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Tag: surgical

  • How far is too far?

    Noel Fitzpatrick runs one Supervet Noel Fitzpatrick runs of the most advanced veterinary practices in Britain.
    Noel Fitzpatrick runs one of the most advanced veterinary practices in the UK.

    In my interview for Glasgow vet school, I was asked the question “how far is too far?”, and recent episodes of The Supervet on TV had me musing on the topic again, particularly as I had used The Bionic Vet as an example in my answer.

    At the time I discussed kidney transplants in cats in the US and, in the UK, the inspiring work and pioneering techniques being carried out at Fitzpatrick Referrals.

    Arguably the most famous patient of Noel Fitzpatrick’s is Oscar the cat who, after having both back paws cut off by a combine harvester, had prosthetic legs specially engineered and fitted (see video below). Oscar’s surgery was the first of its kind, and a huge step for orthopaedic veterinary medicine worldwide.

    While this type of surgery was a world first in cats, prosthetic limbs are not an alien concept in human medicine – and, at a time when the emphasis on “One Health” becomes stronger every day, why shouldn’t routine or even rare human procedures extend their applications to our domestic species too?

    But at what point do we say that medical advances are not ethically suitable for animals? A person may have a reasonable quality of life in a wheelchair, but that doesn’t mean a dog with wheels for back legs would. Such a “cart” would dramatically effect the quality of life of cats like Oscar, but his new legs have given him the freedom to continue to “be a cat”.

    Each individual case is different, and the benefits and risks of undertaking a new, advanced technique would have to be weighed up accordingly. I don’t believe the point at which we draw the line on “going too far” is set in stone – every case is unique.

    Kidney transplants in humans are life saving, and yet not seen in the UK in cats. A cat with kidney failure would gain a lot from a transplant, providing the risk of rejection was reduced to minimal. The ethical issue here lies with the health and welfare of the donor cat and the fact the donor can’t consent to its healthy organ being taken.

    Pet Sematary
    Answering the question “how far is too far?”, Stephen King’s classic 1989 film Pet Sematary is available to buy from www.amazon.co.uk

    In the US, donors are often cats from rescue shelters and the recipient cat not only gains a new organ, but also an adopted friend who will come to live with them after the surgery. I think this is an excellent compromise on the consent dilemma – both cats get a second chance at life.

    But it is not just the ethical question of whether we should perform such surgeries on our pets, we also have to consider the practical aspects of these procedures (i.e whether we could carry them out if we decided it was ethically acceptable).

    There will be a limited number of vets with sufficient surgical experience to attempt such innovations, especially if a certain type of procedure has never been attempted in a particular species yet (such as Oscar’s legs). Financial constraints are also extremely relevant – owners that would love to give their animals the chance to receive such surgery if needed may be limited by the cost that comes with them.

    Personally, I think the work of the surgeons at Fitzpatrick Referrals is exceptional and a real inspiration to vets across the country. I would love to see the day that treatment options for our animals routinely match those available in human medicine, and really hope the work of Noel and his team encourages those interested in such developments to continue and further research in order to make it a possibility – within ethical limits, of course.

  • Should I be a vegetarian?

    Meat is Murder
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    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?

    Vet in abattoir
    ©iStockphoto.com/alle12

    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.

  • It takes balls to neuter

    Sterilising a dog
    A close up of a vet performing sterilisation surgery on a dog. Image ©iStockphoto.com/Dan-Edwards

    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.

    The concept of spaying is actually fairly terrifying, particularly as there is a considerable risk of a bitch 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.

  • Role play… at vet school?

    client communication
    Image © iStockphoto.com/DenGuy

    A role play class with professional actors brought in to help out would be commonplace on a course such as drama, and may sound a little odd for veterinary medicine. But is it really?

    Communication is a vital part of being a vet and can often be the “make or break” factor for client satisfaction. Often, owners won’t have any concept of your surgical skills or medical knowledge, but they will know instantly whether they trust their animals in your care within minutes of meeting you simply from the way you communicate.

    The class uses realistic scenarios with different types of “client” (the actors) that we are likely to come across in practice. These involved breaking the news that a pet has to be euthanised, dealing with tight horse owners that just think you’re trying to rip them off, and discussing alternative treatments for someone struggling to tablet their cat.

    Sometimes, it can be difficult if you don’t know enough about the condition the animals has in your scenario, but the important thing is how you convey the information, not necessarily the content of what you are saying.

    On the whole, the students got stuck in and enjoyed themselves. It was interesting to see how different students took different angles on the same scenario, proving there isn’t just one way to communicate effectively. The actors and supervising vet also gave us pointers on body language and tone of voice.

    Years ago, veterinary graduates were thrown into practice with very limited guidance on communication, which must have been terrifying. The interactive sessions give us the chance to make mistakes in an artificial environment, so that we (hopefully) won’t make them in the real world.

    I found the session incredibly helpful and think that communication is an immensely important skill to develop in order to give us the best chance at getting on with our clients in the future. Sessions like this should become a fundamental component of any veterinary course.

  • Use of hydrogen peroxide to flush abscesses

    Hydrogen peroxide
    A 3% solution of hydrogen peroxide is commonly used as a wound antiseptic.

    Hydrogen peroxide (H2O2) is such a strong oxidiser it is highly reactive.

    Due to its weak disinfectant and antiseptic properties, hydrogen peroxide as a 3% solution was often used to treat cat fight abscesses. However, it has fallen out of favour because it is thought to slow healing by affecting tissue growth through several possible factors.

    Only a very minute concentration of H2O2 can induce healing, and only if not repeatedly applied.

    Surgical use can lead to gas embolism formation.