Have you ever had a puppy that just presents with lethargy, exercise intolerance and sleeps all the time?
This is normal for my teenage daughters, but not so for a young Lhasa apso that presented to my surgery. Physical exam was unremarkable, but the dog was so sleepy we administered IV fluids to perk it up.
Routine biochemistry revealed a low blood urea nitrogen (BUN), and a urine sample demonstrated the presence of urate crystals.
This triggered a request for a bile acid stimulation test, which showed markedly abnormal elevation postprandial levels.
Our diagnosis of hepatic portosystemic shunt was confirmed at Davies Veterinary Specialists and luckily this was shown to be extra hepatic. So, after some very smart surgery, the dog went on to live an energetic life.
Cats with hyperthyroidism are more vulnerable to bacterial UTIs. One study reported bacterial lower UTIs were diagnosed in 12% of hyperthyroid cats.
Bacterial UTIs are clinically “silent” in a high proportion of older cats, with no haematuria, dysuria, or other signs to indicate their presence.
Where possible, bacterial culture of cystocentesis-obtained urine samples (right) is recommended in hyperthyroid cats at time of diagnosis and periodically thereafter, especially if indicated by clinical signs or previous history.
Greenish purulent discharge accompanied by crusting, erythema and punctuate ulcerations in a crossbreed affected by Pseudomonas aeruginosa otitis externa, secondary to an adverse drug eruption. Image source: Veterinary Times 45.01 (Jan 6, 2014) – “Otitis: a diagnostic approach” by Filippo De Bellis.
I suspect we have all come across that tricky Pseudomonas otitis case that just seem to refuse to completely respond to antibiotic therapy in spite of extensive investigation for underlying causes.
I had just one such case recently that, in spite of culture and sensitivity, blood work, skin biopsy, extensive flushing, lack of response to licensed products (and so on), just refused to respond.
A quick look through one of my trusty text books* suggested Ticarcillin.
Ticarcillin potentiated with calvulanic acid (Timentin) is an extended spectrum penicillin that often has good activity against Pseudomonas. The 100mg/ml antibiotic solution can be applied directly to the ear canal as a drop.
The case I’m treating has responded really well.
* Reference: Hill, P.B. (2002) Small Animal Dermatology: a practical guide to the diagnosis and management of skin diseases in dogs and cats. Butterworth-Heinemann. London.
As a student on placement, I’m often in awe of the vets I’m working with. The ability to take a history, examine an animal, run through differentials and come up with a diagnosis or action plan within 10 minutes – all while listening to an owner commenting on the weather or traffic – seems superhuman.
This may seem an exaggeration (after all, vets aren’t superheroes), but when considered like that, it is pretty impressive.
While seemingly intangible at the moment, I know the ability to do this with such ease comes with practice – and clearly some presentations are far more complex than that.
However, while I find this impressive, others have a different opinion…
A family friend recently commented on their own vets, claiming they would avoid seeing the partners if possible because – in their opinion – they see an animal for five minutes and see it as a money making exercise, whereas the younger vets spend a bit more time with the clients.
Obviously I can’t comment on the vet/client rapport, which may have a huge influence on this opinion, but I can’t help but think that a younger, newly qualified vet would spend more time during consultations purely due to experience, or lack thereof.
It has become evident recently that the profession has an image problem and we must try to change that for the better. But what do the public consider as a “good vet”? Apparently the opinion differs depending which side of the table you’re on.
This is just one example, but in general, do clients want the vet to spend more time with their animal? They probably do – but, at the same time, they don’t want to be kept waiting and they want to be able to get an appointment. There has to be a balance between the three.
As for cost, I’ve seen some vets charge meticulously, whereas others would try and keep prices as low as possible to please customers. In the clients’ eyes, the cheaper the better. But a vet practice has to function. It’s no good offering neutering for £10 because the practice would be bankrupt within a week.
“The most highly qualified and experienced surgeon in the practice might not be the best at client communication,” claims Jordan.
Surgical skills and experience are perhaps something that the client will never fully appreciate. For a start, the vet seen in the consultation room may not be the same one who performed the operation, particularly if it’s something fairly routine. Also, the most highly qualified and experienced surgeon in the practice might not be the best at client communication.
A vet can have such a diverse set of skills and knowledge that it is difficult to pinpoint which of these defines a “good vet”. Many vets have certain areas of expertise and will be better than others in certain situations, but not all.
The key to time and money is striking the balance between what the client desires and what is realistic.
Communication, however, doesn’t need to be compromised and can be the difference that alters the client’s opinion. For example, the manner in which an examination is conducted and the attitude of the vet during a 10-minute consult could leave the client feeling rushed, whereas a different vet with a different approach could leave the client with a far more positive impression.
Client opinion is important, but at the end of the day, the welfare of the animal in front of you is your priority, whether or not the client values you highly.
While the profession as a whole should take heed of what clients want, the customer is not necessarily always right, and at the end of the day, it is the welfare of the animal in front of you that should be paramount.
I recently had a male cat presented that was “just a bit quiet” – it wasn’t moving much and, uncharacteristically, had not eaten breakfast that morning.
The owner had barely removed our feline friend from the carrier when I thought: “This guy’s got a blocked bladder.”
Abdominal palpation confirmed my intuitive diagnosis.
I’ve been thinking about this a lot recently – what does it mean? Am I just getting old and have a subconscious feel for what’s coming in through the door?
Then I heard a programme on Radio 4 (that confirms my age!) that said “gut feelings” were actually learned behaviour, and were your subconscious popping ideas into your conscious brain.
So my tip would be to go with those hunches – you might just be right!
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.
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.
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.
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.
