Intraoral view of a dog with bilateral laryngeal paralysis during inspiration. The arytenoid cartilages (a) are immobile and the vocal folds (b) are medially displaced. Credit: Daniela Murgia.
Anaesthesia normally depresses laryngeal movements, making diagnosis of laryngeal paralysis challenging. The animal should be anaesthetised to the point at which the mouth can be easily opened but a laryngeal reflex is still present.
If jaw tone is such that you are afraid of being bitten during the examination, then the plane of anaesthesia is appropriate. If the GA is too deep, the patient will not have normal vocal fold movement and even a normal larynx may appear paralysed. In this case you should wait for drug redistribution allowing the patient to approach consciousness and repeat the examination.
Exposure of the larynx is more readily accomplished with thiopental or propofol than with diazepam-ketamine.
It’s that dreaded time of year again: end of year professional exams.
Having already completed our OSCEs (practical clinical exams), we now have the written exams to “look forward to”. Stress levels at vet school are sky high at the moment, and while my immediate concern is also the fast approaching exams, I have a more long-term concern playing on my mind: how reflective are the exams of our veterinary knowledge, really?
Some people can do exams and some just can’t handle the pressure. I am definitely the sort of person that can cram for an exam and then forget the majority of what I’ve learned as soon as I walk out of the exam room – I think this stems from riding and having to learn four show jumping courses a day, then immediately erasing the route of the first from memory so as to not mix it up with the next.
Don’t get me wrong, I’m not a complete last minute crammer – I have been working towards these exams for the best part of the last six weeks and hope I won’t forget everything immediately, but I know I can’t remember every detail from first year now. So how am I possibly going to retain everything I will need to know as a practising vet?
I have some small animal clinical EMS lined up this summer, and the staff at the practice are well aware that I’m only just finishing second year, so they won’t be expecting me to have expert knowledge on every drug in their cabinet or be a masterful surgeon. However, if I’m shown an radiograph of a limb, from first year anatomy, I should know what I’m looking at… but will I?
I suppose this reinforces the critical importance of EMS in supplementing our knowledge and allowing us to apply it in a practical situation. I can certainly appreciate the retention value of things I’ve seen or done on placements already – even from before vet school.
My first work experience placement at a vets was with a farm practice when I was 15. I remember being very cold while spending three hours pregnancy diagnosing dairy cows in February. But I also remember the three methods of correcting a left displaced abomasum that I saw that week and the unforgettable diagnostic “ping” heard through the stethoscope.
One of our practical exams last week involved the clinical examination of rumen function in the cow, and required that same diagnostic test. At this level, we were given healthy cows, and many of my friends were unaware of what exactly they were listening for. But I’m certain that even now, six years later, if I heard that ping, I’d know what it was.
Perhaps this just means that personally, I’m a practical learner – but being a vet will be a practical job, and the truth is, you can’t learn everything out of a book… and you can’t test long term retention by sitting a written exam.
The real test of whether I’ve remembered first year knowledge will be when vets start quizzing me in context.
Using darkfield microscopy technique, this photomicrograph (magnified 400x) reveals the presence of spirochaete, or “corkscrew-shaped” bacteria, known as Borrelia burgdorferi – the pathogen that causes Lyme disease. Image courtesy US Centers for Disease Control and Prevention.
Diagnosis of Lyme’s disease is challenging and normally depends on evidence of exposure along with clinical signs and diagnostic tests.
Tests for Borrelia burgdorferi can be divided into those that demonstrate presence of the organism, and antibody tests.
Detection of the organism by culture, cytology, or polymerase chain reaction (PCR) assay can be difficult as the organism is difficult to culture and very rarely found in blood, urine, joint fluid or CSF.
Serological testing is helpful, but subclinical infections can occur, and antibodies to B. burgdorferi may cross react with other spirochaetes. A positive serological test does not equate to a diagnosis of Lyme disease, but animals with clinical Lyme disease are unlikely to be negative for anti-Borrelia antibodies.
The cytological changes in synovial fluids from dogs with Lyme disease are often more typical of low-grade immune-mediated joint disease than of a bacterial infection.
The Glasgow Vet School Rodeo is an annual charity event organised by vet students. It is traditional for second year students to make the event happen, and so this year, I was involved in its organisation.
My responsibilities included taking minutes at weekly meetings, correspondence with print media for advertising, compiling the programme and poster/flyer design.
Each year, we support several (usually animal-related) charities with the aim of hosting a fun-filled family day out while raising money for worthy causes. The year, the final total raised came to a huge £16,162.74, which will be split between the charities [see bottom of page for a full list].
The 54th annual Rodeo was held within the grounds of Glasgow Vet School on April 12.
After the committee was soaked to the skin while unloading and directing exhibitors to their pitches in the morning, the rain (but unfortunately not the wind) stopped just in time for the gates to open at 11am – much to everyone’s relief.
The day included falconry, dancing, duck-herding and husky demonstrations in the main arena, with SMAART horse, Trec and horse rescue demonstrations in the horse arena. There was also a dog show, which offered all owners the chance to enter their dog in a variety of classes, as well as an animal tent, reptile tent and pony rides.
Jordan (left) and “friends”
If that wasn’t enough, there were craft stalls in the marquee, bouncy castles, horse and carriage rides, and local animal charities also came along to promote their work.
As has become traditional, we ended the day by drawing our “rodeo raffle”. We had some fantastic prizes, such as a family pass for Blair Drummond Safari Park, afternoon tea at Hilton Glasgow, “Tee Time” at Royal Troon Golf Club and many more – we are grateful to the various organisations for providing these.
Despite battling through the fury of Scottish weather in the morning, and relentless wind throughout the day (resulting in many stalls being relocated into one of the marquees), the committee felt the day was a success overall. After eight months of planning, we pulled it off, and celebrated that evening in true Scottish style with a ceilidh open to students at Glasgow Vet School.
The charities being supported this year were:
World Horse Welfare, which is an international horse charity that ‘improves the lives of horses in the UK and around the world through education, campaigning, and hands- on care’.
Blue Cross, which “finds the right homes for unwanted pets throughout the UK, treats sick and injured animals at their hospitals when owners can’t afford private fees, promotes animal welfare and provides the Pet Bereavement Support Service”.
Hearing Dogs for Deaf People, which helps people experiencing hearing loss throughout the UK by creating “life-changing partnerships between deaf people and specially trained hearing dogs”.
Veterinary Development Fund: the James Herriot Scholarship fund will enable Glasgow Vet School to award scholarships to excellent undergraduate and postgraduate veterinary students who, through financial constraints, may otherwise not be able to study at Glasgow.
Inti Wara Yassi is a Bolivian charity that works to rescue wildlife by confiscating illegally kept wild animals or by offering sanctuary to animals that are voluntarily brought to the charity. These animals are cared for in one of three parks throughout Bolivia (I also volunteered at two of the parks last summer).
Hessilhead Wildlife Rescue, is a charity in North Ayrshire, Scotland, that aims to rescue, treat, rehabilitate and release birds and animals back to the wild.
Students for Animals In Need is a charity made up of veterinary students from the University of Glasgow who work together to provide treatment to sick or injured animals that might not otherwise be treated, due to financial difficulties.
Riding For the Disabled Association (RDA): Glasgow RDA provides equine therapy to more than 300 children and adults with disabilities from across the greater Glasgow area.
Severe otitis externa in a four year old cocker spaniel. The ear canal is inflamed and swollen shut, and ceruminous exudate is present. Image by Joel Mills [GFDL, CC-BY-SA-3.0 or CC-BY-SA-2.5-2.0-1.0], via Wikimedia Commons.As a general guideline, 5-10 drops (depending on the dog’s size) of topical antimicrobial agent should be applied to the ear twice daily, but in cases with ruptured tympanic membranes, all topically applied antibiotics are potentially ototoxic.
When the tympanic membrane is not intact or its patency is unknown, pet owners must be warned of potential adverse reactions. However, such cases are rare, and the benefits of topical antibiotics outweigh the risk of ototoxicity.
In acute Pseudomonas otitis cases, first-line topical antibiotics include neomycin, polymyxin and gentamicin.
Cases that fail to respond to initial therapy or cases of chronic Pseudomonas otitis call for second-line topical antibiotics such as tobramycin, amikacin, enrofloxacin, ticarcillin and silver sulfadiazine.
In these circumstances, presoaking the ear canal with Tris-EDTA enhances the activity of the subsequently applied topical antibiotic. Tris-EDTA disrupts the cell membranes of gram-negative bacteria, such as Pseudomonas species, allowing the antibiotics to permeate the bacteria and work more effectively.
The vet handed me the needle and vacuum tubes and, at the slightly bewildered look on my face, asked if I’d ever taken blood from a horse before. Upon my answer of “no”, he shrugged and said: “I’ll show you the first one, instruct you for the second, then you can do it by yourself.”
Having started at 8am on my first morning, he had me taking blood samples from broodmares used to produce top class racehorses by 8:05 – not something I would expect to be allowed to do as a second year vet student anywhere in England.
I spent the rest of that morning with Neils, the vet, driving to different yards and observing while he performed rectal ultrasound scans on mares, assessed an ongoing case of RAO (Recurrent Airway Obstruction) and extracted a tooth from a very old and very hairy pony, alternating between being utterly flummoxed by his exchange of German conversion with clients and him then explaining things to me in perfect English. I then returned to the stud yard I was based at (between Hannover and Hamburg) to groom, feed and bring in the mares.
Although I was technically supposed to be on pre-clinical EMS at the stud, Neils was eager for me to learn from him, in addition to the more husbandry-based experience I was gaining from being on the yard. Some days were spent entirely on the yard, and others were spent partially with him, gaining bonus clinical experience. Neils was a “one-man-band”, running a mobile equine practice by himself – an alien concept, compared to the practice based vets that are the norm at home.
About halfway through my first week, I spent an entire day with Neils and, having watched him scan (via rectum) more mares than I could count, he decided there were a few safe candidates for me to try my hand on (or, rather, arm in). After a few minutes of fumbling around, I managed to orientate myself and understood far more clearly what the grey and black mush on the ultrasound screen represented.
We then went on to x-ray a horse with a fractured radius and I assisted in applying its Robert Jones bandage. I took a few more blood samples and we called at other horses to drop off medication, vaccinate, assess lameness and rasp some teeth.
I felt like I’d had a taste of what it would be like to be a qualified vet – not from the practical and clinical things I got to see and do that day, but from the 14 hour day, having had nothing but a Creme Egg to eat and not stopping for breath…
However, arriving back to the yard that evening just after the arrival of a new foal made it worth every second. Between them, Neils and the yard manager explained everything that was done and needed to be done just after a foaling; we examined the afterbirth to ensure none had been retained, assisted the foal while it began to suckle and kept an eye on both the mare and foal for the next few hours.
The end of my two weeks in Germany came around all too soon and was quite sorry to have to leave. I was taken aback by their hands-on attitude and desire for me to get as much out of my placement as possible, and not just be another pair of hands for mucking out.
The generosity I experienced from everyone I worked with is something I’m extremely grateful for, and will never forget.
Over the last month there’s been quite an uproar over the reality of the production of halal and kosher meat, which has finally been brought to forefront of the public eye after the controversial decision to ban slaughter without stunning in Denmark.
There has been nationwide outrage and horror at the claims that slaughter without stunning (i.e. slitting the throat of the conscious animal) causes prolonged pain and awareness of aspirated blood before losing consciousness.
I have to say, I’m not as shocked as most people seem to be, including fellow vet students. Religious slaughter was mentioned during anatomy lectures last year with regards to blood supply to the brain. During ritual slaughter, the vertebral artery is not cut (only the common carotid arteries and jugular veins are severed when the throat is slit). In cattle, the vertebral artery is one of the main sources of arterial supply to the brain, and so they lose consciousness more slowly than other species, such as sheep, when slaughtered in this manner.
But after those lectures, nobody in our class expressed the level of disgust and anger that currently seems to be sweeping the nation. Evidently, Denmark’s drastic move to ban all slaughter methods that do not include stunning has brought the facts to public attention. Perhaps many people simply didn’t realise exactly what is meant by halal or kosher meat.
This sudden understanding has resulted in many people, including vets, voicing their opinions and calling for the UK to follow Denmark in banning such practices. However this suggestion was more than a little ambitious, and was put to bed unequivocally when Prime Minister David Cameron said, in Israel, that kosher will never be banned in the UK.
Personally, I think it was unrealistic to ever entertain the idea that the UK would do the same as Denmark. This country’s culture is extremely broad and mixed in the present day, and so could never allow for the banning of religious slaughter without offending a considerable proportion of the population. Religion is always a touchy subject and political correctness, along with fear of being labelled as racist means the Government would never allow a complete ban.
Ensuring animal welfare is the moral priority of any current or future vet, and I am no exception. Yes, I do think that slaughter without stunning is cruel. However, I don’t believe that it is entirely unacceptable, because I respect the fact that it’s not quite as black and white as banning these methods outright.
This might seem defeatist, but I’m just being realistic.
Instead of fruitless protests and campaigning for a ban, I feel that it would be more productive to raise awareness of animal welfare issues such as this instead. The vast majority of the UK public would probably still be blissfully ignorant to what goes on in our very own abattoirs if it wasn’t for Denmark’s recent actions. Slaughter without stunning has been happening for thousands of years, and it seems like the general public are only just beginning to understand what is involved.
It’s not just the species or method of slaughter that makes an animal product kosher. Further laws govern which parts of it can be eaten.
If we want to tackle this issue directly, the best result we could hope for would be better labelling of meat products to enhance public knowledge of how they’ve been produced. Perhaps then, those who are not Jewish or Muslim would be more inclined to buy products from animals which have been stunned, allowing a refinement of the market so that minimal animals are subject to the methods used to produce halal and kosher meat.
Looking at the bigger picture, those of us within the veterinary community should take it upon ourselves to raise public awareness of similar welfare issues that those outside of the industry are not necessarily aware of. It can be difficult for us to distinguish between the issues that the public are or are not aware of because we are immersed in the animal produce industry to a much greater level. However, it is our responsibility to realise this, and bring future welfare issues into the public eye, when they otherwise might go unnoticed for years to come.
Vegetarianism can be quite the controversial topic, with many people choosing not to eat meat or particular types of meat for varying reasons – be that moral, financial or simply down to taste and preference.
But how should I stand on the matter, from the point of view of a vet student?
While on EMS, I’ve been met with differing opinions. At my lambing placement, the farmer’s mother just could not understand why anyone would be vegetarian and believed that we especially – as future vets – should not even entertain the idea. In stark contrast, the farmer and his family at my dairy placement were quite surprised when I told them that I eat all types of meat, and claimed that every previous vet student they’d had was vegetarian.
These views may simply arise from generation differences, with older generations still firmly sticking to the “you get what you’re given” attitude. But is it more than that? Are we, as vet students, expected to have an opinion one way or the other?
Vets contribute massively to the meat industry; they need to be present in abattoirs, and the aim of farm vets is to keep the industry going. On a day-to-day basis the farm vet is likely to undertake routine tasks (TB testing, pregnancy diagnosis or the occasional caesarian or surgical correction of a displaced abomasum), but if you look at the bigger picture, these all contribute to helping the meat and dairy industries run smoothly. The farm vet also plays a vital role in advising on improving production and maintaining high welfare standards in order to produce the optimum quality and quantities of meat.
So, if a farm vet spends their life oiling the cogs in the meat industry, surely it’s entirely counter productive to be vegetarian?
Of course, there is the moral argument against using animals for meat. But, as ambassadors for animal welfare, should vets sit on this side of the fence?
There is the opinion that any type of farming instigates cruelty and unnatural methods of some degree, and that, as vets, we should not stand for this. Dedicated to ensuring good welfare of all species, we, of all people, cannot turn a blind eye because we are faced with the reality of what goes on behind the scenes of the meat industry.
But we are not vets yet. And how much of the “student” in us dictates our diet, whether we like it or not? The hard truth is that meat is expensive to the average student, and a lot of us subconsciously undertake the decision to eat very little meat purely due to finances.
Is this how vets should be expected to think?
While I respect other people’s decisions to become vegetarian, I could never do it. Since we have a pig farm in the family, meat eating has always been a way of life, not a choice – not that I genuinely think I’d be forced to eat meat if I didn’t want to, but vegetarianism is just “not done” in our family (and I always get packed off to uni with enough home-produce to last me the semester).
As for seeing “behind the scenes” of the meat industry, I have very strong opinions on farming, and the reasoning behind methods and techniques that may be deemed as “cruel” to the outsider. These views stem from my farming background, and the ignorance of non-farming folk often frustrates me.
While vets have a much deeper insight into the meat industry than the general public, I’m not convinced that this has a particular effect on our choice in being vegetarian or not – and I don’t think being a vet student changes your opinion in one direction or the other.
However, I do believe that if someone genuinely had very strong objections towards the meat industry, they would find a veterinary course very difficult to handle morally. Even if you’re set on purely becoming a small animal vet, we all get immersed in the meat industry to some extent.
Normal hepatic function is essential for conversion of ammonia to urea. Increasing resting ammonia concentration indicates decreased hepatic mass or shunting of portal blood.
Concentrations of blood ammonia are not well correlated with severity of hepatic encephalopathy, and ammonia levels may be normal in 7% to 21% of dogs with portosystemic shunts (PSS), especially after prolonged fasting.
The ammonia tolerance test was developed to provide a more accurate diagnosis of liver dysfunction.
A heparinised baseline sample is taken after a 12 hour fast, and ammonium chloride is administered orally by stomach tube or in gelatin capsules or as an enema. A second blood sample is obtained 30 minutes after administration. Blood samples are then transported on ice for immediate plasma separation and analysis.
Normal values vary with the method of analysis; results in animals with PSS should be compared to a control sample from a healthy animal to ensure accuracy.
