Prolapsed gland of the third eyelid, or cherry eye as it is sometimes known. Image by Joel Mills (CC BY-SA 3.0) via Wikipedia.
A nice six-year-old Labrador with a history of possible trauma, complete forelimb muscle atrophy and proprioceptive deficits was brought to see me.
Radial paralysis was high up on the list of differentials, but the poor chap had not shown any response to conservative management.
I noticed it had mild anisocoria, slight ptosis and third eyelid prolapse, indicating the less obvious Horner’s syndrome. A bell rang in my mind of a case I recalled seeing as a student – it revealed itself to be indicative of a brachial plexus injury/tumour.
I had a poor feline with a very blocked proximal urethra, and numerous attempts to pass various kinds of [feline] urinary catheter proved unfruitful.
I’m indebted to a young colleague who helped by using two stay sutures through the prepuce to hold the penis in position – this puss was in good body condition, and this really helped expose and stabilise the penis.
My colleague then used a 22G venous catheter inserted to the level of urolith, and a bit of hydro-propulsion, and we had easily passed a catheter.
Catheter options: The standard (Jackson-type) tomcat catheter (A) is stiff with a metal stylet and has rough side holes, so is traumatic.
The Slippery Sam (B) has end hole or side holes, is atraumatic and stiff, so good for initial unblocking. The Little Herbert adapter (C) is also shown as it makes it easier when attaching the catheter (B) to a closed collection system.
The hub of the Slippery Sam catheter is not firmly attached to the insertion tube, so it is recommended not to be left in situ more than six hours. The Fioniavet tomcat catheter (D) has an end hole, is atraumatic and stiff, so good for initial unblocking.
Noel Fitzpatrick runs one of the most advanced veterinary practices in the UK.
In my interview for Glasgow vet school, I was asked the question “how far is too far?”, and recent episodes of The Supervet on TV had me musing on the topic again, particularly as I had used The Bionic Vet as an example in my answer.
At the time I discussed kidney transplants in cats in the US and, in the UK, the inspiring work and pioneering techniques being carried out at Fitzpatrick Referrals.
Arguably the most famous patient of Noel Fitzpatrick’s is Oscar the cat who, after having both back paws cut off by a combine harvester, had prosthetic legs specially engineered and fitted (see video below). Oscar’s surgery was the first of its kind, and a huge step for orthopaedic veterinary medicine worldwide.
While this type of surgery was a world first in cats, prosthetic limbs are not an alien concept in human medicine – and, at a time when the emphasis on “One Health” becomes stronger every day, why shouldn’t routine or even rare human procedures extend their applications to our domestic species too?
But at what point do we say that medical advances are not ethically suitable for animals? A person may have a reasonable quality of life in a wheelchair, but that doesn’t mean a dog with wheels for back legs would. Such a “cart” would dramatically effect the quality of life of cats like Oscar, but his new legs have given him the freedom to continue to “be a cat”.
Each individual case is different, and the benefits and risks of undertaking a new, advanced technique would have to be weighed up accordingly. I don’t believe the point at which we draw the line on “going too far” is set in stone – every case is unique.
Kidney transplants in humans are life saving, and yet not seen in the UK in cats. A cat with kidney failure would gain a lot from a transplant, providing the risk of rejection was reduced to minimal. The ethical issue here lies with the health and welfare of the donor cat and the fact the donor can’t consent to its healthy organ being taken.
Answering the question “how far is too far?”, Stephen King’s classic 1989 film Pet Sematary is available to buy from www.amazon.co.uk
In the US, donors are often cats from rescue shelters and the recipient cat not only gains a new organ, but also an adopted friend who will come to live with them after the surgery. I think this is an excellent compromise on the consent dilemma – both cats get a second chance at life.
But it is not just the ethical question of whether we should perform such surgeries on our pets, we also have to consider the practical aspects of these procedures (i.e whether we could carry them out if we decided it was ethically acceptable).
There will be a limited number of vets with sufficient surgical experience to attempt such innovations, especially if a certain type of procedure has never been attempted in a particular species yet (such as Oscar’s legs). Financial constraints are also extremely relevant – owners that would love to give their animals the chance to receive such surgery if needed may be limited by the cost that comes with them.
Personally, I think the work of the surgeons at Fitzpatrick Referrals is exceptional and a real inspiration to vets across the country. I would love to see the day that treatment options for our animals routinely match those available in human medicine, and really hope the work of Noel and his team encourages those interested in such developments to continue and further research in order to make it a possibility – within ethical limits, of course.
I was called out around 11pm recently to a case of acute onset dyspnoea in a seven-year-old Siamese cat (yes, we do our own out-of-hours work – how weird is that?)
Even with my ageing ears, I felt I could hear a crackling over the lung fields and a cardiac arrhythmia. Its mucous membrane colour was a poor grey and it had a body temperature of 35.9°C.
Obviously, the cat’s owners were very keen to know exactly what was wrong, but I really felt any attempts at handling and investigation would tip it into crisis.
Following a good 20mg IM dose of furosemide, some oxygen supplementation and warmth, by the following morning we had a different, happy cat.
My colleague (who is a whizz with an ultrasound) confirmed the cat, Hugo, had hypertrophic cardiomyopathy and was in congestive heart failure, but was doing well with treatment.
I cannot help but reflect that, in my early days, I might well have rushed to investigations in the middle of the night – perhaps with a very different outcome.
Do you have a puzzling dermatological case? Is it not responding the way you expect? I’d suggest a skin biopsy…
I recently came across a puzzling case in a nine-year-old cocker spaniel called Olli, which presented with a persistent Pseudomonas otitis. This resolved with appropriate antibiotic therapy based on sensitivity results, but erythema and ulceration of the medial aspect of the pinna remained. The otitis then relapsed.
No response to the food trial was evident and thyroid function was normal, so I suggested a skin biopsy, imagining the results would confirm my suspicion of idiopathic seborrhoea of the cocker spaniel.
To my surprise, however, this was not the case.
Histopathology reported interface dermatitis with apoptosis, suggesting it as immune-mediated or possibly drug associated. We are now starting Olli on some immunosuppressive therapy.
In November, Glasgow descended on Liverpool as zombies for an alcohol-fuelled weekend of “sport”.
Having endured the wait for results, I can officially say I’ve passed my second year at vet school, and reflect on another crazy twelve months of life as a Glasgow vet student.
A vet is a unique type of student – despite having a crammed uni timetable we all manage to fill our “spare” time with a mountain of other activities. Not only that, but the close-knit circle of vet students at each individual school and the wider community across the schools in the UK and Ireland is something that is particularly characteristic to vet students.
In November, Glasgow descended on Liverpool as zombies for an alcohol-fuelled weekend of “sport”. Shortly after, however, the Glasgow vet sports teams focused their attention on the far more serious matter of “Dick Day”, the sports day against Edinburgh.
January brought my first experience of Association of Veterinary Students’ Congress, which was a great weekend of helpful practicals and talks. Here, the AVS elections opened, in which I was running for the editor position of JAVS (the vet student magazine).
Jordan gets her hands dirty during IVSA SpringBreak.
In March, I jumped on a plane to Germany to undertake foaling EMS at a thoroughbred stud yard, which was incredible and well worth the travel. Along with having an enthusiastic vet and yard manager (who were both keen for me to learn) I was also given the opportunity to return in the summer for yearling preparation.
After a year of meetings, emails and phone calls, the group of friends that had formed the Rodeo Committee finally pulled off a fantastic charity event for the public, despite battling the typical Scottish weather. It was a marathon effort for everyone involved, but worth it to see families having fun on the day, and succeeding in raising £16,000 for our chosen animal charities.
During the Rodeo aftermath, our exams hit, and the entire vet school population turned into library hermits. But after two weeks of red bull, little sleep and aching writing hands, we were free.
Shortly after, I ventured abroad once again, this time to Naples, Italy, as part of an IVSA (International Veterinary Student Association) trip. In addition to the interesting and unusual practicals and lectures, I met a variety of vet students from various countries and learned far more about veterinary in different cultures.
Having competed with the university riding team all year, I then found myself at the BUCS (British University and College Sport) Riding Championships with my teammates.
After three days of dressage and style jumping, our team was placed second in our league – a fantastic result for our club!
It’s been a busy year, and although exam results may suggest it’s now over, my summer has other ideas.
The most effective method of vitamin B12 supplementation is by injection.
Cats with inflammatory bowel disease (IBD) may have concurrent low vitamin B12 levels (Tams, 2014).
A case recently presented with a history of chronic intermittent vomiting, inappetence and mild weight loss. Routine biochemistry, haematology, fPL (feline pancreas-specific lipase) and faecal analysis did not reveal any abnormalities, but having recently acquired the cat, the owners were reluctant for any invasive procedures.
Trial therapy with antibiotics, a short course of steroids and a novel protein diet produced some response. Trial therapy with weekly vitamin B12 injections for six weeks, then twice weekly for three months, produced a beneficial response.
The cat has a good appetite, has gained weight and has not vomited for the past month (compared to twice a week prior to therapy). Tams recommends monthly ongoing vitamin B12 therapy.
Reference: Tams T R (2014). Inflammatory bowel disease and lymphoma in cats, Proceedings of the North American Veterinary Conference, Gainsville, Florida: 1,492-1,501.
A friend who had attended an International Veterinary Students’ Association trip told me I should definitely attend any of its future events if I had the opportunity. Hence, when an email arrived about the IVSA SpringBreak in Naples, I applied immediately.
In all honesty, by the time I received an email confirming I had a place, I’d forgotten about applying entirely and began to reconsider.
Luckily my “what’s the worst that can happen” and “I have an overdraft if it gets costly” attitude got the better of me, and shortly after my professional exams finished in May, I found myself on a plane to Naples at some ungodly hour of the morning.
After the total of 24 vet students from all over the world (Poland, Taiwan, Israel, Nigeria, Algeria, Grenada, USA, Greece, Ireland and Scotland) had arrived, our Italian hosts held a welcome party in our honour at their university’s veterinary faculty. Despite Naples living up to its dodgy reputation within hours (one of our group got mugged after the party), we were soon thrown headlong into a packed week of vet activities and sightseeing and began to enjoy ourselves.
Over the course of the week, we had a few activities relating to the buffalo that are milked in Italy to produce mozzarella. In addition to sampling fresh mozzarella, we were shown around a buffalo farm and dairy parlour, were able to (attempt to) pregnancy diagnose some buffalo ourselves, dissected pregnant uteri and performed a postmortem on calves.
Standardbreds are a breed of horse best known for their ability to race in harness at a trot or pace instead of under saddle at a gallop – Wikipedia
The racecourse at which we had equine activities held some flat races on turf, but its main use was for harness racing of Standardbred trotters – not a common occurrence at home, but very popular in Italy. We took part in lameness assessment of Standardbreds, were shown the procedure for pre-race documentation checking and doping testing, and watched an endoscopy of a horse with suspected laryngeal problems. We did also, of course, get to watch a few harness races, which were quite the novelty.
An important aspect of the veterinary course in Naples involves the role of the vet at the fish market. For us, this meant waking up at 3am (thankfully supported by beautiful Italian espresso) in order to witness the process from fish arriving from the boats to being sent off to other markets, and the ways in which the vet ensures quality and maintains health and safety standards throughout.
Among all the exciting vet stuff, we managed to squeeze in a little sightseeing, including the breathtaking Cemetery of Fontanelle and the Pompeii ruins, after navigating (and getting in a complete mess with) the Italian public transport system.
After an impressive send off in the form of another party in the veterinary faculty, it was quite sad to say goodbye to some of the friends we’d made in a short space of time and, of course, to our fantastic Italian hosts – however, having being at least two hours late for most activities all week (after all, the Italian way is to not rush), I was relieved to be safely seated on my plane home.
IVSA SpringBreak in Naples: 24 international veterinary students and their Italian hosts
Aside from the experience I gained from the structured activities, I learned even more from the different types of people I encountered and their tales of how veterinary differs in their respective countries, which I think can be even more important than the specific veterinary knowledge acquired.
Sharing experiences with people from different backgrounds and cultures can be truly eye opening, and never ceases to amaze me.
Missing her cats, Jordan ponders the feasibility of owning a pet while at university.
I’ve always had cats at home, and they often played the role of revision buddy/lap warmer. That was one of the things I missed most when I first went to university.
Pets aren’t allowed in student halls, but now that I live in a flat with other vet students, pet ownership becomes a possibility (landlord permitting).
As a student, I meticulously budget in order to ensure I eat well, am able to enjoy myself and get some travelling in without blowing all of my cash the first week that student loan comes in. But even with this amount of planning, could I find some spare to pay to feed a cat as well as myself? Probably. Could I find the money if something went wrong, if said cat needed lifetime insulin or thyroxine treatment or broke a limb in a road traffic accident? Probably not.
Pet insurance would extinguish the worry surrounding the “what ifs”, and I do know other students with pets that are insured. Even then, premiums that cover long-term conditions come at a fair price, and I wouldn’t want to find myself in a financial position forcing me to cancel insurance and risk my pet requiring costly treatment.
Money is not the only commitment that you make to a pet though. The other major consideration is time – although this is more of a concern with dogs, which require a greater time commitment than cats.
I often feel that owning a dog would be excellent stress relief, but as idillic as dog walking seems, could I commit several hours a day, every day, including around exam time?
Even if I could commit the time while I’m around, I know that I don’t stay permanently in one place. For the majority of the time I’m in Glasgow, but during the holidays I’m at home (Leicestershire), on EMS or travelling. Who would look after the pet then? Since I live with vets, they have similarly busy lifestyles and it would be unfair to expect them to pet-sit while I’m away.
And what would happen when I graduate? I don’t know where I’ll be living, where my first job might take me, or whether it will be feasible to take a pet along for the ride.
An alternative to pet owning is fostering. The Glasgow branch of Cats Protection has recently advertised their fostering service to vet students at Glasgow. The fostering scheme encourages taking on a cat, with bedding, litter and food provided. They will provide all veterinary care and will even take back the cats if you go on holiday.
I think fostering is a great way of caring for cats without a lot of the concerns outlined above, and perhaps the only option I’d consider while at university with regards to pets. As much as I’d love to own a pet in Glasgow, I think it would be unfair on the animal if I could not offer the money and time to give it a great quality if life.
It’s unfortunate that many people do not undertake greater consideration when deciding to own a pet. Perhaps many of the day-to-day ethical issues faced in practice could be avoided if they did.
There are no specific packed cell volume guidelines as to when to transfuse an animal with red blood cell containing products.
The decision to transfuse is based on the clinical condition of the patient and the chronicity of the anaemia.
For example, a cat with chronic non-regenerative anaemia due to bone marrow disease may be stable with a PCV of 10%, whereas a cat with acute haemorrhage due to a RTA could be very unstable with a PCV of 15% and in need of emergency blood transfusion.
