Monday evening, at 5 pm, eight of us arrived at the spay clinic. The anesthesia tech who is in charge of the clinc hadn’t arrived yet, but we found that each of the eight dogs in the clinic had one of our names on the front of her cage. We took our dogs outside to let them stretch their legs and pee. Mine was a sweet mid-size dog of a few years of age. My partner, Lily, was assigned a six month old who had the normal energy level of a six month old puppy — she was a handful. Lily was scheduled to spay her puppy (we quickly started referring to them as “our” dogs) on the first day of the lab, and I was scheduled to spay my dog on the second. I would perform anesthesia for Lily on the first day, and she would perform anesthesia for me on the second.
The anesthesia tech and veterinary intern arrived, and helped us draw blood on our dogs. (This was my third time drawing blood. I am still terrible at it.) We tested the blood to make sure that all the dogs were good surgical candidates. Any dog with any medical problem at all would be ineligible for the spay lab program; that dog would need to be spayed by someone with more experience.
Then we gave our dogs physical exams and wrote up our SOAPs (Subjective/Objective Assessment and Plan). We presented our dogs to the veterinary intern. A typical presentation would sound something like: “This is a two year old intact female dog, presenting to the spay clinic for ovariohysterectomy. Her heart rate was...” And so on. The intern was helpful, explaining things to me like “don’t say you found a lesion on her tail, say you found an area of alopecia on the dorsal caudal aspect of her tail.”
Around 7:30 pm we were done. We fed our dogs. Lily and I agreed that I would handle the 9 pm walk that night. I went home, fed my own animals, fed myself, and came back in for the 9 pm walk. I put a note on Lily’s dog’s cage to make sure that no one else gave her more food, since she was scheduled for surgery the next day. Home again, I calculated the drug dosages for Lily’s dog for the next day (since I would be handling her anesthesia), and went to bed.
My alarm went off at 4:45 am the next morning. I was at school by 6 am. We walked our dogs, did another physical exam, and wrote up another SOAP, which was very similar to the previous SOAP from twelve hours before. I fed my dog. Then Lily and I premedicated her puppy. This was difficult, as the puppy didn’t want to hold still, and I had to put a very large needle into her back and inject the premedication cocktail into her muscle. But I managed. The puppy started getting drowsy in a few minutes, while we took care of necessaries before surgery, like food, water, and toilet breaks. By 8 am she was ready and so were we, so we carried the sleepy puppy in to the operating room and put her on the table.
To induce anesthesia, we used an injectable solution. First I put in an IV catheter. This is the second time in my life that I have had to thread a catheter into an animal’s vein; the first time, I almost passed out. I did not even get woozy this time. (Thank you, adrenaline.) Then I injected the anesthesia solution, and the puppy got very sleepy. Good puppy.
Next I put an endotracheal tube down the puppy’s throat. I had been nervous about this, but it was easier than it looks. You can actually see the vocal cords and thread the tube right between them. It helps if the puppy is “deep enough” under anesthesia; we gave her a little more juice after my first try.
Next I hooked her up to the anesthesia machine and started the oxygen and anesthesia gas flowing. We had induced anesthesia with an injectable solution, but maintained it with gas. Gas is a lot easier to control; if you want to change anesthetic depth, you can easily turn it up or down. An injectable solution is out of your hands once it’s in the animal.
Next I added several more monitors and started recording information. Every five minutes, I recorded her heart rate (a machine provided that number), her systolic blood pressure (I took it with a cuff, just as the doctor does it to you), her respiration rate (I counted breaths by watching the breathing bag), and her anesthetic depth (I looked at her eye to see the position of her eyeball, and tested her jaw tone; an eyeball rolled down is a good depth, and a loose but not too loose jaw is also a good depth). If I had time left over, I sometimes listened to her esophageal stethoscope (a stethoscope threaded down her esophagus to lie close to her heart), which let me make sure that her heart was actually echoing the sound I heard on one of the monitors.
Every fifteen minutes, I assessed how much fluid had gone in via her IV catheter, recorded her oxygen pressure, and recorded her temperature. How hard could it be to record a temperature? I had to crawl under the surgical drape and try to see the rectal thermometer. This required a flashlight and lots of craning.
Periodically, the anesthesia tech handed me more meds (pain killers or antibiotics) with instructions on how to administer them. At one point I had three medications stacked up, to be administered “four hours after induction” (in an hour), “when your partner closes the linea alba” (watch partner), and “an hour after the first antibiotics dose.” I had to write down the various times so I didn’t forget them, since I was balancing a few other things in my head at the same time.
The surgery went smoothly. When my partner was done, I turned down the gas and let the puppy breathe pure oxygen for five minutes. Then we unhooked her from the machine, unhooked all the monitors, and carried her back to her cage. When she had swallowed twice (after about ten minutes), I pulled out her breathing tube. We covered her with warm blankets and checked on her frequently while doing paperwork. She did exactly what she was supposed to: went back to sleep after the tube was out, and got steadily warmer.
I had a few minutes to have lunch, then went to four hours of lecture. After lecture, at 5 pm, I walked my dog and helped with clinic cleanup. We planned for Lily to cover the 9 pm walk. The next day I would spay my dog. I was tired, but it felt good to be halfway done, and to have not done a bad job so far.
[How to learn how to spay a dog, Part 1: Basic skills]
[How to learn how to spay a dog, Part 3: Surgery]
[How to learn how to spay a dog, addendum: uterus removal]
Saturday, September 18, 2010
Wednesday, September 15, 2010
How to learn how to spay a dog, part 1: Basic skills
As my advisor once asked: “How many times do you want a veterinarian performing surgery on your dog to have done that procedure before?” My answer is “a thousand.” But there is a first time for everyone. How do vet students learn how to spay female dogs (a procedure that many vets will do commonly during their careers)? This is real surgery, in which you go into the animal’s body cavity. It is serious stuff and animals could potentially die. So who do we learn on? (Take a moment to think about how you would design the perfect spay learning experience. I would be curious to hear how it compares with my school’s approach.)
At my school, spay lab is scheduled at the beginning of our third year. We are given videos to watch (how to scrub in to surgery, how to suture and knot, how to induce general anesthesia, and how to perform the actual ovariohysterectomy, or spay). And our anesthesia course is front-loaded for the first few weeks. During the second week of classes, before most college students have returned to school, we have a practical exam of several of these skills.
The practical exam (which was one of the more relaxed of the exams given at my school, perhaps to balance the extreme stressfulness of the actual spay) is in four parts. This is how it goes.
Prove that you can gown up: pretend to scrub your hands and arms, showing that you know how to hold your arms so that the dirty water doesn’t run onto the clean parts of your hands; show that you know how to crawl inside surgical gloves and gowns without contaminating yourself.
Next, pick out your tools from a massive pile of them. Be able to tell apart different hemostats (clamps) and scissors; there are lots of different kinds. Put together your “spay pack” of appropriate tools.
Next, prove that you can suture and knot. Do not panic when the surgeons ask for suture patterns that the syllabus said you didn’t have to know.
Finally, show that you know how to write a SOAP (Subjective Objective Assessment and Plan). A surgeon rattles off information about a case. You write down the physical exam findings, your assessment of the dog (what is probably going on with her? What are your rule-outs?), and your plan (what diagnostics would you do if this were your patient?).
Students who pass this exam (and so far as I know, all of us did) are theoretically ready to perform their spay. Where do the spay dogs come from? One option is to purchase dogs, usually purpose-bred animals, perform a spay and possibly some other surgeries, and terminate them at the end of that use. My school has gone a different route. We have a relationship with local area shelters; students perform their spays on shelter dogs or dogs from low income families, under the watchful eyes of surgeons to make sure that we don’t screw up. It’s not ideal; the dogs will be under general anesthesia for longer than if someone with more experience performed the surgery, and they will be more painful when they wake up, again because of our inexperience. But I think it’s the best solution there is, given the situation.
Each student is assigned a partner, and each student is assigned a dog. On the first day, one student spays one dog, while their partner performs anesthesia. On the second day, their roles switch for the other dog. Both jobs are stressful; anesthesia entails monitoring a lot of parameters, and all the little tasks are hard to do at once. Moreover, it is easier to kill a dog with anesthesia gone awry than with a surgical mistake, at least in this surgery. Small groups of students are assigned dates for spay lab throughout the semester; the entire class can’t do the lab all at once, obviously. My spay day happened recently. I’ll report on it in detail in the next posts in this series.
[How to learn how to spay a dog, part 2: Anesthesia]
[How to learn how to spay a dog, part 3: Surgery]
[How to learn how to spay a dog, addendum: uterus removal]
At my school, spay lab is scheduled at the beginning of our third year. We are given videos to watch (how to scrub in to surgery, how to suture and knot, how to induce general anesthesia, and how to perform the actual ovariohysterectomy, or spay). And our anesthesia course is front-loaded for the first few weeks. During the second week of classes, before most college students have returned to school, we have a practical exam of several of these skills.
The practical exam (which was one of the more relaxed of the exams given at my school, perhaps to balance the extreme stressfulness of the actual spay) is in four parts. This is how it goes.
Prove that you can gown up: pretend to scrub your hands and arms, showing that you know how to hold your arms so that the dirty water doesn’t run onto the clean parts of your hands; show that you know how to crawl inside surgical gloves and gowns without contaminating yourself.
Next, pick out your tools from a massive pile of them. Be able to tell apart different hemostats (clamps) and scissors; there are lots of different kinds. Put together your “spay pack” of appropriate tools.
Next, prove that you can suture and knot. Do not panic when the surgeons ask for suture patterns that the syllabus said you didn’t have to know.
Finally, show that you know how to write a SOAP (Subjective Objective Assessment and Plan). A surgeon rattles off information about a case. You write down the physical exam findings, your assessment of the dog (what is probably going on with her? What are your rule-outs?), and your plan (what diagnostics would you do if this were your patient?).
Students who pass this exam (and so far as I know, all of us did) are theoretically ready to perform their spay. Where do the spay dogs come from? One option is to purchase dogs, usually purpose-bred animals, perform a spay and possibly some other surgeries, and terminate them at the end of that use. My school has gone a different route. We have a relationship with local area shelters; students perform their spays on shelter dogs or dogs from low income families, under the watchful eyes of surgeons to make sure that we don’t screw up. It’s not ideal; the dogs will be under general anesthesia for longer than if someone with more experience performed the surgery, and they will be more painful when they wake up, again because of our inexperience. But I think it’s the best solution there is, given the situation.
Each student is assigned a partner, and each student is assigned a dog. On the first day, one student spays one dog, while their partner performs anesthesia. On the second day, their roles switch for the other dog. Both jobs are stressful; anesthesia entails monitoring a lot of parameters, and all the little tasks are hard to do at once. Moreover, it is easier to kill a dog with anesthesia gone awry than with a surgical mistake, at least in this surgery. Small groups of students are assigned dates for spay lab throughout the semester; the entire class can’t do the lab all at once, obviously. My spay day happened recently. I’ll report on it in detail in the next posts in this series.
[How to learn how to spay a dog, part 2: Anesthesia]
[How to learn how to spay a dog, part 3: Surgery]
[How to learn how to spay a dog, addendum: uterus removal]
Friday, September 3, 2010
Veterinary fact of the day: changing the face of large animal medicine
A few days ago in anesthesia lecture, Dr. Drile announced, “Now we are going to learn about xylazine. All of you in the audience who are women, or men under 200 pounds, can be thankful for this drug.” She then plunged into her lecture on xylazine, and it took several minutes for her to get around to explaining why I should be thankful for it, during which time I was mostly distracted by what a weird introduction that had been.
Eventually we got to a slide depicting a small woman leading an enormous draft horse, and Dr. Drile explained. Xylazine is a really excellent sedative/tranquilizer, used primarily in large animals (although also sometimes in small animals). Before we had xylazine for chemical restraint, we had to physically restrain these enormous animals in order to do simple procedures on them. This was difficult and dangerous, and if you were a small person, you couldn’t easily do it. Xylazine hit veterinary medicine around the 1970s, which coincides with an increasing influx of women into the field. The estimates vary for women in veterinary medicine now, but we decidedly dominate numerically. In my first year class, there were 70 women and 12 men. My school recently spent a hefty chunk of change to remodel the anatomy building’s changing rooms, to increase the space in the women’s room at the expense of the men’s. There are, of course, lots of reasons why there are so many more women in veterinary medicine now than there used to be, but this was one I hadn’t considered before.
Thanks to xylazine, veterinary medicine is no longer a wrestling match. I am, accordingly, grateful.
What I did today: Quiz in zoological medicine (not supposed to be hard, and wasn’t). Gym! Two hours of dermatology lecture (new class, very engaging guest speaker). Lunch! (Went to meeting about how the lottery for scheduling our clinical rotations will work.) One hour of small animal medicine lecture (vaccines). Out super early.
Eventually we got to a slide depicting a small woman leading an enormous draft horse, and Dr. Drile explained. Xylazine is a really excellent sedative/tranquilizer, used primarily in large animals (although also sometimes in small animals). Before we had xylazine for chemical restraint, we had to physically restrain these enormous animals in order to do simple procedures on them. This was difficult and dangerous, and if you were a small person, you couldn’t easily do it. Xylazine hit veterinary medicine around the 1970s, which coincides with an increasing influx of women into the field. The estimates vary for women in veterinary medicine now, but we decidedly dominate numerically. In my first year class, there were 70 women and 12 men. My school recently spent a hefty chunk of change to remodel the anatomy building’s changing rooms, to increase the space in the women’s room at the expense of the men’s. There are, of course, lots of reasons why there are so many more women in veterinary medicine now than there used to be, but this was one I hadn’t considered before.
Thanks to xylazine, veterinary medicine is no longer a wrestling match. I am, accordingly, grateful.
What I did today: Quiz in zoological medicine (not supposed to be hard, and wasn’t). Gym! Two hours of dermatology lecture (new class, very engaging guest speaker). Lunch! (Went to meeting about how the lottery for scheduling our clinical rotations will work.) One hour of small animal medicine lecture (vaccines). Out super early.
Tuesday, August 31, 2010
Links post
Dog stuff
Meta-science stuff
Miscellany
- Mandatory spay/neuter laws: Follow the (lack of) money (Pet Connection): Why mandatory spay/neuter laws for pets are a bad idea, even though spaying and neutering is a good goal to have.
- Canine Dominance: Is the Concept of the Alpha Dog Valid? (Psychology Today) Article by Stanley Coren, PhD. He has written some great books about dog behavior and cognition; look him up if you want more on this.
- Faeces and flies “found” at US egg farms tied to illness (BBC News): “Officials say chickens’ contact with animal faeces and wildlife are among the main causes of concern as they investigate the source of the salmonella outbreak.” I really hope this story is not spun into “chickens are healthier in cages where they can't come in contact with wildlife.” Infectious disease is a problem when animals live in too-close quarters. Well-managed farms can balance allowing chickens room to move around with disease management. I assert that I am safer eating eggs from backyard chickens (plenty of room to move around, plenty of grass to clean their feet off on, where one sick hen is not going to make all her neighbors sick, because they are not crammed together), even if those chickens interact with wild birds, than eating eggs from factory farms. I don’t have scientific evidence to support this because the studies have not been done (and are hard to do — there are a host of different factors between those two environments to control for).
- ButcherShop (Sugar Mountain Farm): Creative solutions to the lack of slaughter facilities in the Northeast: “We are building our own USDA/State inspected on-farm slaughterhouse and butcher shop... Since banks have not been lending we are bootstrapping the construction from our own cash and selling CSA Pre-Buys where customers get free processing in exchange for buying early.” Lack of local slaughter facilities for small farms is the major impediment to an increase in the number of farmers producing humanely-raised meat in the Northeast. Read more about shortage of slaughterhouses, particularly in the Northeast.
Meta-science stuff
- How to make a difference – Responsible vaccine advocacy (Science-Based Medicine): Nice article about how to approach the problem of spreading your viewpoint, recognizing that repeating facts over and over is probably not very effective.
- Good example of a tag cloud for blogs. This is the interface I really want to see on a larger scale.
- Online science blogregator
- Peer Review and the Internet (Science-Based Medicine): “Imagine an alternate process by which an article is published online, either on an open site or a secure site that only experts have access to. Then dozens or hundreds of experts can comment on the paper, providing feedback directly to the authors in addition to the editors, who can also respond to the commenters. The result would be more of a dynamic conversation than you get with the current review process. But most importantly, in my opinion, is that you would get a broader range of opinions, and a far greater chance to detect error or bias. An editor or editors can oversee the process, and once it has played itself out the final version of the paper can be published to the public, and become part of the official literature.” Sounds great. One question I have: how do you know when “it has played itself out”?
- Asking “Who’s a journalist?” is so 2007 (Global Vue): Proposes a list of questions we should be working on now. (It’s nice when posts don’t just explain why a question is a bad one, but constructively offer alternative questions that we should be asking.)
- Supplementary Information: should I stay or should I go? (Martin Fenner): Nice collection of the blog posts about supplemental information and the implications of the Journal of Neuroscience's recent decision to stop accepting it. Fenner comments “This is a perfect example for why we need better systems to track blog posts relating to an article.“ I concur.
Miscellany
- (Proposed) World Veterinary Year 2011!
Monday, August 30, 2010
Comparative medicine: what is a wallaby?
[ETA: this post was included in Grand Rounds Vol. 6 No. 49 — a conference in a tropical island resort. There are lots of great posts of a medical nature there.]
Last night my ex-roommate, now an intern, called me to say that she had a wallaby as a patient. I was enthused. “Wallaby! It is like a baby kangaroo! Is it really cute? You are so lucky. So what’s wrong with it?” It came in to the hospital with diarrhea, apparently, and feels pretty crappy.
This morning I have a lecture on cow diarrhea, and I thought, I wonder what’s wrong with that wallaby? I wonder if this morning’s lecture will give me any idea? Then I thought: What’s a wallaby?
There’s a popular t-shirt among vet students that says “Real doctors treat more than one species.” We learn about the common ones in vet school: dogs, cats, cows, horses. But we are (at least theoretically) responsible for any animal species except for one. What if something you’ve never seen before comes in the door? How do you start to approach that problem?
In our first year nutrition class, we learned how to deal with a related problem: feeding zoo animals. What do you feed a rhinoceros? Well, the lecturer said, what’s a rhinoceros? They are hind gut fermenters, like horses. So if you don’t have any idea what to feed it, feed it like you’d feed a horse. What’s a giraffe? It’s a cow (a foregut fermenter). What’s a tiger? (You can probably manage that one on your own.) You’re not going to do a perfect job of constructing a diet if this is all the information you have, but in a pinch, it can be a good start.
But that’s nutrition. Can you take the same approach in medicine? The medical problems that we see in different kinds of animals seem to mostly be affected by two things: the animal’s basic anatomy, and how we use the animal. Pets (dogs, horses) have congenital problems (hip dysplasia); they have problems associated with old age (heart disease, kidney disease, cancer); they have trauma (hit by car, athletic injuries). Animals with complicated guts (horses, cows) have gut diseases (colic in horses, all sorts of things in cows). Horses have problems with their legs and feet. Food animals have more herd health issues, associated with management problems (poor husbandry) or infections (lots of animals living in close quarters).
So when a general practitioner encounters an animal like a wallaby, one place to start is to ask: What is a wallaby? This one was a pet, so I might put it into the same framework as a dog, expecting diseases of old age rather than diseases of poor herd management.
Of course, this is only a rough place to start. Even the species we know well have very different medical issues. For example, cats have notoriously ineffective livers when it comes to processing medications; acetominophen can kill a cat. That’s an important species difference to know. A general practitioner really should not be seeing something like a wallaby; an animal like that should go to an exotics practitioner. (This one was presumably a patient of the exotics department, but the ER department was keeping an eye on it over the weekend.) But even the exotics practitioner is going to be lacking a lot of information, and may need to engage in some informed guesswork.
The species differences that we have to learn in school make veterinary education a somewhat overwhelming process. But on the flip side, veterinarians have the opportunity to see medicine from a very different perspective from human doctors. Treat multiple species? Veterinarians treat multiple phyla.
Last night my ex-roommate, now an intern, called me to say that she had a wallaby as a patient. I was enthused. “Wallaby! It is like a baby kangaroo! Is it really cute? You are so lucky. So what’s wrong with it?” It came in to the hospital with diarrhea, apparently, and feels pretty crappy.
This morning I have a lecture on cow diarrhea, and I thought, I wonder what’s wrong with that wallaby? I wonder if this morning’s lecture will give me any idea? Then I thought: What’s a wallaby?
There’s a popular t-shirt among vet students that says “Real doctors treat more than one species.” We learn about the common ones in vet school: dogs, cats, cows, horses. But we are (at least theoretically) responsible for any animal species except for one. What if something you’ve never seen before comes in the door? How do you start to approach that problem?
In our first year nutrition class, we learned how to deal with a related problem: feeding zoo animals. What do you feed a rhinoceros? Well, the lecturer said, what’s a rhinoceros? They are hind gut fermenters, like horses. So if you don’t have any idea what to feed it, feed it like you’d feed a horse. What’s a giraffe? It’s a cow (a foregut fermenter). What’s a tiger? (You can probably manage that one on your own.) You’re not going to do a perfect job of constructing a diet if this is all the information you have, but in a pinch, it can be a good start.
But that’s nutrition. Can you take the same approach in medicine? The medical problems that we see in different kinds of animals seem to mostly be affected by two things: the animal’s basic anatomy, and how we use the animal. Pets (dogs, horses) have congenital problems (hip dysplasia); they have problems associated with old age (heart disease, kidney disease, cancer); they have trauma (hit by car, athletic injuries). Animals with complicated guts (horses, cows) have gut diseases (colic in horses, all sorts of things in cows). Horses have problems with their legs and feet. Food animals have more herd health issues, associated with management problems (poor husbandry) or infections (lots of animals living in close quarters).
So when a general practitioner encounters an animal like a wallaby, one place to start is to ask: What is a wallaby? This one was a pet, so I might put it into the same framework as a dog, expecting diseases of old age rather than diseases of poor herd management.
Of course, this is only a rough place to start. Even the species we know well have very different medical issues. For example, cats have notoriously ineffective livers when it comes to processing medications; acetominophen can kill a cat. That’s an important species difference to know. A general practitioner really should not be seeing something like a wallaby; an animal like that should go to an exotics practitioner. (This one was presumably a patient of the exotics department, but the ER department was keeping an eye on it over the weekend.) But even the exotics practitioner is going to be lacking a lot of information, and may need to engage in some informed guesswork.
The species differences that we have to learn in school make veterinary education a somewhat overwhelming process. But on the flip side, veterinarians have the opportunity to see medicine from a very different perspective from human doctors. Treat multiple species? Veterinarians treat multiple phyla.
Saturday, August 28, 2010
Veterinary fact of the day: placing an esophagostomy tube
Yesterday we learned the theory of how to place an esophagostomy tube. We saw a video of a tube placement on a cadaver dog, but haven’t actually gotten hands-on experience in this area yet. (We may all get to do so before we graduate, though.)
What’s an esophagostomy tube? It’s a feeding tube that goes in through an incision in the animal’s neck, into the esophagus. It is used for animals that will not or cannot eat normally, but can keep food down. So you might use it in an animal with bad facial fractures which cannot move its jaw; you would not use it in an animal which had uncontrolled vomiting (all the food would come right back up).
How do you place it? Put the animal under general anesthesia. Put some forceps into the animal's mouth, into the esophagus. Make an incision in the animal’s neck, right over the esophagus. Poke the foreceps through the esophagus and out the hole in the neck. (Dr. Libbe said at this point: “This part seems kind of scary at first, but it does work!”) The forceps are strong enough to poke through the esophagus and make a hole, but not strong enough to poke through the skin and muscle, which is why you make the incision.
Take the feeding tube and thread it in through the hole in the neck, grab it with the forceps, and pull in out the animal’s mouth. Now you have a tube from outside of the mouth to outside of the neck — not so useful! So turn the mouth-end of the tube around and thread it back down the esophagus in a little loop. When it passes the incision you’ve made, it will lie a little further down the esophagus, and now it is in place: you have a tube passing from outside the neck to inside the esophagus. Suture the tube in place, and you are all done.
What I did yesterday: Two hours of zoo medicine lecture (reptiles). Lunch! (I exercised outside; it was a lovely day. I also did my ethics reading.) Two hours of small animal medicine and surgery lecture (nutritional support). Two hours of ethics lecture/discussion (euthanasia). Home!
What’s an esophagostomy tube? It’s a feeding tube that goes in through an incision in the animal’s neck, into the esophagus. It is used for animals that will not or cannot eat normally, but can keep food down. So you might use it in an animal with bad facial fractures which cannot move its jaw; you would not use it in an animal which had uncontrolled vomiting (all the food would come right back up).
How do you place it? Put the animal under general anesthesia. Put some forceps into the animal's mouth, into the esophagus. Make an incision in the animal’s neck, right over the esophagus. Poke the foreceps through the esophagus and out the hole in the neck. (Dr. Libbe said at this point: “This part seems kind of scary at first, but it does work!”) The forceps are strong enough to poke through the esophagus and make a hole, but not strong enough to poke through the skin and muscle, which is why you make the incision.
Take the feeding tube and thread it in through the hole in the neck, grab it with the forceps, and pull in out the animal’s mouth. Now you have a tube from outside of the mouth to outside of the neck — not so useful! So turn the mouth-end of the tube around and thread it back down the esophagus in a little loop. When it passes the incision you’ve made, it will lie a little further down the esophagus, and now it is in place: you have a tube passing from outside the neck to inside the esophagus. Suture the tube in place, and you are all done.
What I did yesterday: Two hours of zoo medicine lecture (reptiles). Lunch! (I exercised outside; it was a lovely day. I also did my ethics reading.) Two hours of small animal medicine and surgery lecture (nutritional support). Two hours of ethics lecture/discussion (euthanasia). Home!
Thursday, August 26, 2010
A day in the life: ethics from large and small animal vets
I had trouble choosing just one anecdote to relay from today’s lectures, so I’m going with two, and calling this “a day in the life” (of a third year vet student) rather than “veterinary fact of the day.”
Our large animal medicine and surgery lectures this morning were on oral and GI diseases in cows. Dr. Big (not his real name) started the GI lecture with an overview of the situation in which today’s dairy cow finds herself. He pointed out that ruminants made an interesting gamble a long time ago, relying on bacteria in their huge stomachs to convert their food into energy. Then man started selectively breeding them, and today’s dairy cow looks very different than she did even fifty years ago. A cow today might produce 150 lbs of milk a day during her peak lactation. “I bet half of you don’t even weigh that much,” he said. He went on to opine that almost every disease which we will be learning about during our five hours of GI lecture (not all of that was today!) is man made. “Put the cow on a pasture and she’ll live for 20 years with no problems. Put her in a dairy herd and ask for 150 lbs/day, and her mean life expectancy is 5 years.” (I found it interesting that he equated being on pasture with not producing milk. Every week at my local farmer’s market, I purchase yogurt made from milk from grass-fed dairy cows, out on pasture right here in Massachusetts.) He went on to suggest that we should all read The Omnivore’s Dilemma, which he felt was a very interesting book, “though I don’t think Pollan got it entirely right.”
I just get little hearts in my eyes when food animal vets talk like this. Cows should be on pasture! They get sick because of things we do! It is lovely to see people walking in the grey area between ignoring all welfare implications (“cows do just fine in open barns, they don’t need to be out on grass”) and ignoring the realities of the situation (“no one should ever drink milk because cows shouldn’t be raised the way they are”). Dr. Big thinks we can do better than we do, and he tries to make it happen, by teaching vet students and (I presume) by encouraging farmers to make changes where they can. Compare that to the lecture from the swine practitioner earlier this week, who felt that intensive farming of pigs was best for the pigs’ welfare.
From the other side of the fence, in anesthesia lecture we got a moment to think about the welfare of dogs. Dr. Bonne talked about managing brachycephalic (flat-faced) dogs when they recover from anesthesia. When a dog is under general anesthesia, it has an endotracheal tube (“trach tube”) put down its throat to help it breathe. Most dogs need to have the trach tube removed before they are fully awake. Not brachycephalics. Dr. Bonne showed us a photo of a bulldog: “Look, there he is, wide awake with the tube in, breathing wonderfully. They will do that for an hour or so.” Brachycephalics often have tracheas the width of a tomcat’s, just 5.5 mm in diameter. It is not really enough for them to breathe. When they wake up with a trach tube in, it may be the first time in their lives in which they can breathe easily. Dr. Bonne expounded: “Can you imagine, they must spend so much energy every day, just to breathe. They are perfectly happy with the trach tube in. You should leave it in until the last minute, until they are almost ready to walk out the door. Nobody else tolerates the tube the way that these dogs do.” To my mind, she didn’t go quite far enough — she didn’t ever suggest that perhaps brachycephalics should be bred with a little more care to whether or not they can breathe. But I still appreciated the rant, as far as it went.
What I did today: Two hours of small animal medicine and surgery lecture. Two hours of large animal medicine and surgery lecture. Lunch! (A meeting.) Two hours of anesthesia lecture. Home!
Our large animal medicine and surgery lectures this morning were on oral and GI diseases in cows. Dr. Big (not his real name) started the GI lecture with an overview of the situation in which today’s dairy cow finds herself. He pointed out that ruminants made an interesting gamble a long time ago, relying on bacteria in their huge stomachs to convert their food into energy. Then man started selectively breeding them, and today’s dairy cow looks very different than she did even fifty years ago. A cow today might produce 150 lbs of milk a day during her peak lactation. “I bet half of you don’t even weigh that much,” he said. He went on to opine that almost every disease which we will be learning about during our five hours of GI lecture (not all of that was today!) is man made. “Put the cow on a pasture and she’ll live for 20 years with no problems. Put her in a dairy herd and ask for 150 lbs/day, and her mean life expectancy is 5 years.” (I found it interesting that he equated being on pasture with not producing milk. Every week at my local farmer’s market, I purchase yogurt made from milk from grass-fed dairy cows, out on pasture right here in Massachusetts.) He went on to suggest that we should all read The Omnivore’s Dilemma, which he felt was a very interesting book, “though I don’t think Pollan got it entirely right.”
I just get little hearts in my eyes when food animal vets talk like this. Cows should be on pasture! They get sick because of things we do! It is lovely to see people walking in the grey area between ignoring all welfare implications (“cows do just fine in open barns, they don’t need to be out on grass”) and ignoring the realities of the situation (“no one should ever drink milk because cows shouldn’t be raised the way they are”). Dr. Big thinks we can do better than we do, and he tries to make it happen, by teaching vet students and (I presume) by encouraging farmers to make changes where they can. Compare that to the lecture from the swine practitioner earlier this week, who felt that intensive farming of pigs was best for the pigs’ welfare.
From the other side of the fence, in anesthesia lecture we got a moment to think about the welfare of dogs. Dr. Bonne talked about managing brachycephalic (flat-faced) dogs when they recover from anesthesia. When a dog is under general anesthesia, it has an endotracheal tube (“trach tube”) put down its throat to help it breathe. Most dogs need to have the trach tube removed before they are fully awake. Not brachycephalics. Dr. Bonne showed us a photo of a bulldog: “Look, there he is, wide awake with the tube in, breathing wonderfully. They will do that for an hour or so.” Brachycephalics often have tracheas the width of a tomcat’s, just 5.5 mm in diameter. It is not really enough for them to breathe. When they wake up with a trach tube in, it may be the first time in their lives in which they can breathe easily. Dr. Bonne expounded: “Can you imagine, they must spend so much energy every day, just to breathe. They are perfectly happy with the trach tube in. You should leave it in until the last minute, until they are almost ready to walk out the door. Nobody else tolerates the tube the way that these dogs do.” To my mind, she didn’t go quite far enough — she didn’t ever suggest that perhaps brachycephalics should be bred with a little more care to whether or not they can breathe. But I still appreciated the rant, as far as it went.
What I did today: Two hours of small animal medicine and surgery lecture. Two hours of large animal medicine and surgery lecture. Lunch! (A meeting.) Two hours of anesthesia lecture. Home!
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