A flagellated Giardia lamblia protozoan parasite viewed with a scanning electron micrograph (SEM).
Giardia lamblia is a protozoan parasite found in the small intestine of vertebrates. The most common cause of transmission in cats is faecal-oral, but cats can also become infected by drinking water containing the infective cysts.
Most cats are asymptomatic, although they may keep passing on cysts for months or years. Clinical signs are most likely to be seen in younger animals from multi-cat households or environments.
If large numbers of trophozoites develop the cat will develop symptoms, which include:
Faecal flotation in zinc sulfate solution may be used to detect cysts. Three stool samples should be studied over a period of 7-10 days before a definite diagnosis is made. Alternatively, ELISA (enzyme-linked immunosorbent assay) can be used.
Giardiasis (also known as beaver fever) can be treated with metronidazole, furazolidone or fenbendazole.
“If you’re going to bake, you should do it properly.”
There is an unwritten rule that, at the end of each clinical placement (or, in some cases, every Friday), veterinary students are expected to produce some sort of edible creation for staff at the practice that so kindly opened its doors to them.
The cop out (and to be quite honest, more expensive) option is a box of chocolates, which, while quick and easy, can be quite pricey depending on the size of practice you’re catering for.
Another quick(ish) fix is packet baking, which usually requires the addition of a couple of ingredients, sticking in the oven and “bang”, tray bake for the whole practice. While some people swear by these – and if you buy the right one, they can taste pretty good – I feel it’s cheating somewhat. If you’re going to bake, you should do it properly.
Plus, sneaky packet baking can leave you open to awkward questions about the recipe or how you made it, and vet students are already subject to awkward daily grillings on placement, so any that can be avoided if possible would be a bonus.
So that leaves actually baking…
Now, I’m no Mary Berry, but I can whip up a good brownie or some decent cupcakes at 11pm on a Thursday night if need be.
My personal go-to recipe is for coffee cupcakes – it’s simple, involves normal cupboard stocks, is fairly quick to whip up, yet has an impressive edge. After all, most vets live on coffee, so why not add a little more to their Friday?
12 Coffee Cupcakes
INGREDIENTS:
100g butter
100g caster sugar
2 eggs
100g self raising flour
1.5 tsp instant coffee granules mixed with 1 tsp warm water
METHOD:
Heat oven to 180 degrees celcius
Mix the butter and sugar
Beat the eggs in a bowl and add the coffee/water mix to the beaten eggs
Add eggs and flour to the mixture bit by bit and mix
Spoon into cake cases and bake for 15mins
Lift the cakes onto a wire rack to cool
Coffee Buttercream
INGREDIENTS:
100g butter
220g icing sugar
1 tsp instant coffee granules mixed with 1 tsp warm water
METHOD:
Mix the above until they form a paste consistency
Once the cupcakes have cooled, spread buttercream onto the cupcakes or pipe a swirl for a more professional finish.
So, when you sit down to watch the The Great British Bake Off this week, spare a moment to think of the veterinary students up and down the UK burning the midnight oil trying to concoct something even passable in an effort to persuade their vets they know how to do something right.
Cats, particularly long-haired varieties, can be carriers of ringworm but show no clinical signs at all.
Diagnosis in the absence of skin lesions is made by either Wood’s lamp over the entire body (only 50-60% of positives will fluoresce), or by taking coat brushings and incubating the hairs, follicles and debris in a dermatophyte test medium (DTM).
Once a cat is diagnosed as a carrier, treatment is the same as for those with lesions: oral itraconazole.
Even after consecutive negative results, the cat should always be considered a carrier, as it’s so difficult to eradicate ringworm from the environment. Treatment is still considered worthwhile, however, and effective cleaning will reduce/prevent further outbreaks.
I spent a couple of weeks at a mixed practice on extramural studies. It was a placement of firsts – first experience at a very “young” practice (lots of newish graduates), first clinical farm experience and first surgery experience.
It gave me an insight into the difference between older, more experienced vets and new grads – from the way they approach consultations and cases to the time/skill difference in surgical procedures. Obviously, a lot of this comes with experience, but it was reassuring to know I’m not quite as lost as I thought I was (and it also helped me recognise areas to work on).
I did work experience at farm practices before uni, but hadn’t been to one as a proper student. It entailed the bread and butter of farm practice – being shoulder deep in a cow’s rectum.
My younger brother found it particularly fascinating, always asking me when I got home each night how many cows I’d seen. Appealing as it sounds, I found reproductive physiology and pharmacology began making a lot more sense.
One day we were called out to castrate 34 calves, which turned out to be a day of avoiding hailstones while the vet cut, twisted, pulled and I injected. Nearing the end of the never-ending stream of beef calves, the vet invited me to have a go. A few minutes later, covered in blood, cow poo and sweat (it required a surprising amount of elbow grease), I had performed my first surgical procedure.
The following day I found myself being told to scrub up, then was guided through a cat castrate. It was a bit surreal, because the vet started off with “cats are a bit like calves…” I couldn’t help wondering how many students castrated a calf before a cat…
A few days later, the same vet supervised my second unassisted castrate. I had a real sense of achievement, having been able to perform the procedure without being told what to do. I know it’s a simple surgery and may seem like peanuts to a qualified vet, but it was quite a step for me – and everyone has to start somewhere.
I also scrubbed in on an exploratory laparotomy on a ferret, which was unusual to say the least, especially when the huge mass we were investigating in the abdomen turned out to be fluid filled and exploded slightly after a needle was stuck in. Since it was attached to the uterus, the vet decided to spay the ferret, which sparked the conversation of why ferrets aren’t often spayed and the resulting hormonal changes involving the adrenals.
Overall, I had a tiring couple of weeks, but felt the vets were eager to get me involved and my clinical skills certainly progressed further than I expected.
This one’s a little controversial, but some evidence exists that taking swabs for culture from cases of otitis externa can lead to poor reproducibility.
Swabs taken from the same ear may produce different isolates, and even when the isolates agree, they may have different (antibiotic) susceptibility patterns (Bloom, 2015; Graham-Mize et al, 2004; and Schick, 2007).
Bloom (2015), therefore, suggested using rational topical therapy based on cytological findings was more valuable than using bacterial culture and sensitivity. He also only advised repeat cytology if the ear was not clinically resolving or neutrophils and bacteria were present on initial cytology.
He only takes culture and sensitivity where rods are found on cytology, there are proliferative changes and the ear is responding poorly to therapy – a rare set of circumstances in Paul Bloom’s experience.
This approach was supported by a study in which the authors evaluated whether any correlation was noted between topical antibiotic selection, in vitro bacterial antibiotic sensitivity, and clinical response in 17 cases of canine otitis externa complicated by Pseudomonas aeruginosa (Robson et al, 2010).
VIDEO: How to properly swab an ear for aural cytology (source: YouTube).
References
Bloom P B (2015). Diagnosis of Otitis Externa in the Real World, Proceedings of the North American Veterinary Conference, Orlando, Florida: 944-953.
Graham-Mize C A and Rosser E J Jr (2004). Comparison of microbial isolates and susceptibility patterns from the external ear canal of dogs with otitis externa, J Am Anim Hosp Assoc40(2): 102-108.
Robson D C, Burton G G and Basset R J (2010). Correlation between topical antibiotic selection, in vitro bacterial antibiotic sensitivity and clinical response in 17 cases of canine otitis externa complicated by Pseudomonas aeruginosa, (Abst). In 25th Proceedings of the North American Veterinary Dermatology Forum, 2010: 245.
Schick A E, Angus J C and Coyner K S (2007). Variability of laboratory identification and antibiotic susceptibility reporting of Pseudomonas spp isolates from dogs with chronic otitis externa, Vet Dermatol18(2): 120-126.
Demodex gatoi is an unusual cause of pruritus in cats, but given the challenging nature of establishing a diagnosis in cats (Hobi et al, 2011) it is well worth ruling out this parasite as a possible cause (Moriello, 2015).
Karen Moriello reports finding this more oval, rather than cigar-shaped, form of Demodex more frequently in faeces (by faecal flotation) than on skin scrapes due to the cat grooming and ingesting the mite.
The good news is that, if we do find the mite, it is possible to treat (off licence) with Advocate Cat once weekly for six weeks.
References
Hobi S, Linek M, Marignac G et al (2011). Clinical characteristics and causes of pruritus in cats: a multicenter study on feline hypersensitivity associated dermatoses,Vet Dermatol, 2011.
Moriello, K.A. (2015). Itchy Cats: Evidence Based Diagnosis and Treatment, North American Veterinary Conference, Orlando 2015.
If I am being perfectly honest, dentistry has never filled me with excitement.
That said, attending a number of sessions on dentistry at the North American Veterinary Conference this year was fascinating and convinced me of the value of buying a dental x-ray machine.
Goldstein (2015), to name but one speaker, evaluated the use of radiography in assessing dental conditions in cats and convinced me of the need.
In another talk the value in assessing canine lesions was discussed (Lewis, 2015) – definitely something to bring up at our practice’s next clinical effectiveness meeting.
References
Goldstein, G.S. (2015). Dental pathology case presentations, clinical and radiology: interactice discussion of what’s new, North American Veterinary Conference, Orlando 2015.
Lewis, J.R. (2015). Interpreting canine dental radiographs: learning what you were never taught, North American Veterinary Conference, Orlando 2015.
Following the devastating news of the Germanwings crash last week, the co-pilot’s torn-up sick note and the early implication of mental health issues (later suspected to instead be eyesight-related), I witnessed a shocking flare-up of defence regarding mental health on social media.
My gut reaction was of absolute disgust. Whether said sick note referred to mental illness or not, the co-pilot was not 100% mentally sound, otherwise he would not have deliberately crashed an aeroplane into the Alps, killing 149 innocent people.
An article I read describing the rescue efforts to retain the pieces of the bodies (explosion on impact meant there were no bodies intact) was particularly distressing. And yet people preached online, directly referring to the plane crash, that people with clinical depression should be able to hold such jobs. I’m not advocating denying sufferers of severe mental health problems the right to work – but perhaps not in a job that could result in this sort of sickening situation. Can we have some context please?
While a vet may not have it in his or her power to destroy innocent lives to such an extent as pilots, how does this translate? Vets have access to dangerous drugs that could have drastic consequences if used wrongly due to mental instability, and perhaps provide a more accessible option of suicide than the non-medical general public. They also carry responsibility during surgery or other procedures with the potential to act inappropriately with implications on the lives of animals in their care.
You wouldn’t necessarily get on a plane if you were told the pilot had severe clinical depression, so would you leave your dog requiring general anaesthesia with a vet who is?
I think where the confusion has occurred is that word that gets thrown around too easily regarding mental health: “stigma”.
There is a certain stigma regarding mental health, but instead of ranting about discrimination due to mental health, a step forward would be acceptance.
One of the major factors in suicide within the veterinary profession is vets themselves not admitting they need help. In order to prevent professionals (in any sector) slipping through the net and putting on a brave face with unexpected devastating consequences, we need them to accept that they are unwell or stressed in order to take a step towards gaining help to get back on track.
To do this in a veterinary context, we need to remove the fear of being prevented from practising. The words “fitness to practice”, even within vet school, send a ripple of fear through one’s skin. I’m aware of students who have deliberately concealed medical conditions from the faculty through fear of being thrown out. I can only imagine this is carried through to qualified vets, frightened of “being struck off”.
It shouldn’t be that way.
The profession as a whole needs to work towards distinguishing clearly between taking a break from practice to get yourself better and being irreversibly banned from practising as a vet. We need to make it “okay” for vets to admit they need help to have any hope of reducing suicide, among other consequences of mental ill-health, within the profession.
At the end of this month (March), my year group has to submit their choices for final year selectives.
Over the coming week we will have a number of presentations on the different options to help us decide – which will no doubt cause further confusion.
For a number of us, fear has ensued. Others (perhaps the older or postgraduate students) feel excitement as the light at the end of the tunnel seems one step closer. But for everyone, the initial introductory presentation served as a reminder that the “real world” is not that far away.
As with most things in vet school, people hear different things and rumours based on half-truths spread like wildfire. Lecturers and mentors contradict each other, with some advising you to pick options you think you’ll enjoy regardless of future career choice, while others claim you must pick specific options if you have any hope of becoming a particular type of surgeon or clinician.
The options we can select are in addition to the core final year rotations that everyone must undertake, and cover a number of areas. These include further practice in food producing animals, equine and small animals, as well as many “niche” areas such as pigs, poultry and fish.
And along with many of the selective options comes the attractive opportunity for travel.
Following the introduction to the selectives, the question “what do you want to do?” (swiftly altered to “what do want to do when you graduate?”) was thrown about, ultimately making many of us consider for the 1,000th time what we actually want to do after vet school.
During work experience, I changed my mind from farm practice to definitely-not-farm-practice, to definitely-not-only-small-animal to something involving orthopaedic surgery. However, during vet school, the idea of farm and equine has grown on me – although I understand the likelihood of finding mixed work encompassing mainly equine and farm is fairly small.
While working on a stud yard last summer, I think I changed my mind daily about equine work depending on the vet-client interactions and whether I think I could tolerate horse owners day in, day out.
Even now, the more EMS I do, the more I feel I need more experience in different areas to make an informed choice about the direction of my career.
I also do not see myself in clinical practice in the UK for a great deal of time, and instead want to work abroad and ultimately switch path to marketing and publishing. If only you could map out your life that finely and it all work out to plan…
The only thing I know for certain is that I will change my mind at least another 10 times before graduation.
