Hold the stomach tube against the plastron of the tortoise with the tip at the caudal end of the abdominal shield.
Make a mark on the tube just cranial to the jugular notch.
Sit the tortoise upright on its tail and hold the head out of the shell with the middle finger and thumb on each side of the neck. This will extend the oesophagus.
Open the mouth, using the forefinger to prevent the tortoise closing it again.
Lubricate the stomach tube (KY is fine) and press the tip through the mouth and over the back of the throat. It should slip down easily and you may feel the tip passing through the cardiac sphincter. Stop when the mark on the tube enters the tortoise’s mouth.
Resolution of the hypovolaemia is the primary concern. Two large bore catheters are placed in the cephalic veins. If the cephalic veins are not available, the jugular vein is used. Fluid resuscitation through the saphenous veins is unlikely to be successful because of the caudal vena caval obstruction.
Photo of an x-ray showing gastric dilatation and volvulus in a large mixed-breed dog. The large dark area is the gas trapped in the stomach. The pylorus and duodenum are in an abnormal position cranial to the stomach and are separated by a fold in the stomach, creating a “double bubble” appearance.
Image by Joel Mills [CC-BY-SA-3.0], via Wikimedia Commons.Either isotonic crystalloids (90ml/kg in the first hour) or hypertonic saline (7% NaCl in 6% Dextran: 5 ml/kg given over five minutes) followed by crystalloid are administered.
Controversial treatments
The use of corticosteroids remains controversial. They have many theoretical benefits but have not been unequivocally demonstrated to improve survival in cases of gastric dilatation-volvulus (GDV).
Prophylactic antibiotics are also somewhat controversial, but rational arguments are made for their use. GDV dogs do have increased levels of circulating endotoxin, perhaps indicating increased GI mucosal permeability. Poor perfusion to the liver could inhibit reticuloendothelial function.
Improving tissue perfusion by fluid resuscitation and subsequent gastric decompression and de-rotation can potentially result in the production of damaging, highly reactive oxygen free radicals. These radicals can cause significant reperfusion injury that may be as damaging as the initial hypoperfusion episode.
It is possible treatment to prevent free radical generation may be beneficial in dogs with GDV. Of the drugs trialled in experimental models, deferoxamine, an iron chelator, shows the most promise for clinical application.
Gastric decompression
Ideally, a continuous electrocardiogram is connected. Once the animal has been stabilised, gastric decompression is attempted using a silicone or rubber tube. The tube is pre-measured to the level of the stomach and marked. A 2in roll of tape is placed in the dog’s mouth and the tube passed through the tape and slowly into the oesophagus and stomach.
If resistance is encountered at the level of the cranial oesophageal sphincter, the tube must not be forced, as this could cause rupture of the caudal oesophagus.
In some fractious animals, sedation and intubation is necessary for gastric decompression. If orogastric intubation is unsuccessful, the stomach is decompressed by trocarization. The abdomen is carefully palpated, and the enlarged spleen is avoided. A large gauge catheter (10-12F) is placed into the stomach percutaneously to relieve pressure.
Currently nursing a bruised tailbone after being propelled twice from a four-legged fiend I had a disagreement with regarding a small upright jump, I can’t help but wonder why we do these stupid things.
Horses can be hazardous enough when you’re on top of them, but they’re not all angels at ground level either. The results of a 2014 study commissioned by BEVA revealed equine vets are at the highest risk of sustaining injury out of all the civilian occupations in the UK.
While these results have been published for some time, and whether the news was surprising or not on first reading, my recent injury certainly made me consider more seriously whether we are cautious enough around horses in a veterinary context.
I was probably about as safe as possible this week during my falls, kitted out with a high standard helmet and air jacket, yet I still got injured. We can’t prevent every injury or accident possible, but we can try to take measures to minimise the damage.
The second most common site of injury reported by equine vets in the study was the head, but when was the last time I saw a vet enter a stable wearing any form of head protection? Never.
In some cases, I believe this is a matter of pride, practicality or even client confidence. If a vet turned up at the yard with a riding hat on, clients may believe they’re not confident around horses – and how difficult is it to look into a horse’s mouth while rasping teeth with bulky headgear?
“Jousting? No, I’m just off to the stables…”
However, safety should come first and perhaps vets should consider being more vigilant, despite the potential judgemental attitude they may be presented with.
What about repro work? I’ve seen many a fractious thoroughbred mare lash out with her hindlegs while being scanned, luckily with an appropriate board or stocks used to protect the vet. But I have seen an equal number of occasions when vets have been rectal scanning with nothing except confidence in a “good tempered” horse to protect them.
So, how can we make situations like that safer, short of carrying a portable kick board in the car or persuading clients to invest in appropriate equipment.
It should be a daunting prospect entering a profession that has been proven to carry the highest risk of injury in the country, and yet most of us take this as a given, not giving it much thought. The results of the study have only confirmed what many of us already knew about equine work, but I think it should act as a wake-up call to encourage vets or practices to alter policies to maximise safety in the field.
After all, it would be pretty miserable work if most of the time was spent hobbling around like I currently am.
Syringomyelia is rare in most dog breeds but has become widespread in cavalier King Charles spaniels.
Syringomyelia is a condition where fluid filled cavities develop within the spinal cord. It is sometimes known as “neck scratcher’s disease” because scratching in the air near the neck is a common sign.
Owners often report their dog is worse at night, when first getting up, during hot or cold temperature extremes, when excited, or related to posture (e.g. preferring to sleep with their head elevated).
Affected animals may seem overly sensitive to touch, or to scratch more on one side of the neck, ear, shoulder or sternum. This is typically one side only, often while the dog is moving and sometimes without making skin contact. Some dogs, especially younger patients, develop a scoliosis.
Some severe cases may have other neurological deficits such as fore and hind limb limb weakness and ataxia.
Facial nerve paralysis, deafness and seizures have also been associated with the condition, but a link has yet to be proven.
Reptiles, being cold blooded, are dependent on the environment to provide sufficient heat. If they get cold, their metabolism can become so sluggish that they cannot defend themselves, not even against a mouse.
Careless owners of small snakes have been known to toss a live mouse in with the snake and then not supervise. If the snake is cold, the mouse can eat the snake alive and the snake cannot retaliate.
If the snake survives such an attack, it may have such a fear of mice that it will no longer eat. It can take a year of tube feeding before the snake gains the confidence to face another mouse.
I’m a bit of a grammar Nazi, so getting involved in editing has been a lot of fun.
I enjoy writing about my experiences, but I also enjoy reading about others. I’m also a bit (or a lot) of a grammar Nazi, so getting involved in editing over the past couple of years at university has been a lot of fun.
I started by subediting the University of Glasgow’s student newspaper and proofreading emails/letters for fellow students on the organising committee for a charity event, before taking on the role of editor for the student vet magazine (JAVS), which goes out to all UK veterinary schools.
This is something I love doing, but it does have its downsides – and it sometimes feels like trying to draw blood from a stone. The past few editions of JAVS have seen a serious deficiency of contributors, but each one has been saved by my persistent chasing of articles, rallying people I know have an interesting story to tell, and reassuring those who’ve been asked to write but lack confidence in their ability.
Now this begs the question: why do veterinary students not want to write?
Are they too busy and see it as pointless extra work that won’t be recognised or count towards their degree?
Are they worried about not producing an item good enough to publish?
Do they lack confidence in their linguistic abilities?
While the vet degree is insanely busy and students will count every precious moment of free time they have, there are considerable advantages to having a piece of writing published – be that in print or on the internet.
Getting your name out there
“Writing for a student publication is a great start in order to get into the swing of things without strict word counts or other constraints.”
It’s surprising how far an article or blog post can reach. People with seemingly nothing to do with the veterinary profession or, alternatively, those higher up in the profession may see them.
Social media provides a particularly excellent platform for getting your work out there – many of the student written articles published on the AVS (Association of Veterinary Students) Facebook page have received “likes” or comments from BVA and RCVS presidents.
For those looking to publish in the future, whether through research or journalism, writing for a student publication is a great start in order to get into the swing of things without strict word counts or other constraints.
Even if you have no interest in writing as part of your career, having your name on an article can have other advantages. Who knows, maybe in a few years your future employer may have been intrigued by something you’d had published – which could make the difference between being asked to interview or not.
Spread the word
Sharing ideas with other students allows writers the opportunity to pass on information that could benefit other parties as well. For example, if someone undertakes EMS with a charity he or she feels is a particularly worthwhile cause and needs extra help, writing an article to raise awareness could give the organisation a huge boost. It will also make fellow students aware so they could go and have the same great experience as others before them.
Even sharing hints and tips for other things vet related might help other students avoid common mistakes or guide them more smoothly through the maze of the veterinary degree.
Don’t be scared
“Don’t be scared. Bite the bullet. Put pen to paper (or fingers to keyboard) and just go for it,” says Jordan.
It has been suggested many veterinary students don’t want to write because they don’t think they have anything interesting to say, or worry their finished piece won’t be good enough for publication – and I appreciate writing doesn’t come naturally to everyone, but that’s where I come in.
I can’t magic up the entire content for a whole magazine, but if students give me some ideas to work with – regardless of how scrambled they may be – they can be edited into fully formed articles.
It may be that self confidence is the issue, but don’t worry, everyone has to start somewhere. Your first attempt wont necessarily be the next Harry Potter phenomenon, but I guarantee that most veterinary students do have interesting experiences or ideas to talk about – so don’t be scared. Bite the bullet. Put pen to paper (or fingers to keyboard) and just go for it.
Getting published can open a lot of doors you didn’t even know were there, so I would encourage every veterinary student to try to get their names out there. After all, the veterinary world is smaller than you think, and you never know who might be reading.
A histiocytoma on the ear of a boxer dog. Image by Joel Mills (own work) [GFDL, CC-BY-SA-3.0 or CC-BY-SA-2.5-2.0-1.0], via Wikimedia Commons.Histiocytomas are common, benign skin tumours that begin in the immune cells. They usually present as small, firm, dome or button-shaped masses on the skin surface, which are fast growing, non-painful, and usually solitary.
Common sites include the head, nose, ear edges, and limbs. Occasionally, multiple skin nodules or plaques are present. Rarely, an autoimmune blistering is possible that may ulcerate.
Histiocytomas can also occur internally – in the stomach, lungs and intestines.
Retrievers, bull terriers, cocker spaniels, and great Danes are more susceptible to histiocytomas. The masses often spontaneously regress over two to three months.
The most common problem that arise from histiocytomas is when they become pruritic, triggering self-excoriation and infection. Excision is then required.
Anorexia in rabbits is a medical emergency and should be treated aggressively.
Anorexia in rabbits is a medical emergency and should be treated aggressively.
Subcutaneous, intraperitoneal or intraosseous warm isotonic fluids given several times daily will improve hydration and help stabilise the rabbit. Fluids can be given using a 20 or 22 gauge needle into the medullary cavity of the femur.
Syringe feeding nutritious high fibre slurry will increase nutritional status, help prevent ileus and rehydrate stomach contents.
Commercial products such as Critical Care, or homemade diets – such as yoghurt mixed with pureed vegetables, ground feed and glucose solution or baby pablum with a small amount of psyllium fibre and probiotic powder – have also been used successfully.
If you find rules of exposure confusing, then a simple tip is to think of it like toast…
Nurses are usually great at radiographic technique, with the flip side that vets are often poor… if you find rules of exposure confusing, then a simple tip is to think of it like toast: overcooked toast burns and goes black.
If your KV is set too high for the area being imaged, the film will be over exposed (dark) and demonstrate a flat, grey background. That is, of course, if you have not pushed it to far so as to black out (burn out) the image. If the KV is too low, the dense areas being imaged will not be penetrated. The film, or parts of it, will be white.
If the MAS is too high, the film will be over exposed (dark) demonstrating a black background. If the MAS is too low, the film will be white and washed out.
Lastly, if you change one factor (MAS or KV) you may need to change the other so as to balance the film density.
So:
If your films are dark and grey reduce the KV.
If your films are dark and black reduce the MAS.
If your films are light with no bony outlines clearly seen, increase the KV.
If your films are light but the bony outline is there, increase the MAS.
A couple of weeks ago, I received the phone call I’ve been dreading since moving away to university.
My horse had had an accident in the field, hurt her leg, and the vet was on the way. That’s all the information I received until the next call, with the vet on the other end.
“Communication within the tarsal joint… leg swinging… don’t think the long bone is actually fractured but significant damage to tendons at the back… rapid respiratory rate.”
As soon as I knew which way the conversation was going, I barely heard the rest.
My girl, who I’d had for 10 years. My girl, who’d been passed from pillar to post before we gave her the stable long-term home she’d never had. My girl, who had taught me to ride by being an infuriatingly awkward cow at the best of times.
My girl, who, when in the mood, was unbeatable and with whom I achieved a national title. My girl, who was the only one I trusted not to hurt me after my four-week stint in hospital when another horse landed on me. My 21-year-old girl, who’d been steadily getting stiffer from arthritis over the last few months. My girl, who, when I last rode about a week before this incident, was 10 times better than she’d been in a long time.
“My girl, who, when in the mood, was unbeatable and with whom I achieved a national title.”
My girl was about to be shot…
All the vet language stopped making sense, the clinician rationale went out the window. I just needed to know one thing, vet to vet student: is this fair? Could it wait five hours for me to tear down the M6 to say a final goodbye or would even that be an unnecessary amount of suffering?
I think I already knew the answer.
I felt utterly helpless and beyond reason for the following days, but as the shock wore off I was able to consider things retrospectively.
Having spoken to the family that were with her at the time, I’ve gathered a bit more information and been able to convince myself it was the right and only decision.
RIP Pepsi.
I’ve seen many animals have to be euthanised, for varying reasons. Some cases were more upsetting than others, but, for the most part, I’ve been able to detach myself from it – always telling myself it was for the best, in the animals’ interest for welfare reasons, and that there were no alternatives.
They say clients will only take in a small proportion of bad news. Now I know what that means. All the vet talk just went straight over my head, and the only thing I really got was that there was only one way it was going. This has outlined the importance of clear and concise communication when delivering bad news to my own clients in the future.
In communication skills classes, we’re told to encourage owners to bring someone with them who can write down key points and ensure they understand before proceeding. Now I appreciate the value of this so much more, having been the receiver instead of the bearer of bad news.
While the pain is still raw, I think I can take something from this to help me be more empathetic and ensure I communicate effectively in the future.
You can steal all the ham sandwiches you want now, Pepsi.
![Photo of an x-ray showing gastric dilatation and volvulus in a large mixed-breed dog. The large dark area is the gas trapped in the stomach. The pylorus and duodenum are in an abnormal position cranial to the stomach and are separated by a fold in the stomach, creating a "double bubble" appearance. By Joel Mills (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC-BY-SA-2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/2.5-2.0-1.0)], via Wikimedia Commons](http://www.vettimes.co.uk/app/uploads/2013/09/GDV_x-ray.jpg)
