. I was also interested to see that homeopathic drugs also come under licensed medicine- even though they're not really proven by efficacy. The homeopathic route is one which interests me, but our work needs to be based on 'scientific evidence based medicine' which makes the unproven homeopathic route one which is hard to take. However, its definately something I intend to do more research into. This will start with the book I recently purchased- homeopathic care for dogs and cats. It seems a reasonably good book and details advice for owners on different remedies to try and also the points when they should really consult with their vet. I think the divide between vets are allopathic (traditional) and homeopathic (alternative herbal based medicines). Whilst there isn't much based evidence for homeopathy I do not believe it is a route of medicine should not be disregarded, especially if a dog is not responding to conventional treatments. 

Toxicology was a lot more interesting that I thought. We learnt a few common toxic plants found in fields and their toxic agent and clinical signs and treatment. All very interesting stuff, especially as we were given a few different scenarios to work out :). I also learnt that activated charcoal for poisoning would be a very good thing to have around the house.. The plants are below with the toxic principles related to signs seen in sheep (book= Sheep flock health, a planned approach, very good overall sheep book):

Ragwort plants- yellow.

1. Ragwort. Main toxic agent is pyrrolizidine alkaloids. These are transformed in the liver to reactive pyrrols which are hepatotoxins causing cell necrosis, inhibition of mitosis (resulting in megalocytes) and vascular damage. Usually results in a chronic liver disease leading to liver failure. The main UK plant is Senecio Jacobea. Mature flowering plants are most toxic, and plants become palatable when they are cut and somehow end up in the hay that the horse eats. Cattle and horses are most affected by these toxins. Sheep are less susceptible as they can detoxify ragwort toxins in the rumen. In sheep, some animals die from chronic copper poisoning as hepatocyte damage releases copper which has been ingested in large amounts into the blood stream. Gross and clinical findings= diffuse subendocardial haemorrhage, inflammation of gut, cirrhosis of liver and spongiotic degeneration of the brain and spinal cord. Diagnosis is based on ragwort availability, clinical signs, elevated serum AST/GGT concentrations or liver biopsy can support the diagnosis. 

Yew. 

2. Alkaloids e.g. Yew/Laburnum. 

Yew- cattle and sheep are predisposed mainly due to grazing pressures if there is little to eat in the surrounding pasture. All parts of the tree are poisonous, and the main principle is taxine. This has a strong depressive effect on the heart an possible also affect the respiratory centre in the brain. Clinical signs are generally sudden death. Trembling, bradycardia, dyspnoea and collapse are other clinical signs. The abomasum at PM is distended with gas. Rumenotomy, removal of contents and supportive therapy are the only treatment options.

Laburnum 

Laburnum- all parts of the tree are toxic especially the bark and seeds. The main toxic principle is cystine which stimulates the respiratory centre of the brain, causes excitation of skeletal muscle and paralyses the peripheral sympathetic nerve ganglia. Animals show abdominal pain, muscular spasms, salivation, incoordination, regurgitation and diarrhoea. No specific treatments for this condition are available. 

Foxgloves.

3. Foxgloves- contain digitoxin and digitalin. These toxins increase contractility and slow the heart rate. Moderate intoxication results in bradycardia, depression, regurgitation, and diarrhoea whilst large amounts of toxin cause cardiac irregularities- bradycardia, tachycardia and dysrhythmia. Signs develop within 12 hours and persist for up to 3 days. Most deaths occur within 24 hours. Treatment may be supportive therapy, atropine (0.5mg/kg), and propanolol (5mg dosed to effect). Oral administration of charcoal (5g/kg) and rumenotomy have also been reported to be effective. 

4. Bracken- The whole plant is poisonous with younger plants having higher toxicity. Poisoning occurs when animals are forced to eat a diet of bracken- in dry summer/autumn. Large amounts need to be ingested over a few weeks before poisoning is seen. Major toxic principles are:

Bracken.

• Cardiogenic glycoside. 
• Thiaminase- poisoning in monogastrics.
• Ptaquiloside- cardiogenic glycoside. 
• Aplastic anaemia factor.
• Prunasin- cardiogenic glycoside.

Generally affects cattle more than sheep. Peractue harmorrhagic disease with haemangiomas of the bladder wall. Ill thrift, depression, exercise intolerance, anorexia and anaemia. Prolonged exposure in some sheep is associated with progressive retinal degeneration 'bright blindness' where the eyes shine abnormally in semi darkness. High prevalence of squamous cell carcinomas and papillomas reported in the jaw in sheep grazing bracken. Prevention is difficult. 

The last plant we will consider is Rhododendron poisoning. They contain andromedotoxin which give rise to hypotension, respiratory depression, CNS depression after an initial transient excitation period. It is commonly seen in sheep after snow where they are forced to graze on hedges. Clinical signs include excessive salivation, green froth around the mouth/nose, attempts to retch, severe abdominal point, a staggering gait and possible recumbency. Death may follow after 3-7 days. Several treatments have been tried including purgatives and stimulants e.g. caffeine. Supported therapy is reccomended with many cases recovering within 7-14 days. Do not administer fluids by stomach tube as this evokes a painful nervous response. 

 

Laurel is also a poisonous plant. 

ICC Clinical Years Day 7 - FANTASTIC ECC DAY.

Chest drain placement.

The first week of the introductory clinical skills week comes to a close. What an exhilarating and   very busy week it was too!

Since the first day I blogged the rest of the week has been a mix of radiography lectures, triage, care of the in-patient and other much interesting stuff :). I must say both the fluid therapy and radiography lectures went over my head but I'm going to use today to learn the basic principles. We've had a lot more small animal focused stuff in the past week and its been awesome. I can say it may just be the best week of lectures in vet school so far :D

Friday saw a mix of small animal toxicology lectures (a lot of information there!) and then a visit to Aintree. We got to go behind the scenes and it was really interesting to learn about the veterinary suites they have there, the rationale behind the grand national jumps and we got to see a stable tour :D. Each stable box has the name of a grand national winner above it if the winner had that box, exciting. 

  

The best day of the week has got to be the SVECCS day I had yesterday. This is emergency critical care society (student) which is new to Liverpool vet school. It put on its first fantastic day. We had an inspiring lecture from the European President from Vets Now who are based in Glasgow. They do a 10 week course for new graduates who have been out at least six months in practice- salaried and also counts towards CPD hours. It seems like it gives a lot of confidence in both out of hours and emergency work. This will be something I am seriously considering when I graduate. Whilst I don't think I want to specialise in small animal emergency care, this course sounds pretty amazing. It is known as the vets now cutting edge programme. 

CLICK HERE FOR WEBSITE LINK.

If you check this out, it looks like an amazing opportunity. 

Placement of oesophagostomy tube and incisions.

The day went on to provide a taster of the range of critical care skills we might need. This started with a lecture in ultrasound and a practical for abdominal ultrasound. The woman leading this was very good at explaining the ultrasound imaging and even at the beginning of my clinical course I feel like I know a lot more about ultrasound and how to work it than I did- brilliant. The afternoon followed with clinical techniques on cadaver specimens. The vet leading this was again very good at both explaining and helping people with the techniques. Group were kept small throughout the day (4 people per dog ultrasound for an hour, 2 people per cadaver specimen for 2 hours) and we practiced chest drains, oesophagostomy tubes, epidural injections and bitch urinary catheterisation. Definitely the most practical I've ever had so far and each technique was explained and practiced with surgical equipment and from a purely surgical viewpoint with a emergency critical care emphasis for its uses. I would recommend any new recruits to Liverpool vet school to seriously consider coming on one of these societies courses- fantastic day. 

Clinical School- day 1!

Very excited to have started the clinical theory course today. Feels like everything is finally fitting together for me :). 

Started off with an introductory lecture- all exciting stuff as to how everything fits together. We then had two interesting lecture on the basic clinical exam of the dog and cat- systems approaches seemed the best way although there was a bit to remember and some things I guess could easily be missed. One thing I learned- it's better to look for something than not look and regret it later :). 

We then had a further lecture on the different administration methods of injections for farm animals. Whilst this may seem something simple, its actually not! There are different sized needles used for different volumes and situations- will save me from looking like a fool hopefully on my farm animal rotations. Can also be asked in something called osces????not quite sure what these are yet but maybe they fit in to some sort of practical exam???

I then had my 'cow clinical exam' practical. I learnt a number of things- the importance of safety in crushes, how mean beef cows can be, and got to carry out various fun things- such as ACTUALLY USING MY STETHOSCOPE, putting a halter on a cow, listening for rumen sounds and other fun things in the basic clinical exam of the cow :)