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A follow-up to New Graduate Problems, which I published in Nov ‘13. Which means I’ve been doing this crazy job full-time now for an entire year.

People often comment and say, 'it must be hard being a vet, having to put down all those animals’, and it certainly is. But, after having a particularly harrowing week, I thought I’d highlight a few of the other day-to-day difficulties faced by the vet crew that you might not have thought about.

Please, be kind to your vets and vet nurses. :)

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Aquariumstuck drawings based from an rp. It was one of the most enjoyable group chats I’ve ever come across

Plus

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There were actually a lot more interesting characters but I forgot what they looked like OTL 

Online Vet Student Resources

Here are some great resources I have used throughout vet school: 

Imaging: 

Clinical Pathology:

  • eClinPath: by Cornell, wonderful site that has explanations for findings on ClinPath results, lists differentials, as well as describes that pathophysiology basis of some processes. 
  • Serum Chemistry: You will need VIN access to open this, but another great Clin Path resource to refresh your memory on what each profile tests for and various differentials for the fluxes. 

Parasitology:

  • CAPC Vet: Great site that list parasites, life cycles, prevalence, emerging patterns, diagnosis, treatment, prevention, and public health concerns. 

Antimicrobials:

  • AMRLS: A wonderful website that provides information on antimicrobial pharmacology and provides information on resistance patterns.

Bacteriology:

  • VetBact: provides basic information on veterinary important bacteria. List current bacteria name changes, microbial tests, hosts, and a basic description of the clinical disease. 

Veterinary Search Engine: 

  • VETNEXT: Essentially a search engine like that on VIN. You can search by species or clinical sign. Provides decent information about diseases. 
  • WikiVet: Another decent search engine, I believe you will need to be a student to use this site (like VIN), I don’t use it often because it is extremely slow, but there is a lot of information on there. 
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Veterinarians Read Bad Pet Advice.

me-myself-my-mind asked:

Whats your opinnion on eating meat and being a vet? Does it mean you don't love animals?

Now that is a loaded question. I see it debated periodically by vegetarians and vegans online, but rarely among veterinarians.

Seems to me that proponents of the “You can’t really love animals if you eat them” argument mostly want to make themselves feel better about their life choice by trying to make other people feel bad about theirs. There is nothing wrong with choosing to be vegetarian or vegan, but trying to shame and guilt people is not on. Accusing a group of professionals that have dedicated their entire lives to understanding and advocating for them of not loving the focus of their lives is not only hurtful, but ignorant.

I eat some types of meat. I always have. Some of my friends are vegetarian, some are vegan, and when socialising we try to make sure there is always something everyone can eat. For some of my colleagues, their appetite preferences changed over the course of our vet degree, some changed to vegetarians, some progressed to vegans, and some reverted to omnivores. As you are involved in animal industries, as you actually work on farms as part of your placement, you form your own opinions about what it is acceptable to subject animals to. Generally we can agree on minimum standards, and there is a general trend towards better welfare. Beyond that, we’re all individuals.

I have no treat-your-patient / eat-your-patient dilemma, though there are some that do. I know full well that the calf with scours I save today will most likely be steak and burgers in 18 months, but today it is a living creature and needs help.

As a veterinarian every animal you treat will die. Hopefully it is a planned, controlled death with the minimum of suffering. Death is not the ‘worst possible thing’, it’s neutral. The life the animal has beforehand is what matters. However, if you are the sort of person who does believe that death is the worst possible thing under any circumstance, then eating meat and veterinary medicine is probably not for you.

I was told as a student that beef and lamb farmers will be inherently distrustful of someone who does not eat meat. I don’t know whether that is true or not, but producers of a good steak are certainly glad to hear from a student that can appreciate a good steak. The thing about these farmers is that they generally like the animals they work with. They often have favourites, individuals with names as well as numbers, and do a actually care for these creatures. The fact that these animals will eventually be eaten doesn’t lessen the affection they have for them, and the fact that some of our patients are destined for the dinner plate doesn’t make our love of animals any less.

There are certain people that believe animals are not ours to use. Following that belief means that they are also not our source of meat, milk, fibre or companionship. That means no domesticated animals, and I would rather live in a world where animals are part of our lives. Of course they should be treated well. That’s what we veterinarians strive towards. Most of us choose this path before we turn 13. Animals are our lives, our passion, our obsession. To accuse any of us of not loving them because we eat some of them is misguided and laughable.

The argument is often thrown about “you care about some animals more than others.” Of course I do! I value the life of the cat infinitely more than I do of its fleas. I’m always happy to see a demodex mite, but I still do my best to kill the mangey buggers. My cat has to eat meat that comes from somewhere, but that source of meat might as well have had as little stress or suffering in its life as possible.

The choice of whether or not to eat meat is, of course, a personal one. If after studying domestic animals in depth, understanding their anatomy, physiology and welfare, working in their production and walking through the abattoir as they are slaughtered and taken apart you still find you can stomach eating meat, then so be it. No internet vigilante has the right to call you uneducated or ‘ignorant of the facts’ after that. It’s a personal choice, and whatever choice you make after the acquisition of knowledge will be a valid one.

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My, a two-year-old chimpanzee, was so distraught when her mother Jutta needed to be sedated for an operation on two broken teeth that the veterinarian let her stay with her mother during the operation. Apart from a few chewed wires, the operation went smoothly and Jutta and My has rejoined the rest of their troop in Aalborg Zoo.

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Canine Parvovirus, from a vet who treats it.

The early years of my career were spent in a rural Australian practice. I saw a lot of canine parvovirus from poorer socioeconomic areas, and by ‘a lot’ I mean up to 5 per week in Summer. 

There’s no way to sugarcoat parvo. It’s a nasty, highly infectious, highly durable virus with a near 100% mortality rate if not treated. Conventional hospitalization and treatment in early to mid cases can provide up to 98% survival though, which is why I laugh as ‘alternative treatment’ spruikers who want to prey on your vulnerability and make you buy their book with new ‘magic cures’. The difficulty is that treating it is expensive.

Canine parvovirus attacks stem cells in the dog. For most dogs, their must abundant stem cells are in their gut lining. This means their gut lining stops replenishing, producing foul, copious, watery and bloody diarrhea as their intestinal lining falls away. This is as horrendous and painful as it sounds. There are also stem cells in bone marrow and severely affected dogs will find those attacked as well, worsening anemia from blood loss and causing immunosuppression. In very young pups it will attack stem cells of the heart also, as though these pups didn’t have enough to worry about.

The virus itself is highly contagious. It’s also very durable, and by that I mean the virus survives in soil very well, potentially up to 20 years. This means that if there has ever been a parvo dog in your backyard, your soil is probably contaminated. It can also be spread by foxes and cats, so good luck keeping those off your property too.

It takes 3-7 days from infection to first clinical signs. People would often buy a healthy looking puppy only to have it come down with parvo a few days after it arrived home. Usually it was not vaccinated.

I want to make it very clear that vaccines do not cause parvovirus. The actual, live virus causes parvovirus. It’s common for an infected puppy to be brought to the vet on the first day with its new family, before it starts showing clinical signs, only to then become sick 3-5 days later. When you’re a vet in this situation, vaccinating the puppy becomes a race against time. You want to vaccinate them before they get a chance to be infected, but not before their mother’s immunity has faded. Generally the risks of having a parvovirus vaccination are less than not having it. This is especially frustrating when the pup has already been out in highly contaminated areas, like dog parks or the beach.

And when the poor little pup, or the young adult dog, does come down with parvo, hopefully its owners brought it in early instead of wasting two days researching ‘cures’ on the internet before coming in.

Treatment is expensive. Parvovirus dogs need to be in isolation to stop every other pup that comes into the clinic from potentially becoming sick as well. They need lots of fluid therapy, pain relief (those guts hurt), gut protectants, antibiotics (bacteria cross the damaged gut into the bloodstream too easily) and anti-nausea medication. Sometimes they need intravenous nutrition, and you know its bad at that point.

There’s no cheap miracle cure for canine parvovirus. A canine plasma transfusion is the closest I’ve found, because it contains antibodies from a vaccinated donor, as well as proteins the patient needs. A plasma transfusion can have a pup going home 48 hours later. The trouble is, it costs about $300 wholesale for only 200ml.

Vaccination is the only way to prevent canine parvovirus. Vaccinate the mother before she gets pregnant. Vaccinate every dog that comes onto your property. Vaccinate adult dogs to keep them from shedding. Keep pups away from likely contaminated areas until after their 16 week vaccine, especially in known parvovirus hotspots. Vaccinate pups as per your veterinarian’s directions. Don’t buy them if they’ve not had at least their first vaccine, no matter how cute they are. 

Parvovirus absolutely sucks and I would happily never see it again, despite the enormous vet bills it generates. I now work in a higher socioeconomic area where people have generally listened to their veterinarian’s advice and vaccinated their pups and adult dogs as recommended. I haven’t seen a parvovirus case in 18 months in general practice, and only two in emergency. Vaccination makes a huge difference. 

I’m not trying to sell you anything, unlike every other ‘miracle cure for parvo’ and ‘what-your-vet-wont-tell-you’ salesman. This is just free advice, and my sincere condolences if you’ve ever found yourself with a parvo puppy.

To anyone considering declawing their cat and those who find to problem with declawing,

Please watch the Paw Project. Declawing is extremely harmful to cats. Declawing does not simply remove the nail, it removes the last segment of the cat’s toes. In an attempt to regrow the nail, declawed cats’ toes often have small nail particles growing in their toes and as you can imagine, it is extremely painful to the cat. Additionally, while one may think that declawing will make a cat more “friendly” (because it cannot scratch), cats will often resort to biting. 

Anyways, the Paw Project can articulate all of this and more better than I can so please head over to netflix and watch it now!

hstdvm.wordpress.com
Students, new grads, old hats - please read this! The "Practice" of Veterinary Medicine

Want to be rich and famous? Don’t become a veterinarian. Want to have a career where you can wear designer clothes that stay pressed and clean all day? Don’t become a veterinarian. Want to eat a big fat slice of humble pie on a regular basis? THIS IS THE CAREER FOR YOU!!

Seriously…the veterinary profession tends to keep you humble. You’ll make a tricky diagnosis and start strutting around like you are the next Dr. House one day, and then miss a case of ear mites the next. You’ll be a kick ass surgeon and rework a cat’s intestinal tract on Monday, and then on Wednesday you’ll puncture a bladder while performing a routine spay. One week you will be the golden child, the one that clients absolutely love and adore, and the next week you’ll be getting nastygrams, or letters from the Better Business Bureau.

Make no mistake…this career will humble you. When I graduated from vet school, I was on top of the world. I was going to be the best veterinarian ever…clients would adore me, animals would calm in my magnificent presence. They would write books one day about my awesomeness.

(In reality, I was fairly terrified my first year out and oftentimes had no idea what I was doing. Of course, I couldn’t let clients or my technicians see that, so I learned to fake it pretty well. I was sort of like the little weeny Chihuahua that barks really loud at a passing Rottweiler…I sounded tough but often felt like running away with my tail between my legs)

A few months out of school, a 5 month old pit bull presented to the clinic with a two day history of vomiting and not wanting to eat. It did not have diarrhea. Those of you that are experienced vets probably know already what the diagnosis is. I had no clue.

I did take a history and performed a physical exam. The owner assured me that the dog was “totally vaccinated.” The dog was dehydrated, lethargic and actually vomited during the exam. I was certain it was a foreign body or some kind of toxicity. I recommended taking x-rays of the abdomen.

As I was confidently walking the dog back to the x-ray room, one of my technicians asked me why I wasn’t testing the dog for Parvovirus. I glared at her a bit, puffed myself up and told her that it couldn’tpossibly be parvo, because the dog didn’t have diarrhea! DUH. Also, the owner said it was fully vaccinated. DOUBLE DUH. The technician stated that a lot of times Parvo dogs came in initially vomiting. I rolled my eyes and told her to get the x-rays.

As they were x-raying the dog, it puked a few more times. As they were developing the x-rays it sprayed bloody diarrhea over every surface of the x-ray room. I would later find some on the ceiling.

Well, as it turns out the x-rays were normal other than showing very angry looking small intestines. I muttered under my breath that there was NO WAY it was Parvo, but reluctantly allowed the technician to run a Parvo test. Low and behold, it most definitely was Parvo. I had just paraded a dog with a VERY contagious disease all around the hospital. The dog had sprayed Parvo infested diarrhea all over the imaging room.

I learned from that episode to A) Never trust an owner when they say their dog is “vaccinated.” B) Parvo dogs can present initially with just vomiting. C) Listen to your technicians.

Another time my head got pretty swollen because a client actually requested me to change her dog’s splint. It was a little Chihuahua with a broken radius that my boss had been treating by splinting. The splints he put on kept falling off, which annoyed the client. I happened to put on a splint that stayed, and she was singing my praises in the lobby.

I took the dog to the back, hemmed and hawed to my staff about my vastly superior bandaging technique, and even managed to put two little red hearts made out of vet wrap on the splint. The client loved it! I was awesome! I walked on water! As she was bowing down to my immense greatness the Chihuahua shook its leg a little bit and the splint came flying off. Oops. The client didn’t really care so much about the vet wrap hearts at that point.

I have tried to spay a neutered male cat. I’ve accidentally cut into a bladder during a spay. I’ve raved to clients about how AWESOME they are doing with weight loss on their fat cat only to find out that the cat is a diabetic. I once did a physical exam on a newly adopted Boxer, and told the owners it was in great health and there were no abnormalities. They called the next day, pretty upset because overnight their “normal” dog gave birth to 12 puppies.

On a more somber note, I’ve made mistakes that have resulted in the death of my patients. A little Labrador puppy was bitten pretty badly by a neighbor dog. I saw some deep puncture wounds, but not much else. I cleaned her wounds and put her on antibiotics. I missed the hole that had been torn in her intestines, and she died a few days later of a raging abdominal infection. I misdiagnosed a cat with asthma, when it had heart failure. That night when the owner attempted to give him medication for the asthma, the cat died of heart failure, most likely secondary to the stress of medication. I missed that a dog I put on Rimadyl was also on steroids, and ended up causing the dog to suffer a perforated stomach ulcer.

I even had a cat die after I neutered it. I still to this day am not sure what happened, but I know that he was very little, and I was “fairly” sure I was cutting a testicle. Whatever it was that I cut wouldn’t stop bleeding and he died a few days later. A cat neuter is considered to be one of the simplest surgeries we do as veterinarians.

Now, I know you are all thinking that after knowing all this there is no way in heck you would use me as a veterinarian. Here’s the thing though….we all have messed up. We have all missed diagnoses, screwed up a surgery, given a wrong medication. My grandma always says that is why they call it the “Practice” of medicine.

As horrible as some of the mistakes I’ve made have been, I have learned from every single one. Today, I would not miss that Parvo diagnosis. I treat dog bite wounds very seriously and always look for deeper injuries. I am careful to try and differentiate a cat with asthma and a cat with heart disease. Every time I neuter a cat I think of my neuter that went horribly wrong, and I remind myself to not treat it lightly even though it is such a straight forward surgery.

I also don’t let myself get too cocky or confident. I’ll smile when I make a tricky diagnosis or do a tough surgery, but I don’t strut. I know that probably within a day or so I’m going to do something that will knock me back down to earth. When I hear of mistakes other veterinarians have made, instead of feeling superior, I nod with sympathy and think back on the mess ups I have had.

Phyllis Theroux, in Night Lights states that “Mistakes are the usual bridge between inexperience and wisdom.” If you are a new veterinarian or technician, give up on the idea that you are going to be perfect. You will make mistakes. You will harm a patient because of those mistakes. Learn from your mistakes. Don’t blame others, or incessantly beat up on yourself. Take a deep breath, file it away in your memory, and keep carrying on.

Second most important thing for a veterinarian to remember about the species they are treating

I’m surprised and thrilled that my previous post, Single most important thing for a veterinarian to remember about the species they are treating, has achieved so many notes. I didn’t expect so many people to find this helpful or amusing, but you did.

But it’s been a while. You all work or study hard, so you must be ready for the next lesson.

Here it comes!

If you can find room in your busy brains to remember two factoids about the species you are treating, make room for these.

Dog: Mast Cell Tumors can look like anything. Do your Fine Needle Aspirates!

Cat: Cats are nature’s jigsaw puzzles. Put the pieces close enough together and they will heal.

Horse: Do not trust a pony to tell you it is in pain. They rarely show pain to the same degree as a horse.

Cattle: You cannot push around 500kg worth of opinionated beef. I don’t care how much you work out at the gym, you will not out muscle a cow. Don’t try, sedatives are wonderful things.

Sheep: One day you may have to euthanise somebody’s pet sheep, and a bullet won’t be appropriate. They have a reasonable cephalic vein where wool changes to fur. Actually, all animals have a cephalic vein.

Goats: Goats can be sensitive to sedatives and anaesthesia, but it’s hard to go wrong with valium.

Deer: Why haven’t you shot it yet? They are wild, you can’t medicate them regularly, can barely handle them and fawns raised as orphans will see you as a rival come mating season…

Birds: There are only minor differences between the beak of a large macaw and a flesh eating eagle. Mind fingers.

Raptors(eg Eagles): They are actually easy to poison, they will eat baited meat and poisoned prey.

Chickens: It is not as difficult as you think to give tablets to a chicken.

Water birds: They get fungal pneumonias very easily. Keep all your expired antifungals, you just might need it for a duck on a budget one day.

Rabbits: Don’t fast them very long before surgery. Half an hour to ensure they haven’t got any food in their mouths is adequate, you need them up and eating again fast.

Guinea Pigs: Don’t assume the owner knows what sex they are. Big honking testicles are not as much of a clue as you might think.

Rats & Mice: Caesarians never (to my knowledge) end well. If you have to, treat it like a spey and forget about the young.

Snakes: Remember how I said above every animal has a cephalic vein? There is one notable exception.

Lizards: Some species have a ventral midline vein. If you enter the body cavity like you would speying a mammal, they will bleed to death. Check your anatomy.

Aussie Mammals: A sick joey is probably coccidia.

Fish: If they need antibiotics, be prepared to use large animal drugs with tiny insulin needles and lots of fractions.

Ferrets: Being on heat endlessly will eventually kill a non-speyed female.

Pigs: They investigate with their mouths and will eat just about anything.