Space-filling model of the glutamine molecule, one of the 20 amino acids used to build proteins. This image shows the L isomer in neutral form.
Postoperative ileus (POI) is a transient bowel dysmotility that occurs following many types of operations and is one of the most common complications of gastrointestinal surgery.
Enteral supplementation of glutamine after abdominal surgery restores fuel to the small intestine, suppresses oxidative stress, and leads to improvement in POI.
Therefore glutamine, along with other appropriate medication (metoclopramide, cisapride, lactulose, warm enemas, antibiotics) can act as a motility-recovery agent after abdominal surgery and thereby decrease the duration of POI.
As graduates, one of the most routine surgeries that we will be expected to be competent at is neutering. As students, when on work experience or EMS, we will have seen at least one of these procedures a day at small or mixed practices… often more.
But routine does not necessarily mean easy, simple or without risk. When learning about reproductive anatomy, we were faced with a harsh truth: the concept of spaying is actually fairly terrifying, particularly as there is a considerable risk of a bitch bleeding to death.
Spaying is not to be underestimated. Among the usual complications and risks involved in the use of general anaesthetic, there are also a few scary blood vessels to worry about.
During the surgery, it is necessary for both pairs of ovarian and uterine arteries to be cut. It is of vital importance that these are ligatured (tied off) securely to prevent the likelihood of internal bleeding post-surgery. Neither of these are to be underestimated – the ovarian arteries are particularly important to ligature properly, since they branch directly from the aorta. A slipped ligature could result in serious problems, and could potentially result in the patient bleeding to death.
Clients should always be made aware of surgical risks and all eventualities, but I would imagine that the last thing an owner would expect after taking their dog or cat to be neutered would be the death of their beloved pet post-surgery.
This is quite a daunting prospect for the “most routine” surgery in practice. You can’t afford to be complacent – you really do have to get it right.
As an avid traveller, I had always intended on getting involved in a neutering clinic in India for EMS, even before learning just how risky neutering can be if not done properly. Now, I will make sure to realise that aim, in order to get as much surgical practise as possible before graduating. Hopefully, it will help boost my confidence, so that I won’t be as concerned as I am currently about this “routine” surgery by the time I am a qualified vet.
I think it’s fair to say I have a less than conventional pre-veterinary school story. In early 2011, after years of working hard at school, gathering experience at different animal establishments and doing regular work experience at a nearby practice, I finally received an offer for veterinary school.
Student blogger Jordan Sinclair.
All I had to do was get the right grades in my final A-Level exams that summer. Or so I thought. In March, a horse I’d been exercising had other ideas.
One moment I was mounting in a car park at a showjumping competition; the next thing I knew, I was waking up in hospital 10 days later.
Involuntary gap year
Despite 12 broken ribs, a punctured lung, a collapsed lung, a broken clavicle and nerve damage, I was still determined to go to the University of Glasgow that year. After a month, I came out of hospital and soon realised I couldn’t fight the sleepy side effects of the morphine long enough to pick up a book, let alone try to catch up with the schoolwork I’d missed.
Glasgow were fantastic – I remember mum being on the phone trying to explain the situation, while I tried to gauge the response from half the conversation. They would not only allow me to defer, but told her I needed to, in order to guarantee full physical fitness for the start of the course.
So what did I do with my involuntary gap year? I spent quite a lot of it recovering. The Air Ambulance Service saved my life by operating at the scene of the accident, and since it is a charity, I started volunteering and fund-raising for it.
When I was well enough, I rode again. Over Christmas, I visited family in Australia and, while I wasn’t allowed to scuba dive due to the previously collapsed lung, nothing was stopping me snorkelling on the Great Barrier Reef. I then returned to school to finish my A-Levels.
The long journey begins
Finally, after seeing my friends go through it the previous year, results day came. And so began the mad rush to kit up for veterinary school; books, wellies, overalls and goodness knows what else were gathered up and rammed into the car. Unfortunately, my horse wouldn’t fit in the boot, and I heard cats weren’t permitted in halls. So, petless and not knowing what to expect, I started the long journey north.
I thought A-levels were hard; veterinary school is a whole new ball game. You know it’s not going to be easy when even working out your timetable is almost impossible. It was equally daunting to see the proportions of internationals and postgraduates who all seemed to know everything compared to us Brits, who were fresh(ish) out of school.
One moment I was at a showjumping competition, the next I was waking up in hospital.
Anatomy was like learning a new language, with hundreds of obscure words being thrown at you in one lecture; in a whole sentence, the only recognisable words could be “the” or “and”.
Dissections took some getting used to, when you’ve only ever observed surgery and never actually made contact with a cadaver before. However, after a couple of weeks you can actually visualise where everything is and things start to slot into place.
A whole new world
For those not from farming backgrounds (I’m not sure what I consider myself – my horses were kept on a pig farm), husbandry was a whole new world. We all have varying degrees of experience in some area of farming or animal care, otherwise we wouldn’t be here, but trying to learn a lifetimes worth of experience in keeping sheep from someone in six hours seemed crazy. Now, it’s easy to see the importance of preclinical EMS – you can’t learn everything from a book. Though it is good to take a break from bookwork and head out to the uni farm for handling sessions every so often.
After my riding accident, I was given a CD with all of my radiographs and CT scan pictures on. Although the idea of having my own x-rays was novel, aside from seeing the obvious snap in the collar bone, they meant very little. After being shown an example of a radiograph showing the collapsed lung in a dog in the first couple of weeks at Glasgow, I went back to my stashed away x-rays. To my delight, I could see things more clearly, although did find it odd being able to understand how smashed up my insides had been. So far, the CT pictures still remain a mystery though.
I’m not sure if the beginning of vet school is what I expected or not. In some respects, it seems very real now, with professionalism being drummed into us from the outset. And in others, it’s hard to see the light at the end of the tunnel from here.
