This week is a little hectic between finishing up my internship, packing up my apartment and trying to get some last minute social time with everyone down here. I don't have loads of time to blog so I'm making this my last post *tear*. I have absolutely loved it here at Auburn and I have learned so much. The staff at the veterinary hospital is amazing. There are so many people that are so knowledgeable about what they do and are excited to teach anyone who is willing to learn. I wanted to thank everyone there that trusted me to do all kinds of things, taught me a ridiculous amount of stuff and let me help them even when they didn't really need it.
I will always have a little soft spot for my peeps in Neuro and Anesthesia who will forever know me as "Eeyore" and to my pals in Onco who let me run their anesthesia and do an epidural and blood draws on their patients all the time. It was a tough decision not to stay at Auburn (especially with the incessant guilt trips about it!!) and I will definitely miss all of the people there that I had the opportunity to work with.
For all of the Bel-Rea kids going into internship, here's a tidbit or two of advice from my experience. First, be willing to learn different ways of doing things that what we were taught in school. It's important to communicate that you have a good base of knowledge without being the dreaded "know-it-all", asking questions that make is clear that you have some sense of what you're talking about but that you don't already know the answer to is not only a great way to do that but to also communicate that you are willing and eager to learn. Second, TAKE INITIATIVE! Sure, it'll take a few days to adjust, but do not spend the first several weeks like a bump on a log because no one is specifically asking you to help with things. Ask people "hey is there anything I can help with?", "do you need help?", "let me know if you need anything"; they will get you involved if you keep asking. Third, don't be afraid to make mistakes or ask for help if you don't know how to do something. Hello? You're a student, you're learning, they are there to help and teach you. Last, have fun. Enjoy it, this is the beginning of your career, you might as well make it a good one.
For all of my blog readers. Thank you so much for reading this and giving me your feedback. I hope that it's been informative, educational, maybe mildly entertaining?? I may start blogging again in the future...we shall see.
That's it for me! Good luck to all the Bel-Rea kids whether it's passing tests or finding jobs. To my Auburn peeps, goodbye FOR NOW and thank you so much for everything you've taught me and for making me feel welcome. I heart you all :)
Wednesday, June 1, 2011
Saturday, May 28, 2011
We've got a bleeder!
Friday was my last day on Sports Medicine and it started out pretty chill. I learned about various physical therapy modalities and then the kennel workers brought Bob the greyhound in so we could do his therapy. After we took the splint off on Tuesday, Bob's leg was looking really good. We did therapy on his leg every day and were hoping to increase the range of motion in his joints and get him using that leg again. Then, on Thursday the entire medial side of his leg was swollen and had a huge hematoma (big bruise looking thing-when blood collects under the skin outside of the blood vessels) covering the inside of his thigh down past the joint that had been surgically repaired. He also had a fever, his temp was 104.8 and normal is about 101-102. So we continued giving Bob an antibiotic and also gave him an anti-inflammatory/pain med then rebandaged his leg to prevent any further injury.
Ok, now back to Friday. Bob comes in and the vet asks me to remove the splint/bandage and call him when I get it off. The vet also made a comment about how he wouldn't be surprised if the wound broke open and started draining while we were doing therapy today. Great. So I'm cutting the bandage off and Bob is just chilling, letting me do what I need to do. I pull the splint off and pick up my phone to call the vet. Before I could call him, blood starts POURING out of Bob's leg, it was like a fire hose people! At first, I thought it was just draining and the flow of blood would stop, or at least slow down, soon. Nope. Nope, that did NOT happen. So, I grabbed two huge handfuls of gauze (the closest absorbent material I could find) and put some pressure on the crazy shooting ridiculous blood pouring forth. While doing that, I called the vet and was like "Hi, I got the bandage off of Bob and--" he cuts me off before I can say "and he's bleeding profusely". He says he'll be right down and hangs up. Wonderful. Bob bleeds through the gauze in about 10-15 seconds so I grab a towel to put on there until the vet comes down. Fortunately, it wasn't long.
When he saw the bleeding and that it was shooting out like it does from an artery like you see in a crazy chainsaw massacre movie, he decided we needed to sedate Bob and figure out what was happening. He called in the other vet and we sedated Bob. They initially thought that the area was draining and that they could quickly go in, remove any blood clots and such and close up the wound that had been created by the shooting blood. After removing a few golf ball sized gelatinous blood clots, it became clear that there was a severed artery. Blood continued to pulse out of the wound and they tried to get some some hemostats clamped down on it to stop the bleeding, but they couldn't find it because it was too far up the leg to be able to access. At one point, Bob stopped breathing and we all just kind of stopped for a second and stared at his side just waiting...waiting...waiting. Then he breathed! Thank goodness. Then the craziness continued. At some point, it was decided that we needed to intubate Bob and get him on gas anesthesia. Let me just say that they don't often do surgery that requires gas anesthesia down in Sports Med-land. So we didn't really have any monitoring equipment and only the bare minimum of surgical instruments. I'm "monitoring" anesthesia by checking Bob's femoral pulse, looking at the reservoir bag for respirations and checking his mucous membrane color. At first, Bob's pulse was strong and regular but his mucous membranes were really pale due to the blood loss. As things proceeded, his mucous membranes turned grey (really bad!), his mouth was literally cold and his pulse became weak and "thready". All very bad things. We were giving Bob fluids, a full liter pretty much wide open. We were doing everything we could for Bob but things were a little scary. The vets were able to slow the blood flow but still couldn't find the artery. They decided there wasn't anything else they could do so they sutured up the wound and left part of it open to drain.
Bob's pulse and color started to come back to normal as he recovered but he was still pretty cold when I took his temperature. We bundled him up and got him snuggled into a crate. I checked on him periodically, his temp came up to normal and his color was looking really good by the end of the day.
I've never seen so much blood come out of one animal in such a short period of time and it was definitely scary at times. I maintained my composure throughout and felt like I had some sense of what I was doing, which is good considering internship is almost over and I have to get a real job in this field soon. Hopefully, Bob does ok this weekend. I'll definitely be checking in on him next week.
Ok, now back to Friday. Bob comes in and the vet asks me to remove the splint/bandage and call him when I get it off. The vet also made a comment about how he wouldn't be surprised if the wound broke open and started draining while we were doing therapy today. Great. So I'm cutting the bandage off and Bob is just chilling, letting me do what I need to do. I pull the splint off and pick up my phone to call the vet. Before I could call him, blood starts POURING out of Bob's leg, it was like a fire hose people! At first, I thought it was just draining and the flow of blood would stop, or at least slow down, soon. Nope. Nope, that did NOT happen. So, I grabbed two huge handfuls of gauze (the closest absorbent material I could find) and put some pressure on the crazy shooting ridiculous blood pouring forth. While doing that, I called the vet and was like "Hi, I got the bandage off of Bob and--" he cuts me off before I can say "and he's bleeding profusely". He says he'll be right down and hangs up. Wonderful. Bob bleeds through the gauze in about 10-15 seconds so I grab a towel to put on there until the vet comes down. Fortunately, it wasn't long.
When he saw the bleeding and that it was shooting out like it does from an artery like you see in a crazy chainsaw massacre movie, he decided we needed to sedate Bob and figure out what was happening. He called in the other vet and we sedated Bob. They initially thought that the area was draining and that they could quickly go in, remove any blood clots and such and close up the wound that had been created by the shooting blood. After removing a few golf ball sized gelatinous blood clots, it became clear that there was a severed artery. Blood continued to pulse out of the wound and they tried to get some some hemostats clamped down on it to stop the bleeding, but they couldn't find it because it was too far up the leg to be able to access. At one point, Bob stopped breathing and we all just kind of stopped for a second and stared at his side just waiting...waiting...waiting. Then he breathed! Thank goodness. Then the craziness continued. At some point, it was decided that we needed to intubate Bob and get him on gas anesthesia. Let me just say that they don't often do surgery that requires gas anesthesia down in Sports Med-land. So we didn't really have any monitoring equipment and only the bare minimum of surgical instruments. I'm "monitoring" anesthesia by checking Bob's femoral pulse, looking at the reservoir bag for respirations and checking his mucous membrane color. At first, Bob's pulse was strong and regular but his mucous membranes were really pale due to the blood loss. As things proceeded, his mucous membranes turned grey (really bad!), his mouth was literally cold and his pulse became weak and "thready". All very bad things. We were giving Bob fluids, a full liter pretty much wide open. We were doing everything we could for Bob but things were a little scary. The vets were able to slow the blood flow but still couldn't find the artery. They decided there wasn't anything else they could do so they sutured up the wound and left part of it open to drain.
Bob's pulse and color started to come back to normal as he recovered but he was still pretty cold when I took his temperature. We bundled him up and got him snuggled into a crate. I checked on him periodically, his temp came up to normal and his color was looking really good by the end of the day.
I've never seen so much blood come out of one animal in such a short period of time and it was definitely scary at times. I maintained my composure throughout and felt like I had some sense of what I was doing, which is good considering internship is almost over and I have to get a real job in this field soon. Hopefully, Bob does ok this weekend. I'll definitely be checking in on him next week.
Thursday, May 26, 2011
Adventure into the land of horses
Alright, before I delve into this, I want to preface it with the soon to be obvious fact that I am more of a small animal person. I know just enough about large animals to be dangerous. So as I stumble through this anatomy and jargon keep that in mind, and if you are a large animal person, feel free to correct me and try not to wince too much. Also, this may be horribly boring to some of you who couldn't care any less about this stuff, that's ok, I'm not offended. Thanks!
I mosied on over to the lameness arena at the large animal hospital today to watch a study that was being done on horses that are prone to laminitis (aka founder). Laminitis is, literally, inflammation of the laminae. But, what also occurs is that the laminae also breaks down and cannot support the structures of the hoof and provide the shock absorption which is designed to do. Here's a diagram of the structures of the horse's distal limb:
I mosied on over to the lameness arena at the large animal hospital today to watch a study that was being done on horses that are prone to laminitis (aka founder). Laminitis is, literally, inflammation of the laminae. But, what also occurs is that the laminae also breaks down and cannot support the structures of the hoof and provide the shock absorption which is designed to do. Here's a diagram of the structures of the horse's distal limb:
See how the "sensitive laminae" surrounds all those bones and tendons within the hoof? It's uber-important. When the laminae breaks down, it often allows the coffin bone to rotate and this whole process is very painful for the horse and creates significant lameness. There are many causes of laminitis ranging from diet related issues to type of pasture to conformation. Conformation refers to a horse's basic structure, how they are put together. Did they get Aunt Edna's knock knees or Grandpa Frank's hunch back, etc. Horses that are conformationally prone to laminitis tend to walk more on their toes which reduces the use of the tissues in the heel area that do a lot of shock absorption (the "frog" plays a big role in that). Because of that, there is much more stress and trauma inflicted on the structures of the hoof. From my understanding, (this is where horse people are welcome to interject or make corrections) there is no real effective treatment for this condition. On horses that have laminitis issues due to conformation, special shoes and pads are often used that try to correct the angle of the hoof but still do not allow pressure on the heel and the frog. However, this approach doesn't actually treat the problem and, in some ways, makes it worse.
This vet at Auburn is doing a study to determine the effectiveness of "natural hoof care" on laminitis issues. So instead of using special shoes and such, they are trying to determine if there is a way to trim the horse's hoof and NOT use shoes so that the horse is actually healing itself by using all of the structures of the hoof as they were designed to be used. This is how the vet explained it to me: bones in a healthy animal/person will adapt to how much load/strain is put on them and, over time, bone density will increase to account for increased load or activity whereas, bone that does not have a significant load placed on it will begin to breakdown (Wolff's Law for those of you that may be familiar with it). Similarly, if we don't use our muscles we lose them, right? Same deal with the soft tissue in a horse's hoof, if they are not able to use it, it will breakdown and will no longer be able to perform it's ever important functions.
Here's the cool stuff that I got to see. This horse who had severe lameness after becoming a lawn ornament (not being worked) for several years was being asked to work again. The owners hadn't realized he was so lame because he was fine just hanging out in the pasture and such. So when they wanted to ride him again and realized the issue, they brought him to Auburn. Today, he was outfitted with a bunch of cool little dots on all the major joints of his limbs and three little balls stuck on his front hooves. A slow motion camera was used to record his foot fall before a hoof trimming, after a hoof trimming and with special boots on. The other dots were used while filming his full body movement at each stage. The full body film will use the dots on the horse to create a digital image that, I am guessing, can be analyzed with some crazy computer something. They will use it to evaluate the horse's gait and hoof position as it relates to soft tissue structures like tendons that play a large role in lameness issues. The angles at which the horse's hooves are trimmed will be evaluated to see if it helps with the horse's issues or not. There is a lot more to the anatomy and science of the study but, basically, this is a major study that incorporates some cutting edge information on the treatment of laminitis in horses. Here are a few links about the study if you care to know more...
Hopefully, I didn't just severely disappoint my large animal instructors or bore the mess out of anyone. I thought it was cool so I felt like sharing, that's kind of how this whole blog deal works I suppose. One more week of internship left! Unbelievable!
Thermographic zebras!
OK this is a quick, fun-filled post before I get to my real post (which, of course, is also fun-filled but somehow different)
Earlier this week, I went with one of the vets out to the area where the dogs are roaded and imprinted. He brought a thermographic camera with him to get some pictures and video. A thermographic camera shows the image in various colors that represent temperature. It's kind of like something you see in movies like "Predator" and other Arnold Schwarzenegger/Sylvester Stallone type deals. They've done some studies about temperature zones and the importance of being aware of them when working and training dogs. Basically, we have to consider the temperature of the environment where the dog is working (close to the ground) not the temperature that the weather man tells us that it is (from some thermometer way up high off of the ground). It's often much hotter close to the ground, and various things like tall grass or asphalt can increase the temperature even more. Overheating is a major concern with working dogs of all kinds.
So while we were waiting for some dogs to come back from roading, he was telling me about all these studies that have been done with wild animals and thermographic imaging. Apparently, when polar bears are filmed with these cameras, all you can differentiate is their eyes because they are so good at regulating their temperature to their surroundings. Kangaroos will dig down a few inches in the dirt, to where it can be more than 20 degrees cooler than the ground surface. Then, the kangaroos will lick their forearms and the moisture from their saliva increases the heat that is released from the blood vessels underneath, and you can see that on a thermographic camera! Ok and last, but most definitely NOT least. Zebras. So there are two main reasons why zebras have black and white stripes. One is so that when they are in a herd, predators can differentiate an individual zebra, it just looks like a big heap of black and white stripes. The OTHER reason has to do with all things thermographic. When there isn't a breeze out on the plains or wherever zebras hang out they are still able to keep cool. Do you know how? No?? Well I'm gonna tell you. The heat difference between the areas of black fur and the areas of white fur actually CREATES A BREEZE! A little zebra sized personal breeze. Amazing, totally and utterly amazing.
Oh and FYI the main areas that dogs expel heat from (aka "thermal windows") are their eyes, nose, groin, and armpit area.
**This blog is dedicated to my brother Kris who, I am certain, will have a great appreciation for its title**
Earlier this week, I went with one of the vets out to the area where the dogs are roaded and imprinted. He brought a thermographic camera with him to get some pictures and video. A thermographic camera shows the image in various colors that represent temperature. It's kind of like something you see in movies like "Predator" and other Arnold Schwarzenegger/Sylvester Stallone type deals. They've done some studies about temperature zones and the importance of being aware of them when working and training dogs. Basically, we have to consider the temperature of the environment where the dog is working (close to the ground) not the temperature that the weather man tells us that it is (from some thermometer way up high off of the ground). It's often much hotter close to the ground, and various things like tall grass or asphalt can increase the temperature even more. Overheating is a major concern with working dogs of all kinds.
So while we were waiting for some dogs to come back from roading, he was telling me about all these studies that have been done with wild animals and thermographic imaging. Apparently, when polar bears are filmed with these cameras, all you can differentiate is their eyes because they are so good at regulating their temperature to their surroundings. Kangaroos will dig down a few inches in the dirt, to where it can be more than 20 degrees cooler than the ground surface. Then, the kangaroos will lick their forearms and the moisture from their saliva increases the heat that is released from the blood vessels underneath, and you can see that on a thermographic camera! Ok and last, but most definitely NOT least. Zebras. So there are two main reasons why zebras have black and white stripes. One is so that when they are in a herd, predators can differentiate an individual zebra, it just looks like a big heap of black and white stripes. The OTHER reason has to do with all things thermographic. When there isn't a breeze out on the plains or wherever zebras hang out they are still able to keep cool. Do you know how? No?? Well I'm gonna tell you. The heat difference between the areas of black fur and the areas of white fur actually CREATES A BREEZE! A little zebra sized personal breeze. Amazing, totally and utterly amazing.
Oh and FYI the main areas that dogs expel heat from (aka "thermal windows") are their eyes, nose, groin, and armpit area.
**This blog is dedicated to my brother Kris who, I am certain, will have a great appreciation for its title**
Tuesday, May 24, 2011
Workin' with the workin' dogs!
This week I'm spending some time in the Sports Medicine Department aka Animal Health and Performance Program. They have all kinds of stuff going on at the same time and it's a totally different world than your standard small animal vet med.
Yesterday, I went with the director of the program (he's a vet) up to their breeding and training facility about two hours north of Auburn. They breed Labradors for their training program so there are loads of cute puppies all over the place. These kids pretty much begin training right away. They are put outside in little fenced in areas while the lawn mowers, leaf blowers, weed wackers and all kinds of vehicles are going by to get them used to loud noises and such. Then they literally play on one of those plastic play sets with the slide and clubhouse and what not so that they get used to different surfaces. THEN, when they are a few months old, they are temporarily adopted by a prisoner at a local prison in order to help with socialization and again get used to a new environment. Eventually, dogs are trained to do various jobs depending on which studies are going on or what various government agencies need them for. So you've got dogs that can sniff out bombs in war zones, dogs that sniff out narcotics in airports/cars/buildings, dogs that sniff out fungus that's destroying trees, dogs that sniff out boa constrictors in the everglades that used to be someone's pet but got released by their silly owners and it's destroying the whole balance of the ecosystem in that area and loads of other stuff. There were some military veterinarians at the facility checking out dogs to see if they met various physical standards to become military dogs. The dogs had to be radiographed to check for hip dysplasia and various vertebral issues (like an extra lumbar vertebrae that one of the dogs had...whaaaaat?!?) and they also underwent a basic physical exam and had blood drawn for testing. Depending on how dire the need for dogs is in war zones, the leniency of the standards that these dogs have to meet changes. Verrrry interesting.
Today I stayed on campus to see some of the things that they have going on here in Auburn. They have several studies going on with various breeds of dogs that are being trained to do different jobs. First, we went out to see the dogs that were being "roaded". Roading is a form of conditioning in which metal extension bars are attached to golf carts, the bars hang out over the side of the cart and dogs are attached by lines to these bars. The dogs then run along side the cart while it's driven around for various amounts of time. It seems a little harsh at first, but the dogs are constantly monitored for fatigue and signs of overheating. It is imperative that the dogs be in excellent physical condition in order to do their jobs effectively under various conditions.
At the same time, different dogs are being "imprinted". Imprinting is a dog's initial training to learn to recognize and respond to a specific scent (explosives, narcotics, fungus, etc). Studies have shown that dogs can pick up a scent when there are only a few parts per billion in the air they are sniffing. That could mean that something was buried underground or is in some type of container. In order to imprint the dog, they first have to choose a reward. They are given the option of all types of toys...tennis ball, squeaky tennis ball, kong, doodly bopper, whatever. The dogs choose by seeking out a specific toy when a whole bunch are tossed out for them to pick from. During their training, they are given that toy each time they correctly find and respond to a scent. So there's a line of about 6 wooden boxes on the ground with holes in the top. In one box, there is a petri dish holding whatever it is the dog is to be trained to detect. While the dog is learning, the trainer will tell the dog to sit and then give the reward each time the dog sniffs the box with the target scent in it. The boxes are moved around and this whole process is repeated until the dog sniffs the right box and sits on his/her own. During the process, it's important that the person moving the box with the scent in it around touches several boxes so that the dog is not being trained on that person's scent (that's cheating! and it won't help in a real situation). It's also important that a dog be trained on only one scent. An example where it may become a problem is if a dog were trained on narcotics and say...explosives. So Rex (my imaginary scent dog) is sniffing through a parking lot in Shadyville, USA. Rex stops and sits next to the trunk of an abandoned car, good boy Rex! But, the problem is that we don't know if he picked up the scent of explosives or narcotics so his handler may go open the trunk expecting narcotics and have a bomb explode in his face. Not cool. It's also very difficult to UN-train a dog on a scent so you had better be sure you're using the correct scent to train Rex with or you'll be in for loads of additional training to reprogram his nose.
Ok THEN. I went back and worked with a tech doing some rehab on Bob the greyhound (he's owned by the school so I can tell you his name). Bob tore his ACL while doing a running trial back at the end of April. He had TPLO surgery to repair the injury and he has been receiving different types of therapy and his leg has been in a splint. The type of therapy we did today is called TENS therapy- Transcutaneous (through the skin) electrical nerve stimulation. So we put little pads with electrodes on his leg above and below the stifle joint (where the injury occurred) and we turn the electrodes on and increased the intensity of the pulse they emit until we see the muscles actually twitching. This therapy can be used for various things, but our intention was to decrease pain. I'm not going to go in to the whole science of TENS therapy but you can easily do an online search for more info if you're interested. We did two ten minute TENS sessions and did passive range of motion exercises in between. Passive range of motion or PROM is done to assess and potentially increase the movement of a joint without the participation of the patient. Obviously, that last part is more difficult to get an animal to cooperate with, but we do what we can. After being splinted for several weeks, Bob's joints had a significant decrease in their range of motion. In order for him to regain strength and use of his injured leg, his ROM had to be increased. Two points of concern for me were his stifle (obviously, that was where the injury was) and his tarsus. The tarsus is the joint just above the digits that allows the foot to be flexed and extended. Bob's tarsus had decent ROM in regards to flexion but not in extension. This means that he wasn't able to bend his foot forward in order to place it normally, he was basically on his tippy toe on his injured leg. He was already hesitant to put weight on the leg, but not being able to place his foot normally is a further deterrent that needs to be addressed to get him on the road to recovery. Bob got this treatment twice today AND we took his splint off for good, so hopefully he'll think about using that leg a bit more.
I also got to massage another greyhound, Hannah. She's an old lady (11 years old) and is sporadically having issues with hind end weakness and lameness. The radiographs on her did not show any structural issues, so it's unclear what is going on with her. She started out all wide eyed and stiff, giving me weird looks and refusing to sit or lay down while I worked on her front end (I'm used to this initial reaction). But, I just kept working on her non-affected areas to get her used to the massage and to me. I worked my way back to her hips, lumbar area and hind limbs (weird looks and stiffness continue with moments of relaxation). After a few minutes of working on this area, Hannah laid down on her side on the blanket and became as much of a pile of mush as she could be. She had several areas where, when I applied pressure, the entire muscle body would visibly spasm. I did some stretching and some secret ninja massage techniques and was able to significantly reduce the spasming. I also addressed significant tension in her iliopsoas, quadratus lumborum (most fun muscle name EVER--another band name, Kris??), quadriceps and adductor group (Homework: go ahead and look those muscles up...it's time to learn on your own friends). I probably worked on the kid for 45 minutes and she was ASLEEP and having dream twitches. It was adorable and reminded me that, even with every available technology and gadget out there, a good massage can do wonders and, if you know what you're looking for and feeling it can give you loads of information about your patient. I may be a bit biased towards massage given my training in human and small animal massage, but I'm pretty sure Hannah (and Bob, because I massaged him too) would agree with me.
Ok that's all I have time for today. Hopefully, I will get a chance to post about thermographic imaging and zebras later this week. Yes, zebras. Also, kangaroos and polar bears. (Ooooh, now you're on the edge of your seat just WAITING for my next post aren't you???)
Yesterday, I went with the director of the program (he's a vet) up to their breeding and training facility about two hours north of Auburn. They breed Labradors for their training program so there are loads of cute puppies all over the place. These kids pretty much begin training right away. They are put outside in little fenced in areas while the lawn mowers, leaf blowers, weed wackers and all kinds of vehicles are going by to get them used to loud noises and such. Then they literally play on one of those plastic play sets with the slide and clubhouse and what not so that they get used to different surfaces. THEN, when they are a few months old, they are temporarily adopted by a prisoner at a local prison in order to help with socialization and again get used to a new environment. Eventually, dogs are trained to do various jobs depending on which studies are going on or what various government agencies need them for. So you've got dogs that can sniff out bombs in war zones, dogs that sniff out narcotics in airports/cars/buildings, dogs that sniff out fungus that's destroying trees, dogs that sniff out boa constrictors in the everglades that used to be someone's pet but got released by their silly owners and it's destroying the whole balance of the ecosystem in that area and loads of other stuff. There were some military veterinarians at the facility checking out dogs to see if they met various physical standards to become military dogs. The dogs had to be radiographed to check for hip dysplasia and various vertebral issues (like an extra lumbar vertebrae that one of the dogs had...whaaaaat?!?) and they also underwent a basic physical exam and had blood drawn for testing. Depending on how dire the need for dogs is in war zones, the leniency of the standards that these dogs have to meet changes. Verrrry interesting.
Today I stayed on campus to see some of the things that they have going on here in Auburn. They have several studies going on with various breeds of dogs that are being trained to do different jobs. First, we went out to see the dogs that were being "roaded". Roading is a form of conditioning in which metal extension bars are attached to golf carts, the bars hang out over the side of the cart and dogs are attached by lines to these bars. The dogs then run along side the cart while it's driven around for various amounts of time. It seems a little harsh at first, but the dogs are constantly monitored for fatigue and signs of overheating. It is imperative that the dogs be in excellent physical condition in order to do their jobs effectively under various conditions.
At the same time, different dogs are being "imprinted". Imprinting is a dog's initial training to learn to recognize and respond to a specific scent (explosives, narcotics, fungus, etc). Studies have shown that dogs can pick up a scent when there are only a few parts per billion in the air they are sniffing. That could mean that something was buried underground or is in some type of container. In order to imprint the dog, they first have to choose a reward. They are given the option of all types of toys...tennis ball, squeaky tennis ball, kong, doodly bopper, whatever. The dogs choose by seeking out a specific toy when a whole bunch are tossed out for them to pick from. During their training, they are given that toy each time they correctly find and respond to a scent. So there's a line of about 6 wooden boxes on the ground with holes in the top. In one box, there is a petri dish holding whatever it is the dog is to be trained to detect. While the dog is learning, the trainer will tell the dog to sit and then give the reward each time the dog sniffs the box with the target scent in it. The boxes are moved around and this whole process is repeated until the dog sniffs the right box and sits on his/her own. During the process, it's important that the person moving the box with the scent in it around touches several boxes so that the dog is not being trained on that person's scent (that's cheating! and it won't help in a real situation). It's also important that a dog be trained on only one scent. An example where it may become a problem is if a dog were trained on narcotics and say...explosives. So Rex (my imaginary scent dog) is sniffing through a parking lot in Shadyville, USA. Rex stops and sits next to the trunk of an abandoned car, good boy Rex! But, the problem is that we don't know if he picked up the scent of explosives or narcotics so his handler may go open the trunk expecting narcotics and have a bomb explode in his face. Not cool. It's also very difficult to UN-train a dog on a scent so you had better be sure you're using the correct scent to train Rex with or you'll be in for loads of additional training to reprogram his nose.
Ok THEN. I went back and worked with a tech doing some rehab on Bob the greyhound (he's owned by the school so I can tell you his name). Bob tore his ACL while doing a running trial back at the end of April. He had TPLO surgery to repair the injury and he has been receiving different types of therapy and his leg has been in a splint. The type of therapy we did today is called TENS therapy- Transcutaneous (through the skin) electrical nerve stimulation. So we put little pads with electrodes on his leg above and below the stifle joint (where the injury occurred) and we turn the electrodes on and increased the intensity of the pulse they emit until we see the muscles actually twitching. This therapy can be used for various things, but our intention was to decrease pain. I'm not going to go in to the whole science of TENS therapy but you can easily do an online search for more info if you're interested. We did two ten minute TENS sessions and did passive range of motion exercises in between. Passive range of motion or PROM is done to assess and potentially increase the movement of a joint without the participation of the patient. Obviously, that last part is more difficult to get an animal to cooperate with, but we do what we can. After being splinted for several weeks, Bob's joints had a significant decrease in their range of motion. In order for him to regain strength and use of his injured leg, his ROM had to be increased. Two points of concern for me were his stifle (obviously, that was where the injury was) and his tarsus. The tarsus is the joint just above the digits that allows the foot to be flexed and extended. Bob's tarsus had decent ROM in regards to flexion but not in extension. This means that he wasn't able to bend his foot forward in order to place it normally, he was basically on his tippy toe on his injured leg. He was already hesitant to put weight on the leg, but not being able to place his foot normally is a further deterrent that needs to be addressed to get him on the road to recovery. Bob got this treatment twice today AND we took his splint off for good, so hopefully he'll think about using that leg a bit more.
I also got to massage another greyhound, Hannah. She's an old lady (11 years old) and is sporadically having issues with hind end weakness and lameness. The radiographs on her did not show any structural issues, so it's unclear what is going on with her. She started out all wide eyed and stiff, giving me weird looks and refusing to sit or lay down while I worked on her front end (I'm used to this initial reaction). But, I just kept working on her non-affected areas to get her used to the massage and to me. I worked my way back to her hips, lumbar area and hind limbs (weird looks and stiffness continue with moments of relaxation). After a few minutes of working on this area, Hannah laid down on her side on the blanket and became as much of a pile of mush as she could be. She had several areas where, when I applied pressure, the entire muscle body would visibly spasm. I did some stretching and some secret ninja massage techniques and was able to significantly reduce the spasming. I also addressed significant tension in her iliopsoas, quadratus lumborum (most fun muscle name EVER--another band name, Kris??), quadriceps and adductor group (Homework: go ahead and look those muscles up...it's time to learn on your own friends). I probably worked on the kid for 45 minutes and she was ASLEEP and having dream twitches. It was adorable and reminded me that, even with every available technology and gadget out there, a good massage can do wonders and, if you know what you're looking for and feeling it can give you loads of information about your patient. I may be a bit biased towards massage given my training in human and small animal massage, but I'm pretty sure Hannah (and Bob, because I massaged him too) would agree with me.
Ok that's all I have time for today. Hopefully, I will get a chance to post about thermographic imaging and zebras later this week. Yes, zebras. Also, kangaroos and polar bears. (Ooooh, now you're on the edge of your seat just WAITING for my next post aren't you???)
Friday, May 20, 2011
Goat dermatology!
Yeah buddy, goat dermatology! We were finishing up our day of dermatology on Thursday and were about to begin what would have, without a doubt, been a riveting lecture about antibiotics when the vet received a phone call. The vet students and I heard some key words: "barn", "goat", "non-pruritic" and, perhaps my favorite word of the entire conversation...consult. SCORE! We're going to see the goat!
We get down to the barn and we find this goat, this poor miserable goat. The kid is emaciated despite a hearty appetite due to his diarrhea issue. His hair coat is awful and his skin is equally bad. He has bilateral (on both sides) bald patches along the top of his back leaving a little mohawk strip of hair on top of his spine. He also had a few other bald patches here and there. The skin on his back peeled off of him kind of like dried paint with a tad more flexibility to it. Based on the condition of his skin, we thought it maybe dermatophilus, which is actually caused by a bacteria. But, considering the symmetrical alopecia (hair loss) we had to consider a metabolic issue. The reason that the symmetrical alopecia was a concern is that it's not something that the animal could have done just by rubbing up against a fence to get to his itchy spot. Also, the large animal vet said that the animal presented as non-pruritic (remember, pruritic= itchy) so he wouldn't be trying to take care of a persistent itchy back anyway. However, to cover our bases, we took all kinds of samples and made our usual slides in addition to a few of some hair clumps. We took it all back to the lab to check things out, although we were pretty sure we weren't going to find much due to the symptoms we had observed. We were checking out slides, not finding stuff, not finding stuff, boooooooring. Then one of the students is looking at one of the hair clump slides and she sees something and has the vet look at it. He looks at it and thinks it's nits, little baby lice! COOOOOOOL! Ok so the vet went back out to the barn to get some tape preps from the goat and sent us all home for the day.
I come in today and the student who had originally seen the little lice babies tracked me down and showed me the tape prep slides and THIS is what I saw:
We get down to the barn and we find this goat, this poor miserable goat. The kid is emaciated despite a hearty appetite due to his diarrhea issue. His hair coat is awful and his skin is equally bad. He has bilateral (on both sides) bald patches along the top of his back leaving a little mohawk strip of hair on top of his spine. He also had a few other bald patches here and there. The skin on his back peeled off of him kind of like dried paint with a tad more flexibility to it. Based on the condition of his skin, we thought it maybe dermatophilus, which is actually caused by a bacteria. But, considering the symmetrical alopecia (hair loss) we had to consider a metabolic issue. The reason that the symmetrical alopecia was a concern is that it's not something that the animal could have done just by rubbing up against a fence to get to his itchy spot. Also, the large animal vet said that the animal presented as non-pruritic (remember, pruritic= itchy) so he wouldn't be trying to take care of a persistent itchy back anyway. However, to cover our bases, we took all kinds of samples and made our usual slides in addition to a few of some hair clumps. We took it all back to the lab to check things out, although we were pretty sure we weren't going to find much due to the symptoms we had observed. We were checking out slides, not finding stuff, not finding stuff, boooooooring. Then one of the students is looking at one of the hair clump slides and she sees something and has the vet look at it. He looks at it and thinks it's nits, little baby lice! COOOOOOOL! Ok so the vet went back out to the barn to get some tape preps from the goat and sent us all home for the day.
I come in today and the student who had originally seen the little lice babies tracked me down and showed me the tape prep slides and THIS is what I saw:
Ewwwwwwcoooooooooolewwwwwwwawesome! Now, this kid and his friends were not the cause of the goat's issues, we aren't sure exactly what is just yet, but it's not often that you get to see goat lice in a small animal hospital! Fun times people, fun fun times.
Next week is my second attempt at a Sports Medicine rotation. I'm pumped for it, variety is the spice of life right??
Wednesday, May 18, 2011
The joys of dermatology
Well it's been an erythematous, exudative and cerumenous week on derm. Translation: Redness, oozy ickiness and earwax!
We've had some very interesting patients so far this week and I've learned that derm is often like an episode of House. We have to go through the patient's entire history from when the dermatological problem began including every attempted treatment and it's effect on the issue, any possible exacerbating factors, any other health issues and the corresponding medications that may be on board and the patient's current state. We also have to consider the owner's compliance when determining if previous treatments have been effective and if the possible treatments we are suggesting will be carried out effectively by the owner. Once we have a list of potential diagnoses, we try to start crossing them off the list by doing all the cytologies and scrapes that I mentioned in my previous post. If we don't find anything there we have to consider other things like food allergies, environmental allergies or flea allergies. It's always an adventure!
One of our patients yesterday presented with chronic otitis externa (external ear infection). Aside from her ears, she had some irritated areas on her abdomen and between her toes (dogs lick the spaces between their toes excessively when they are itchy!). In addition to the otitis, this kid (I will call her Bertha) had previously been diagnosed with hypothyroidism, Addison's disease and had recently had an issue with pancreatitis potentially due to the ridiculous amount of steroids she had been on for a looooong time. On her laundry list of medications along with Prednisone (steroid) was Rimadyl (non-steroidal anti-inflammatory). Traditionally, it's a major no-no to give an animal both of these because it wreaks havoc on their GI system (ulcers, bleeding, general ickiness), but Bertha was on both of those plus quite a few others. However, our main concern was the otitis. Given her circumstances, we took samples to look for the usual bacteria, yeast and parasites. We didn't find anything fun or exciting despite her ears being disgusting and full of debris and discharge. Some ear cleaning solution was put into her ears, after we took samples, and was allowed to sit in there for a bit to break up the cerumen (earwax, remember?) before we cleaned all the ickiness out.
She is an older dog so we also had to consider neoplasia (i.e. a mass in her ear canal) as well as other growths like a cyst or polyp. We didn't find anything in the outer canal using the otoscope but the owner OK'd us to run a CT scan. On the CT, it's easy to see the entire ear canal and the bullae which is the large opening in the middle ear (past the eardrum). Fortunately for Bertha, we did not find anything of concern on the CT. We went back to do a more in depth cleaning of her ears while she was still sedated. You would not believe the amount of junk that came out of there. Once we had a clear path, we used the video otoscope to see down into her ear canal to the eardrum (and take some sweet pictures!). We could tell that the more problematic ear definitely had a thickened and unhealthy eardrum (tympanum/tympanic membrane), but it was still intact (yay!). The other tympanum looked healthy and happy. So basically, all we could do for this dog was give the owner some ear drops to keep the ears clean and free of debris and give her some topical treatment for the itchy toe problem.
Today we had a pit bull (well-known for having dermatological issues) with MAJOR pruritis all over and clear signs of chronic itching and irritation. The most glaring issue was the dog's vulva (maybe I should prepare everyone, this is gonna get graphic). According to the owner, the dog had such intense pruritis in that whole area that she would literally go outside and drag her lady parts along the concrete seeking relief. Because of this, her vulvar area was hyperpigmented (black, when it should have been pink), hyperplastic (enlarged, it looked like she had boy parts) and super sensitive. In addition to this, the area between her toes was erythematous and swollen, her belly was red, the area around her eyes and ears was swollen and she had several areas where her fur was thinning due to her scratching. So so sad to see a dog like this. The worst part is that her current state was an improvement over how she presented on her initial visit. We took all kinds of samples from all over the place and we really thought we would find some crazy stuff. We essentially found nothing. No crazy parasites, no overwhelming bacterial or yeast infection, nothing. According to her history, the dog had previously been on high doses of steroids for a long time which had caused her to gain A LOT of weight and lead to the development of congestive heart failure. Also, because she was on the steroids for so long and was not weaned off of them properly, she had issues with iatrogenic Cushing's disease which is basically when there is too much cortisol in the blood. Iatrogenic simply means "caused by treatment". So by giving steroids long term we pump the body full of cortisol to the point that it stops producing it on it's own and kind of forgets to do it when we abruptly take away the steroids. Understandably, the owner was hesitant to put the dog back on anything involving steroids. This makes it a little difficult from the dermatology end of things, because it is common in cases of severe pruritis to prescribe steroids to get it under control. The steroids work to reduce inflammation and control the itchiness to a manageable level. So we went another route to try to help this dog. First, the dog will be bathed weekly with a shampoo that contains an anti-histamine and an anti-fungal agent. That is allowed to sit on the skin for 10 minutes before being washed off. Right after that, the dog is sponged down with a Lime-Sulfur dip which is often helpful in treating a wide variety of dermatologic issues. Then, for her vulvar area, she was given Silver Sulfadiazine cream. SSD is a topical antibiotic that is often used on burns because of it's ability to soothe irritated skin. We suggested that the owner put a diaper on the dog after applying the SSD to ensure that it was not licked or rubbed off of the area. Lastly, the dog is being started on a food trial to attempt to eliminate any food allergies. She was given a hypoallergenic food and will not receive any other food or treats of any kind during the food trial. Usually, a food trial lasts at least 8 weeks. It can go longer depending on the severity of the dermatitis and various other factors. Hopefully, some of these things help this dog and she gets some relief. Despite her obvious discomfort she was such a sweetheart when we were getting samples and doing a physical exam. Poor kid!!
That's it for today. No doubt, there will be more dermatological excitement tomorrow!
We've had some very interesting patients so far this week and I've learned that derm is often like an episode of House. We have to go through the patient's entire history from when the dermatological problem began including every attempted treatment and it's effect on the issue, any possible exacerbating factors, any other health issues and the corresponding medications that may be on board and the patient's current state. We also have to consider the owner's compliance when determining if previous treatments have been effective and if the possible treatments we are suggesting will be carried out effectively by the owner. Once we have a list of potential diagnoses, we try to start crossing them off the list by doing all the cytologies and scrapes that I mentioned in my previous post. If we don't find anything there we have to consider other things like food allergies, environmental allergies or flea allergies. It's always an adventure!
One of our patients yesterday presented with chronic otitis externa (external ear infection). Aside from her ears, she had some irritated areas on her abdomen and between her toes (dogs lick the spaces between their toes excessively when they are itchy!). In addition to the otitis, this kid (I will call her Bertha) had previously been diagnosed with hypothyroidism, Addison's disease and had recently had an issue with pancreatitis potentially due to the ridiculous amount of steroids she had been on for a looooong time. On her laundry list of medications along with Prednisone (steroid) was Rimadyl (non-steroidal anti-inflammatory). Traditionally, it's a major no-no to give an animal both of these because it wreaks havoc on their GI system (ulcers, bleeding, general ickiness), but Bertha was on both of those plus quite a few others. However, our main concern was the otitis. Given her circumstances, we took samples to look for the usual bacteria, yeast and parasites. We didn't find anything fun or exciting despite her ears being disgusting and full of debris and discharge. Some ear cleaning solution was put into her ears, after we took samples, and was allowed to sit in there for a bit to break up the cerumen (earwax, remember?) before we cleaned all the ickiness out.
She is an older dog so we also had to consider neoplasia (i.e. a mass in her ear canal) as well as other growths like a cyst or polyp. We didn't find anything in the outer canal using the otoscope but the owner OK'd us to run a CT scan. On the CT, it's easy to see the entire ear canal and the bullae which is the large opening in the middle ear (past the eardrum). Fortunately for Bertha, we did not find anything of concern on the CT. We went back to do a more in depth cleaning of her ears while she was still sedated. You would not believe the amount of junk that came out of there. Once we had a clear path, we used the video otoscope to see down into her ear canal to the eardrum (and take some sweet pictures!). We could tell that the more problematic ear definitely had a thickened and unhealthy eardrum (tympanum/tympanic membrane), but it was still intact (yay!). The other tympanum looked healthy and happy. So basically, all we could do for this dog was give the owner some ear drops to keep the ears clean and free of debris and give her some topical treatment for the itchy toe problem.
Today we had a pit bull (well-known for having dermatological issues) with MAJOR pruritis all over and clear signs of chronic itching and irritation. The most glaring issue was the dog's vulva (maybe I should prepare everyone, this is gonna get graphic). According to the owner, the dog had such intense pruritis in that whole area that she would literally go outside and drag her lady parts along the concrete seeking relief. Because of this, her vulvar area was hyperpigmented (black, when it should have been pink), hyperplastic (enlarged, it looked like she had boy parts) and super sensitive. In addition to this, the area between her toes was erythematous and swollen, her belly was red, the area around her eyes and ears was swollen and she had several areas where her fur was thinning due to her scratching. So so sad to see a dog like this. The worst part is that her current state was an improvement over how she presented on her initial visit. We took all kinds of samples from all over the place and we really thought we would find some crazy stuff. We essentially found nothing. No crazy parasites, no overwhelming bacterial or yeast infection, nothing. According to her history, the dog had previously been on high doses of steroids for a long time which had caused her to gain A LOT of weight and lead to the development of congestive heart failure. Also, because she was on the steroids for so long and was not weaned off of them properly, she had issues with iatrogenic Cushing's disease which is basically when there is too much cortisol in the blood. Iatrogenic simply means "caused by treatment". So by giving steroids long term we pump the body full of cortisol to the point that it stops producing it on it's own and kind of forgets to do it when we abruptly take away the steroids. Understandably, the owner was hesitant to put the dog back on anything involving steroids. This makes it a little difficult from the dermatology end of things, because it is common in cases of severe pruritis to prescribe steroids to get it under control. The steroids work to reduce inflammation and control the itchiness to a manageable level. So we went another route to try to help this dog. First, the dog will be bathed weekly with a shampoo that contains an anti-histamine and an anti-fungal agent. That is allowed to sit on the skin for 10 minutes before being washed off. Right after that, the dog is sponged down with a Lime-Sulfur dip which is often helpful in treating a wide variety of dermatologic issues. Then, for her vulvar area, she was given Silver Sulfadiazine cream. SSD is a topical antibiotic that is often used on burns because of it's ability to soothe irritated skin. We suggested that the owner put a diaper on the dog after applying the SSD to ensure that it was not licked or rubbed off of the area. Lastly, the dog is being started on a food trial to attempt to eliminate any food allergies. She was given a hypoallergenic food and will not receive any other food or treats of any kind during the food trial. Usually, a food trial lasts at least 8 weeks. It can go longer depending on the severity of the dermatitis and various other factors. Hopefully, some of these things help this dog and she gets some relief. Despite her obvious discomfort she was such a sweetheart when we were getting samples and doing a physical exam. Poor kid!!
That's it for today. No doubt, there will be more dermatological excitement tomorrow!
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