If, like me, you get frustrated using scotch tape in the Diff-Quik to check for Malassezia, I recently came up with a tip to avoid the tape going all soggy and cloudy in the fixative solution prior to staining.
Take the strip as normal, but stick it directly onto a microscope slide. Then, using a 1ml syringe, collect a small amount of the final purple stain and inject it directly under the tape. Leave for a few minutes and then examine under oil immersion as normal.
In my experience, this works just as well as the usual process.
This line always makes me think of the James Herriot books – and I recently thought of this when I had a poor cavalier King Charles that presented with a colon impacted with numerous shards of cooked lamb bones.
The poor chap was in quite a bit of discomfort and was straining without any production. It took ages to flush out his colon and, to be honest, more than one attempt.
Eventually some warm soapy water and repeated flushing with a cut dog-urinary catheter did the trick and he’s now feeling much better.
All too often the deciding factor in an animal’s veterinary treatment is cost.
It has to be a factor because there is no NHS for pets. But it is unfortunate that, when undertaking the care of an animal, many people underestimate this cost or even seem to give it no consideration at all – although this is a crying shame because, in an ideal world, welfare should always come before cost. The truth is that it often doesn’t.
Countless times on placements I’ve seen owners arrive in an expensive motor, or flash a handbag worth more than my own car, and yet grumble about the cost of treatment for their pet. However, I was pleasantly surprised by the total selflessness of one particular client I had the gratification of meeting recently.
From appearance (and sadly smell) this client evidently doesn’t have much in the way of spare cash, but comes into the practice frequently throughout the year to add what money is around to their account, ensuring they are always in credit.
This client owns numerous cats, every one of which is up to date with vaccinations, worming etc and receives any other veterinary attention as and when required, despite that none of them are insured.
During one consultation, the vet asked what food the cats all eat, to which the client answered “Sheba”.
As one of the premium brands on the market, this came as a surprise, but cemented the notion that this client really does put their animals before themselves and will provide nothing less than the very best for them.
It was so refreshing to meet someone who genuinely prioritises their pets over anything material in their life – and while this client is an extreme example of dedication to animals, there are other clients who will do all they can with the funds they have for their animals.
The unfortunate reality that so very few people have this mentality can often be disheartening and enraging, but it is the clients that really care and genuinely put their animals first that make the less grateful ones bearable.
Image by Nancy Wong (Own work) [CC-BY-SA-3.0], via Wikimedia Commons.I find retching cats usually present last thing in an evening surgery, leaving you with that tricky choice of whether to anaesthetise and investigate immediately, or delay until the next morning.
It also seems to be the ones you delay (because they’ve eaten, of course) that do have a grass blade while, more often than not, the ones you investigate there and then don’t.
Anything there?
A young colleague showed me a nifty way of elevating the soft palate with a spay hook, which neatly reveals the presence of grass (or not, as the case may be).
Some careful work with the crocodile forceps and you can usually whip out the offending blade of grass very easily.
Do you ever get blind spots, where you forget a particular test that might be useful as a prognostic indicator?
I used to forget about the usefulness of urinary protein/creatinine ratios… until recently that is.
To be honest, I think it may have been the need to collect a sample, package it up and send it off that sent this test scurrying into my subconscious.
However, we now are able to run this in house and, as a result, we are running the test much more frequently – among all vets.
This has really helped approach those renal cases in a rational way, both to give the owners an idea of prognosis and to decide when to institute a ACE inhibitor too.
Vet school doesn’t prepare you for making a complete idiot out of yourself.
At vet school, you learn some basic clinical skills and are taught how to conduct a general clinical examination to prepare you for EMS placements in veterinary surgeries. What they don’t prepare you for is making a complete idiot out of yourself.
Before my first clinical placement I told the vets I would be working with that I had only just finished second year and had no pharmacological knowledge as of yet, non-existent surgical experience and very little understanding of small animal medicine in general.
Luckily, all the vets in the practice were very good at judging the level of my understanding and seemed to find the right balance between patience and pushing me for answers.
Things seemed to be going OK. I’d successfully taken blood samples and started to make sense of abdominal palpation. However, applying clinical skills taught at vet school isn’t necessarily straightforward – cadavers have a distinct lack of weapons in the form of claws and teeth, but I was coping with that reasonably well and taking note of the vets’ advice on particular techniques.
This was until a few days in, when I found myself working with the head vet…
In the same morning, I managed to spray penicillin all over my face while trying to administer an injection, incorrectly insert an endotracheal tube despite being 99% sure it was OK, and cover myself in guinea-pig blood while clipping nails, leaving me to wear the stained tabard for the rest of the day.
To add insult to injury, I later misread the scales and recited the incorrect weight without thinking (it didn’t occur to me that there’s no way a fully grown border collie could weigh 10kg).
Isolated, these incidents might not seem like the end of the world, but when they all happen in the same day in front of the head vet and when one of the clients involved is your neighbour, you do feel like shouting “I am a vet student – honest”, despite feeling like a complete moron.
This was, however, followed by days of mini-triumph, such as inserting an IV catheter correctly for the first time or scaling and polishing a dog’s teeth myself.
The important thing to remember is that you are inexperienced, and you just have to accept there will be days when nothing seems to go your way, get past them and carry on with your head held high – even if it is covered in yellow spots of penicillin.
Sarcoptes scabei – a parasitic arthropod that burrows into skin and causes scabies. Image by Kalumet. Licensed under CC BY-SA 3.0 via Wikimedia Commons.
Have you ever had an atopic dog that’s really well managed but suddenly flares, becomes very pruritic and seems to stop responding to therapy? I had one such case just a couple of months ago.
Skin scrapes did not reveal the presence of any ectoparasites and cytology was pretty unexciting (a bit of bacterial colonisation but otherwise unremarkable).
However, noticing the pruritus to be primarily around the head, ears and ventral abdomen tipped me off to think about Sarcoptes scabei – particularly as we have a very prolific and confident urban fox population in our practice area.
A serum sample was duly sent off and – lo and behold – proved positive for Sarcoptes antibodies.
The client then confessed to missing “a dose” of Advocate but, upon reapplication, management was readily restored.
Characteristic changes in the facial skin of a Labrador retriever with hypothyroidism. Image by Caroldermoid (own work) [CC-BY-SA-3.0], via Wikimedia Commons.To be truthful, I have a bit of a blind spot when it comes to hypothyroidism. I often find few dogs follow the traditional textbook description of the clinical signs.
I have seen two cases of late with elevated cholesterol, but no hair loss, unexplained weight gain, heat seeking and mucinous skin thickness.
Both cases had blood submitted for total thyroxine (TT4) and thyroid-stimulating hormone (TSH), and both had very low TT4 levels and markedly increased TSH.
Both cases are also improving nicely on thyroxine supplementation.
A couple of articles have been brought to my attention this week regarding the public perception of vets versus the reality.
When somebody finds out that you want to be a vet or are studying veterinary medicine, there are a few arduous questions that usually follow:
“Is it seven years at university for that?”
“It’s hard to get into isn’t it?”
And, of course:
“Well, vets earn loads of money don’t they?”
Unfortunately, only one of those three assumptions is true. However, those detached from the veterinary world still uphold the perception that vets are rich and set high prices to rip off the unsuspecting public. What these people don’t understand is that a new veterinary graduate can expect to start on a salary of around £20k while working all living hours of the day, plus being on call.
While each individual job varies, the reality is that we can expect to earn very little considering the length of intense training required and the high levels of stress and responsibility that come with the job.
With experience and promotion to more superior roles – such as becoming a partner in a practice – the salary will increase, but often to less than half the average wage of a GP doctor. In general, vets accept this and are highly dedicated to the health of the animal they work with. If they were after a high salary, they’d be better off in a different career field entirely.
But the public can’t be entirely blamed for their own ignorance – I think a lot of the problem lies with the National Health Service…
“There is no NHS for pets, and I think many people would do well to remember this.”
We are blessed with a “free” health service in the UK, but this means those of us outwith the field of human medicine have very little understanding of how much treatments, operations or drugs cost.
Perhaps if people knew how much these things would cost if they had to fund them privately, they’d have a greater appreciation of both the NHS itself and the veterinary care they pay for for their animals. After all, there is no NHS for pets, and I think many people would do well to remember this.
My American friends tell me that clients in the US do seem to have a more grounded understanding of the cost of healthcare and are able to apply this to veterinary care without quite so much complaining.
It’s also worth noting that the money people spend on their animals’ treatments does not go directly into the pocket of the surgeon, but contributes to the cost of anything required for the procedure, including medication, electricity, needles and syringes, catheters, x-ray plates, bedding, food, anaesthetic, licensing… this list goes on – and somewhere at the bottom of that list sit the wages of the hardworking and dedicated vet, who often only receives a grumbling about the expense in “thanks”.
On a recent EMS placement at a small animal veterinary surgery, I witnessed a lot of this grumbling, and sometimes even full blown arguments about cost. Luckily it’s the few clients that are truly grateful and would do anything for their animals that make it all worth it.
I find it highly offensive and disrespectful when I hear remarks that vets are “only in it for the money” because, if that were true, then we are not as intelligent as our education might suggest.
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.
