When it came to moving across the country for the summer, not exactly sure where I would be living or who I would meet, it is fair to say that even being the open-minded and adventure seeking person I am, I was definitely a bit nervous. That all melted away quickly. As soon as I arrived, I knew I had made the right choice. Within the first day at my externship, I already made a few great friends, who I was lucky enough to call co-workers, and continued to meet client after client who was friendly and excited to hear that I was visiting from Ontario. I don’t know if I encountered a single person who didn’t wish me luck with my schooling and travels after their appointment.
In addition, the main reason I wanted to choose this clinic was to be around mentors who were willing to teach, and who I felt comfortable and confident working with. I could not have asked for anything better! I have been lucky enough to shadow three different veterinarians so far, including one large animal veterinarian and two who practice small animal medicine and also some large animal and equine work. Seeing the case load and the variety of things coming through the clinic doors (and farm truck doors) has been eye-opening! Of course, there are everyday wellness appointments and vaccination appointments, which is expected in general practice, but it is the hands-on experience that I have been completely blown away with.
Within the first few days, I was completely immersed in the life of a true mixed animal practitioner. One day, I would be correcting LDA’s and castrating bull calves, and the next morning I would be running cytology for itchy dogs, or spaying 4 to 6 month old barn kittens. It’s all in a day’s work… and that’s what has made this experience all the more exciting. There is never a lack of mental stimulation and problem solving, and I’m beginning to realize in this career of veterinary medicine, that’s what I love the most.
Here is a bit about two of the experiences I’ve had so far – completely on opposite ends of the spectrum! (And yes, I was as excited as a kid in a candy store for both of them).
On the first day of my externship, I was lucky enough to help with an emergency LDA surgery in a dairy cow. Coming from a mostly small animal background, I feel I should explain exactly what this is to readers who may not see farm animals on a regular basis. An LDA stands for Left Displaced Abomasum. In cows, there are 4 stomachs in comparison to 1 in humans. The abomasum is one of those 4 stomachs which is closest in similarity to our own, and is responsible for helping in the acidic breakdown of food. In a cow, it is suspended by tissues known as the greater and lesser omentum, and can actually move from side to side since these tissues act like a bit of a “sling”. Normally, it sits on the right side of the cow, low to its belly (referred to as the ventral part of the cow). Unfortunately, this also means that sometimes, the abomasum can become displaced either to the right (Right Displaced Abomasum) or to the left (Left Displaced Abomasum), or even lateral to the liver.
So… why does it happen?
The reason why this displacement occurs is believed to be multifactorial, but hypomotility (caused by poor nutrition, diseases, genetics, or other causes) and dysfunction of the nervous system within the gut are thought to play very important roles. Most of the time, displacements are seen within 1 month after the cows give birth (80% of cases), and LDA is much more common than RDA (30:1). The problem with this kind of displacement lies in the inability to pass digested food material, which leads to decreased appetite and dehydration, both of which are signs that the farmer can pick up to note that something is off. In addition, decreased milk production will often be noted. More rarely, the distension becomes severe and can compromise blood supply and/or cause marked gas distension in the area.
Alright, so it’s displaced you think. But how do you know?
Diagnostically, the most important physical finding is a ping when auscultating and percussing the abdomen of the cow (using your hand and stethoscope to listen). Most commonly for an LDA, that ping, which sounds very much like a basketball on a gym floor, is found between ribs 9 and 13, which is pretty much exactly where we found it in this cow. In addition, a rectal examination needs to be performed to confirm how much gas is filling the rumen (the 2nd of the 4 stomachs in the cow, which is the largest of them all). It is the gas filling this rumen that produces the distinctive ping heard by the stethoscope because of the decreased food intake by the cow, and thus emptiness of the rumen. If bloodwork is performed, which was not done in this case given the emergency nature of the situation, a mild metabolic alkalosis (more alkaline blood values than normal), hypokalemia (decreased potassium levels), and hypochloremia (decreased chloride levels) are often noted.
So it’s displaced. Now what?
To treat an LDA, there are a variety of approaches practitioners choose based on the situation, their experience, and their personal preferences. Rolling a cow 180° (yes I know, it sounds strange) after putting her down on the right side can be effective, however, recurrence of the problem is common. A variety of surgical methods can also be used to correct the problem, and the one we chose to perform in this case was a right flank pyloric omentopexy, which essentially means replacing the abomasum where it belongs on the right side, and placing sutures to attach it by the pyloris (top part of the stomach) to the omentum (that sling we talked about earlier) and the body wall to prevent it from reoccurring. In addition, calcium borogluconate given via stomach tube (to help restore normal electrolyte levels) and intraoperative antibiotics to help prevent infections (Penicillin in this case) were used.
But was the cow okay!?
After being treated, this cow was just fine. She appeared more bright and alert, and walked on her own very well from the holding pen we had performed surgery in.
Overall, the prognosis for a simple LDA and RDA like this one has a very good survival rate – about 95%. Last we heard from the farmer a few days ago, this girl was doing great!
Merck Veterinary Manual. Subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA c2016 [updated 2017]. Available from http://www.merckvetmanual.com/digestive-system/diseases-of-the-abomasum/... Last accessed July 17, 2017.
All in a day’s work
As I explained before, the mixed animal medicine experience here really has been just that. Less than 24 hours after scrubbing in on my first LDA, I was scrubbed in and performing my first solo ovariohysterectomy at Tsolum Mobile Veterinary Clinic on a ~6 month old kitten.
An ovariohysterectomy (“spay”) is a routine procedure performed in dogs and cats to help prevent overpopulation and various other health problems associated with in-tact animals, including cancers (ovarian, uterine, mammary, testicular, prostatic, etc.) and behavioural problems (spraying, aggression, etc.). In an ovariohysterectomy, both ovaries and the uterine body are removed.
As with any new experience in a new setting, going into the procedure I definitely felt the typical nervousness of a student, but once I was in the surgery suite, I got into my zone and was able to complete the surgery solo! With the support of Dr. Peter Parke and other staff at the clinic, both the surgery and recovery process was smooth, and as a result my confidence levels definitely boosted from the experience.
Having this much freedom with mentors who are trusting of my work has been fantastic. It is invaluable to have this kind of experience prior to graduation to build my skill set and confidence prior to looking for jobs in the upcoming year, and I will be forever grateful for the experience.
With such an exciting week, I am thrilled for everything that is still to come! Thank you for reading, and continue to stay tuned! :)
PS. The sights and sounds around here don’t hurt either… Vancouver Island, you are beautiful!